Eritrea’s health system has undergone significant transformations since independence from Ethiopia in 1993. The government has prioritized rebuilding primary health care services and expanding access to services, with notable improvements in maternal and child health, infectious disease control and immunization coverage. Historically, Eritrea’s health care financing has been primarily supported by government funding, donor assistance and out-of-pocket (OOP) payments by households.[1] However, the system has struggled with limited financial resources, given the country’s challenging economic circumstances compounded by international economic sanctions.
Barriers to sustainable health financing
Several challenges impede sustainable health financing in Eritrea.
- Limited financial resources: The country still relies heavily on external funding and donor support, which can be unpredictable. In 2021, external resources accounted for about 29.3% of current health expenditure (CHE), and in the same year, the government allocated 2.4% of the government’s general expenditure to health.[1] This is significantly lower than the 15% Abuja target and among the lowest in Africa. The country’s economy has been impacted by prolonged conflicts, sanctions and low-income levels, which limit the tax base and further hinder the government’s ability to allocate sufficient resources to the health sector.
- High out-of-pocket payments: A significant portion (49.5%) of CHE comes from OOP expenditure, which can lead to inequities in access to care and potential catastrophic expenditure.
Policies for universal health coverage
Eritrea has worked advanced universal health coverage through various policies and initiatives.
- Primary health care: The government adopted a primary health care approach as a principal strategy to improve health access and outcomes. This model emphasizes community-based services and has expanded health care access significantly since independence.
- Strategic Partnership Cooperation Framework: Launched in 2016, this framework aims to strengthen health systems and improve service quality by collaborating with multilateral and bilateral partners.
- Integration of donor contributions into the national budget: This promotes greater coordination of external resources with domestic priorities.
References
[1] World Health Organization, Global Health Expenditure Database, Health Expenditure Profile (choose country)