Ethiopia is a decentralized low-income country that has experienced significant economic growth and made remarkable improvements in health outcomes in the recent decades.
Over the past 20 years, under-five mortality declined by 67%, from 166 deaths per 1,000 live births in 2000 to 55 deaths per 1,000 live births in 2019. Infant mortality declined by 56% from 97 deaths per 1,000 live births in 2000 to 43 deaths per 1,000 live births in 2019. These positive trends occurred in tandem with significant increases in health expenditure. Between 1995/96 and 2016/17, annual health expenditure per capita increased from USD 4.5 to USD 33, driven mainly by increases in donor spending and government expenditure.
Despite these achievements, Ethiopia’s health expenditure is still significantly below the World Health Organization’s (WHO) recommended spending of USD 86 per capita for low income countries. Ethiopia remains heavily dependent on donor funding and out of pocket expenditure, accounting for 35% and 31% of total health expenditure according to the most recent NHA from 2016/17. Mortality and morbidity from communicable diseases and maternal and child health conditions are still high. Emerging diseases, such as covid-19, the rise in NCD prevalence and conflicts leading to displacement of populations place further burden on the health system.
The Government of Ethiopia, in the second Health Sector Transformation Plan for 2020/21-2024/25 (HTSP II), aims to address these issues through several ambitious reforms. Building upon the long-term achievements of the health sector and aligning with SDG3, HSTP-II aspires to attain UHC through increasing effective coverage of essential health services by 2030. Improving health financing is one of 14 strategic direction in the HTSP II with the aim to ensure adequate and sustainable financing to realize Ethiopia’s progress towards UHC through strengthening of Primary Health Care.
Among major priorities includes the expansion of community-based health insurance (CBHI) to cover the informal sector, with subsidization of the very poor through fee waivers for prioritized health services and CBHI premiums. The government also plans to launch a Social Health Insurance (SHI) for the formal sector and reform the role of Ministry of Health in health financing to improve mobilization and allocation of resources based on priorities of health programs. Another priority is to have a clearly defined benefit package developed through a evidence-based process and then translate this package to actual service availability and utilization. The Ethiopian Essential Health Service Package (EHSP) was revised in 2019 and defines which high impact interventions will be made available for each respective level of care and through which financing mechanism.
P4H, through WHO, is working with the Ministry of Health (MOH), the Ethiopian Health Insurance Agency (EHIA), development partners and other stakeholders to strengthen Ethiopia’s health financing system and support Ethiopia to reach the goal of UHC through PHC by 2030.
The following page contains key documents related to Ethiopia’s path to UHC, including the above mentioned reforms and government priorities.
