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USAID Health Financing Improvement Program


  • HCF reforms need further institutionalization in Ethiopia.
  • Abt and our partners are scaling-up HCF reforms and strengthening HCF functions and systems.
  • We anticipate more health sector resources and institutionalized HCF reforms.
The Challenge

Much progress has been made in the design and implementation of health care financing (HCF) reforms in Ethiopia. These reforms address growing needs for health services, health sector resource constraints, quality of care concerns, and financial barriers to accessing and utilizing health services. Reforms also support Ethiopia’s goal of attaining universal health coverage. More remains to be done to expand and consolidate these interventions, and to ensure that the right systems and capacities are in place to sustain them.

The Approach

Through the USAID Health Financing Improvement Program, Abt and its consortium partners strengthen HCF functions and systems in Ethiopia, and increase local capacities that facilitate sustainable and continuous reform implementation. Our efforts focus on facilitating the nationwide rollout and institutionalization of first-generation reforms (such as health facility boards and revenue retention and utilization) that increase domestic resources for health and improve governance. We’re also refining and scaling-up second-generation reforms, including community-based health insurance (CBHI); and exploring new third-generation interventions to further enhance HCF reforms.

The Results

By the end of the Program in 2023, Ethiopia’s health sector is anticipated to have more resources available for primary health care services; the share of domestic financing of health services will increase; and more people will have insurance coverage, including the poorest. We anticipate that:

  • First-generation reforms will be fully managed and implemented by the Ethiopian government.
  • The system elements for sustained continuation of viable CBHI schemes will be institutionalized (i.e., will be implemented by institutional structures with roles and responsibilities, operational procedures and manuals, and capacity-building arrangements).
  • CBHI will be rolled out in urban settings.