In 1998, the Council of Ministers of the Government of Ethiopia (GoE) endorsed the Health Care and Financing
Strategy for the country. The fourteen years since that approval have seen dramatic and positive changes in Ethiopia’s
health systems conditions and health outcomes. One positive example of this noted globally, was the announcement in
2014 that Ethiopia had achieved the 4thMillennium Development Goal of reducing child mortality by two-thirds from
1990 levels.
Today, Ethiopia’s health system looks very different from that of 1998. Health expenditures per capita have increased
from US$4 (1996) to US$21 (2011) and almost certainly higher in 2014, perhaps a six-fold increase in nominal
dollar terms. Substantial financial support for health has been generated from international development partners,
government, and retained fees. More than 35,000 health extension workers on government salary provide services in
rural and urban kebeles throughout the country. Significant scale-up in training physicians and other health workers is
underway. Preparations are advanced to launch social health insurance and expand community-based health insurance.
The 1998 Health Care and Financing Strategy envisioned and laid foundations that contributed to many of these
changes. With development of the health ministry’s visioning document for 2035, which aims at universal health
coverage through primary care, and anticipating the next 20-year overall national Growth and Transformation Plan
(GTP II) as well as the next five-year Health Sector Transformation Plan in 2015-20, the Federal Ministry of Health
(FMOH) decided to review the experience in health care financing since 1998 with an eye to update and revise the
Health Care and Financing Strategy. This report contributes to that review by generating evidence on what has worked
as well as lessons learned from what has not worked as well as expected.