Pictured from right to left: Dr. Messay Hailu, Director General of Ethiopian Public Health Institute (EPHI); Dr. Aderajew Mekonnen, Director of the Health System Research Directorate; His Excellency Dr Dereje Duguma, State Minister Health; Dr. Getachew Tollera, Deputy Director General of EPHI; Dr. Melkamu Abite, Deputy Director General of EPHI; and Dr. Ashenif Tadele of EPHI.
Since the 2025 annual meeting, the Countdown to 2030 country collaboration in Ethiopia has been promoting data for action, presenting its analyses at three events for Ministry of Health leadership and other key stakeholders within the country. At the Global Health Innovation and Quality Summit in June, they presented posters on (1) geographic and socioeconomic inequalities in maternal health services from 2011-2022, and (2) subnational inequalities related to immunizations. At the annual performance review meeting for the Ethiopian Public Health Institute (EPHI) in July 2025, the Countdown team presented their findings on antenatal care effective coverage. During the Ministry of Health’s Innovation and Quality Lead Executive office 2024/2025 Annual Performance Review Meeting and 2025/26 annual plan launching program in September, they presented results from the 2025 annual meeting and the immunization multicountry study. The immunization analysis had also been presented at an event organized by the maternal, child and youth health lead executive office of the Ministry of Health in May.
Key messages from these events include:
- Ethiopia has shown remarkable progress in service coverage over the past two decades based on data through 2022, with antenatal care (ANC) 1+ visits rising from 43% to 90%, ANC4+ increasing from 19% to 54%, institutional deliveries reaching 56%, skilled birth attendance at 59%, postnatal care at 46% for mothers and 43% for newborns. The data also show declines in inequality, although significant socioeconomic and geographic disparities persist.
- However, the 2021/22 data suggest that the quality of ANC services remains low. Half of the facilities were ready to provide quality ANC services, with quality processes observed in 59%. The readiness-adjusted coverage was 75%, whereas the content-adjusted coverage was 67%, and the quality-adjusted coverage was only 41%. Most women sought ANC services at lower-level facilities, which had lower readiness than hospitals did. Readiness gaps were driven by poor infrastructure, insufficiently trained personnel, and low availability of medicines and commodities, leading to low adherence to protocols and consequently poor quality-adjusted coverage.
- The magnitude of “zero-dose” children (those who have not received any immunization) has declined in Ethiopia, however significant inequalities continued across regions and other sociodemographic variables. Strengthening health care facilities in pastoral and conflict affected areas would be helpful to reach more eligible children. Significant inequality has been observed across regions, as well as by household wealth and urban/rural residence. For example, nearly two-thirds of children (65%) in Afar region and nearly half (48%) in Somali region were zero dose in 2022; while Addis Ababa city and Amhara region had only 11% and 15% burden of zero dose children during the same year, respectively. Since the burden of the zero-dose children and dropouts vary across regions, specific interventions are needed for the high burden regions.
- It is necessary to strengthen the health system, including infrastructure, human resources, equipment, maternity waiting homes, ambulance services – especially addressing urban-rural inequities. Improved training, competitive compensation and performance-based recognition systems are important for retaining health workers. Community awareness and engagement also remain essential, including improving better among communities and tailoring health services to meet community’s needs.
- Health facility (DHIS2) data remains a valuable yet under-utilized asset for RMNCAH monitoring. When data quality is prioritized, DHIS2 can generate timely, actionable district-level insights for program managers and decision-makers. Over time, data quality and completeness have improved, yet continued investment in health information systems is necessary to maintain progress. Under-reporting of mortality events remains a major challenge.
- Workforce density and bed density remain below global targets, while facility density meets the World Health Organization standards, although great disparities exist among regions. Strengthening the health workforce and engaging the private sector are essential to sustain RMNCAH gains.
- There is a need to continue this approach to generating evidence using the routine health information system data and increase investment in data systems, quality assurance, and local data use to ensure no woman, newborn, or child is left behind. Analyzing routine data should directly guide tracking of progress toward national and global goals.
About the Country Collaboration
The Ethiopia country collaboration is a partnership between the EPHI and the Ministry of Health in collaboration with the African Population and Health Research center (APHRC), the University of Manitoba, and the London School of Hygiene and Tropical Medicine (LSHTM). The main objectives of the collaboration are to strengthen the local capacity in data analysis by producing estimates on key reproductive maternal, newborn, child, and adolescent health (RMNCAH) indicators by integrating DHIS2 data with other data sources, such as the Demographic and Health Surveys, United Nations estimates and other data sources to evaluate regional progress and disparities. The initiative also promotes innovative data analysis techniques to facilitate evidence-based decision-making by developing DHIS2 based denominator adjustment for RMNCAH estimates. Accurate denominators in DHIS2 are crucial in to ensure reliable estimations of health service coverage by providing the correct reference population for health interventions.
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