The Federal Democratic Republic of Ethiopia

National Health Policy

(Draft 1)

2015
Addis Ababa
 Contents

Contents .............................................................................................................................................................. i
1. Preamble .................................................................................................................................................... 2
2. Mission, Vision and Objectives of the policy ............................................................................................. 4
3. Values and Guiding principles .................................................................................................................... 5
4. Policy Priorities........................................................................................................................................... 6
5. Policy Framework and Strategic Directions ............................................................................................... 6
5.1. Community empowerment ................................................................................................................. 6
5.2. Leadership, Management and Governance ........................................................................................ 7
5.3. Health Service Delivery ..................................................................................................................... 8
5.4. Human Resource for Health (Health Workforce) ............................................................................ 11
5.5. Information, research and knowledge management ......................................................................... 12
5.6. Medicines and Health Technologies ................................................................................................ 13
5.7. Healthcare Financing ....................................................................................................................... 14
6. Strategy Directions ....................................................................................................................................... 15
7. Policy Implementation ............................................................................................................................. 17
7.1. National Health Sector Capability Building .................................................................................... 17
7.1.1 Priority health Programs ................................................................................................................. 17
7.1.2. Multi-sectoral programs ................................................................................................................ 18
7.1.3. Building Community Capacity .................................................................................................. 19
7.1.4. Institutional Capacity Building ................................................................................................ 19
7.2. National implementation strategies, guidelines and monitoring tools ........................................... 20
7.3. Governance ...................................................................................................................................... 20
7.4. Regulatory/Legislative framework ................................................................................................... 22
7.5. Planning, Monitoring and Evaluation .............................................................................................. 22
7.6. Funding ............................................................................................................................................ 23

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1. Preamble

Following the 1993 National Health Policy which was developed by the Transitional
Government, Ethiopia exhibited considerable achievements to improve the health of its people.
The successes are the results of appropriate policies and strategies coupled with a strong
partnership and leadership in building health system capacity. The efforts made in empowering
the community through the health extension program, massive expansion of health facilities and
extensive production of frontline and midlevel health work force are showing commendable
progress in creating enabling environment to produce its own health. As the result, Ethiopia
registered laudable results in conventional health parameters of morbidity and mortality. A
number of other health and health related indicators including the average life expectancy at birth
have showed a sizable improvement compared to the 1990’s estimate. However, a lot is
remaining to ensure the health of the people is optimal to enjoy healthy life and contribute to the
socioeconomic development.

The government of Ethiopia;

 Based on the constitution’s guidance on:
o Women have the rights to be protected from harm arising from pregnancy and
childbirth and in order to safeguard their health, women have the right of access
to family planning education, information and capacity (Constitution: Article
35:9)
o Every child has the right to life and not be subject to exploitative practices which
may be hazardous or harmful to his or her health (Constitution Article 36: 1&3)
o Every person has the right to life (Constitution: article 15)
o All persons have the right to live in a clean and healthy environment (constitution
article 44:1)
o to provide access to public health to the extent the country’s resource permit
(Constitution Article 90:1)
 Recognizing the World Health Organization’s definition of health as Health is a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity.
 Cognizant of the dynamics in epediomology, demography, economy, climate,
technology and globalization on health of people
 considering the importance of health in all policies,
 appreciating the need to have a health sector that commensurate with needs of the people
of middle income country,

has revised health policy of the Federal Democratic Republic of Ethiopia as part and
parcel of the country's socio-economic development taking into account the local,
regional and global realities.
The revised health policy is the result of critical examination of the nature, magnitude and root
causes of the prevailing health problems of the country and awareness of newly emerging and
reemerging health problems. Besides, the policy perceives health as a human right issue and an
investment to improve the economy of the country.

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The policy is founded on commitment to democracy, rights and power of the people in a federal
government system for the full exercise of these rights and powers of Ethiopia’s diverse society.
It accords appropriate emphasis to the needs of less-privileged and hard-to-reach population.

The policy proposes realistic objectives and means for attaining health based on the fundamental
principles that health is a prerequisite for enjoyment of life and for optimal productivity. The
Government accords health a very high priority and is committing internal and external
resources. In particular the government fully appreciates the decisive role of community
empowerment and the development of self-reliance and is therefore determined to creating the
necessary social and political conditions conducive to their realization.

The government believes that health policy cannot be considered in isolation from policies
addressing population dynamics, food security/food availability, acceptable living condition and
other requisites essential for health improvement and shall therefore develop effective inter-
sectoral partnerships. Furthermore, Ethiopia shall pay due attention to global health agenda
considering the increasing globalization of the health sector as the result of increasing mobility
of people, use of technologies and private healthcare companies.

In general, health development shall be seen not only in humanitarian terms but as an essential
component of the packages of social and economic development as well as being instrument of
social justice and equity. Pursuant to the above the health policy of the Federal Democratic
Republic of Ethiopia shall be an integral part of other social and development sectoral policies.

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2. Mission, Vision and Objectives of the policy

Existing:
 To see healthy, productive, and prosperous Ethiopians
Alternative:
 To see healthy population in Ethiopia that contributes to socioeconomic growth and
development of the country.
 To ensure the enjoyment of the highest attainable standard of health and well-being
to all Ethiopians as a fundamental human right and prerequisite for socioeconomic
development

Mission
Recommended:
 To promote health and wellbeing of the Ethiopian people through providing and
regulating a comprehensive package of promotive, preventive, curative, palliative
and rehabilitative health services via a federalized and democratized health system
and empowered community.

Existing:
 To reduce morbidity, mortality and disability, and improve the health status of the
Ethiopian people through providing and regulating a comprehensive package of
preventive, promotive, rehabilitative and curative health services via a decentralized
and democratized health system.

Goal
The ultimate goal is to improve the quality of life of the population of Ethiopia through
provision of equitable, affordable and quality health services of maximum
possible level at all tiers of the service delivery.
Objectives
The general objective is to achieve the health outcomes that commensurate with lower
middle-income country by 2025.
 To increase the life expectancy of the Ethiopian population
 To reduce morbidity, disability and mortality
 To ensure community satisfaction with health services
 To ensure financial risk protection

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3. Values and Guiding principles
Values
 Right to health
 Community ownership
 Solidarity
 Equity (Equity of service regardless of gender, age, geography, disability, ethnicity,
religion, economic status to attain social justice and pro-poor health care delivery)
(and pro-poor health service)
 Gender sensitivity
 Respect
 Professionalism, integrity and ethics
 Accountability and transparency

Guiding Principles

 Focus on promotive, preventive, curative, palliative and rehabilitative aspects of

health care through PHC approach.
 Quality health services (integrated health care delivery)
 Democratization of the health system
 Federalism
 Decentralization
 Teamwork, partnership and multi-sectoral approach
 Efficient use of resources /value for money
 Effectiveness
 Application of appropriate technology
 Evidence-based decision-making
 Sustainability, self reliance
 Public-Private-Partnerships

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4. Policy Priorities

The Government of Ethiopia shall provide priorities to health and health related programs or
interventions that address health needs of majority of the people and/ or people on forefront of
productivity, known to have high impact, threaten social, economical and environmental status if
not addressed and reach hard-to-reach or less-privileged population to the extent the country’s
resource permit. Therefore, Essential Health Service Packages need to be revised accordingly.
Strategies that help realization of universal health coverage for essential health services will be
prioritized based on sets of criteria including cost-effectiveness, priorities to worse off, and
financial risk protection. Service delivery platforms and mechanisms that help to expand
coverage for high priority services will be given due emphasis. While doing so, the health system
shall ensure no one is left behind.
Health and health related programs or health service delivery mechanisms or platforms shall be
carefully selected considering the guiding principles the following set of criteria:
 Ensuring access and effective coverage to health services
 Ensuring quality of health care
 Ensuring safety in range of providing health services
 Promoting self reliance in health system
 Ensuring equity
 Embracing opportunities
 Addressing emergencies
 Honoring Continental/International/global commitments
 Strengthening effective partnership
 Ensuring continuity/sustainability
Based on the above dimensions of setting priorities, a number of health programs are listed under
capacity building section of the policy.

5. Policy Framework and Strategic Directions

5.1. Community empowerment

Future interventions shall focus on strengthening, utilizing and sustaining the existing formal and
informal community structures to further pursue an empowerment agenda while considering new
approaches that may be more appropriate to embrace emerging health, social and economic
conditions. Moreover, creating an environment where the community, the health professionals
and managers/administrators work together to nurture conditions necessary to make
empowerment possible would be the focus of the health system. While introducing,
strengthening and sustaining the mechanisms for community empowerment; flexibility,

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responsiveness and adaptability to the local contexts would be the key considerations to address
our diversity and changes over time within the same community.

Policy Objective

To ensure that communities, households and individuals are empowered to play their role and
take responsibility for their own health and well being

Strategic Directions
In order to achieve this objective, Government shall:

a) Build self-esteem and capacity of the community and create opportunities to gain more
power over their determinants of health
b) Create enabling environment for the community to be organized in or organize
community groups in an open, democratic and accountable manner to control their own
health
c) Harness partnerships at different levels and sectors for the greater good of the public
d) Put in place community-led structures to monitor whether services are delivered to all
community members regardless of their social, political or economical status; decide
upon or otherwise address key issues of concern to the community.
e) Enforce supportive and enabling environment, legal provisions, useful social norms to
enhance community decision and influence in the health system

5.2. Leadership, Management and Governance

Leadership, management and governance in the Ethiopian health sector ensure that strategic
policy frameworks exist and encompass strategic directions that integrate all health systems
building blocks to achieve results. The health sector would continue to build itself with inspiring
leadership, which requires the ability to identify and face health sector challenges to attain
results in complex and rapidly changing epidemiological, social, economic, technological and
political environments. The Ethiopian health system needs also good governance, which is
characterized by competently directing health system resources, performance, and stakeholder
participation towards the goal of improving health of the population in Ethiopia, in ways that
are transparent, accountable, equitable, and responsive to the needs of the people. Instituting
strong leadership, management and governance within the health sector ensures availability of
conducive environment where the health sector improves the implementation of federalized and
decentralized health systems; develop and follow up of implementation of guidelines, standards

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and protocols and better coordination of public-private partnerships. It is imperative to create an
environment that encourages the existing community based structures, to improve
accountability in making and executing decisions that affect the health of the population.

Policy objective
To ensure that the health sector at all level builds visionary (transformational) leadership,
effective management and good governance that mobilize the health workforce and the
community at large achieve better health outcomes.
Strategic Directions
In order to achieve this objective, the government shall:
a) Foster decision making environment based on system and structure that support
transparency, inclusion, accountability and all dimensions of equity in the health system
b) Enforce legal frameworks for better stewardship of public resources with ethics integrity,
efficiency and trust in accomplishing the health sector goals.
c) Create and sustain cultures of identifying, engaging and collaborating with diverse
stakeholders (government and non state actors) representing all spectrums of interested
parties in achieving the health sector goals.
d) Promote transformational leadership that leads the health sector thorough shared vision at
all levels within the health system.
e) Enhance the capacity of health and health related institutions that effectively respond to
evolving and emerging health issues with particular emphasis on district transformation
and multi-sectoral collaboration.
f) Establish and strengthening autonomous regulatory organs that set standards , monitor,
license and accredit institutions and professional practices
g) Enhance partnership with principles of Harmonization and alignment in support of
priority areas of the health sector.
h) Enhance utilization of health information for strategic leadership and decision making
i) Establish enabling mechanisms to periodically redefining of the health service packages
and delivery platforms that responds to the health needs of the population
j) Put in place a system for effective, efficient and responsive management of resources
k) Ensure that gender issues are addressed in all legitimate decision making processes
supervision and administration of structures within the health sector

5.3. Health Service Delivery

The health delivery platforms shall facilitate provision of continuum of care through integrated
and appropriate health promotion, disease prevention, curative, palliative and rehabilitative

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services at each tier as well as across the life course. The upcoming strategies and sub policies
are expected to be comprehensive enough to properly characterize and address the demands of
the public for health and health related services including diagnostic, pharmaceutical, regulatory
and health information services. The supplies and workforces for all sorts of services need to be
in place in harmonized manner to the extent resources permit.
The health service delivery focuses on equitable access, improving coverage, assuring quality
and Safety. Bringing healthcare closer to the community would make services accessible and
improves affordability to a certain degree. Sustainability of services with such aspiration can
only be achieved through community empowerment, collaborative efforts multi-sectors, public-
private and non-state actors and Multidisciplinary teamwork with appropriate Task sharing and
task shifting approaches to the extent resources permit.

5.3.1 Policy Objective

To improve equitable access to quality health services appropriate to each levels of healthcare

Strategic Directions
To achieve the objective, the government shall
a) Promote healthy behaviours and motivation to make positive contributions to improve
health by applying healthy life style and reducing the exposure to risk factors through
evidence based models
b) Prevent the occurrence of disease by taking measures to reduce risk factor, to arrest
disease progression, and to reduce its consequences once established
c) Introduce, expand, strengthen curative services for early detection treatment and follow-
up to minimize morbidity, disability and mortality
d) Improve the quality of life of patients and their families facing problems associated with
life-threatening conditions and severe disabilities, through palliative care for physical,
psychosocial and spiritual suffering
e) Ensure comprehensive rehabilitative care that enhance and restore functional ability and
quality of life to those with physical and mental impairments, disabilities or through
variety of techniques for all ages and for those recuperating from injuries and other
conditions to all level of care
f) Ensure diagnostic and pharmaceutical services for health care delivery shall be developed
to strengthen the scientific and technical basis of health care, facilitate prompt diagnosis,
early detection and treatment and guide to continuing monitoring and care
g) Harness the potentials of alternative medicine and traditional Medicine (Indigenous
wisdom/herbal medicine, and spiritual healing mechanisms)

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 h) Ensure the private sector and other non state actors are part of the health care system in
terms of increasing geographic access to health services, address the changing disease
landscape, the scope and scale of services provided
i) Encourages the private sector to provide high-tech and advanced medical services
j) Ensure health services are delivered with up-to-date technology by adopting evidence
based health infrastructure, medical equipment and technology investments, maintenance
and replacement
k) Ensure essential health service packages identified and the worst offs are addressed first
l) Ensure appropriate models of care are in place suitable to reach all in need of essential
health services
m) Periodically define essential services considering reorientation of servicec delivery
models through person and family-centered approach for effective/efficient healthcare
delivery
n) Transform referral and consultation system including laboratory services so that
utilization of health care at all facilities is optimized, costs rationalized, quality
maintained, and communications strengthened assuring in the end access to an
appropriate continuum of care

5.3.2 Policy Objective 2

To ensure health is addressed in all sectors and regulated to improve health outcomes

Strategic directions
a) Promote ‘one-health’ strategy of addressing environment, human and animal health
issues
b) Establish quality health care standardization, coordinating and monitoring system for
continued quality improvement
c) Ensure client and provider safety and risk are properly managed
d) Inter-sectorial collaboration for adequate food and nutrition, provision of safe and
adequate water supply, safe disposal and recycling of waste and safe and healthy
environment for health and road and transport safety
e) Enhance and sustain public private partnership in the delivery of high impact public
health services
f) Strengthen collaboration with non-state actors (associations, societies, community
organizations, NGO) to exploit the potential for maximum public benefit
g) Strengthen the regulatory body to enforce standards of health infrastructure, personnel,
practice and products;
h) Ensure appropriate and functional organizational and management system for different
levels of units within each health facilities to safe guard dependable health service

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 i) Strengthen a mechanism of ensuring the health facilities are accountable to the
community
j) Ensure health facilities are given priorities in accessing basic utilities such as water,
electricity and means of connectives

5.4. Human Resource for Health (Health Workforce)

Owing to rapid scale up of health worker education, the Government of Ethiopia has increased
the health workforce density. However, more work is needed to ensure evidence-based health
workforce planning, competent, ethical and motivated workforce, and reduce attrition and
inequitable distribution. Accordingly, the HRH policy and strategies shall focus on evidence-
based HRH planning, strengthening capacity of education institutions to produce adequate health
workforce with improved quality and relevance of education, ensuring maintenance and
improvement of competencies of health workers through continuing professional development,
and strengthening regulation and management of the health workforce to ensure availability of
committed, competent, motivated and supported health workforce to achieve universal health
access.

Policy Objective 6.3.1: Ensure the health sector is staffed with adequate health worksforce with
appropriate skill mix and competencies.
Strategic directions
In order to achieve this policy objective, the Government shall:
a) Develop comprehensive HRH strategic plans based on needs taking into account current
stock, demand, supply, skill mix, and local and global labor markets
b) Develop capacity for HRH planning, implementation, monitoring, evaluation and
regulation at all levels of health system
c) Consider gender, cultural, ethnic and regional and societal diversity in health workforce
development and management
d) Strengthen the capacity of pre-service education institutions to improve the quantity,
quality and relevance of education while increasing number to meet service requirements
e) Maintain and improve competence of the health workforce through effective, efficient
and sustainable continuing professional development (CPD)
f) Establish a comprehensive, effective, efficient, fair, transparent, optimal and accountable
health workforce regulation system to protect the public from incompetent and unethical
practitioners and improve the quality of education and healthcare.
g) Strengthen HRH leadership and management capacity at all levels of the health system
for improved health workforce performance and retention

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 h) Increase and sustain HRH financing to fill the gap in health workers availability and
performance improvement

5.5. Information, research and knowledge management

Health Information Management System is being used to produce health reports on selected
indicators to monitor progress against plans. Attempt to disaggregate data by gender, district and
other relevant equity dimensions needs to be encouraged. Moreover, improving the quality and
completeness of data need to be further strengthened. The GoE focuses on strengthening research
and development as the basis for policy development, decision-making and planning of health
sector programmes and projects. Particular attention will be given to frame national health
agenda, and develop a mechanism for ensuring research and innovations are used to guide the
development and implementation of health systems, health promotion, environmental health,
disease prevention and early diagnosis and treatment. The health system will also focus on
developing innovations to contain issues emerging following the globalization, urbanization and
socio economic transitions. Furthermore, a mechanism of ensuring access to information and
data will be established/ strengthened to promote research and development. Institutes shall be
encouraged to build their capacity in knowledge management in the spirit of creating learning
institutes.

Policy Objective
Ensure data generated through integrated health information system, and researches are properly
utilized to scale up innovations, and inform decisions made at various levels.

Strategic Directions
In order to achieve this objective Government shall:

a) Strengthen human resource and infrastructure capacity to plan, collect and utilize routine
service statistics data generated from Integrated Health Information System
b) Ensure the community has an awareness and is empowered to provide and use
information to make informed decision and influence the health system
c) Ensure multi-sectoral collaboration (health- industry- agriculture, Vital Events
Registration Agency, Central Statistics Agency, etc) to generate relevant information for
the health sector
d) Promote the use of health technology for generating and storing data for research and
development
e) Strengthen institutes to develop and implement a prioritized national health research
agenda in a consultative manner and disseminate the findings

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 f) Harness development partners’ and government funds to successfully implement the
national health research agenda
g) Promote dialogue and information sharing between the policy makers, researchers,
healthcare providers and communities in order to ensure that research is relevant to the
needs of the people and consistent with the national priorities and findings are utilized by
the relevant stake holders
h) Promoting triangulation of data and utilization of information at all levels
i) Ensure an ethical code of conduct for health research promote the safety and rights of
research participants, as well as the researchers
j) Ensure the involvement of universities, and research institutions to innovate new ways of
organizing service delivery, and production of new bio-medical products
k) Establish incubation/knowledge centers for research (innovation centers) at various level
l) Promote knowledge value chain through knowledge management platforms (Planning,
acquisition, storage, dissemination, translation and utilization)
m) Ensure that health laboratories are encouraged to participate in operational health
research to generate evidence based data, to strengthen local production of in-vitro
diagnostics and to improve laboratory performance, patient management, disease control,
and industry linkage.

5.6. Medicines and Health Technologies

Medicines and health technologies are critical resources that need to be in place for effective
delivery of health services so as to save or enhance human life. As a result, these resources are
taking the lion’s share of the health service expenditure. The very fact of these compels the
country to guarantee availability of quality-assured medicines and health technologies, universal
access and their appropriate use. Accordingly, access to medicines and technologies,
pharmaceutical local production, research and technological advancement, regulation, and
improving the quality of pharmaceutical services should be priority policy directions. In addition,
to harness the benefits of traditional medicines due attention should be given to research and
development, linkages with modern medicines, and regulation of traditional practices.

Policy Objectives
Ensure access to quality assured medicines and health technologies including laboratory and
imaging as well as guarantee their appropriate use through developing a resilient national
capacity.

Strategic directions
In order to achieve this objective, Government shall:

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 a) Build efficient and robust pharmaceuticals supply chain management system to ensure
continuous availability of medicines in all parts of the country
b) Expand patient-centered pharmacy services and ensure rational prescribing, dispensing
and use of medicines
c) Devise mechanisms to monitor access to essential medicines
d) Maintain that clinical performance, analytical validity and post market surveillance
studies are conducted properly to ensure safety and compliance with regulatory standards
e) Create platforms for public-private partnership to increase access to medicines
f) Encourage private sector to produce medicines and medical equipment locally
g) Invest on research and development on modern and traditional medicines, human capital
and technological advancement to enhance local production of medicines and health
technologies
h) Modernize the country’s medicines regulatory system to ensure access to quality assured,
safe and efficacious medicines
i) Develop efficient and effective systems for standardization, regulation and management
of medical and laboratory equipment including their maintenance
j) Establish centers of excellence in key areas of the pharmaceutical sector
k) Harmonize and standardize procedures for rational selection, procurement, maintenance
and disposal of medical equipment and supplies
l) Establish environment friendly medicines and health technologies waste management and
disposal system in accordance with country’s regulations primarily focusing on
minimization of wastes
m) Develop and implement pharmaceutical sector strategic plan and its monitoring and
evaluation system for the country

5.7. Healthcare Financing

Healthcare Financing relates to the process of mobilizing and managing required finances to
ensure provision of health services. The policy’s commitment is to progressively facilitate access
to services by all by ensuring financial risk protection through adequate mobilization, pooling,
and efficient utilization of financial resources for health service delivery. The primary
responsibility of providing the financing required to have a healthy and productive citizens lies
with governments at all levels of the governance hierarchy. Ensuring financial risk protection
and sustainable financing for health will be attained through ensuring equity, efficiency,
transparency, and accountability in resource mobilization, allocation, and use. Efforts will be
made to progressively build a sustainable country wide political and community commitment
with a view towards achieving and maintaining universal health coverage through increased and
diversified domestic financing options. In addition, all possible efforts shall be made to mobilize

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more funding from external sources while the effort to rely on its own means going
progressively. To this effect, the government shall focus on mobilizing adequate resources for
health in an innovative and sustainable way mainly from domestic sources with the main aim of
reduce out of pocket spending and addressing avoidable inequalities in health outcomes.

Policy objective
To ensure universal access to a range of health care services of adequate quality, through
improved resource mobilization and utilization and without excessive financial burden.
Strategy Directions
In order to ensure adequate and sustainable resource flows to the health sector, the GoE shall:

a) Increase government budget allocation to health at federal, regional and woreda levels
b) Develop and implement innovative health financing options
c) Mobilize aligned external resources through enforcement of mutual accountability and
trust
d) Ensure long term financing of periodically defined essential services and public health
emergencies
e) Enhance community and other sectors contribution in mobilizing additional resources
f) Establish/ strengthen risk pooling /prepayment mechanism for formal and informal
sectors to gradually form national health insurance system (NHIS) to ensure Universal
Health Coverage (UHC).
g) Encourage private health Insurance schemes
h) Provide support for covering the cost/ premium of indigents, elderly and differently-
abled segments of the population
i) Implement resource allocation criteria that reduce geographic, economic, gender based
and other forms of disparities
j) Implement effective resource pooling and “strategic purchasing” that enhance value
for money
k) Enhance transparent and accountable resource utilization and sound financial
management and tracking
l) Explore feasibility and implement Results Based Financing(RBF)
m) Build the capacities of the health sector at all levels with particular focus on regions
that need special support.
n) Enhance outsourcing of non-clinical and clinical services
o) Create enabling environment for the private sector to invest on medical tourism
p) Provide “incentives” to the private sector to fill gaps in financing health sector priorities.

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7. Policy Implementation

Successful implementation of the National Policy, strategic approaches and action Plan will be
achieved through enhancing institutional capabilities to implement priority programs and the
development of appropriate implementation strategies and guidelines. This includes setting
effective coordination mechanisms, building capacity at all levels, acquiring essential evidence,
eloquent monitoring and evaluation mechanisms, designing supportive regulatory mechanisms
and ensuring a sustainable resource mobilization. Besides, institutes that translate policies and
strategies are expected to be learning organization through effective knowledge management
platforms. The policy implementation modalities shall take into account:

 The political and leadership commitment of the developmental state for health capacity
building
 Integration of health policy, strategies, plans, and programmes with the national socio-
economic development plan.
 Inter and multisectoral collaboration with state and non-state actors
 Engage and support non state actors including the traditional health sectors in order to
enhance the implementation of the health policy.
 Efficient, effective, accountable and transparent allocation and utilization of resources to
be made available for health programs, projects and activities.
 Foster joint implementation of the health policy and strategy based on the principles of
federalism and involving all stakeholders.
 Establish and strengthen governance structures and institutions to coordinate the
implementation of health policy and strategies.
 Foster conscious and continuous learning organizational culture from success and failure,
domestic and global experiences, to ensure transformation of the health system.

7.1. National Health Sector Capability Building

The health sector capacity building efforts should focus on priority health and multi-sectoral
programs with emphasis to building institutional capacity at all level to better manage resources
systematically and ensure sustainability.

7.1.1 Priority health Programs

A Priority health program is a set of interventions or delivery platforms that can be planned,
implemented, monitored and evaluated in coherent manner in order to address a particular or
combined major public health issues. The following are list of priority health programs

 Primary health care  Health insurance

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  Hygiene and environmental health  Emergency and critical care service
 Family health(FP, Maternal, system
newborn and child health and  Patient-centered pharmacy services
elderly)  Pharmaceutical supply chain
 Adolescent health management system
 Communicable diseases  Medical equipment management
 Non communicable diseases system (including laboratory and
 NTD imaging equipments)
 Injuries & accidents  Assurance of quality, safety and
 Public health emergencies efficacy of medicines program
 Nutrition  Pharmaceuticals waste management
 Research and program
development/knowledge  Alternative and Traditional
management medicines development program
 CPD  Public-Private-Partnerships
 Prevention and containment of
antimicrobial resistance program

7.1.2. Multi-sectoral programs

Investment shall be made to build capacity in coordinating multi-sectoral issues that affect health
directly or indirectly within and outside the health sector. Mechanisms of developing healthy
policies and translating them into actions shall be put in place in collaboration with the
respective line and collaborative ministries. Multi-sectoral programs are projects or initiatives
that are managed or implemented jointly or that requires the collaboration of one or more sectors
to maximize impact or improve efficiency. Legal and structural framework to foster multilevel
partnership and collaboration shall be enhanced. The following are among multisectoral
programs that foster health in all policies and strategies approach:
 WaSH  Environmental health

 Nutrition  Occupational health and safety

 Road construction and  Health infrastructure (power, water,

management/Injuries connectivity such as road and
telecommunication)
 NCD
 Climate change and adaptation
 PPP
 Mapping/GIS
 Urban development
 Social security
 Villagisation/resettlement
 Technology transfer and use of ICT
 Mega projects

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 Human Resource Development and platforms
management
 Leadership Management Governance

 Research and Information system

7.1.3. Building Community Capacity

Capacity building efforts to capacitate the community shall be given due importance to identify
their own priority health and health related issues, combine resources and actively engage in
activities that address their needs, jointly monitor and evaluate progresses. Communities are
expected to be self reliance in addressing challenges and harness opportunities by their own and
serve as a regulator of the healthcare system. For this to happen, the following capacity building
elements are expected to be heightened in the upcoming health strategies and programs.

 Develop knowledge and skills of individuals, groups, communities and providers to

make them competent and confident to deal with their needs and improve their
wellbeing.
 Develop capacity for proactive and equitable engagement of all to eliminate
discrimination and create equitable participation
 Develop the capacity for organizing and leading groups or communities with social
and legal accountability
 Create legal and structural framework to foster multilevel partnership and
collaboration.
 Build negotiation and advocacy skills

7.1.4. Institutional Capacity Building

Institutional Capacity Building is among one of the main types of Capacity Building efforts by
systemic coordination of capacity building efforts on human capacity, infrastructure and supply
chain systems. All are closely inter-related and complement each other. Institutional Capacity
Building addresses Capacity Building beyond the provision of education and training of
professionals. It aims to enhance the capacity of governments, non-state actors and communities
to plan, and manage the sector efficiently and effectively. It also aims to improve institutional
arrangements to maximize impact in efficient and equitable manner. This implies
addressing Capacity Building on a long-term and strategic level. Concepts such as leadership,
awareness, and constituency building are part and parcel of institution building.

The following institutions or systems are proposed to be established in the years to come:
- Research and development and knowledge management centers
- Health Research Council
- Human Resource Development council
- National health technology assessment centers
- National health education council
- Medical equipment maintenance and refurbishment centers

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 - Institution for Health Promotion and well-being (Resource center for Behavioral change
communication)
- National health accreditation and standardization council ( Quality of premises, products,
profession ,practice)
- National reference and back up laboratory system
- An independent and health service standards regulatory body
- Units for Public private partnership at appropriate levels
- Establish Institute of pharmaceuticals research and development (IPRD)
o Center for bioequivalence study
o Center for traditional medicines
o Center for pharmaceuticals technology and Good Manufacturing Practices
o Center of excellence for medicines and health technologies quality assurance
- Establish government entities that guide pharmaceutical services at all levels

7.2. National implementation strategies, guidelines and monitoring

tools
 National strategic roadmaps or plans and relevant policies for each areas of priority
 Long term health sector Envisioning document (20 years road map)
 Health Sector five year strategic plan (Health Sector Transformation Plans)
 National HRH strategy
 National health products policy and strategy
 National Laboratory policy and strategy
 National road map for infrastructure development
 National strategy or multi-year plans of priority programs
 National technical and program implementation guideline and technical working
group on relevant thematic areas such as HRH, Health care financing, health products
etc
 National standardized training materials
 National service standards (service ,HR, training packages, professional premises,
product and practice)
 National program Monitoring & Evaluation Guideline (indicators to monitor, targets
to achieve)
 Interoperable Health information system with emphasis of using latest technologies to
speed up information exchange, minimize errors, verifiable and usable at the place
and time of information generation and relevant supportive structure above them.

7.3. Governance

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 The health policy will be implemented by all relevant stakeholders. The council of
Ministers monitors the overall implementation of the policy. The Ministry of health and
regional health bureaus are responsible for developing implementation strategies and
monitoring frameworks as well as support health facilities and related institutes.
The governance system shall:
 Establish appropriate structure/ mechanism to recognize voices from formal and
informal groups in the community empowerment process.
 Actively strengthen indigenous decision making and control over their
organizations
 Build on peoples skills, personal and collective contributions and shared
commitment to an organization’s chosen governance processes , goals and
identity
 Enhance legitimacy, leadership, power , resources and accountability in
community organizations and protect community and individuals from corruption,
favoritism, nepotism, apathy, neglect, red tape and self- serving political leaders
and public officials
 Build community ownership of health systems
 Ensure community representation in health facility governance boards
 Ensure multi-sectorial coordination to strengthen community empowerment
 Ensure community participation in health care financing approaches
 Improve capacity of the community to demand services from duty bearers
 Broaden delivery of primary health care structure, scope and quality
 Strengthen harmonization and alignment
 Strengthening Knowledge Management across the health sector
 Transparent practice standards in supply chain management and service delivery,
research, education, regulation and manufacturing and a platform for all
stakeholders to ensure transparency and accountability in pharmaceutical sector
governance will be established
 A national governance structure at the Federal Ministry of Health will be
established to direct, guide and oversee the implementation of pharmaceuticals
related policy directions
 Coordination mechanisms
 Establish National advisory Council (NSC) led by the deputy prime minister
consisting of different ministries
 Establish National Multi- sectorial Technical Advisory Group (NMTAG)

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7.4. Regulatory/Legislative framework
It is the responsibility of the government to create an environment for people’s
participation as stipulated in Constitution 89(6)
“Government shall promote, at all levels, the participation of peoples in the
formulation of national development policies and programs. Government shall
have the duty to support the initiatives of peoples in their development.”

The following regulatory and legal frameworks need to be considered:

 Development of community empowerment act
 Ensure favorable environment and circumstances are in place to implement respective
strategic plans
 With regards to Evidence / Information
 Create conducive environment to generate reliable evidence linked with service
delivery to guide health planning and orientation.
 Avail legal framework regarding health information including information
security, access to health information and false reporting
 Developing appropriate measures to assure strict observance of ethical principles
in service delivery and research
 Developing Knowledge Management legislation related to KM database, indigenous
knowledge and documentation
 Up-to-date pharmaceutical, laboratory and other health related policy and legislation
that govern the health sector sector from research to practice/service delivery will be
in place
 HRH regulation to explicitly and comprehensively address accreditation of education
programs, licensing and certification of health workers, continuing professional
development, fitness to practice, revalidation

7.5. Planning, Monitoring and Evaluation

 Integrate community decisions into strategic and annual plans through open
discussion and participation, collaborative and sustained engagement
 Develop relation of trust and dialogue and create participatory processes to identify
problems and develop a sense of togetherness
 Foster a continuous learning through regular review to improve the plan and planning
processes
 Policy indicators require a regular, systematic, and independent assessment to
evaluate whether the policies are in place, implemented, and enforced.

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  Monitor and evaluate landscape of disease and risk prevalence, medical
capacity for care and national behavioural trends to determine progress in the
prevention and control of diseases and circumstances
 Monitor and evaluate if standards are met
 Ensure appropriate ICT infrastructure are in place
 Ensure Quality Improvement and assurance of HIS are continuously
performed
 Promoting establishment and strengthening Knowledge Management systems
 Ensure governance structure at all level make use of available information for
timely and informed decision making

7.6. Funding
Sustainable health care financing is prerequisite for successful implementation of health
policy. Ethiopia is signatory to Abuja joint declaration of adequate funding for priority
health agenda
 Health care financing shall emphasize domestic resource mobilization
 Consider strategy for financial sustainability at the planning stage
 Ensure community participation in financial mobilization, monitoring and
decision making
 Ensure transparency and accountability in financial management
 Facilitate private sector engagement in mobilization and use of resources
 Dedicating funding for research and development, KM, M&E
 The government will establish pharmaceutical fund to finance the
development of the pharmaceutical industry to ensure both economic and
social benefits from the sector

The country is committed to a long term goal of Universal Health Coverage where
every citizen will have access to essential healthcare service without financial
barriers. The realization of this commitment, however, requires a clear strategy and
sound leadership from the government to mobilize adequate and sustainable financing
through popular participation and full support of the relevant government and non-
government bodies and the people of the country. Above all, the roles and
responsibilities of every actor in the system have to be clearly defined and mutually
agreed with resultant sense of accountability. It is imperative to adopt a
comprehensive approach to ensure better implementation of the policy. This in turn
requires a sound implementation plan developed through a consultative process that
ensures ownership and support by all stakeholders.

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 The implementation plan should focus on creation of conducive policy and legal
environment, development of robust institutional arrangements and implementation
capacity, and designing of sound monitoring and evaluation mechanism to gauge
performance of the health care financing system in terms of sustainability, equity,
efficiency, and accessibility. Therefore, the implementation will focus on:
a. Creating an enabling legal and policy environment
b. Strengthening institutional capacity and governance architecture such as
establishing HCF council and board comprised of relevant ministries.
c. Establish effective health financing monitoring, evaluation and forecasting system

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