Overview 

The Government of Ethiopia is working to strengthen the healthcare system to align it with the Sustainable Development Goals.  Ethiopia has a large, predominantly rural population with poor access to safe water, housing, sanitation, food, and health service.  The government has made significant investments in the public health sector that have led to improvements in health outcomes.  Nevertheless, communicable diseases like HIV/AIDS, TB, malaria, hepatitis B&C, respiratory infection, leprosy, and diarrhea remain a serious challenge in Ethiopia.  Premature death, suboptimal quality of life, and nutritional diseases constitute a major health challenge.  With a growing middle class, the GOE is facing an increase in non-infectious diseases such as cancer, diabetes, heart diseases, and high blood pressure.  Mental health and eye problems are also becoming major issues in Ethiopia.  

The Ethiopia Food and Drug Authority (EFDA) is being strengthened to provide increased regulatory oversight for the registration, importation and quality control of medicines, supplies, and equipment into the Ethiopian market.  EFDA has a mandate to regulate practices, facilities, professionals, and products in the health sector.  The agency is also responsible to ensure the safety and quality of food; efficacy, the safety and quality of medicine; and the safety and performance of medical devices, cosmetics, tobacco and tobacco products control, as well as the provision of up-to-date regulatory information.  The GOE is implementing a plan to transform EFDA to make its operations more efficient with the aim of ensuring 100% availability of vital and essential drugs at all levels of the healthcare delivery system without stock shortages.  Currently, EFDA is trying to implement a “zero backlogs” strategy for medicine registration and licensing activities.  EFDA has digitized the importation and registration of health commodities to Ethiopia using the below listed programs: 

i-Register: Used by importers for application of market authorization and product registration (new products, request registration exceptions and renew existing registrations).   

i-Import: Used by importers to apply for and receive permits to import all health commodities.

Ethiopia Pharmaceuticals Supplies Agency (EPSA) is the public procurement agency responsible for purchasing pharmaceuticals, medical supplies, and equipment throughout Ethiopia.  EPSA has developed a suite of applications for ensuring proximity of EPSA distribution hubs to health facilities across Ethiopia and to establish efficient systems for inventory, fleet, and information management.  These improvements are targeted to increase efficiencies and improve the availability of commodities throughout the public sector.  EPSA has recently implemented a more streamlined procurement process to reduce the amount of lead time required to obtain medical equipment and supplies.

The GOE encourages private sector participation in quality of care and quality of service.  The government is also working with the private sector to build advanced tertiary care hospitals to meet domestic demand that would otherwise be met through outbound medical tourism.  The Ethio-American Hospital, which is under construction, and the recently announced Roha Group medical center, which will be built with a cost of $300 million in Addis Ababa are examples of the government’s commitment to developing major new healthcare facilities. These projects also demonstrate the government’s commitment to encouraging foreign investment in the sector through PPP arrangements.  Standardization and expansion of hospitals located in different regions is also the focus under health infrastructure development in the country.  The following health care facilities are available in Ethiopia: 

• Health Posts: 17,534 available and 77 under construction 
• Health Centers: 3,587 available and 89 under construction 
• Hospitals: 3643 available and 57 under construction 
• Private Clinics: 3,867 
• Private Hospitals: 43 

In addition to increasing the number of healthcare facilities in the country, the MOH is working to improve services to reduce health related burdens.  The GOE has started to address the high out of pocket costs for health services through the introduction of community-based health insurance (CBHI) and social health insurance (SHI) for the informal and formal segments of society, respectively.  

Challenges:

• Lack of available forex for the private sector to import the necessary equipment and supplies.
• Price sensitivity of the market and lack of expertise/awareness to differentiate between product qualities.
• Import of medical equipment and supplies is highly dominated by Chinese companies.
• Bureaucracy in the government.
• Lack of manpower capacity in the regulatory bodies.
• Lack of manpower capacity and technology in healthcare service providers.
• Delays in the bidding process.
• Poor data management and reporting for proper decision making.

 Source: National Bank of Ethiopia (total market size = (total local production + imports) - exports)

 Leading Sub-Sectors 

• Equipment and services to new hospitals and health centers 
• Construction of modern hospitals, blood banks, warehouse for pharmaceuticals, and health care facilities 
• Pharmaceuticals and supplies 
• IT support 
• Cold storage facilities 
• Knowledge and skill transfers

Opportunities 

The GOE is keen to acquire services, equipment, supplies, information management systems, and knowledge and skill transfers to improve the quality of the healthcare system. This is an opportunity for U.S. companies that are providing equipment and supplies, hospital furniture, ambulances for emergency, pharmaceuticals, vaccinations, and other services.  

Resources 

• Ethiopian Ministry of Health
• Ethiopian Food and Drag Authority (EFDA)  http://www.efda.gov.et/
• Ethiopian Pharmaceuticals Supply Service (EPSS)