Ethiopia - Country Commercial Guide
Healthcare

This is a best prospect industry sector for this country. Includes a market overview and trade data.

Last published date: 2020-07-20

Overview

The Government of Ethiopia (GOE) is working to strengthen the healthcare system to align it with the Sustainable Development Goals. Ethiopia has a large, predominantly rural and subsistence agriculture 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, respiratory infection, leprosy, and diarrhea remain a serious challenge in Ethiopia. Premature death, suboptimal quality of life, and nutritional diseases constitute a major health challenges. With a growing middle class, the GOE is facing an increase in non-infectious diseases such as cancer, diabetes, heart diseases, hepatitis B&C, and high blood pressure. Mental health and eye problems are also becoming major issues in Ethiopia. 

Under the second Growth and Transformation Plan (GTP II) and Health System Transformation Plan, the Ministry of Health (MOH) is implementing reforms to various aspects of the healthcare system. In pursuit of improved management, the government has increasingly decentralized management of its public health system to the Regional Health Bureau levels. The MOH has also continued to reform agencies such as the Ethiopian Food and Drug Administration (EFDA) and the Ethiopian Pharmaceutical Supply Agency (EPSA). 

EFDA is being strengthened to provide increased regulatory oversight for the registration, importation and quality of medicines, supplies and equipment into the Ethiopian market. EFDA has a mandate to regulate practices, facilities, professionals and products in the health sector. This agency is responsible for promoting and protecting public health by ensuring the safety and quality of products and health services through registration, licensing and inspection of health professionals, pharmaceuticals and health institutions, 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 implementing 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: is used by importers for application of market authorization and product registration (new products, request registration exceptions and renew existing registrations).  
-    i-Import: is an online application used by importers to apply for and receive permits to import all health commodities. PSA also has access to this application as they are participating in procurement activities.
EPSA is the public procurement agency responsible for purchasing pharmaceuticals, medical supplies, and equipment throughout Ethiopia. PSA has developed the below listed applications for ensuring proximity of PSA 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. 
-    Vitas: A platform designed to support logistics management information and warehouse management and inventory control. It starts functioning at the central warehouse and 18 regional hubs throughout Ethiopia.
-    Dagu: A platform designed to support logistics management information and inventory control at service delivery points by using systematic record keeping. This application provides service at more than 700 sites all over the country.
-    mBranaA platform integrated with Vitas and other programs in PSA that it uses to manage inventory from beginning to end. 

EPSA has developed a list of medical devices to procure that are categorized as products that are durable capital equipment and non-capital items.  Based on this the agency plans to design different procurement modalities to enhance the efficiency of the procurement process. PSA plans to procure and store the non-capital items  in its warehouse and distribute immediately when the demand arises in the country. This also helps the agency reduce the amount of lead time required to procure medical equipment and supplies.

The following are the 2020 impact-level targets for the Health System Transformation Plan (HSTP):
•    Reduce infant and neonatal mortality rates.
•    Decrease HIV contraction and achieve zero new infections among children.
•    Lessen the number of TB deaths and incidence.
•    Diminish malaria case incidence and mortality rate. 

The plan also sets targets to stabilize and reduce deaths and injuries from road traffic accidents, which are high in Ethiopia. 

The GOE encourages private sector participation in the area of 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, and ultimately to attract medical tourism to Ethiopia. The Ethio-American Hospital, which is under construction, is an example of the government’s commitment to developing major new healthcare facilities. This project also demonstrates the government’s commitment to encouraging foreign investment in the sector through public private partnership (PPP) arrangements.  A guideline to implement PPPs in the healthcare sector in Ethiopia is under development by the Ministry of Finance. The pre-feasibility studies on six selected services: imaging, laboratory, pathology, sterilization, oncology, and laundry have been conducted and approved by the Ministry of Finance. 

Standardization and expansion of hospitals located in different regions is also the main focus under health infrastructure development in the country. 

The following health care facilities are available in Ethiopia:
Health Posts:  17,162 available and 425 under construction
Health Centers: 4,063 available and 86 under construction
Hospitals: 314 available and 108 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. Cancer is a leading healthcare challenge in Ethiopia. The MOH is working to establish cancer diagnosis centers at different hospitals. To address this significant burden, MOH has continued to work on radiation therapy expansion programs and access to chemotherapy services. Cancer chemotherapy services were provided in a limited number of health centers. Currently MOH has decentralized the service into 12 hospitals in different regions of the country. 

Some of the upcoming priorities in the health care sector are:
-    Prevention and containment of COVID19
-    Prevention and control of communicable diseases and neglected tropical diseases
-    Prevention and control of non-communicable diseases and mental health
-    Improving medical services such as clinical services, emergency and critical care, blood transfusion and laboratory services
-    Improve regulatory framework
-    Improve health system infrastructure
-    Enhance private sector engagement in the healthcare sector 
-    Improve the management of human and infrastructural resources
-    Improve resource mobilization
-    Improve research and evidence-based decisions and enhance the use of technology and innovation by supplementing with the deployment of appropriate information systems
-    Facilitate the procurement of  and access to drugs, supplies and equipment 
-    Increase patient satisfaction and address good governance
-    Work on an early warning system, risk assessment and multi-sectorial coordination mechanisms that can improve response time for epidemics
-    Procurement of medical equipment from quality providing companies and considering after sales maintenance service as part of contract package

The MOH is developing a new mobile-based electronic Community Health Information System (eCHIS). The eCHIS is the national digital Community Health Information System that intends to capture data on the Health Extension Program and other community-level services, as well as utilize this data to improve performance, community health outcomes, and Health Extension Workers support across Ethiopia. This system is designed to be a single platform to meet the needs of urban, agrarian and pastoralist population. 

MOH, in partnership with EthioTelecom, is working to roll out a Healthnet program to improve IT infrastructure and connectivity of healthcare facilities through the country. Through this program MOH seeks to collect data to deliver national level reports on healthcare needs and service delivery.
Telemedicine is a priority for the MOH. Telemedicine is being carried out with respect to some specialty care services through multiple telemedicine technologies. Currently, preparatory work for the implementation of telemedicine services is underway.

The GOE’s seeks to address 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. The Ethiopian Health Insurance Agency (EHIA) has already been established and is undertaking the necessary steps. Currently 522 woredas in Ethiopia have started implementing CBHI. 

Challenges in the healthcare sector in Ethiopia include:
•    Lack of transparent and accountable pharmaceutical and logistics management system.
•    Shortage of foreign currency hindering timely procurement of equipment, supplies and pharmaceuticals. Foreign exchange shortages also result in payment delays. 
•    Delays in the bidding process.
•    Poor data management and reporting for proper decision making.
•    Lack of capacity.

Healthcare Market (‘000)                                

 Unit: USD ‘000

2018  

2019

2020 (estimated)

2021 (estimated)

Total Market Size

86,130

99,176

114,052

131,159

Total Local Production

 

29,000

 

29,000

 

33,350

 

38,352

Total Exports

-

-

-

-

Total Imports

 

 57,130

 

 

70,176

 

80,702

 

 

92,807

Imports from the United States

  347

 

301

346

 

397

Exchange Rate

 27.4

28.73

 

 

Source: National Bank of Ethiopia and Ministry of Health

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. 

Web Resources

Ministry of Health 
www.moh.gov.et/

Ethiopian Food and Drag Authority (EFDA)
http://www.fmhaca.gov.et/

Ethiopian Pharmaceutical Supply Agency (EPSA)
https://epsa.gov.et/