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Analytical summary - Health workforce

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Most low-income countries suffer from a severe shortage of health professionals and Ethiopia is no exception. Ethiopia has a health workforce of 0.7 per 1000 population, which is low compared with the WHO recommendation of 2.3 health workers per 1000 population.[1]

Health extension workers and general nurses dominate the available supply of health workers and there are critical shortages of physicians, dentists, midwives and anaesthesia professionals. The greatest inadequacy is for physicians, whose numbers show a decreasing trend over past years and are now 1: 42 706 population, which is among the lowest ratio in sub-Saharan Africa.[1]

However, numbers of other health professionals such as health officers, nurses, midwives and health extension workers have shown significant improvement over the past 5 years. The country has also achieved the minimum WHO recommendation of 1 nurse per 5000 population.[1]

In addition to a low workforce density, an imbalance in skills distribution along geographic, gender and sector dimensions poses a serious challenge for the delivery of essential health care services, mainly in rural areas.[1]

In rural and remote areas, 83% of the population is underserved by health workers. There is also an uneven distribution of highly skilled health workers, which is highly skewed towards private and nongovernmental organizations that only serve a small segment of the population. For instance, of the 1806 physicians in 2006–2007, about 56% of the specialists and 38% of the general practitioners worked in health facilities outside the public sector.[1]

The human resources situation is further disrupted by health workers’ emigration. For instance, in 2002, 17% of nurses and 30% of doctors left the country. In cognizance of the human resources problems, the Ministry of Health devised several innovative flooding and retention strategies to maximize professional coverage.[1]

In 2005, the Government of Ethiopia launched an innovative Health Extension Programme[2] using 34 000 locally recruited female health extension workers to provide community-based health promotion and disease prevention services. The roll out of the Health Extension Programme doubled the country’s health workforce in less than 3 years. Other continuing efforts include accelerated health officer training, which was launched in November 2005 in five universities and 20 hospitals and out of which 5431 health officers have now graduated.

In addition, to address a shortage of professionals in emergency surgery, training in basic emergency obstetrics care and comprehensive emergency obstetric and newborn care was implemented at primary health care units. A 3-year Masters programme was launched in five universities in 2007–2008 and a total of 252 professionals enrolled. There has also been an expansion in the enrolment capacity of midwifery schools and efforts are being made to transform selected hospitals into medical training institutions by devising an innovative training curriculum for medical student.[3] Currently, there are 12 public universities that train health professionals.[4]

As part of its efforts to retain qualified professionals, the Government has implemented the balanced scorecard as a strategic planning and management tool. The balanced scorecard helps to lay a foundation for identifying and rewarding high-performing organizations, teams or individuals. Alongside this, the Government is finalizing financial and non-financial incentive packages as a means of retaining highly skilled and qualified professionals.

Several discussions and consultations have been held with stakeholders to ensure that incentives packages are fully financed by the Government in a sustainable way and that they achieve the desired outcome. The predeployment training of physicians has also shown a positive trend in retaining new medical graduates.

Besides launching innovative approaches, the Ministry of Health has also recently developed a comprehensive 12-year human resources for health strategic document, which has undergone a new design to better facilitate human resource development and management. Under the new design, the two major human resources functions fall under two arms of the Ministry:

  • the Directorate of Human Resource Management falls under the service provider arm of the Ministry and is responsible for human resources for health management functions;
  • the Directorate of Health Facilities and Professionals Licensing falls under the Health and Health Related Services and Products Regulation Agency, which is the regulatory arm of the Ministry responsible for licensing of degree level and above professionals and the development of various supportive staff.[1]

The way forward

  • Continue to use predeployment training as a way of retaining new medical graduates.
  • Improve motivation and retention of human resources for health through implementation of evidence-based financial and non-financial incentives.
  • Introduce a continuing professional development programme for technical and administrative staff linked to health sector needs and a career development plan.
  • Develop and institutionalize human resource management systems at all levels of the decentralized health system alongside a human resources information system and provide training on human resources management to human resource officers at all levels.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Health Sector Development Programme IV, 2010/11–2014/15. Final draft (pdf 780.81kb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2010
  2. Health Extension Programme in Ethiopia. Profile (pdf 2.10Mb). Addis Ababa, Government of Ethiopia, Ministry of Health, 2007
  3. Ethiopia country profile: human development indicators. United Nations Development Programme
  4. Health Sector Development Programme. Annual performance report. Addis Ababa, Government of Ethiopia, Ministry of Health, 2010