In 1993, the Ethiopian government established the National Health Policy and Strategy with the goal of improving access to primary health care through decentralization, strengthening of programs, promotion of equitable access, and collaboration with the private sector.1 The National Health Policy and Strategy laid the groundwork for the 20-year, four phase Health Sector Development Plan (HSDP). The various health system strengthening efforts that have emerged in Ethiopia over the last couple of decades can be mapped to the HSDP.

How facility organization and management was integrated into health reforms:

What are the components of a performanc monitoring system?

Developing or strengthening a facility performance monitoring system can help managers more readily identify areas for improvement and implement improvement strategies. The core components of performance measurement and management systems are: 1) choosing measures and targets, 2) tracking progress, and 3) adapting and improving. 

Ethiopia launched the Health Extension Program (HEP) in 2003 under the second phase of the HSDP. A core component of this program was the creation of a new cadre of providers, Health Extension Workers (HEW). Two HEWs share a health post with an empaneled population of approximately 5,000 individuals and form the foundation of community-based primary health care service delivery in Ethiopia. HEWs provide care outlined in 16 health packages across four components: promotion of hygiene and environmental sanitation; prevention and control of communicable disease; promoting and providing family health services and health education; and communication.23 While Ethiopia has not established more robust care teams to date, the HEW component of the HEP has created a team-like dynamic and displays the efficiency of task shifting for community-based care. In addition to a focus on community-based care, Ethiopia also developed a national plan for performance monitoring in hospitals. This plan was developed in collaboration with the Clinton Health Access Initiative and Yale Global Health Leadership Institute and included 124 hospital management standards.4 These data are used in quarterly meetings with hospitals and regional health bureau staff, and new cadre of the workforce – called data owners – were introduced to meet these demands.4 To support this hospital performance transformation, an executive master’s degree program was developed to train hospital managers who could then oversee performance monitoring and reporting. an intervention that has been found to be critical in sustaining these reforms.

Outcomes & Impact:

As a result of these interventions, approximately 38,000 HEWs have been trained and deployed in communities across Ethiopia. Additionally, facility management processes have improved considerably. the percentage of hospitals reporting performance standards has increased from 40% in 2011 to 84% in 2014,4 and 2013, 60% of facilities had a full-time data owner.5 Communities throughout Ethiopia have experienced increased access and utilization of latrines, contraceptive acceptance, antenatal care use, assisted delivery, vaccination, and HIV prevention.3

Suggested citation: “Facility Organization and Management: Ethiopia.” Improvement Strategies. Primary Health Care Performance Initiative, 2018, https://improvingphc.org/ethiopia. Accessed [insert date].


  1. El-Saharty S, Kebede S, Dubusho PO, Siadat B. Ethiopia: Improving Health Service Delivery [Internet]. HNP Discussion Paper. 2009. Available from: http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/EthiopiaHealthSystemDelivery.pdf
  2. Abrahim O, Linnander E, Mohammed H, Fetene N, Bradley E. A Patient-Centered Understanding of the Referral System in Ethiopian Primary Health Care Units. PLoS One [Internet]. 2015 Jan 5 [cited 2015 Oct 9];10(10):e0139024. Available from: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139024
  3. Ethiopian Federal Ministry of Health. Health Sector Transformation Plan (2015/16-2019/20). Vol. 20. 2015.
  4. McNatt Z, Linnander E, Endeshaw A, Tatek D, Conteh D, Bradley EH. A national system for monitoring the performance of hospitals in Ethiopia. Bull World Health Organ [Internet]. 2015;93(10):719–26. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4645435&tool=pmcentrez&rendertype=abstract
  5. Annis E, Ratcliffe H. Strengthening Primary Health Care Systems to Increase Effective Coverage and IOmprove Health Outcomes in Ethiopia [Internet]. Primary Health Care Performance Initiative. [cited 2018 Sep 10]. Available from: https://improvingphc.org/strengthening-primary-health-care-systems-increase-effective-coverage-and-improve-health-outcomes-ethiopia