In Ethiopia, the Federal Ministry of Health is committed to developing a resilient health system that is accountable to all of its stakeholders, including government, communities, patients, service providers, and professional associations.12 The government is the main health service provider in Ethiopia, and the autonomous regulatory body, the Health and Health-Related Services and Products Regulatory Agency, is funded by the Federal Ministry of Health to license and monitor health professionals, facilities, and delivery processes in both public and private sectors.13 In addition, the Ethiopian Food, Medicine and HealthCare Administration and Control Authority is charged with performing quality assurance activities in both private and public sectors, with a particular focus on issuing licenses, registrations, and certifications for professionals, premises, practices, and products.14 The National Health Care Quality Strategy aims to “consistently improve the outcomes of clinical care, patient safety, and patient-centredness, while increasing access and equity for all segments of the Ethiopian population, by 2020”. 5 14 15
Challenges to the country’s regulatory capacity have included a lack in uniformity of the regulatory structure at the local level, insufficient attention to health regulatory systems in some regions, and overly specific focus on limited areas within the health regulatory framework in others.16 The Federal Ministry of Health and other federal agencies are key players in influencing many of the important aspects of quality delivery within health care. They have several levers to influence quality, primarily oriented around patient-focused interventions, regulatory interventions, incentives, data-driven interventions, organizational interventions, and health care delivery models.14 Quality-focused regulations can set specific standards, requiring health providers to comply with certain policies, but there is flexibility built in to allow health care or professional organizations to prescribe their own rules.13 This potential for flexibility allows regulators to monitor the perceived competence of provider institutions to produce the desired outcome of the regulation and provide more, or less, extensive oversight depending on their level of confidence.13
According to Ethiopia’s Minister of Health from 2012-16, “accountability to communities and accountability to professional standards of care based on current evidence are both essential for resilient health systems”.12 Health systems cannot be reformed or reshaped swiftly, so commitment to the time and persistence required to make important changes is essential12, and Ethiopia’s health system strengthening efforts are an emblematic example.