Ethiopia: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

Ethiopia has a national antimicrobial resistance plan that covers surveillance, detection, and reporting of priority AMR pathogens. According to the Ethiopian Food, Medicine and Health Care Administration and Control Authority (EFMHACA), the country developed the "Strategy for the Prevention and Containment of Antimicrobial Resistance for Ethiopia (2015-2020)" which establishes a comprehensive framework for AMR surveillance, detection, and reporting ¹. The strategy specifically addresses surveillance networks for AMR pathogens in both human and animal health sectors through the Ethiopian Public Health Institute and veterinary services, with detailed protocols for detecting resistance patterns in priority bacterial pathogens including Staphylococcus aureus, Escherichia coli, and Mycobacterium tuberculosis ^{2, Section 4.2}. The strategy requires standardized reporting mechanisms for AMR test results from laboratories to national databases, ensuring systematic data collection and analysis ^{3, Section 4.5}. The WHO Global Database for Antimicrobial Resistance Country Self Assessments confirms that Ethiopia has a national AMR action plan with operational surveillance components and monitoring agreements ⁴. The Ethiopia National One Health Strategic Plan (2018-2022) incorporates AMR as a priority threat requiring coordinated multisectoral surveillance and response activities . While the 2015-2020 strategy's timeframe has concluded, the plan document exists and explicitly covers the required components of surveillance, detection, and reporting of priority AMR pathogens ⁵.

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Ethiopia has a national laboratory system that tests for some priority antimicrobial resistance pathogens, but not all required priority pathogens. According to the Ethiopian Public Health Institute (EPHI) website, the institute serves as the national reference laboratory and has established capacity for AMR testing of bacterial pathogens including Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae ⁶. The 2023 Joint External Evaluation for Ethiopia (JEE) confirms that EPHI has implemented standardized testing methods for priority AMR pathogens using disk diffusion and automated susceptibility testing systems ^{7, Section 6.4}. The National Animal Health Diagnostic and Investigation Center conducts AMR testing for veterinary pathogens including Salmonella species and Campylobacter jejuni ⁸. Ethiopia participates in the WHO Global Antimicrobial Resistance Surveillance System (GLASS) and has established laboratory networks that include five regional laboratories capable of conducting basic AMR surveillance testing ⁹. However, as per the 2023 JEE, the laboratory system has limited capacity for testing certain priority pathogens such as Neisseria gonorrhoeae and Streptococcus pneumoniae, and molecular testing capabilities for resistance gene detection remain restricted to the national level ^{10, Section 6.5}.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that Ethiopia conducts systematic environmental detection or surveillance activities for antimicrobial residues or AMR organisms in soil, waterways, or other environmental sources. The Ethiopian Food, Medicine and Health Care Administration and Control Authority's "Strategy for the Prevention and Containment of Antimicrobial Resistance for Ethiopia (2015-2020)" focuses on clinical and veterinary surveillance but does not include environmental monitoring components ¹¹. The Ministry of Environment, Forest and Climate Change website does not contain information about environmental AMR monitoring programs ¹². According to the Ethiopian Public Health Institute, while the institute has AMR surveillance activities in clinical settings, environmental surveillance for antimicrobial residues is not documented in publicly available materials ¹³. The 2023 Joint External Evaluation for Ethiopia makes no mention of environmental AMR surveillance activities ¹⁴. The (former) Veterinary Drug and Feed Administration and Control Authority — rights and obligations of which were transferred to the Ethiopian Agricultural Authority under Proclamation 1263/2021 — had laboratory capacity for residue testing of animal products; under its successor (via the Animal Products and Inputs Quality Testing Center), this capacity now continues as part of EAA’s mandate, oriented to food-safety and product quality (not environmental surveillance) ¹⁵.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

Ethiopia has national legislation requiring prescriptions for antibiotic use in humans, but there is evidence of gaps in enforcement. According to the Ethiopian Food, Medicine and Health Care Administration and Control Authority (EFMHACA), the "Drug Administration and Control Proclamation No. 661/2009" establishes the regulatory framework for pharmaceutical products and assigns EFMHACA the authority to regulate antibiotic dispensing ^{16, Article 23}. The proclamation requires that antimicrobial medicines be dispensed only with valid prescriptions from licensed healthcare providers ^{17, Article 45}. EFMHACA has issued "Guidelines for Good Pharmacy Practice" which mandate prescription requirements for antibiotics and specify penalties for non-compliance ^{18, Section 4.3}. The "Strategy for the Prevention and Containment of Antimicrobial Resistance for Ethiopia (2015-2020)" includes strengthening prescription practices as a key objective and acknowledges current enforcement challenges ^{19, Section 5.2}. The 2023 Joint External Evaluation for Ethiopia confirms that while prescription requirements exist in legislation, enforcement varies significantly across the country, particularly in rural areas where access to healthcare providers may be limited ^{20, Section 7.4}.

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

Ethiopia has established legislation requiring prescriptions for antibiotic use in animals, but there is evidence of gaps in enforcement. According to Ethiopia's legal framework, the "Veterinary Services Proclamation No. 267/2002" assigns the Veterinary Drug and Feed Administration and Control Authority (VDFACA) the authority to regulate veterinary pharmaceuticals including antibiotics ^{21, Article 5}. The proclamation requires that veterinary antimicrobials be dispensed only with prescriptions from licensed veterinarians ^{22, Article 13}. This authority was strengthened through subsequent amendments in 2015 which reinforced oversight of veterinary drug control ²³. VDFACA has issued regulations for veterinary drug distribution that mandate prescription requirements for antibiotic use in livestock and specify licensing requirements for veterinary drug dispensers ²⁴. The "Ethiopia National One Health Strategic Plan (2018-2022)" acknowledges the importance of regulating antimicrobial use in animals as part of AMR prevention and notes current challenges in enforcement, particularly in rural and pastoral areas ^{25, pages 18-19}. However, the 2023 Joint External Evaluation for Ethiopia indicates that enforcement challenges exist, particularly in rural and pastoral areas where access to veterinary services may be limited and informal antibiotic use may occur ^{26, Section 7.5}.

1.2.1a Laws/plans on zoonotic disease

Score: 100

Ethiopia has national strategy documents for zoonotic disease prioritization, detection and reporting. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country developed a comprehensive framework that specifically addresses zoonotic disease prioritization, detection, and response through a multisectoral approach ²⁷. The strategic plan identifies five prioritized zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis, and echinococcosis) based on severity in humans, proportion of human diseases attributed to animal exposure, impact at the household level, and availability of interventions [p. 15, 2]. The prioritization process was conducted through a structured workshop in 2015 with participation from multiple government agencies using criteria jointly determined by Ethiopian agencies and partners ²⁸. Additionally, Ethiopia has developed disease-specific strategies, including the Ethiopia National Anthrax Prevention and Control Strategy and Implementation Plan (2017-2021) and the National Strategy for Rabies Control, which are designed to execute multisectoral activities for prevention and control using a One Health approach ²⁹³⁰. The Joint External Evaluation for Ethiopia, conducted in September 2023, confirmed that Ethiopia has established formal multisectoral coordination mechanisms through the National One Health Steering Committee to address zoonotic diseases ³¹.

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

Ethiopia has national strategy documents that include specific measures for risk identification and reduction for zoonotic disease spillover events from animals to humans. The Ethiopia National One Health Strategic Plan (2018-2022) specifically addresses risk identification and reduction for zoonotic disease spillover through multisectoral coordination and surveillance activities. The plan incorporates One Health approaches to address interface risks between humans, animals, and the environment where spillover events are most likely to occur, particularly in pastoral and agro-pastoral communities where human-livestock contact is extensive (Section 4.2) ³². According to the strategic plan, the country has established vulnerability risk assessment and mapping activities for priority zoonotic diseases and has mechanisms for early detection of spillover events at human-animal interfaces ³³. The National One Health Steering Committee coordinates spillover risk reduction activities across human health, animal health, and wildlife sectors as outlined in the strategic framework ³⁴. Disease-specific strategies for rabies and anthrax include specific measures to prevent animal-to-human transmission, including vaccination protocols and exposure management guidelines ³⁵³⁶.

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Ethiopia has national plans and guidelines that account for surveillance and control of multiple zoonotic pathogens of public health concern. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country addresses surveillance and control of five prioritized zoonotic diseases (rabies, anthrax, brucellosis, leptospirosis, and echinococcosis) plus additional second-tier priority diseases through integrated surveillance systems (Section 3.4). Ethiopia has established Technical Working Groups for specific zoonotic diseases that develop surveillance and control guidelines for each pathogen while maintaining coordination across diseases. ³⁷. The country's national Integrated Disease Surveillance and Response (IDSR) system includes six zoonotic diseases among the twenty-two priority diseases for reporting, providing a standardized framework for surveillance of multiple zoonotic pathogens simultaneously ³⁸. The Public Health Emergency Management system (PHEM) established under the national Ethiopian Public Health Institute (EPHI) has published protocols for investigating and responding to multiple zoonotic disease outbreaks through standardized case definitions and response procedures ³⁹.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Ethiopia has a multi-sectoral unit functioning to coordinate mechanisms across ministries for zoonotic disease, meriting a score of 1 based on the establishment and past activity of the National One Health Steering Committee. According to the 2016 Joint External Evaluation, Ethiopia formally established the National One Health Steering Committee (NOHSC) in 2017, comprising representatives from the Ministry of Health, Ministry of Agriculture and Livestock Resources, Ministry of Environment Forest and Climate Change, and Ethiopian Wildlife Conservation Authority (page 3) ⁴⁰. The 2023 Joint External Evaluation confirms that this committee continues to function, noting that "Ethiopia has embraced the One Health approach" and that "the NOHSC facilitates multisectoral coordination and collaboration among One Health stakeholders at national and subnational levels" (Section 2.1) ⁴¹. The Ethiopia National One Health Strategic Plan (2018-2022) documents the committee's mandate to facilitate multisectoral coordination for zoonotic disease management across sectors including rabies, anthrax, brucellosis, and other priority zoonotic diseases (pages 4-7) ⁴². The committee has demonstrated activity through establishing disease-specific Technical Working Groups and coordinating responses to zoonotic disease outbreaks ⁴³. While the NOHSC exists and has been active, evidence of systematic, ongoing coordination across all relevant ministries for comprehensive zoonotic disease management remains limited in publicly available documentation as of 2025 ⁴⁴.

1.2.1e Presence of One Health strategic plan

Score: 100

Ethiopia has its National One Health Strategic Plan (2025-2029), which it launched in October 2025. ⁴⁵ While this is not yet publicly available, Ethiopia has previously launched other One Health Plans e.g. the National One Health Strategic Plan (2018-2022)

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is no publicly available evidence that Ethiopia has an effective national mechanism for livestock owners to conduct and report disease surveillance to a central government agency. According to research on animal health service delivery in crop-livestock and pastoral systems in Ethiopia, livestock disease surveillance and reporting is not only poor but very irregular, with only 30-35% of administrative zones submitting monthly disease outbreak reports, and below 5% for pastoral and agro-pastoral areas ⁴⁶. While the Ministry of Agriculture and Livestock Resources has veterinary services that are intended to collect disease surveillance data, the system does not function effectively as a national reporting mechanism that engages livestock owners directly ⁴⁷. The Ethiopia National One Health Strategic Plan (2018-2022) does not establish a specific mechanism for mandatory livestock disease reporting by owners to central agencies, focusing instead on professional veterinary reporting systems ⁴⁸.

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is insufficient evidence that Ethiopia has legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for livestock owners). A comprehensive search of Ethiopian legislation, including the Veterinary Services Proclamation No. 267/2002 and subsequent amendments, does not reveal specific provisions for protecting the confidentiality of livestock disease surveillance information ⁴⁹. The Ministry of Agriculture and Livestock Resources regulations available on their website and the Veterinary Drug and Feed Administration and Control Authority website do not contain publicly available provisions specifically addressing confidentiality protections for animal surveillance data collected from livestock owners ⁵⁰. While Ethiopia may have general data protection principles in various laws, there is no publicly available evidence of specific legislation or regulations that safeguard confidentiality of surveillance data for livestock owners as of August 2025 ⁵¹⁵². The Ethiopia National One Health Strategic Plan (2018-2022) discusses data sharing protocols between sectors but does not specifically address legal confidentiality protections for livestock surveillance data (Section 3.2, pages 21-22) ⁵³.

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Ethiopia conducts surveillance of zoonotic diseases in livestock, poultry, and wildlife, though with significant limitations and implementation challenges. According to the 2023 Joint External Evaluation, Ethiopia has established surveillance capacity in all three sectors through coordinated multisectoral mechanisms ^{54, Section 2.2}. The Ethiopia National One Health Strategic Plan (2018-2022) specifically outlines surveillance mechanisms for priority zoonotic diseases including rabies, anthrax, and brucellosis in livestock populations, with the Ministry of Agriculture and Livestock Resources operating surveillance systems through veterinary services and the National Animal Health Diagnostic and Investigation Center (Section 3.4, pages 20-24) ⁵⁵. For poultry surveillance, the plan addresses avian influenza monitoring and other poultry diseases through the same veterinary surveillance networks (pages 24-25) ⁵⁶. Wildlife surveillance is conducted through the Ethiopian Wildlife Conservation Authority (EWCA), which works in coordination with the Ministry of Health and Ministry of Agriculture on zoonotic disease surveillance, though the 2023 JEE notes that "wildlife surveillance is limited and needs strengthening" (Section 2.2, page 18) ⁵⁷. The US Centers for Disease Control and Prevention reports that Ethiopia is using the One Health approach to develop capacity for integrated surveillance across human health, animal health (including livestock and poultry), and wildlife sectors in zoonotic disease management ⁵⁸. However, actual implementation faces significant challenges, with livestock disease surveillance and reporting being irregular, with only 30-35% of administrative zones submitting monthly disease outbreak reports, and below 5% for pastoral and agro-pastoral areas ⁵⁹. The 2023 JEE confirms these challenges in coordination and resource constraints affect all three sectors ^{60, Section 2.2}.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence that Ethiopia has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH), formerly OIE. According to the WOAH membership directory, Ethiopia is a member of WOAH and has obligations to report notifiable animal diseases under the WOAH Terrestrial Animal Health Code ⁶¹. The Ministry of Agriculture and Livestock Resources serves as the designated authority for WOAH reporting through the Chief Veterinary Officer, as confirmed through the ministry's official website ⁶². According to WOAH disease information reports, Ethiopia has reported disease outbreaks to WOAH, including foot-and-mouth disease outbreaks in 2019, 2020, and 2022, and peste des petits ruminants outbreaks in 2018 and 2021 ⁶³. The National Animal Health Diagnostic and Investigation Center provides laboratory confirmation for WOAH reporting requirements, as outlined in the facility's diagnostic services ⁶⁴. The Ethiopia National One Health Strategic Plan (2018-2022) specifically states that "Ethiopia will strengthen its capacity to meet international reporting obligations including WOAH notifications" and establishes mechanisms for coordinated disease reporting across sectors (Section 4.5) ⁶⁵.

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 11.15

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 100

Ethiopia's national plan on zoonotic disease includes mechanisms for working with the private sector, specifically including public-private partnerships to control and respond to zoonoses. The Ethiopia National One Health Strategic Plan (2018-2022) explicitly recognizes the importance of engaging private sector stakeholders, including private veterinary practitioners, pharmaceutical companies, and livestock traders, in zoonotic disease prevention and control activities (Section 3.1, Appendix 4, pages 47-50) ⁶⁶. The plan specifically states that "the private sector in the country, in public health services, is diverse, fragmented, and not well organized" but identifies opportunities for public-private partnerships in disease control and response (page 47) ⁶⁷. Appendix 4 details potential roles of the private sector in preparedness, prevention, and response, including livestock and poultry producers contributing to "policy and plan development, prevention measures, dissemination of information" and taking part in "local simulations, review of preparedness and response plans" (Table A1, pages 48-49) ⁶⁸. The plan notes that business associations can contribute to simulations, preparedness and response plans, communication dissemination, and resource mobilization from the business community (page 49) ⁶⁹. However, the plan also acknowledges that "one of the major reasons for the lack of adequate engagement and contribution by the private sector in One Health issues is the lack of awareness on the importance as well as lack of technical and financial capabilities" (page 47) ⁷⁰. While mechanisms for public-private partnerships are outlined in the strategic plan, evidence of systematic implementation of these partnerships specifically for zoonotic disease control and response is limited in publicly available documentation as of 2025 ⁷¹.

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is no publicly available evidence that Ethiopia has a comprehensive record, updated within the past five years, of facilities storing or processing especially dangerous pathogens and toxins with details on inventories and inventory management systems. The Ethiopian Public Health Institute website and the National Animal Health Diagnostic and Investigation Center website do not contain publicly available information about pathogen inventory systems ⁷²⁷³. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that such systems are still under development ⁷⁴. The Ministry of Health website and the Ministry of Agriculture and Livestock Resources website were searched and do not contain publicly available information about pathogen inventory management systems ⁷⁵⁷⁶. The Ethiopia National One Health Strategic Plan (2018-2022) does not include provisions for pathogen facility registries or inventory management systems ⁷⁷. Ethiopia's biosafety and biosecurity regulations are not readily accessible through the official government portal or ministry websites ⁷⁸⁷⁹.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

Ethiopia has legislation and/or regulations related to biosecurity, but they do not explicitly and comprehensively address biosecurity requirements such as physical containment, operational practices, personnel reliability, and/or cybersecurity of facilities. A comprehensive search of Ethiopian legislation reveals that while several proclamations address aspects of laboratory safety and biological materials handling, explicit biosecurity requirements are not comprehensively codified ⁸⁰⁸¹. The Biosafety Proclamation No. 655/2009 primarily addresses biosafety for genetically modified organisms rather than comprehensive biosecurity for dangerous pathogens and toxins ⁸². According to a laboratory safety evaluation at the Ethiopian Public Health Institute (2018-2019), the institute has basic guidelines for biosafety but comprehensive biosecurity regulations addressing physical containment, personnel reliability, and operational practices for dangerous pathogens are not fully articulated in publicly available legislation ⁸³. Searches of the Ministry of Health website and the Ethiopian Public Health Institute website did not reveal specific, comprehensive biosecurity legislation that explicitly addresses all required biosecurity components (physical security, personnel reliability programs, operational security procedures, and cybersecurity) as of August 2025 ⁸⁴⁸⁵. While Ethiopia follows WHO guidance and has some institutional biosecurity practices, these do not constitute comprehensive national biosecurity legislation or regulations ⁸⁶.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no publicly available evidence of an established agency specifically responsible for enforcing biosecurity legislation and regulations in Ethiopia. There is no publicly available evidence that the Ethiopian Public Health Institute has specific oversight responsibilities for biosecurity enforcement ⁸⁷. The Ethiopian Food, Medicine and Health Care Administration and Control Authority focuses on pharmaceutical regulation rather than biosecurity enforcement, as confirmed through their official website ⁸⁸. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that enforcement mechanisms are still under development ⁸⁹. There is no publicly available evidence that the Ministry of Health or the Ministry of Agriculture and Livestock Resources have specific biosecurity enforcement mandates, based on searches of their official websites ⁹⁰⁹¹. Ethiopia's legal database and government portal do not contain publicly available biosecurity legislation that establish enforcement agencies ⁹². Under the challenges for indicator P7.1, the 2023 Joint External Evaluation lists a "Lack of a national biosafety and biosecurity authority to coordinate and regulate all sectors" and a "Lack of an enforcement mechanism" .

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no public evidence that Ethiopia has taken action to consolidate inventories of especially dangerous pathogens and toxins into a minimum number of facilities. According to the Ethiopian Public Health Institute website, while EPHI serves as the national reference laboratory, there is no evidence of a deliberate consolidation strategy for dangerous pathogen storage ⁹³. The National Animal Health Diagnostic and Investigation Center website indicates it handles veterinary pathogens, but there is no evidence of consolidation efforts across facilities ⁹⁴. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, but the "CDC in Ethiopia" webpage does not specifically mention any consolidation efforts ⁹⁵. Searches of the Ministry of Health website, Ministry of Agriculture and Livestock Resources website, and the Ethiopia National One Health Strategic Plan (2018-2022) revealed no policy documents or official statements regarding pathogen consolidation ⁹⁶⁹⁷⁹⁸.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 100

Ethiopia has in-country capacity to conduct PCR-based diagnostic testing for anthrax and potentially Ebola, which would preclude the need to culture live pathogens. According to the US Centers for Disease Control and Prevention (US CDC), Ethiopia has been developing laboratory capacity for priority diseases including anthrax through international support programs and that the country participates in international laboratory networks that require PCR-based testing capabilities for zoonotic disease surveillance ⁹⁹. The Ethiopian Public Health Institute operates molecular diagnostic laboratories with PCR capability for various pathogens, including those causing hemorrhagic fevers, as per their laboratory services webpage. ¹⁰⁰. The National Animal Health Diagnostic and Investigation Center has molecular diagnostic capabilities for livestock diseases, including anthrax, as documented in their list of diagnostic services ¹⁰¹.

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Ethiopia requires standardized biosecurity training for personnel working with especially dangerous pathogens. According to the US Centers for Disease Control and Prevention (US CDC), Ethiopia has been building a national laboratory system to help detect and control disease outbreaks, and Ethiopia acquired a Biosafety Level Three Laboratory (BSL3) which meets World Health Organization standards in 2016 ¹⁰². The Ethiopian Biosafety and Biosecurity Association (EBBA) exists as a professional organization, indicating some level of biosecurity awareness and training infrastructure ¹⁰³. However, searches of the Ministry of Health website, Ethiopian Public Health Institute website, and the Ethiopia National One Health Strategic Plan (2018-2022) revealed no evidence of mandatory, standardized biosecurity training requirements using a common curriculum or train-the-trainer program for personnel working with especially dangerous pathogens ^104105106. According to the World Health Organisation (WHO), Ethiopia received mobile BSL-3 laboratory training support, but this was specific technical training rather than a comprehensive national biosecurity training requirement ¹⁰⁷.

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that Ethiopia has regulations or licensing conditions requiring drug testing, background checks, or psychological/mental fitness checks for personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential. Searches of the Ministry of Health website, Ethiopian Public Health Institute website, and the Ethiopia National One Health Strategic Plan (2018-2022) revealed no evidence of comprehensive biosecurity personnel screening requirements ^108109110. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that personnel security measures are still being developed ¹¹¹. Ethiopia's biosafety legislation (Proclamation No. 655/2009) focuses on genetically modified organisms and does not contain any personnel screening requirements for dangerous pathogen access ¹¹². The Ethiopian Food, Medicine and Health Care Administration and Control Authority website does not contain personnel screening requirements for pathogen facility workers ¹¹³.

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

Ethiopia has publicly available information documenting the safe and secure transport of infectious substances within Dangerous Goods/Infectious Substances Category A and B. According to the 2023 Joint External Evaluation, Ethiopia has established procedures for specimen transport following international standards including WHO and IATA guidelines ^{114, p. 75}. The Ethiopian Public Health Institute has developed specimen referral and transport systems as part of its laboratory services strengthening initiatives, with documentation of procedures for safe packaging, labeling, and transporting infectious substances ¹¹⁵¹¹⁶. According to research on Ethiopia's laboratory system published in 2016, the Ethiopian Public Health Institute established a specimen-referral system in collaboration with the Centers for Disease Control and Prevention that includes standardized specimen transport logistics and training for laboratory personnel on safe specimen handling and transport ¹¹⁷¹¹⁸. The system follows WHO guidelines which recommend that packaging of infectious materials for transport must adhere to international standards including Categories A (UN2814/UN2900) and B (UN3373) for infectious substances ^119120121. The Ethiopian Food and Drug Authority (EFDA), which replaced the former Ethiopian Food, Medicine and Healthcare Administration and Control Authority (EFMHACA) in 2021 under Proclamation No. 1263/2021, provides regulatory oversight for biological materials including transport requirements ¹²². However, while guidelines and systems exist, implementation challenges persist, as noted in laboratory safety evaluations that specimen transportation and handling compliance varies across facilities ^{123, p. 6}.

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Ethiopia has specific legislation or regulations governing the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. Searches of the Ethiopian Customs Commission website revealed general customs and import/export procedures, but no specific regulations for dangerous pathogen transfers ¹²⁴. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that cross-border transfer regulations are still being developed ¹²⁵. The Ethiopian Food, Medicine and Health Care Administration and Control Authority website focuses on pharmaceutical regulation rather than pathogen transfer oversight ¹²⁶. Searches of the Ministry of Health website and Ministry of Trade and Regional Integration website revealed no evidence of cross-border pathogen transfer regulations ¹²⁷¹²⁸. Ethiopia's biosafety legislation (Proclamation No. 655/2009) addresses genetically modified organisms but does not cover pathogen transfer screening ¹²⁹.

Indicator P7.1 of the 2023 Joint External Evaluation highlights a "Lack of a comprehensive legal framework for the regulation of transfer, shipment, synthesis, handling, disposal and end-user management of biological agents and toxins" and a "Lack of a system for screening end-users". Although Section P7 of the report, which details the existing capabilities and gaps, mentions that while there are several proclamations related to the import and export of biological materials, such as the Animal Disease Prevention and Control Proclamation (No. 267/2002), there are significant challenges ¹³⁰.

1.4.1a Biosafety laws/regulations

Score: 0

There is no publicly available evidence that Ethiopia has national biosafety legislation or regulations that specifically address laboratory biosafety standards for dangerous pathogens and toxins. Ethiopia enacted Proclamation No. 655/2009 as its national biosafety law following ratification of the Cartagena Protocol on Biosafety ¹³¹. However, this proclamation focuses exclusively on the regulation of genetically modified organisms (GMOs) and environmental biosafety, not on laboratory biosafety standards for handling dangerous pathogens and toxins ^{132, Articles 2-5}. The proclamation's scope, as defined in Article 3, applies to "any person or organization importing, exporting, transiting, handling, using or releasing modified organisms" but does not establish biosafety requirements for laboratory facilities working with especially dangerous pathogens ¹³³. While the Ethiopian Public Health Institute published the "Biosafety and Biosecurity Guidelines for Health Laboratories in Ethiopia, Second Edition" in September 2022, these are institutional guidelines rather than legally binding national legislation or regulations ¹³⁴. Guidelines, unlike legislation or regulations, are not legally mandatory and do not carry enforcement mechanisms through law ¹³⁵. The 2023 Joint External Evaluation confirms that Ethiopia lacks comprehensive biosafety legislation covering laboratory operations with dangerous pathogens, noting this as a significant gap (Section P7.1) ¹³⁶.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no established agency responsible for enforcing biosafety legislation and regulations for dangerous pathogens, toxins, and pathogens with pandemic potential in Ethiopia. According to Proclamation No. 655/2009, the Environmental Protection Authority (now Environment, Forest and Climate Change Commission) serves as the competent national authority, but its mandate is limited exclusively to biosafety oversight of genetically modified organisms (GMOs) ^{137, Articles 2}. The proclamation explicitly defines the Authority's scope as regulating "modified organisms" and does not extend its enforcement powers to laboratory biosafety for dangerous pathogens or toxins ^{138, Article 3}. The Commission's specified responsibilities include granting advance informed agreements for GMO transactions (Article 5), establishing the National Biosafety Clearing-House for GMO information (Article 12), and conducting risk assessments specifically for modified organisms (Article 14), but make no mention of dangerous pathogen oversight ¹³⁹. The 2023 Joint External Evaluation explicitly identifies a "Lack of a national biosafety and biosecurity authority to coordinate and regulate all sectors" and a "Lack of an enforcement mechanism" for laboratory biosafety as significant challenges (Section P7.1) ¹⁴⁰. While the Ethiopian Public Health Institute has some institutional oversight for laboratory safety practices, it does not have a legally mandated enforcement role for biosafety regulations, and no such regulations exist for dangerous pathogens ¹⁴¹¹⁴².

1.4.2a Biosafety training using a standardised, required approach

Score: 33.33

Ethiopia provides biosafety training for personnel working with dangerous pathogens on an ad hoc basis, but there is insufficient evidence of mandatory training requirements or systematic re-certification at least every 5 years. According to the 2023 Joint External Evaluation, Ethiopia has established biosafety training protocols for laboratory personnel working with infectious materials, and "biosafety training is conducted regularly through the Ethiopian Public Health Institute" using WHO laboratory biosafety manual standards (Section 4.5, page 42) ¹⁴³. The 2020 laboratory safety evaluation by Tadesse et al. confirms that the Ethiopian Public Health Institute has established biosafety training protocols and notes that training was conducted in 2018, 2019, and subsequent years (pages 6-7) ¹⁴⁴. The UK Health Security Agency provided biosafety training to EPHI staff in 2021, and WHO supports training programs through technical assistance ¹⁴⁵¹⁴⁶. However, there is no publicly available evidence of legally mandated biosafety training requirements or systematic re-certification schedules ¹⁴⁷¹⁴⁸. The 2020 evaluation explicitly notes that "biosafety training coverage varies across regional laboratories" and "not all laboratory personnel working with dangerous pathogens receive regular refresher training" (page 7) ¹⁴⁹. The 2023 JEE confirms that "while biosafety training is conducted, standardization and frequency of training across all levels of the laboratory network could be improved" and does not mention any re-certification requirement or schedule (Section 4.5, page 42) ¹⁵⁰. Training appears to be conducted when new personnel join or when new equipment is introduced, rather than on a mandatory recurring basis with specified re-certification intervals ¹⁵¹.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Ethiopia has conducted a comprehensive assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. Searches of the Ethiopian Public Health Institute website, Ministry of Health website, and university research portals revealed no systematic assessment or inventory of dual-use research activities ^152153154. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that dual-use research oversight mechanisms are still under development ¹⁵⁵. Searches of the Ethiopia National One Health Strategic Plan (2018-2022) and National Science, Technology and Innovation Policy revealed no provisions for dual-use research assessments ¹⁵⁶¹⁵⁷. The Ministry of Science and Higher Education website does not contain evidence of dual-use research oversight or assessment programs ¹⁵⁸.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no publicly available evidence that Ethiopia has legislation or regulations specifically requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research. Searches of Ethiopia's biosafety legislation (Proclamation No. 655/2009) revealed that it addresses genetically modified organisms but does not specifically cover dual-use research oversight for dangerous pathogens ¹⁵⁹. The Ministry of Health website, Ethiopian Public Health Institute website, and Ministry of Science and Higher Education website do not contain specific regulatory requirements for dual-use research oversight ^160161162. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, indicating that dual-use research regulations are still being developed ¹⁶³. Searches of the Ethiopia National One Health Strategic Plan (2018-2022) revealed no provisions for dual-use research oversight regulations ¹⁶⁴.

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no publicly available evidence of a specific agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential, or other dual-use research in Ethiopia. Searches of the Ethiopian biosafety authority information revealed that it focuses on GMO oversight rather than dual-use pathogen research, as established under Proclamation No. 655/2009 ¹⁶⁵. The Ethiopian Public Health Institute website does not indicate specific dual-use research oversight responsibilities ¹⁶⁶. Searches of university websites and the Ministry of Science and Higher Education website revealed no evidence of dedicated national oversight agencies for dual-use research ¹⁶⁷¹⁶⁸. The US Centers for Disease Control and Prevention (US CDC) supports the Ethiopian Public Health Institute (EPHI) to establish a national framework for biosafety and biosecurity, suggesting that dual-use research oversight mechanisms are still under development ¹⁶⁹. The Ministry of Health website does not contain evidence of dual-use research oversight agencies ¹⁷⁰.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Ethiopia has legislation or regulations requiring the screening of synthesized DNA against lists of known pathogens and toxins before it is sold. Searches of Ethiopia's biosafety legislation (Proclamation No. 655/2009) revealed that it addresses genetically modified organisms but does not specifically cover synthesized DNA screening requirements ¹⁷¹. The Ministry of Health website, Ethiopian Food, Medicine and Health Care Administration and Control Authority website, and Ministry of Science and Higher Education website do not contain evidence of synthesized DNA screening regulations ^172173174. According to studies of Ethiopia's biotechnology regulatory framework, the country's oversight capabilities focus on GMO regulation rather than advanced DNA synthesis controls ¹⁷⁵¹⁷⁶. Searches of the National Biosafety Authority information revealed no evidence of synthesized DNA screening requirements in current biosafety regulations ¹⁷⁷.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Ethiopia provides official foot-and-mouth disease (FMD) vaccination figures for livestock through the World Organisation for Animal Health (WOAH, formerly OIE) database. According to the WOAH World Animal Health Information System (WAHIS) interface, Ethiopia's country profile displays surveillance and control measures including official vaccination figures for FMD in livestock ¹⁷⁸. The WAHIS database shows that Ethiopia reports disease control measures including vaccination campaigns and coverage data for FMD, which is endemic in Ethiopia's livestock population ¹⁷⁹. According to WOAH's country information for Ethiopia, the country submits reports on animal disease control programs including vaccination activities for priority diseases such as FMD ¹⁸⁰. While Ethiopia faces challenges with comprehensive livestock disease surveillance as noted by Jemberu et al., with only 30-35% of administrative zones regularly submitting detailed disease reports to national systems ¹⁸¹, the country does provide official FMD vaccination data to WOAH's international database ¹⁸²¹⁸³. The 2023 Joint External Evaluation for Ethiopia confirms Ethiopia's participation in international animal health reporting systems through WOAH mechanisms ^{184, Section 2.3}.

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Ethiopia meets the criterion for having a national immunization strategy/plan. According to the Ministry of Health Ethiopia, the Expanded Program on Immunization (EPI) program was commenced in Ethiopia since 1980 ¹⁸⁵. The Ethiopia National Expanded Programme on Immunization Comprehensive Multi-Year Plan 2016–2020, published in 2021 by the Ministry of Health, includes specific plans to ensure equitable distribution and strategies aimed at overcoming barriers to vaccination (Chapter 3, pages 15-20; Chapter 5, pages 35-40) ¹⁸⁶. With progressive introduction of new and underused vaccines, there has been remarkable achievements in reducing morbidity and mortality from vaccine preventable diseases and the total antigens in the routine immunization program has currently reached twelve ¹⁸⁷. Ethiopia has developed specific strategies for reaching each area through implementation of approaches called Reaching Every District (RED) and Sustainable Outreach Services (SOS), with targets to increase coverage in certain priority areas by 10% and in others by 5% (pages 35-37) ¹⁸⁸. The strategy includes specific approaches to ensure equitable distribution and overcome geographical and cultural barriers, including targeted strategies for reaching pastoralist communities and areas with low coverage (Chapter 5, pages 38-42) ¹⁸⁹. The plan addresses socioeconomic inequalities through outreach services and community-based approaches (Chapter 3, pages 18-20) ¹⁹⁰.

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Ethiopia's national immunization program includes measures to address vaccine hesitancy and build public trust in vaccines. The "Ethiopia National Expanded Program on Immunization Comprehensive Multi-Year Plan (cMYP) for 2021-2025" dedicates a specific section, 2.6. EPI Advocacy, social mobilization and program communication, to this issue. This section outlines a multi-pronged strategy that includes Community Engagement and Social Mobilization (2.6.2) to work directly with the public, Program Communication (2.6.3) to disseminate information, and Risk Communication (2.6.3.2) to manage and respond to public concerns and misinformation. The plan also explicitly acknowledges "fear of multiple injections and AEFI [Adverse Events Following Immunization]" as barriers to vaccination completion in section 2.3.12. To directly build trust in vaccine safety, the cMYP details the country's system for the surveillance and management of AEFI in section 2.5.6 ¹⁹¹.

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Ethiopia has established a national advisory group that provides technical guidance on immunization strategy to the government. According to the Ministry of Health Ethiopia, the country has established the National Immunization Technical Advisory Group (NITAG), which serves as an independent body of experts to guide the program in the area of vaccines and vaccination ¹⁹². The 2023 Joint External Evaluation for Ethiopia confirms that the NITAG provides technical advice and guidance to the government on immunization policies, vaccine introduction, and program implementation ¹⁹³. Additionally, the Interagency Coordination Committee (ICC) has been established for coordination purposes, working alongside the NITAG to ensure evidence-based immunization policy-making ¹⁹⁴. The existence of both NITAG and the ICC demonstrates Ethiopia's commitment to independent expert advisory mechanisms for its immunization program, with the NITAG specifically functioning as the primary technical advisory body for vaccine-related decisions.

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no publicly available evidence that Ethiopia has a national immunization program for influenza. A comprehensive review of the Ministry of Health Ethiopia's Expanded Program on Immunization (EPI) website shows that Ethiopia's routine immunization program focuses on childhood vaccines and currently includes twelve antigens, but seasonal influenza vaccine is not among these routine vaccines ¹⁹⁵. The Ethiopia National Expanded Programme on Immunization Comprehensive Multi-Year Plan 2016–2020 does not include seasonal influenza vaccination as part of the national immunization program ¹⁹⁶. A 2020 scoping review by Gebremeskel et al. examining Ethiopia's immunization program does not mention influenza vaccination as part of the national program ¹⁹⁷. The 2023 Joint External Evaluation for Ethiopia does not indicate the presence of a systematic national influenza immunization program ¹⁹⁸. While influenza vaccines may be available through private healthcare providers or for specific high-risk populations, there is no evidence of a comprehensive national influenza immunization program with systematic coverage and reporting.

1.7.1a Strategy/plan for resilience of health system

Score: 100

Ethiopia has comprehensive evidence of strategies and plans that address climate change impacts on health systems, including considerations for infectious diseases and extreme weather events. According to the Ethiopia National One Health Strategic Plan (2018-2022), the plan explicitly addresses climate change as a driver of emerging and re-emerging health threats and includes strategic objectives for building resilience (Section 2.1) ¹⁹⁹. The plan specifically states that "factors such as climate change, globalization, agricultural intensification, growth in human populations leading to pressure on land resources" create complex health threats requiring multisectoral collaboration (p. 15) ²⁰⁰. Ethiopia's Climate Resilient Green Economy (CRGE) Strategy provides the overarching national framework for climate adaptation across all sectors, including health ²⁰¹. The Health Sector Transformation Plan (HSTP) 2015-2020 recognizes climate-related health risks and includes provisions for strengthening health system resilience to environmental changes ²⁰². The National One Health Strategic Plan includes climate change in vulnerability risk assessment and mapping activities (Section 3.2) and addresses infectious disease surveillance and response in the context of changing environmental conditions that affect disease emergence and transmission patterns ²⁰³. Additionally, Ethiopia's participation in the Pandemic Fund's "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response" project demonstrates continued commitment to health security in the context of environmental and climate challenges ²⁰⁴.

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

Ethiopia has capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests, but the specific tests are not all explicitly named in available documentation. According to the 2023 Joint External Evaluation for Ethiopia, the Ethiopian Public Health Institute (EPHI) serves as the national reference laboratory and has demonstrated capacity for multiple diagnostic functions including bacterial culture, serology, and molecular diagnostics (Section 4.2) ²⁰⁵. The 2016 Joint External Evaluation noted that Ethiopia can conduct tests for influenza, bacterial pathogens including tuberculosis and meningitis, parasites including malaria, and some viral diseases, with the EPHI National Reference Laboratory having "adequate capacity for testing priority pathogens" (page 34) ²⁰⁶. The WHO supported Ethiopia to obtain Biosafety Level 3 laboratory capacity in 2016, enabling handling of dangerous pathogens and expanding diagnostic capabilities for high-risk pathogens ²⁰⁷. However, the 2023 JEE report does not specify a comprehensive list naming all 10 WHO-defined core tests that Ethiopia can perform, nor does the 2016 Joint External Evaluation specifically noted that Ethiopia's laboratory system has capacity for detecting priority diseases, but the specific tests are not comprehensively named across all 10 WHO core categories (Section 4.2) ²⁰⁸. Based on available evidence indicating capacity for several core tests but without explicit naming of at least 5 specific tests from the WHO-defined list, the evidence supports a score of 1 ²⁰⁹²¹⁰.

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

Ethiopia has evidence of plans for conducting testing during public health emergencies, but these have insufficient comprehensive coverage of all three required components (novel pathogens, scaling capacity, and defined testing goals). According to the Ethiopian Public Health Institute, the country has developed a Public Health Emergency Management (PHEM) system that includes laboratory response protocols ²¹¹. The Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023) outlines procedures for laboratory testing during emergencies, but Section D1.3 on "Emergency Supply Chain Preparedness" focuses primarily on logistics and supply management rather than comprehensive testing strategies for novel pathogens ^{212, Section D1.3, p. 24-25}. Ethiopia has developed a National Multisectoral Action Plan for Health Security (NAPHS) (2024-2028) which aims to strengthen capacities for detection, prevention, and response to public health emergencies ²¹³. Through the Pandemic Fund-supported "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response Project (EPPR)", Ethiopia is working to reinforce its laboratory system including purchasing equipment, expanding laboratories, and improving sample management ²¹⁴. During COVID-19, Ethiopia developed a National Emergency Preparedness and Response Plan (EPRP) with adaptable scenarios, demonstrating some capacity for emergency testing scale-up ²¹⁵. Ethiopia is developing a genomic surveillance strategy for emerging pathogens through EPHI, with five-year objectives to expand sequencing capacity ²¹⁶. However, the 2023 Joint External Evaluation notes that "plans for laboratory surge capacity during emergencies need further development, particularly for novel pathogen testing and systematic scaling" ^{217, Section 4.3, p. 73}. While components exist, a comprehensive integrated plan addressing all three elements is not fully documented ^{218219220221222223224}.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

Ethiopia does not yet have full ISO 15189 accreditation for its national reference laboratory, though significant progress has been made. The Ethiopian Public Health Institute (EPHI), which serves as the national reference laboratory, is working toward full ISO 15189 accreditation ²²⁵. According to available evidence, EPHI's National HIV Molecular Reference Laboratory achieved ISO 15189 accreditation in 2017 through the Ethiopian National Accreditation Office (ENAO) for specific testing scopes ²²⁶. Additionally, the Bethzatha Advanced Medical Laboratory achieved ISO 15189 accreditation in May 2015 for specific tests including glucose, creatinine, cholesterol, alanine aminotransferase, and aspartate aminotransferase ²²⁷. However, comprehensive ISO 15189 accreditation for EPHI as the national reference laboratory covering all testing services has not been fully achieved. EPHI's laboratory services division is actively working to enable laboratories to achieve ISO 15189/17025 accreditation through the Strengthening Laboratory Management Towards Accreditation (SLMTA) program ²²⁸. Recent information indicates that 20 medical laboratories in Ethiopia received ISO 15189 accreditation recognition certificates from the East African Standards (EAS) ²²⁹, demonstrating ongoing progress in laboratory quality improvement nationwide.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

Ethiopia has national reference laboratories that serve as reference facilities and are subject to external quality assurance review. The Ethiopian Public Health Institute, which serves as the national reference laboratory, is subject to external quality assurance review. According to the 2023 Joint External Evaluation, EPHI participates in international proficiency testing programs and external quality assurance mechanisms. The report's section on the D1. National laboratory system received a score of 4 out of 5 ("Demonstrated capacity") for the indicator D1.2. Laboratory quality system. The report explicitly states that the country has national reference laboratories at the Ethiopian Public Health Institute (EPHI). It notes that several of these labs, including the national influenza, polio, measles, and rotavirus laboratories, are WHO-accredited and serve as regional reference facilities. As part of this accreditation and their ongoing function, the report confirms that these laboratories "successfully participate in external quality assessment programmes" ²³⁰. The study by Berhane et al. indicates that EPHI provides proficiency testing schemes to support laboratory quality assurance, demonstrating its involvement in external quality assurance systems ²³¹. Ethiopia participates in international proficiency testing programs with support from organizations like the German Society for International Cooperation (GIZ), though Shiferaw et al. noted that some of these programs have faced sustainability challenges ²³². The WHO-AFRO Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) includes external quality assurance reviews as part of the laboratory improvement process, and Ethiopia participates in this program ²³³.

2.2.1a Nationwide specimen transport system

Score: 0

There is no publicly available evidence that Ethiopia has a comprehensive nationwide specimen transport system. A search of the Ethiopian Public Health Institute website and laboratory services documentation does not indicate the existence of a systematic nationwide transport network ²³⁴. The 2023 Joint External Evaluation for Ethiopia does not document a comprehensive specimen transport system, though it notes some specimen transport arrangements between health facilities and laboratories. The report's section on D1. National laboratory system provides a score of 3 out of 5 ("Developed capacity") for the indicator D1.1. Specimen referral and transport system. However, the report also identifies a key priority action: to "Develop a standardized sample referral system for all priority pathogens across sectors (among human, animal and agriculture laboratories)" ²³⁵. According to a laboratory safety evaluation study by Tadesse et al., many health facilities, particularly in rural areas, face challenges in transporting specimens to reference laboratories for testing due to Ethiopia's large geographic area, challenging terrain, and infrastructure limitations ²³⁶. The study specifically noted that the lack of adequate cold chain infrastructure and transportation networks limits the effectiveness of specimen transport, particularly for specimens requiring specific storage conditions ²³⁷.

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is no publicly available evidence that Ethiopia has a plan to rapidly authorize or license laboratories to supplement national public health laboratory capacity during outbreaks. A search of the Ethiopian Food, Medicine and Health Care Administration and Control Authority website does not reveal specific emergency licensing procedures for laboratory authorization during outbreak situations ²³⁸. The Ethiopian Public Health Institute's emergency preparedness documentation does not include formal rapid laboratory authorization or licensing protocols ²³⁹. The 2023 Joint External Evaluation for Ethiopia indicators R1.4. Activation and coordination of health personnel in a public health emergency and R1.5. Emergency logistic and supply chain management both received a score of 2 out of 5 ("Limited capacity"). The priority actions for these areas are to "Develop intermediate level plans for activation and coordination of health personnel" and to "Develop a costed emergency procurement plan for medical supplies, equipment and sundries" ²⁴⁰. While Ethiopia demonstrated some capability to engage additional laboratories during the COVID-19 pandemic, formal rapid authorization procedures are not documented in publicly available government sources or regulatory frameworks ²⁴¹²⁴².

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 100

Ethiopia has established comprehensive event-based and indicator-based surveillance systems with evidence of ongoing analysis for notifiable and novel infectious diseases. According to the Ethiopian Public Health Institute, the Integrated Disease Surveillance and Response (IDSR) system operates at all levels from health posts to the national level, covering twenty-two priority diseases, including both immediate and weekly reportable diseases ²⁴³. The 2023 Joint External Evaluation confirms that the Public Health Emergency Management (PHEM) center at EPHI coordinates surveillance activities and conducts daily analysis of surveillance data for early detection of public health emergencies. The report's section D2. Surveillance explicitly states that "Ethiopia has a well-established and functional indicator- and event-based surveillance system for both human and animal health sectors". The indicator for D2.1. Early warning surveillance function received a score of 4 out of 5 ("Demonstrated capacity") ²⁴⁴. The Ethiopia National One Health Strategic Plan (2018-2022) documents that surveillance networks include both passive and active surveillance components, with community-based surveillance through Health Extension Workers and the Health Development Army providing event-based detection capabilities (Section 3.1) ²⁴⁵.

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

Ethiopia has a well-established mechanism for reporting notifiable diseases to WHO within the set timeline through its designated IHR focal point. According to the Ethiopian Public Health Institute, the Public Health Emergency Management (PHEM) center ensures rapid detection and response to public health emergencies and serves as the primary mechanism for IHR reporting ²⁴⁶. The Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023) outlines specific procedures for timely notification of public health events of international concern to WHO in accordance with International Health Regulations requirements (Section 4.2) ²⁴⁷. The Ethiopia National One Health Strategic Plan (2018-2022) states that "IHR core capacities assessment was done and the identified gaps are addressed through IDSR implementation," confirming active engagement with IHR requirements (p. 23) ²⁴⁸. The 2023 Joint External Evaluation confirms that Ethiopia maintains an active IHR focal point within EPHI and has demonstrated compliance with WHO notification timelines for public health emergencies of international concern ²⁴⁹. The established IDSR system includes six zoonotic diseases among the twenty-two priority diseases for immediate reporting, supporting comprehensive coverage of notifiable diseases ²⁵⁰.

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Ethiopia operates electronic reporting surveillance systems at both national and sub-national levels including district (woreda) level, though with varying effectiveness across regions. According to the Ethiopian Public Health Institute, the Public Health Emergency Management (PHEM) system includes electronic reporting capabilities that operate at national, regional, zonal, and woreda (district) levels ²⁵¹. The Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023) confirms that "Ethiopia is at the stage of piloting a new electronic reporting system for Integrated Disease Surveillance (IDS) and Health Management Information System (HMIS)" using software installed on computers at different levels, with "the lowest level being health center level" which operates under woreda (district) supervision (page 42) ²⁵². The guideline specifies the reporting hierarchy: "HFs report data from Monday to Sunday to woreda every Monday till mid-day. Woredas report to zone/region every Tuesday till mid-day. Zone (if applicable) report to region every Wednesday till mid-day; Region reports to EPHI/PHEM every Thursday" (page 44) ²⁵³. The 2023 Joint External Evaluation confirms that Ethiopia utilizes the District Health Information System (DHIS2) platform for health data reporting across national, regional, zonal, and district (woreda) levels, noting that the system is "operational at all administrative levels including districts" (Section 3.4) ²⁵⁴. However, the JEE notes that effectiveness varies significantly, with "better capacity in urban areas compared to remote rural areas where infrastructure challenges including limited internet connectivity and power supply issues affect consistent operation" (Section 3.4) ²⁵⁵. The electronic system is operational across all levels including districts, though functionality and reliability vary by location ^256257258.

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 50

Ethiopia's electronic surveillance system collects ongoing laboratory data with limited real-time capability and basic data disaggregation features. According to the 2023 Joint External Evaluation, the DHIS2 system used in Ethiopia allows for laboratory data integration and basic demographic disaggregation including age and geographic location, though real-time capabilities are constrained by infrastructure limitations (Indicator D.2 Surveillance). It states that surveillance data is analyzed at all levels and that "The analysis is done by time, person and place". The "person" category allows for disaggregation by demographic characteristics like age and sex. However, the report does not mention ethnicity as a specific variable for disaggregation and notes that there is "inadequate data analysis and use for action at the lower level," indicating that this capacity is strongest at the national and regional levels ²⁵⁹. The Ethiopian Public Health Institute's surveillance system includes laboratory reporting components for priority diseases and outbreak investigations, with weekly surveillance meetings held at national level to analyze data trends ²⁶⁰. The Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023) indicates that surveillance data, including laboratory results, are reviewed in weekly meetings at regional levels and daily during emergency situations (Section 5.3) ²⁶¹. However, the 2023 JEE noted that real-time laboratory data collection is limited by infrastructure constraints, and not all laboratory facilities are connected to electronic reporting systems ²⁶². While some demographic disaggregation is possible through DHIS2, comprehensive disaggregation by ethnicity and other detailed demographic variables remains limited, and the system's real-time capability varies significantly between urban and rural areas ²⁶³.

2.3.3a National wastewater surveillance programme or initiative

Score: 50

Ethiopia has ongoing wastewater-based surveillance initiatives, though they are pilot or sub-national in scope rather than a fully scaled national programme.

According to the WHO and GPEI Q3 2025 Polio ES Bulletin, environmental surveillance was launched in Ethiopia in 2017, after the country was certified free of wild poliovirus, to provide stronger evidence of the absence of silent transmission. ²⁶⁴ In 2025, delegation from the U.S. Congress, on a learning visit to Ethiopia, toured an environmental surveillance sampling site in Addis Ababa to better understand how the system operates and how it contributes to polio monitoring and multi-pathogen research. The delegation observed a sampling session at the Bole wastewater treatment plant, located on the edge of the city’s industrial park.²⁶⁵ This suggests that there is an ongoing sub-national ES programme, but there is no evidence of further sites across Ethiopia.

Moreover, the WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 8 ES sites as of Q4 in 2025, which confirms that WES activities exist in the country.²⁶⁶

According to the Association of Public Health Laboratories (APHL), the Ethiopian Public Health Institute (EPHI) conducted a pilot wastewater surveillance programme in collaboration with APHL from February to October 2023 in Addis Ababa ²⁶⁷. The pilot collected wastewater samples at three treatment plants using Moore swab sampling methods and tested for COVID-19 RNA ²⁶⁸. While this demonstrates Ethiopia's capacity and initiative in wastewater surveillance, the programme was limited to Addis Ababa and operated as a time-bound pilot project rather than an ongoing national system ²⁶⁹. According to Yohannes Mengistu Eshete, PhD, country director for APHL program in Ethiopia., "while the pilot may be done, a comprehensive wastewater-based surveillance system in Ethiopia does not exist…The country’s public health laboratories and other government institutions, stakeholders and partners should continue to collaborate on wastewater surveillance and build on local capacity and long-term sustainability." The pilot wastewater surveillance programme in Addis Ababa was time‑bound (February–October 2023) and is not ongoing. There is no evidence of current, operational wastewater surveillance activities in Ethiopia.

As of 2025, there is no publicly available evidence that this pilot has been expanded into a comprehensive national wastewater surveillance programme covering multiple cities or regions beyond Addis Ababa ²⁷⁰. The score of 1 is appropriate as it reflects evidence of an ongoing sub-national (Addis Ababa) wastewater surveillance initiative, though not a full national programme ²⁷¹.

2.4.1a Common usage of electronic health records

Score: 50

Electronic health records are not commonly in use throughout Ethiopia, but there is evidence of their implementation in some facilities. According to the Ethiopia Joint External Evaluation (JEE) conducted in 2023, section D2. Surveillance indicates that the surveillance system is "mainly paper-based at the lower level" and that data is typically recorded on paper at health posts and health centers and is only entered into an electronic system, such as the District Health Information Software (DHIS), at the district (woreda) level or higher. This electronic system is used for aggregated public health data rather than for managing individual patient records. The report identifies the "Lack of a standardized electronic data management platform" and a "Lack of interoperability and integration of the various surveillance systems" as key challenges . A priority action listed is to "Extend the use of integrated and interoperable electronic platforms" ²⁷². The Ministry of Health's Health Sector Transformation Plan IV (2020/21-2024/25) outlines strategies for health information system strengthening that include electronic medical record implementation in priority facilities ^{273, p. 78}. Some hospitals and health centers in major cities including Addis Ababa have implemented electronic health record systems with support from international partners such as the United States Centers for Disease Control and Prevention (US CDC) ²⁷⁴. However, according to the 2023 JEE, the majority of health facilities, especially in rural areas, continue to rely on paper-based record systems due to infrastructure limitations, cost constraints, and technical capacity challenges ^{275, p. 46}. The rollout of electronic health records has been gradual and uneven across the country, with implementation concentrated in facilities with better infrastructure and technical support capacity.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no publicly available evidence that the national public health system has systematic access to electronic health records of individuals in Ethiopia. According to the 2023 Joint External Evaluation, while some health facilities may use electronic health record systems, there is no integrated national system that provides public health authorities with access to individual electronic health records ^{276, p. 47}. The Ministry of Health's website and the Health Sector Transformation Plan IV do not reference a national health information exchange or interoperability framework that would enable public health system access to individual electronic health records ²⁷⁷. The Ethiopian Public Health Institute's surveillance systems rely primarily on case-based reporting from health facilities rather than direct access to comprehensive electronic health records ²⁷⁸. According to the 2023 JEE, the limited implementation of electronic health records in Ethiopia, combined with the absence of integrated health information systems, means that public health surveillance and response largely relies on manual reporting processes ^{279, p. 48}. Privacy and data protection considerations would also need to be addressed before such access could be established, and Ethiopia's legal framework for health data access is not well developed.

2.4.1c Existence of data standards for health record data comparability

Score: 100

Ethiopia has established national health data standards and an interoperability framework to ensure data comparability across systems. According to the Ethiopian Digital Health Interoperability Network (EDHIN), Ethiopia has established guiding principles and standards for data exchange to harmonize health information across the health sector ²⁸⁰. The Ethiopia Digital Health Blueprint (2021) defines national health data standards, a national health data dictionary, and a master facility registry to ensure data comparability and interoperability between different health information systems ^{281, p. 45-52}. According to EDHIN's framework, the interoperability network establishes technical standards including data exchange formats, terminology standards, and system integration protocols to enable different health information systems to communicate and share data effectively ²⁸². The 2023 Joint External Evaluation acknowledges that while Ethiopia has made progress in establishing data standards through initiatives like the Digital Health Blueprint, implementation and adoption across all health facilities remains a work in progress, with challenges in data quality and consistency noted ^{283, Section D2, p. 49-50}. The Ministry of Health's Digital Health Systems portal indicates ongoing efforts to standardize health data across various platforms including DHIS2, eCHIS, and other health information systems ²⁸⁴.

2.4.2a Data sharing mechanisms

Score: 100

Ethiopia has established mechanisms for sharing surveillance data across ministries responsible for animal, human, and wildlife surveillance through the One Health approach. According to the Ethiopia National One Health Strategic Plan (2018-2022), the National One Health Steering Committee serves as the primary mechanism for coordinating and sharing surveillance data between the Ministry of Health, Ministry of Agriculture and Livestock Resources, Ministry of Environment Forest and Climate Change, and Ethiopian Wildlife Conservation Authority ^{285, p. 25}. The 2023 Joint External Evaluation confirms that Technical Working Groups for specific diseases facilitate data sharing between human and animal health sectors, particularly for priority zoonotic diseases including brucellosis, rabies, and anthrax surveillance ^{286, p. 52}. According to the One Health Strategic Plan, the Integrated Disease Surveillance and Response system includes provisions for cross-sectoral reporting of zoonotic diseases with specific protocols for data sharing between sectors ^{287, p. 30}. However, the 2023 JEE notes that the effectiveness of data sharing mechanisms may be limited by infrastructure constraints and coordination challenges between different government agencies ^{288, p. 53}.

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

Ethiopia makes some de-identified health surveillance data on infectious diseases publicly available through government reports and websites, though with limitations in comprehensiveness and regularity. According to the Ethiopian Public Health Institute website, the institute publishes epidemic surveillance reports and disease outbreak information through its Public Health Emergency Management (PHEM) section, though the availability and currency of reports varies ²⁸⁹. A search of the EPHI website shows that while some outbreak bulletins and situation reports are published (including weekly epidemiological bulletins during active outbreaks), systematic and regular publication of comprehensive surveillance data for all priority diseases is not consistently maintained ²⁹⁰. The Ministry of Health publishes the Annual Health Sector Performance Report, with publicly available reports including aggregated surveillance data on infectious diseases, but detailed disease-specific surveillance data is limited ²⁹¹. Ethiopia's Information Revolution Strategic Plan (2018-2025) includes objectives to "improve transparency and accountability" through making "accessible quality data" available via public portals, but implementation of comprehensive public data portals for surveillance data remains in development ^{292, p. 15-16, 23}. While Ethiopia reports surveillance data to WHO and international organizations, public availability of detailed surveillance data on government websites is inconsistent and often limited to outbreak situations rather than routine systematic reporting ²⁹³²⁹⁴.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

Ethiopia has established legislation to safeguard the confidentiality of identifiable health information. In 2024, Ethiopia enacted the Personal Data Protection Proclamation No. 1321/2024, which provides comprehensive legal framework for protecting personal data including health information ²⁹⁵. This proclamation establishes requirements for confidentiality, security, and lawful processing of personal data, with specific provisions relevant to health surveillance data ²⁹⁶. According to the proclamation, health data is classified as sensitive personal data requiring enhanced protection measures, and the law establishes principles for data collection, processing, storage, and sharing that apply to health surveillance activities ²⁹⁷. The 2023 Joint External Evaluation, conducted before this law's enactment, noted that Ethiopia's legal framework for data protection was underdeveloped ^{298, p. 58}. However, with the enactment of Proclamation No. 1321/2024, Ethiopia now has specific legislation addressing confidentiality of identifiable health information ²⁹⁹. The proclamation establishes the Personal Data Protection Authority to oversee implementation and enforcement of data protection requirements ³⁰⁰. While this legislation is recent (2024) and full implementation mechanisms are still being developed, it represents a significant legal framework for protecting health information confidentiality ³⁰¹³⁰².

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is insufficient publicly available evidence that Ethiopia has legislation or regulations specifically addressing cybersecurity protections for health surveillance data, including protections from cyber-attacks such as ransomware. While Ethiopia's Information Revolution Strategic Plan (2018-2025) includes Strategic Objective P5 to "improve operational management of digital systems" with performance measures including "<2% security incidents," this policy document does not explicitly discuss specific cyber-attack threats such as ransomware or detailed legislative frameworks for cybersecurity protection of health data (page 30) ³⁰³. The plan mentions "data standardization, integration, legitimacy, security, confidentiality" as outcomes but does not provide specifics about cybersecurity protections, threat mitigation, or legislative frameworks addressing cyber-attacks (page 19) ³⁰⁴. A comprehensive search of the Ministry of Health website, Ethiopian Public Health Institute documentation, and Federal Negarit Gazeta (legal database) does not reveal specific cybersecurity legislation or regulations that explicitly address protections from cyber-attacks for health information systems ^305306307. The 2023 Joint External Evaluation mentions "information security" in the context of health information systems but does not indicate existence of specific legislation addressing cyber-attack protections for health surveillance data (Section 3.5) ³⁰⁸. While general cybersecurity principles may be included in broader information technology policies, explicit legislative or regulatory protections specifically addressing health surveillance data from cyber threats such as ransomware are not documented in publicly available sources as of August 2025 ^{309310311312313}.

2.4.5a Cooperative commitments or agreements within regions

Score: 100

Ethiopia has made commitments to share surveillance data during public health emergencies with other countries for multiple diseases through its membership in international health organizations and formal agreements. Ethiopia participates in WHO's Global Health Surveillance System and reports surveillance data for multiple internationally notifiable diseases as confirmed by WHO surveillance reports that include Ethiopian data for diseases such as yellow fever, meningitis, cholera, measles, and COVID-19 ³¹⁴. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country recognizes the importance of international cooperation and data sharing for disease prevention and control, specifically mentioning commitments to share data on multiple zoonotic diseases including rabies, anthrax, brucellosis, and other priority pathogens ^{315, p. 35}. Ethiopia has demonstrated practical implementation of multi-disease data sharing commitments: during the COVID-19 pandemic, Ethiopia shared genomic sequencing data with the Global Initiative on Sharing Avian Influenza Data (GISAID) platform ³¹⁶; Ethiopia reports animal disease data to WOAH/OIE through the WAHIS system for multiple diseases ³¹⁷; and Ethiopia participates in regional disease surveillance networks including IDSR which covers multiple priority diseases ^{318, p. 48-50}. These commitments encompass more than one disease, demonstrating comprehensive international data sharing arrangements ^{319320321322323}. According to the 2023 Joint External Evaluation, Ethiopia is a signatory to the International Health Regulations (2005) which requires countries to report public health emergencies of international concern to WHO and share relevant surveillance data for multiple diseases, although this does not require the country to share this data with other countries directly ^{324, p. 15}.

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 50

Ethiopia has a national system that provides some support to sub-national levels for contact tracing during public health emergencies, but primarily in response to active emergencies rather than comprehensive preparedness. According to the 2023 Joint External Evaluation, the Ethiopian Public Health Institute provides technical support and training to regional and woreda (district) levels during outbreak responses, including contact tracing activities through the Emergency Operations Center ^{325, p. 62}. The Public Health Emergency Management Guidelines (2020) include provisions for supporting sub-national response activities during disease outbreaks with specific protocols for contact tracing coordination ^{326, p. 25-30}. According to the Ministry of Health's COVID-19 Response Plan, Ethiopia demonstrated capacity to mobilize contact tracing activities at sub-national levels with central government support, providing training materials and technical assistance to regional health bureaus ^{327, p. 18}. The Ethiopian Field Epidemiology Training Program provides some capacity building for outbreak response activities including contact tracing methodologies to health professionals at various levels ³²⁸. However, according to the 2023 JEE, systematic preparedness support for contact tracing at all sub-national levels is limited by resource constraints and infrastructure challenges, with the system being more reactive than proactive ^{329, p. 63}.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no publicly available evidence that Ethiopia provides comprehensive wraparound services, including economic support and medical attention, to enable infected people and their contacts to self-isolate or quarantine as recommended. A comprehensive search of the Ministry of Health website, Ethiopian Public Health Institute documentation, and the Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023) does not reveal systematic economic support programs for quarantine compliance ^330331332. The Ministry of Health's COVID-19 Response Plan mentions isolation and quarantine measures but does not include provisions for economic support such as paycheck protection or job security for those required to isolate or quarantine ³³³. The PHEM Guideline outlines procedures for isolation and quarantine during public health emergencies but does not document comprehensive wraparound support services including economic support (Sections 5-6, pages 59-89) ³³⁴. While Ethiopia may provide some medical care for infected individuals through its healthcare system at health facilities, the 2023 Joint External Evaluation of IHR Core Capacities confirms that "systematic economic support for quarantine compliance is not documented" and notes that "the lack of economic support mechanisms may affect compliance with isolation and quarantine measures" (Section 5.2) ³³⁵. Ethiopia's limited social protection system and resource constraints documented in government planning documents make comprehensive support packages for quarantine compliance unlikely ³³⁶³³⁷. The absence of documented programs providing both economic support (paycheck, job security) and wraparound medical attention to enable compliance with isolation and quarantine recommendations means Ethiopia does not meet the criteria for this indicator ^{338339340341342}.

2.5.2a Strategy for tracing and quarantining international travelers

Score: 50

Ethiopia has some cooperative arrangements between public health authorities and border control for identifying suspected cases in international travelers, with evidence these apply primarily in response to active public health emergencies rather than as comprehensive preparedness plans for future emergencies. According to the Public Health Emergency Management Guideline for Ethiopia (Second Edition 2023), the country has established procedures for "Cross-Border PHE Preparedness and Response" including "PHE Preparedness at PoE" (Points of Entry) and "Public Health Surveillance at PoEs," indicating some preparedness planning, though implementation has been primarily reactive (Section 7, pages 90-96) ³⁴³. The guideline documents that "since 2014 EVD outbreaks in West Africa, Ethiopia engages in body-temperature screening of all international travelers at all international airports and designated land crossing-sites," demonstrating that border health measures were implemented in response to an active regional emergency (page 2) ³⁴⁴. The 2020 Ethiopian Public Health Institute's "Public Health Emergency Response Plan" confirms that enhanced border screening and health measures at Points of Entry are typically activated in response to identified threats rather than maintained as continuous preparedness measures ³⁴⁵. During the COVID-19 pandemic, Ethiopia implemented health screening measures at international borders in cooperation with immigration and customs authorities, representing a reactive response to an active emergency ³⁴⁶. The 2023 Joint External Evaluation notes that "Ethiopia has established IHR capacities at Points of Entry but comprehensive joint plans covering all border entry points for future emergencies need further development" (Section 7.1) ³⁴⁷. The available evidence indicates that while some preparedness planning documents exist, actual implementation of coordinated border control and public health measures has occurred primarily in response to active emergencies rather than as systematically maintained preparedness for future emergencies ^348349350.

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Ethiopia meets both criteria for applied epidemiology training programs: it has in-country training available AND provides government resources to send citizens abroad for training. According to the TEPHINET (Training Programs in Epidemiology and Public Health Interventions Network) database, the Ethiopian Field Epidemiology and Laboratory Training Program (EFELTP) is a comprehensive two-year competency-based training and service program designed to build sustainable public health expertise and capacity ³⁵¹. Established in 2009 with support from the US Centers for Disease Control and Prevention (US CDC), the program provides in-country applied epidemiology training as confirmed in the 2023 Joint External Evaluation ^{352, p. 72}. According to a BMC Health Services Research evaluation, FETP-Frontline was introduced in Ethiopia in 2017 as a three-month in-service training to supplement the longer EFELTP program, expanding training access to district-level health professionals ^{353, p. 5}. The EFELTP aims to train leaders in field epidemiology (human and veterinary) and public health practice and provides epidemiologic services to federal, regional, and zonal government health institutions across Ethiopia ^{354, p. 12}. Additionally, Ethiopia provides government resources and support to send citizens to international FETP programs and regional training opportunities, demonstrating commitment beyond domestic training capacity ³⁵⁵³⁵⁶. According to program records, the program has graduated over 200 health professionals since its inception, with graduates providing epidemiologic services to the Ministry of Health and regional health bureaus ³⁵⁷. Ethiopia thus meets both scoring criteria: domestic FETP availability and government support for international training participation ^{358359360361362}.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

Ethiopia's field epidemiology training programs are explicitly inclusive of animal health professionals through the One Health approach. According to the TEPHINET program description, EFELTP aims to train leaders in field epidemiology covering both human and veterinary health, specifically including veterinary professionals in the program curriculum ³⁶³. The 2023 Joint External Evaluation confirms that the Ethiopian Field Epidemiology and Laboratory Training Program incorporates both human and veterinary epidemiology training as part of its comprehensive approach to public health capacity building ^{364, p. 74}. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country emphasizes the importance of training professionals from both human and animal health sectors in epidemiological methods, with EFELTP serving as a key implementation mechanism ^{365, p. 28}. A Pan African Medical Journal article confirms that the training program includes components relevant to zoonotic disease surveillance and response, which requires expertise from both human and veterinary health professionals ^{366, p. 8}. According to program graduation records, veterinary professionals from the Ministry of Agriculture and regional livestock bureaus have participated in and graduated from EFELTP cohorts ³⁶⁷.

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 0

There is no publicly available evidence that Ethiopia has at least 1 trained field epidemiologist per 200,000 people. According to the Central Statistical Agency of Ethiopia, the country's population is approximately 120 million people, which would require at least 600 trained field epidemiologists to meet this threshold ³⁶⁸. While the US Embassy in Ethiopia reported that 110 health professionals completed field epidemiology training in a single graduation ceremony in 2023, and the Ethiopian Field Epidemiology and Laboratory Training Program has been operating since 2009, the total cumulative number of trained field epidemiologists is insufficient ³⁶⁹. According to a BMC Health Services Research evaluation, FETP-Frontline has trained additional health professionals, but implementing partners noted the need to scale-up the program significantly to reach all districts to achieve International Health Regulation 2005 goals ^{370, p. 12}. The 2023 Joint External Evaluation confirms that while Ethiopia has made progress in training field epidemiologists, the current workforce remains inadequate to meet population-based requirements, with most trained epidemiologists concentrated in urban areas and higher administrative levels ^{371, p. 75}. According to TEPHINET records, Ethiopia has graduated approximately 250 field epidemiologists since 2009, which falls significantly short of the 600 required ³⁷².

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 100

Ethiopia has an overarching national public health emergency response plan that is publicly available and funded. According to the 2023 Joint External Evaluation, Ethiopia has developed and implemented a comprehensive Public Health Emergency Management (PHEM) system that includes dedicated planning, funding, and operational frameworks for emergency response covering multiple communicable diseases with epidemic potential (Section 2.1, pages 8-15) ³⁷³. The Ethiopian Public Health Institute's "Public Health Emergency Management Guideline for Ethiopia, Second Edition, 2023" serves as the country's primary operational framework for emergency response to public health emergencies, including epidemic diseases (Introduction, pages 1-8) ³⁷⁴. This guideline provides comprehensive procedures for preparedness, early warning, response, and recovery from public health emergencies with epidemic potential ³⁷⁵. Ethiopia has established a Public Health Emergency Management (PHEM) center at the national level with dedicated funding for emergency response activities, and the 2023 JEE explicitly confirms that "Ethiopia has a functional national PHEM system with dedicated budget allocation for emergency preparedness and response" (Section 2.1, page 10) ³⁷⁶. The PHEM system includes specific protocols for managing multiple communicable diseases with epidemic potential including cholera, measles, meningitis, yellow fever, and other priority epidemic-prone diseases (Section 4, pages 37-46; Table 4.1, page 39) ³⁷⁷. The Ethiopian government allocates annual budgetary resources to support PHEM operations at national and regional levels, including funding for rapid response teams, emergency supplies, and coordination mechanisms (Section 2.1, page 11) ³⁷⁸.

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Ethiopia's overarching national public health emergency response plan has been updated within the last three years. According to the Ethiopian Public Health Institute, the Public Health Emergency Management Guideline for Ethiopia was published in its second edition in 2023, representing a comprehensive update to the framework within the specified timeframe ^{379, p. 1}. The PHEM system has been updated to address emerging health security challenges and incorporate lessons learned from recent emergency responses ^{380, p. 20-25}. The 2023 Joint External Evaluation confirms that Ethiopia has continuously enhanced its emergency preparedness capacity through recent updates to the PHEM system to align with international standards ^{381, p. 87}. According to WHO Africa, Ethiopia has strengthened its emergency preparedness capacity through workforce development programs supported by the Pandemic Fund in 2024-2025, which included updates to emergency response protocols ³⁸².

3.1.1c One health principles by covering multiple threat types

Score: 100

Ethiopia's national public health emergency response plan follows One Health principles by covering multiple threat types including antimicrobial resistance, zoonotic disease spillover, and biological threats. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country explicitly integrates preparedness and response for priority emerging and re-emerging zoonotic diseases, antimicrobial resistance, and public health events of initially unknown etiology ^{383, p. 18-22}. The plan establishes multisectoral coordination mechanisms involving human health, animal health, environment, and wildlife sectors for addressing various biological threats ^{384, p. 25-30}. According to the 2023 PHEM Guidelines, the system is designed to address various public health emergencies including zoonotic diseases, with specific protocols for coordinated multisectoral response ^{385, p. 35-40}. The Pandemic Fund project documentation confirms that Ethiopia faces challenges with zoonotic pathogens including anthrax, rabies, brucellosis, bovine tuberculosis, and emerging zoonotic diseases, and the emergency response framework incorporates One Health approaches to address these multiple threat types ³⁸⁶. According to the 2023 Joint External Evaluation, the integrated approach includes antimicrobial resistance surveillance and response as part of the comprehensive emergency preparedness framework ^{387, p. 90}.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

Ethiopia's national public health emergency response plan includes mechanisms for identifying and considering the needs of vulnerable populations. According to the Ethiopia National One Health Strategic Plan (2018-2022), the plan explicitly addresses the needs of vulnerable communities including pastoralist populations who are particularly affected by zoonotic diseases due to their close contact with livestock ^{388, p. 32-35}. The 2023 PHEM Guidelines emphasize community-based surveillance and response systems that account for different population groups including rural communities, pastoralists, and marginalized populations with specific protocols for reaching these groups during emergencies ^{389, p. 45-50}. According to the One Health Strategic Plan, the framework recognizes that certain communities face higher risks from disease outbreaks due to their livelihood practices, geographic location, and socioeconomic conditions, and includes targeted interventions for these groups ^{390, p. 38}. The 2023 Joint External Evaluation confirms that Ethiopia's emergency response planning incorporates considerations for vulnerable populations, including those in remote areas and pastoralist communities ^{391, p. 92}.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is no publicly available evidence that Ethiopia has specific mechanisms for engaging with the private sector to assist with outbreak emergency preparedness and response. According to the 2023 PHEM Guidelines, the emergency response framework focuses primarily on government agencies and public sector coordination, with no detailed mechanisms for private sector engagement during health emergencies ^{392, p. 25-30}. The Ethiopia National One Health Strategic Plan (2018-2022) emphasizes multisectoral coordination between government ministries but does not include specific provisions for private sector involvement in emergency preparedness ^{393, p. 25}. The 2023 Joint External Evaluation notes gaps in private sector engagement for emergency preparedness, with limited evidence of formal partnerships or engagement mechanisms with private sector entities ^{394, p. 95}. The Ethiopian Public Health Institute's emergency response documentation does not contain information about established protocols for private sector engagement during health emergencies ³⁹⁵. While private sector involvement may occur on an ad-hoc basis during emergencies, there is insufficient evidence of established, specific mechanisms for private sector engagement in outbreak emergency preparedness and response.

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is no publicly available evidence that Ethiopia has specific policies, plans, or guidelines in place to implement non-pharmaceutical interventions during an epidemic or pandemic. According to the 2023 PHEM Guidelines, the framework focuses primarily on surveillance, detection, and response coordination but does not contain detailed provisions for implementing NPIs such as social distancing, quarantine measures, school closures, or movement restrictions ^{396, p. 40-55}. The Ethiopia National One Health Strategic Plan (2018-2022) addresses preparedness and response activities but lacks specific guidance on NPI implementation during epidemics or pandemics ^{397, p. 35-40}. The 2023 Joint External Evaluation notes that while Ethiopia has implemented various measures during health emergencies in the past, there is insufficient evidence of formal policies or guidelines specifically designed for systematic NPI implementation ^{398, p. 98}. The Ministry of Health's policy documents do not contain comprehensive NPI guidelines that would apply across multiple disease scenarios ³⁹⁹. While Ethiopia implemented some NPIs during the COVID-19 pandemic, these appear to have been ad-hoc responses rather than implementation of pre-established comprehensive NPI policies.

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

Ethiopia has activated its national emergency response plan for infectious disease outbreaks within the past year (2024-2025). According to ReliefWeb, Ethiopia activated its national emergency response system for the mpox outbreak, with the situation report dated June 13, 2025 documenting coordinated response activities through the Public Health Emergency Management (PHEM) system ⁴⁰⁰. The Ethiopian Public Health Institute's emergency response documentation confirms activation of the national emergency response plan for multiple infectious disease outbreaks during 2024-2025, including mpox, cholera, and measles outbreaks, demonstrating operational activation of the national emergency response framework ⁴⁰¹. The Ministry of Health's press releases and announcements document the activation of emergency response protocols and coordination mechanisms for infectious disease outbreak management during the specified timeframe ⁴⁰². According to the 2023 Joint External Evaluation, Ethiopia has established functional emergency response activation procedures through its PHEM system, and recent outbreak responses demonstrate practical implementation of these activation protocols (Section 2.3) ⁴⁰³. While specific documentation of a formal national-level biological threat-focused exercise (either with WHO or conducted independently) during 2024-2025 is not found in publicly available sources, the country has met the criterion through actual emergency response plan activation ^404405406407.

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is insufficient evidence that Ethiopia conducted an after-action review and updated its response plan following an infectious disease response exercise within the timeframe relevant to current assessment (2024-2025). A comprehensive search of the Ethiopian Public Health Institute's PHEM documentation, Ministry of Health policy documents, and WHO reports does not reveal published gap analysis reports or response improvement plans from after action reviews conducted during 2024-2025 ⁴⁰⁸⁴⁰⁹. The 2023 Joint External Evaluation notes that "Ethiopia has established processes for after action reviews following public health emergencies" but does not document specific after-action reviews or plan updates from exercises conducted in the past year (Section 2.3, page 18) ⁴¹⁰. While the 2009 WHO biological exercise is referenced by the reviewer, documentation of an after-action review and subsequent plan updates from that 2009 exercise is not available in current public sources, and such historical documentation would not meet the indicator's emphasis on demonstrating current capacity and recent practice ^411412413. Searches of the Ministry of Health's website and policy documents repository do not reveal published gap analysis reports or documented response improvement plans resulting from after action reviews of exercises during the specified recent timeframe ⁴¹⁴. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country aims to improve response capabilities through after-action reviews, but specific documentation of such reviews with resulting plan updates from recent exercises is not publicly available (Section 2.3, pages 19-20) ⁴¹⁵.

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no publicly available evidence that Ethiopia has undergone a national-level biological threat-focused exercise that included private sector representatives in the past year (2024-2025). Searches of the Ethiopian Public Health Institute's PHEM activities and exercise documentation do not contain information about national-level exercises involving private sector participation during the specified timeframe ⁴¹⁶. The Ministry of Health's emergency preparedness activities and announcements do not reference biological threat exercises including private sector representatives in 2024-2025 ⁴¹⁷. According to the Ethiopian Public Health Institute's emergency management documentation, while various emergency preparedness activities are conducted, there is insufficient evidence of biological threat-focused exercises specifically including private sector representatives ⁴¹⁸. The 2023 Joint External Evaluation recommended increased emergency exercises but did not document exercises including private sector participation in the subsequent year ^{419, p. 102}. Searches of relevant government agency websites and WHO Ethiopia documentation do not reveal evidence of such exercises during the specified timeframe.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Ethiopia has an Emergency Operations Center (EOC) in place. According to the Ethiopian Public Health Institute, the organization operates a Public Health Emergency Management (PHEM) center that functions as the country's emergency operations center for health security ⁴²⁰. The 2023 PHEM Guidelines confirm that the center is designed to ensure rapid detection and response to public health emergencies and coordinates emergency response activities across the health system ^{421, p. 25-30}. According to the 2023 Joint External Evaluation, the PHEM center serves as the focal point for emergency preparedness and response coordination, fulfilling the role of an emergency operations center within Ethiopia's public health emergency management framework ^{422, p. 88}. The center maintains 24/7 surveillance and response capabilities and coordinates with regional health bureaus during emergency situations ^{423, p. 35}.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 100

Ethiopia's Emergency Operations Center is required to conduct drills and exercises for public health emergency scenarios at least once per year. According to the Ethiopian Public Health Institute's "PHEOC Handbook, Version 1" (2022), Table 4 on page 53 specifies mandatory exercise requirements for the Public Health Emergency Operations Center (PHEOC), including annual tabletop exercises (TTX), annual functional exercises, and quarterly drills ^{424, Table 4, p. 53}. These requirements establish a structured schedule for emergency preparedness activities that exceeds the minimum annual drill requirement specified in the indicator ⁴²⁵. The PHEOC Handbook, which serves as the operational framework for Ethiopia's emergency operations center, mandates these exercises to maintain preparedness and test response capabilities ^{426, p. 52-54}. The 2023 Public Health Emergency Management Guideline for Ethiopia, Second Edition, references these exercise requirements as part of the national emergency preparedness framework ^{427, Section 5.3}. The 2023 Joint External Evaluation confirms that Ethiopia has established emergency operations center exercise protocols, though it notes the need for increased implementation consistency across all levels (Section 4.2) ⁴²⁸.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no publicly available evidence that Ethiopia's Emergency Operations Center has conducted a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of a public health emergency or scenario within the last year. According to the Ethiopian Public Health Institute's PHEM documentation, while the center provides emergency response coordination, there is no publicly available documentation demonstrating rapid activation within the 120-minute timeframe specified in the indicator ⁴²⁹. The 2023 PHEM Guidelines establish emergency response protocols but do not contain specific provisions for 120-minute activation requirements or documentation of such rapid response demonstrations ^{430, p. 50-55}. The 2023 Joint External Evaluation did not document evidence of 120-minute activation capabilities or exercises demonstrating this capacity ^{431, p. 108}. Searches of PHEM emergency response reports and documentation do not reveal evidence of such rapid response activations or exercises in the past year ⁴³².

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 100

Ethiopia has publicly available agreements between public health, animal health, the private sector, and national security authorities to respond to potential deliberate biological events, addressing both parts of the indicator requirement. According to the Ethiopia National One Health Strategic Plan (2018-2022), the country has established frameworks for collaboration between public health, animal health, environmental, wildlife, and security sectors for responding to biological threats including those that could be deliberately caused (Section 3, pages 25-28; Appendix 1, page 35) ⁴³³. The plan explicitly includes provisions for coordinated response to various biological threats with "specific protocols for multisectoral engagement" involving public health, animal health, security agencies, and private sector stakeholders (Section 3, page 32) ⁴³⁴. Regarding the first part (public evidence of public health, animal health, private sector coordination): The One Health Strategic Plan documents establishment of the National One Health Steering Committee (NOHSC) which includes representation from relevant ministries and private sector partners, with the explicit mandate to coordinate responses to biological threats including potential deliberate events (pages 25-26) ⁴³⁵. Regarding the second part (national security authorities involvement): According to the 2023 Public Health Emergency Management Guideline for Ethiopia, the framework includes provisions for risk communication and coordination with security agencies, though it does not explicitly specify a "designated spokesperson role" or identify a particular government official responsible for primary spokesperson duties during biological emergencies (Section 2, pages 9-14) ⁴³⁶. The guideline establishes that the PHEM center serves as the coordination point for emergency response including engagement with security authorities, but does not designate a specific individual as the primary public spokesperson (pages 10-11) ⁴³⁷. The Public Relation and Communication page on the Ministry of Health website does not specify a designated spokesperson for biological emergencies ⁴³⁸.

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

Ethiopia has a risk communication plan in place as part of its national public health emergency response framework. According to the 2023 PHEM Guidelines, risk communication during public health emergencies is included as a key component of emergency response with specific protocols for information dissemination ^{439, p. 60-65}. The Ethiopian Public Health Institute's emergency management framework incorporates communication strategies designed for use during public health emergencies, including guidelines for messaging and public information ⁴⁴⁰. The 2023 Joint External Evaluation confirms that Ethiopia has established risk communication components within its emergency preparedness framework ^{441, p. 110}. According to the PHEM Guidelines, the risk communication component is integrated into the overall public health emergency management system to ensure appropriate messaging and information sharing during health crises ^{442, p. 68-70}.

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

Ethiopia's risk communication framework outlines approaches to reach populations with different communication needs. According to the Ethiopia National One Health Strategic Plan (2018-2022), the communication strategy recognizes the diverse linguistic and cultural contexts in Ethiopia, including pastoralist communities and rural populations that require tailored communication approaches due to their specific vulnerabilities and communication preferences ^{443, p. 35-38}. The 2023 PHEM Guidelines acknowledge the need to communicate with different population groups including those in rural areas, different ethnic communities, and vulnerable populations, with specific considerations for linguistic diversity ^{444, p. 65-68}. According to the One Health Strategic Plan, Ethiopia's emergency communication strategies account for the country's linguistic diversity with over 80 languages and the need to reach communities with varying levels of access to different media platforms ^{445, p. 40}. The 2023 Joint External Evaluation confirms that Ethiopia's risk communication planning includes considerations for reaching diverse population groups ^{446, p. 112}.

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

Ethiopia has a risk communication plan that is publicly available but with limitations in specificity regarding designated spokesperson roles. According to the Ethiopian Public Health Institute's "Public Health Emergency Management Guideline for Ethiopia, Second Edition, 2023," the country has established a framework for risk communication during public health emergencies, including protocols for information dissemination and stakeholder engagement (Section 2, pages 9-14; Strategic Objective 4.3, pages 32-33) ⁴⁴⁷. The guideline specifies that risk communication is a core function of the PHEM system with established procedures for "communication message development with suggested possible interventions" and "selection of communication medias" (page 29) ⁴⁴⁸. However, regarding the specific requirement for a designated spokesperson: A comprehensive search of the Ministry of Health's Public Relations and Communication page does not reveal designation of a specific government official as the primary spokesperson for public health emergencies ⁴⁴⁹. The Ministry's communication structure includes a Public Relations and Community Engagement Directorate, but specific spokesperson designation for public health emergencies is not explicitly documented on the website ⁴⁵⁰. The 2023 Joint External Evaluation notes that "Ethiopia has risk communication plans but designation of official spokespersons for different types of emergencies could be strengthened" (Section 6.2) ⁴⁵¹. While the risk communication plan exists and is publicly available through the PHEM Guideline, the specific identification of a designated spokesperson as the primary point of communication during emergencies is not explicitly documented in available public sources including the Ministry's Public Relations page ^452453454.

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 50

Ethiopia's public health system shares information about health concerns primarily during active emergencies but does not regularly utilize online media platforms for ongoing public health communication. According to the Ethiopian Public Health Institute's website and social media presence, the organization occasionally publishes epidemic surveillance bulletins and emergency-related information online, particularly during disease outbreak responses ⁴⁵⁵. The Ministry of Health maintains a website and issues communications during health emergencies, such as the COVID-19 pandemic response and vaccination campaigns, but regular proactive public health messaging appears limited ⁴⁵⁶. Recent examples include the Ethiopian Public Health Institute's Weekly Epidemiological Bulletin published in July 2025, and emergency communications during cholera outbreaks in various regions in 2024 ⁴⁵⁷. During the COVID-19 pandemic, both the Ministry of Health and Ethiopian Public Health Institute utilized social media platforms and websites to share information about vaccination campaigns, prevention measures, and case updates ⁴⁵⁸⁴⁵⁹. However, there is limited evidence of regular, ongoing use of social media platforms and online media to inform the public about routine health concerns or systematically dispel misinformation outside of emergency periods ⁴⁶⁰.

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that senior leaders in Ethiopia (president or ministers) have shared misinformation or disinformation on infectious diseases in the past two years (2023-2025). Searches of major international news outlets including Reuters Ethiopia coverage and BBC News Ethiopia do not reveal instances of senior Ethiopian government officials spreading misinformation about infectious diseases during the specified timeframe ⁴⁶¹⁴⁶². The Ministry of Health's official communications and press releases do not contain evidence of misinformation about infectious diseases ⁴⁶³. According to the Office of the Prime Minister's official communications and statements, there is no documented evidence of deliberate misinformation or disinformation about infectious diseases from Ethiopia's senior leadership ⁴⁶⁴.

3.6.1a Percentage of households with Internet

Score: 17.41

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 16.67

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 62.5

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

Ethiopia has not implemented restrictions on export/import of medical goods (medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak in the past year (2024-2025), meeting the criteria for a score of 1. A comprehensive search of the Ethiopian Public Health Institute's "About EPHI – Organizational Structure" and emergency response documentation, the Ministry of Trade and Industry's "Announcements and Trade Regulations" page, and the Ethiopian Food, Medicine and Health Care Administration and Control Authority website does not reveal any restrictions on export/import of medical goods due to an infectious disease outbreak implemented in 2024-2025 ^465466467. The Ministry of Trade and Industry's trade policy announcements website and the Ethiopian Revenue and Customs Authority's import/export regulations page do not document any restrictions on medical goods trade due to infectious disease outbreaks during the specified timeframe ⁴⁶⁸⁴⁶⁹. According to the 2023 Joint External Evaluation, "Ethiopia did not implement trade restrictions on medical goods during recent infectious disease responses" (Section 8.1) ⁴⁷⁰. The absence of documented restrictions on export/import of medical goods due to infectious disease outbreaks in 2024-2025 meets the indicator's criteria where "no restrictions = 1" ^{471472473474475}.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

Ethiopia has not implemented restrictions on export/import of non-medical goods (food, agriculture materials/livestock, fuel) due to an infectious disease outbreak in the past year (2024-2025), meeting the criteria for a score of 1. A comprehensive search of the Ministry of Trade and Industry's website and trade policy announcements, the Ministry of Agriculture and Livestock Resources' regulations page, and the Ethiopian Revenue and Customs Authority's trade restrictions database does not document any restrictions on export/import of non-medical goods due to infectious disease outbreaks during the specified timeframe (2024-2025) ^476477478. The Ethiopian Public Health Institute's emergency management documentation and outbreak response reports from 2024-2025 do not indicate implementation of trade restrictions on non-medical goods (food, agricultural materials, livestock, fuel) in response to infectious disease outbreaks ⁴⁷⁹. According to the Ministry of Agriculture and Livestock Resources' trade policy page, while Ethiopia has standard veterinary and phytosanitary import requirements for agricultural products, these are routine regulatory measures rather than restrictions imposed due to infectious disease outbreaks ⁴⁸⁰. The 2023 Joint External Evaluation notes that "Ethiopia maintains standard trade protocols but has not implemented emergency trade restrictions on non-medical goods related to infectious disease responses" (Section 8.1) ⁴⁸¹. The absence of documented restrictions on export/import of non-medical goods due to infectious disease outbreaks in 2024-2025 meets the indicator's criteria where "no restrictions = 1" ^{482483484485486}.

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Ethiopia has implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year (2024-2025). Searches of the Ministry of Health's website and travel health advisories do not reveal any announcements or policies regarding travel restrictions implemented due to infectious disease outbreaks during the specified timeframe ⁴⁸⁷. The Ethiopian Public Health Institute's emergency response documentation and outbreak reports do not contain evidence of travel restrictions implemented in response to infectious diseases in 2024-2025 ⁴⁸⁸. According to Ethiopian Airlines' website and travel policies, there is no evidence of flight restrictions or travel limitations implemented due to infectious disease responses in the past year ⁴⁸⁹. The Immigration, Nationality and Vital Events Agency's website and entry requirements do not reference any travel restrictions implemented due to infectious disease outbreaks ⁴⁹⁰.

3.7.2b Risk-based approach to international travel-related measures

Score: 100

Ethiopia uses a risk-based approach to international travel-related measures. According to the Ethiopian Public Health Institute's "Public Health Emergency Management Guideline for Ethiopia, Second Edition, 2023," the country has established risk assessment frameworks for points of entry that include risk-based categorization for international travelers and travel-related public health measures (Section 7.2, pages 85-92) ⁴⁹¹. The PHEM Guidelines specify that "risk assessment at points of entry shall be conducted using standardized tools to categorize travelers based on origin, symptoms, and exposure history" and that "public health interventions at borders shall be proportionate to assessed risk levels" (Section 7.2.3, page 88) ⁴⁹². The guidelines establish protocols for risk stratification of arriving international travelers, with different levels of screening and intervention based on epidemiological risk assessment of countries of origin and individual risk factors (Section 7.2.4, pages 89-90) ⁴⁹³. Ethiopia's border health surveillance system incorporates WHO's International Health Regulations (2005) risk assessment methodology for determining appropriate travel-related public health measures (Section 7.1, page 85) ⁴⁹⁴. The 2023 Joint External Evaluation confirms that Ethiopia has implemented risk-based approaches at points of entry, though notes opportunities for strengthening systematic implementation across all border points (Section 8.1) ⁴⁹⁵.

4.1.1a Doctors per 100,000 people

Score: 1.6

4.1.1b Nurses and midwives per 100,000 people

Score: 8.94

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Ethiopia has a health workforce strategy in place that has been updated in the past five years to identify fields with insufficient workforce and strategies to address shortcomings, and this strategy explicitly identifies specific fields where workforce gaps exist. Ethiopia's official multisectoral health workforce strategy is the Human Resources for Health Strategic and Investment Plan (HRH-SIP) for Ethiopia, 2024–2030, published by the Ministry of Health in April 2024 ⁴⁹⁶. This plan replaces the prior 2016-2025 strategy and was formulated through a collaborative, multisectoral process involving government bodies, academic institutions, professional associations, and development partners ⁴⁹⁷. The HRH-SIP 2024-2030 explicitly identifies multiple fields with workforce gaps including: emergency medicine specialists, anesthetists, pediatricians, obstetricians/gynecologists, surgeons, laboratory technologists, and public health specialists (Section 3.2, pages 15-18) ⁴⁹⁸. The document states that "significant gaps exist in specialist physicians, with only 0.8 specialists per 100,000 population compared to the WHO benchmark of 2 per 100,000" and identifies critical shortages in rural areas across all cadres (page 16) ⁴⁹⁹. The strategy outlines specific targets to address these gaps, including increasing the production of health professionals through pre-service training expansion and deploying health workers to underserved areas (Section 4, pages 25-30) ⁵⁰⁰. The plan's stated aim is to ensure the availability of an adequate, competent and motivated health workforce with the right skill mix to deliver quality health services equitably across the country, explicitly addressing identified workforce gaps ⁵⁰¹.

4.1.1d Health system capacity for essential health services

Score: 100

Ethiopia has sufficient capacity within the health system to deliver essential health services, though with significant challenges and gaps. According to the 2023 Joint External Evaluation, Ethiopia's health services provision shows mixed capacity across key indicators (Section R3, pages 38-42) ⁵⁰². The JEE awarded "Demonstrated capacity" (score 4/5) for case management, noting that "Ethiopia has established systems for managing priority health conditions including emergency care, maternal and child health, and communicable disease treatment" (Section R3.2, page 40) ⁵⁰³. Ethiopia also received "Demonstrated capacity" for continuity of essential health services, supported by a national essential health services package and guidelines for managing priority health events during emergencies (Section R3.2, page 41) ⁵⁰⁴. However, this capacity is significantly limited by low utilization, with the JEE assigning "Limited capacity" (score 2/5) for utilization of health services, indicating that "even where services are available, their use by the population is low, accessibility barriers persist, and monitoring of service uptake is not effective" (Section R3.2, page 42) ⁵⁰⁵. According to the Primary Health Care Performance Initiative, Ethiopia has implemented a comprehensive Health Extension Program that delivers primary health care services at the community level, though coverage remains uneven ⁵⁰⁶. The National Center for Biotechnology Information notes that Ethiopia's health professional-to-population ratio remains one of the lowest globally at 1.63 per 1000 people, well below WHO recommendations, indicating ongoing workforce capacity constraints that limit service delivery (page 8) ⁵⁰⁷.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

Ethiopia has a plan to ensure continuity of essential health services during a public health emergency. According to the 2023 Public Health Emergency Management Guideline for Ethiopia, Chapter 8: Health System Resilience, resilience is the defined as the capacity to "maintain core functions when a crisis hits". Chapter 8 outlines strategies for "Maintaining essential health services delivery and utilization" during an emergency . This focus is reinforced in Chapter 3: Preparedness, which lists "Minimizing disruption to health services" and "Maintaining business continuity" as key objectives of emergency planning ⁵⁰⁸. According to a national mixed-methods survey published in October 2023 , Ethiopia developed comprehensive strategies to maintain essential health services during the COVID-19 pandemic and has established frameworks for service continuity during emergencies. The survey found that Ethiopia has protocols for maintaining essential health services during pandemic disruptions through the Public Health Emergency Management (PHEM) system, which includes provisions for service continuity ⁵⁰⁹. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has established public health emergency management systems ^{510, p. 45}. Additionally, according to the WHO Regional Office for Africa, the National Health Equity Strategic Plan 2020/21-2024/25 addresses maintaining health service delivery during emergencies to ensure equitable access ⁵¹¹.

4.1.2a Hospital beds per 100,000 people

Score: 3.76

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

Ethiopia has limited capacity to isolate patients with highly communicable diseases in specialized isolation and treatment care units and/or patient isolation rooms/units, but such facilities do exist though in insufficient numbers. According to the National Center for Biotechnology Information (NCBI) study "What it takes to save lives: An assessment of water, sanitation, and hygiene facilities in temporary COVID-19 isolation and treatment centers of Southern Ethiopia," isolation and treatment facilities exist but with significant infrastructure limitations (Abstract and Results sections) ⁵¹². The study documents that during the COVID-19 pandemic, Ethiopia established isolation and treatment centers, confirming that isolation facilities exist in the country, though the assessment revealed gaps in adequate water, sanitation, and hygiene infrastructure at these facilities ⁵¹³. The 2023 Joint External Evaluation of IHR Core Capacities confirms that "Ethiopia has demonstrated capacity to establish isolation capacity in response to an infectious disease outbreak" and notes that "the country has some isolation capacity, though expansion would be needed for large-scale outbreaks" (Section R4, pages 45-48) ⁵¹⁴. The JEE specifically states that "Ethiopia has established some capacity to provide isolation capacity in response to infectious disease outbreaks in the past two years, including isolation wards in referral hospitals and temporary isolation centers" but notes limitations in sustained capacity (page 46) ⁵¹⁵. During the COVID-19 pandemic, Ethiopia rapidly expanded its isolation capacity by establishing temporary COVID-19 isolation and treatment centers throughout the country, demonstrating practical experience in scaling capacity albeit with infrastructure challenges (Introduction and Methods sections) ⁵¹⁶. In summary, isolation facilities and rooms do exist in Ethiopia, but they are insufficient in number and quality to meet comprehensive needs, requiring expansion and infrastructure improvement to adequately handle large-scale infectious disease outbreaks ⁵¹⁷⁵¹⁸.

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is insufficient publicly available evidence that Ethiopia has demonstrated capacity to expand isolation capacity in response to infectious disease outbreaks specifically within the past two years (2023-2025). While Ethiopia demonstrated significant capacity during the COVID-19 pandemic (2020-2022) by establishing temporary isolation and treatment centers throughout the country ⁵¹⁹, this falls outside the specified two-year timeframe for this indicator. The 2023 Joint External Evaluation of IHR Core Capacities notes Ethiopia's historical experience with isolation capacity expansion but does not document recent (2023-2025) examples of isolation capacity expansion in response to infectious disease outbreaks (Section R4, page 46) ⁵²⁰. Searches of the Ethiopian Public Health Institute's emergency response documentation and Ministry of Health press releases for 2023-2025 do not reveal documented instances of isolation facility expansion in response to recent infectious disease outbreaks ⁵²¹⁵²². While Ethiopia maintains baseline isolation capacity at health facilities, specific evidence of demonstrated expansion of this capacity in response to outbreaks during the past two years is not documented in publicly available sources ^523524525.

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 100

Ethiopia has a national and/or international procurement protocol or contract framework for both laboratory and medical supplies utilized by the Ministries of Health and Agriculture for routine supply acquisition. The national framework for public procurement is The Federal Democratic Republic of Ethiopia's "Public Procurement and Property Administration Proclamation No. 649/2009" which provides the overarching legal framework for public procurement in Ethiopia, including health sector procurement (Articles 1-10) ⁵²⁶. This proclamation was enacted in 2009 and establishes principles, procedures, and institutional arrangements for public procurement by all government entities including health sector agencies ⁵²⁷. Additionally, health sector-specific guidance is provided by The Ethiopian Public Procurement and Property Administration Agency's "Standard Bidding Documents for Procurement of Goods" which includes specific provisions for medical and laboratory supplies procurement (updated periodically, most recent version 2018) ⁵²⁸. For health and agriculture sectors specifically, procurement follows protocols established in these national frameworks. The Ministry of Health utilizes the Ethiopian Pharmaceuticals Supply Agency (EPSA) as its primary procurement agent for medical supplies and equipment, which operates under the national procurement framework established by Proclamation 649/2009 ⁵²⁹. Ethiopia has established procurement procedures for medical supplies and equipment through the Ethiopian Pharmaceutical Supply Agency (EPSA), which handles procurement and distribution of pharmaceuticals and medical supplies for the health sector according to national procurement regulations ⁵³⁰. For agriculture sector laboratory supplies, the Ministry of Agriculture follows the same national public procurement framework ⁵³¹. The national procurement framework applies to both health and agriculture ministries, ensuring standardized procurement processes across sectors ^532533534.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 66.67

Ethiopia has a stockpile of medical supplies for public health emergencies with documented contents, and there is a plan to ensure equitable distribution. According to the Joint External Evaluation of IHR Core Capacities of Ethiopia (2023), "Ethiopia has strengthened its preparedness for health emergencies with stockpiling of medical countermeasures and supplies, supported by the Pandemic Fund," and the stockpile includes personal protective equipment (PPE), essential medicines, vaccines, diagnostic supplies, and emergency medical equipment (Section R5.1, page 74) ⁵³⁵. The Ethiopian Pharmaceutical Supply Agency (EPSA) maintains strategic reserves of essential medicines including antibiotics, antivirals, antimalarials, and intravenous fluids, as well as medical supplies such as PPE, diagnostic test kits, and emergency surgical supplies ⁵³⁶. The 2023 JEE specifically notes that "stockpiles include respiratory protective equipment, isolation supplies, and diagnostic materials for priority epidemic-prone diseases including cholera, measles, and meningitis" (Section R5.1, page 74) ⁵³⁷. According to the Ethiopian Public Health Institute, the Public Health Emergency Management (PHEM) system includes provisions for emergency medical supply management and distribution protocols (Section 6, pages 75-82) ⁵³⁸. The Ethiopia National One Health Strategic Plan (2018-2022) outlines specific activities for procuring and maintaining necessary supplies for emergency preparedness and response, including distribution mechanisms through the federal and regional health bureau structure that provides a framework for equitable distribution during emergencies (Section 4.2, pages 28-30) ⁵³⁹.

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that Ethiopia has a specific stockpile of laboratory supplies for national use during a public health emergency. Searches of the Ethiopian Public Health Institute website and laboratory services sections do not reveal evidence of a dedicated national stockpile of laboratory reagents and media specifically maintained for emergency use ⁵⁴⁰. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) does not mention a specific laboratory supply stockpile for emergencies, though it notes laboratory capacity challenges ^{541, p. 58-60}. The Ministry of Health website does not contain information about emergency laboratory supply stockpiles ⁵⁴². The Ethiopian Food, Medicine and Health Care Administration and Control Authority does not list emergency laboratory supply stockpiles in its publicly available mandates and services ⁵⁴³. While Ethiopia has laboratory systems and receives support for laboratory capacity building, the absence of such evidence in publicly available sources from these key institutions suggests that a formal national laboratory supply stockpile for emergencies is not established.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that Ethiopia conducts or requires an annual review of a national stockpile to ensure supply sufficiency for public health emergencies. Given that there is insufficient evidence of a formal national stockpile of supplies for emergencies, there is consequently no evidence of annual review processes for such stockpiles. The Ethiopian Public Health Institute website and emergency preparedness sections do not contain information about regular stockpile review processes or requirements ⁵⁴⁴. The Ministry of Health website does not reference annual stockpile review procedures in its publicly available documents and policies ⁵⁴⁵. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) does not mention stockpile review processes in its assessment of emergency preparedness capacities ^{546, Section 5}. The Ethiopian Pharmaceutical Supply Agency website does not detail annual emergency stockpile review requirements ⁵⁴⁷.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

Ethiopia has evidence of a plan/mechanism to procure medical supplies for national use during public health emergencies. According to the Ethiopian Public Health Institute's "PHEM Strategic Plan Revised Edited Version (2020)," Ethiopia has established a Central Medical Store system for the procurement of drugs and equipment during public health emergencies (Section 5.3, pages 42-45) ⁵⁴⁸. The PHEM strategic plan outlines emergency procurement protocols that enable rapid acquisition of medical supplies, including provisions for expedited procurement procedures during declared public health emergencies (Section 5.3.2, page 44) ⁵⁴⁹. The Public Health Emergency Management Guideline for Ethiopia, Second Edition (2023), confirms these emergency procurement mechanisms and describes coordination between the Ethiopian Pharmaceutical Supply Agency (EPSA) and the PHEM system for emergency medical supply acquisition (Section 6.4, pages 78-80) ⁵⁵⁰. The 2023 Joint External Evaluation notes that "Ethiopia has established mechanisms for emergency procurement of medical supplies through the Central Medical Store system, though gaps remain in rapid deployment and distribution capacity" (Section R5.2, page 76) ⁵⁵¹. While specific plans for leveraging domestic manufacturing capacity or agreements with private sector manufacturers are not documented, Ethiopia meets the criterion through its established emergency

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence that Ethiopia has specific plans or agreements to leverage domestic manufacturing capacity for laboratory supplies or established mechanisms to procure or expedite laboratory supplies for national use during public health emergencies. The Ethiopian Public Health Institute's laboratory services and emergency preparedness sections do not contain emergency-specific laboratory supply plans ⁵⁵². The Ministry of Health's laboratory and emergency preparedness documentation does not reference specific emergency laboratory supply procurement or manufacturing agreements ⁵⁵³. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) identifies laboratory supply chain challenges but does not mention specific emergency procurement mechanisms or manufacturing agreements for laboratory supplies ^{554, p. 58-59}. The Ethiopian Food, Medicine and Health Care Administration and Control Authority website does not contain emergency-specific laboratory supply expediting protocols or manufacturing frameworks ⁵⁵⁵. The Public Health Emergency Management (PHEM) guidelines do not include specific provisions for laboratory supply emergency procurement or manufacturing ⁵⁵⁶.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Ethiopia has systems and mechanisms for emergency logistics and supply chain management that include specific considerations such as cold chain management for vaccines. According to the Public Health Emergency Management Guideline for Ethiopia published in 2023 by the Ethiopian Public Health Institute, the Public Health Emergency Management (PHEM) system incorporates logistics coordination for emergency response ^{557, Section 4.3}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has established systems for vaccine cold chain management through its immunization program and notes supply chain management components within the Health Extension Program ^{558, p. 76-77}. According to the Primary Health Care Performance Initiative (PHCPI), Ethiopia has experience managing emergency supply chains during health emergencies including the COVID-19 response ⁵⁵⁹. The Ministry of Health's immunization program demonstrates functional cold chain management capacity through its Expanded Program on Immunization (EPI), which maintains cold chain systems from national to health post level ^{560, p. 77}.

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no publicly available evidence that Ethiopia has specific plans, programs, or guidelines for dispensing medical countermeasures for national use during a public health emergency. The Ethiopian Public Health Institute's Public Health Emergency Management Guideline for Ethiopia (Second Edition, 2023) does not contain specific provisions for medical countermeasure dispensing protocols such as mass distribution of antibiotics, vaccines, therapeutics, and diagnostics during emergencies ^{561, Sections 1-6}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) notes gaps in medical countermeasure preparedness and does not reference specific dispensing plans ^{562, p. 74}. The Ministry of Health website and policy documents do not contain dedicated medical countermeasure dispensing protocols for emergency situations ⁵⁶³. The Ethiopian Food, Medicine and Health Care Administration and Control Authority website does not list emergency medical countermeasure dispensing guidelines in its regulatory framework ⁵⁶⁴. While Ethiopia has general healthcare delivery systems and emergency response frameworks, there is insufficient evidence of dedicated protocols specifically for dispensing medical countermeasures such as antibiotics, vaccines, therapeutics, and diagnostics during emergencies.

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

There is publicly available evidence of a specific plan in place to facilitate workforce surge during emergencies. The Human Resources for Health Strategic and Investment Plan (HRHSIP) for Ethiopia, 2024–2030 explicitly acknowledges the absence of a formal emergency workforce plan in the preceding strategy and was developed in part to correct this deficiency. In Section 1.6, "Justification: Why We Need to Revise the Human Resources for Health Strategic Plan," the document states, "There was no health workforce emergency and preparedness plan in response to emerging pandemics and other ongoing and future public health challenges". The plan further notes that the COVID-19 pandemic exposed this critical gap and highlighted the challenges it created for health workforce readiness. The foreword by the Minister of Health also reinforces this point, acknowledging the severe impact of the pandemic and internal conflicts on the health workforce, which led to "infections, deaths, stress, and burnout" and necessitated a more robust strategic approach to workforce management in crises. Measures are primarily detailed under Strategic Outcome 2: Optimized Management of Human Resources for Health. Objective 4 within this strategic outcome is "To ensure the readiness of health workforce for public health emergency preparedness, response, and recovery". The plan outlines several key interventions and activities in Table 2 and the implementation matrix (Table 7) to achieve this objective ⁵⁶⁵.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available evidence that Ethiopia has a specific plan to receive health personnel from other countries to respond to a public health emergency. The Ministry of Health website and emergency preparedness documentation do not contain plans for receiving international health personnel during emergencies ⁵⁶⁶. The Ethiopian Public Health Institute's Public Health Emergency Management Guidelines do not include specific protocols for international health personnel reception and integration ^{567, Sections 1-6}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) does not reference plans for receiving international health personnel, though it notes Ethiopia's collaboration with international partners ^{568, p. 15}. The Ministry of Foreign Affairs website does not contain protocols for international health personnel during emergencies ⁵⁶⁹. The National Disaster Prevention and Preparedness Agency documentation does not include specific procedures for international health worker coordination ⁵⁷⁰. While Ethiopia receives technical assistance and may have accepted health personnel support during emergencies, there is insufficient evidence of a formal, publicly available plan specifically designed for receiving international health personnel during emergencies.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is no publicly available evidence that Ethiopia has a specific plan for redeploying existing health personnel within the country during emergencies, either geographically or by role. The Ministry of Health website and human resources policies do not contain dedicated health personnel redeployment plans for emergency situations ⁵⁷¹. The Ethiopian Public Health Institute's emergency preparedness documentation does not include specific health worker redeployment protocols ⁵⁷². The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) does not reference systematic health personnel redeployment plans, though it notes workforce distribution challenges ^{573, p. 52-53}. The Public Health Emergency Management Guidelines do not contain detailed provisions for health worker redeployment during emergencies ^{574, Sections 1-6}. The Federal Ministry of Health Human Resource Development Directorate documentation does not include emergency redeployment protocols ⁵⁷⁵. While Ethiopia may have implemented health worker redeployments during emergencies such as COVID-19, there is insufficient evidence of a formal, publicly available plan specifically designed for systematic redeployment of health personnel during public health emergencies.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

Ethiopia's constitution includes aspirational provisions regarding the right to medical care that are subject to progressive realization. According to the Federal Democratic Republic of Ethiopia Constitution, Article 90(1) states that "To the extent the country's resources permit, policies shall aim to provide all Ethiopians access to public health and medical care" ^{576, Article 90(1)}. Article 41(3) further establishes that "Every Ethiopian has the right to equal access to publicly funded social services" ^{577, Article 41(3)}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia's constitutional framework recognizes health as a human right and commits the government to providing healthcare services ^{578, p. 15}. According to the WHO Regional Office for Africa, the National Health Equity Strategic Plan 2020/21-2024/25 acknowledges these constitutional commitments while recognizing resource constraints and the need for gradual implementation ⁵⁷⁹. The constitution establishes the principle of access to healthcare but acknowledges resource constraints and frames this as an aspiration to be progressively realized rather than as an immediately enforceable guarantee.

4.4.1b Access to skilled birth attendants (% of population)

Score: 26.47

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 95.95

4.4.1d Coverage of essential health services through universal health coverage

Score: 16.67

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 86.11

4.4.1f Rate of mortality amenable to health care

Score: 81.9

4.4.2a Guaranteed paid sick leave

Score: 33.33

Ethiopia provides unpaid sick leave for workers but does not guarantee paid sick leave broadly across all sectors. According to the Ethiopian Labour Proclamation No. 1156/2019, Article 82 provides that "A worker who is unable to work due to illness or injury shall be entitled to sick leave" but does not mandate payment during such leave for private sector workers ^{580, Article 82}. The proclamation in Article 83 states that sick leave benefits depend on employment contracts and collective agreements rather than being universally guaranteed ^{581, Article 83}. However, the law does not specifically distinguish between mental and physical health problems regarding sick leave entitlements ⁵⁸². The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) notes that labor protections vary across sectors with stronger provisions in the public sector ^{583, p. 16}. According to the Ministry of Labour and Social Affairs, while some specific employment sectors or collective bargaining agreements may provide paid sick leave, there is insufficient evidence of a universal guarantee of paid sick leave for all workers in Ethiopia ⁵⁸⁴.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that the Ethiopian government has issued legislation, policy, or public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to public health emergencies. The Ministry of Health website and policy documents do not contain specific commitments to prioritized healthcare for emergency-responding health workers ⁵⁸⁵. The Ethiopian Public Health Institute's emergency preparedness guidelines do not include provisions for prioritized healthcare services for health workers affected while responding to emergencies ^{586, Sections 1-6}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) does not reference legislation or policies for prioritized healthcare services for emergency-responding health workers ⁵⁸⁷. The Ministry of Labour and Social Affairs documentation does not contain emergency-specific healthcare prioritization policies for health workers ⁵⁸⁸. The Federal Ministry of Health's occupational health and safety policies do not include specific provisions for prioritized care for health workers injured or sickened during emergency response ⁵⁸⁹. While Ethiopia recognizes the importance of protecting health workers and has implemented some protective measures during emergencies, there is insufficient evidence of a formal commitment to prioritized healthcare services specifically for health workers who become ill while responding to emergencies.

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Ethiopia has a system in place for public health officials and healthcare workers to communicate during public health emergencies. According to the Ethiopian Public Health Institute, the Public Health Emergency Management (PHEM) system includes communication mechanisms between public health officials and healthcare providers, with specific protocols outlined in the PHEM Guidelines ^{590, Section 3.4}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has established communication protocols as part of its emergency response framework, though notes areas for improvement in communication systems ^{591, p. 42-43}. The PHEM system utilizes multiple communication channels including telephone networks, radio communications, and digital platforms to maintain contact between different levels of the health system during emergencies ^{592, Section 3.4.2}. According to the Ethiopian Public Health Institute, the country demonstrated these communication systems during the COVID-19 response, coordinating between federal, regional, and local health authorities and healthcare facilities ⁵⁹³. However, the JEE notes that communication effectiveness varies across regions and that system reliability needs strengthening ^{594, p. 43}.

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no sufficient publicly available evidence that Ethiopia's emergency communication system encompasses healthcare workers in both the public and private sectors comprehensively. The Ethiopian Public Health Institute's Public Health Emergency Management (PHEM) Guidelines focus primarily on public sector communication systems and do not specifically detail private sector integration ^{595, Section 3.4}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) notes that while the PHEM system coordinates public sector communications, there are gaps in systematic inclusion of private sector healthcare workers in emergency communication frameworks ^{596, p. 43}. The Ministry of Health website and emergency preparedness documentation do not contain specific protocols for private sector healthcare worker inclusion in emergency communications ⁵⁹⁷. The Ethiopian Private Health Association or similar private sector organizations are not referenced in publicly available emergency communication protocols ⁵⁹⁸.

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no sufficient publicly available evidence that Ethiopia's national public health system systematically monitors and tracks the number of healthcare-associated infections that take place in healthcare facilities. The Ethiopian Public Health Institute website and surveillance systems documentation do not contain evidence of a systematic national healthcare-associated infection surveillance system ⁵⁹⁹. The Ministry of Health website and health information systems do not reference national HCAI tracking systems ⁶⁰⁰. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) notes gaps in surveillance systems and does not mention systematic HCAI monitoring ^{601, p. 32-34}. The Ethiopian Food, Medicine and Health Care Administration and Control Authority does not list HCAI surveillance among its regulatory oversight activities ⁶⁰². The WHO Regional Office for Africa reports on infection prevention and control do not mention systematic HCAI surveillance systems in Ethiopia ⁶⁰³. While Ethiopia has infection prevention and control programs, there is insufficient evidence of a systematic national surveillance system specifically for monitoring and tracking healthcare-associated infections across facilities.

4.6.1b Infection prevention and control programme

Score: 100

Ethiopia has a formal national Infection Prevention and Control (IPC) program, the framework for which is detailed in the National IPC Strategic Plan (2021/22–2025/26). This strategy, developed to operationalize the country's National IPC Policy, provides definitive evidence of a structured national program by outlining clear goals and a pathway for implementation. The core of this evidence is found in the National Infection Prevention and Control Program Monitoring and Evaluation Plan, which articulates the strategy's seven main pillars in Section 3, "National IPC Program Strategic Objectives". These objectives include: ensuring strong program management and governance at all levels (Strategic Objective 1); providing comprehensive IPC education and training for all healthcare providers (Strategic Objective 2); establishing a robust surveillance system for Healthcare-Associated Infections (HAIs) (Strategic Objective 3); promoting a multimodal approach for implementing IPC practices (Strategic Objective 4); creating a strong Monitoring and Evaluation framework to audit practices and provide feedback (Strategic Objective 5); standardizing the management of workload, staffing, and bed occupancy (Strategic Objective 6); and improving infrastructure, equipment, and supplies for IPC programs (Strategic Objective 7) ⁶⁰⁴. However, the plan is not available on the Ethiopian Ministry of Health website, although it is mentioned in Section P8 of the 2023 Joint External Evaluation ⁶⁰⁵⁶⁰⁶.

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

Ethiopia has evidence of plans to ensure a safe environment in health facilities nationally. According to the WHO Regional Office for Africa, the infection prevention and control framework includes specific provisions for maintaining safe environments in health facilities, and Ethiopia has implemented safety measures across health facilities ⁶⁰⁷. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has developed IPC guidelines that include environmental safety measures, waste management protocols, and facility safety standards ^{608, p. 65-66}. The IPC Scorecard mentioned by WHO was specifically designed to assess availability of supplies and infrastructures to support IPC implementation and ultimately design feasible solutions for safe health facility environments ⁶⁰⁹. According to the Ministry of Health, Ethiopia has national guidelines for health facility safety that address infrastructure requirements, waste management, water and sanitation, and environmental infection control measures ⁶¹⁰. The National IPC Strategic Plan (2021/22–2025/26) explicitly details within the National Infection Prevention and Control Program Monitoring its Strategic Objective 7 to "Improve infrastructure, equipment and supplies for IPC program," which is dedicated to creating a safe and adequate physical environment for healthcare delivery. This objective outlines the plan to ensure that healthcare facilities have the necessary infrastructure and resources, including patient care equipment and essential supplies like personal protective equipment (PPE), to implement IPC standards effectively. It also encompasses the critical components of a safe environment such as water, sanitation, and hygiene (WASH) services and healthcare waste management infrastructure ⁶¹¹.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

Ethiopia has national requirements for ethical review before beginning clinical trials. According to the Ethiopian Food, Medicine and Health Care Administration and Control Authority (FMHACA), established processes exist for clinical trial oversight that include mandatory ethical review requirements ⁶¹². The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has institutional review boards and ethics committees that must review clinical trials before they can proceed, in alignment with international standards for clinical research oversight ^{613, p. 80}. The Ministry of Health website references regulatory requirements for ethical approval of clinical research ⁶¹⁴. The Ethiopian Health and Nutrition Research Institute and other research institutions operate ethics review committees that evaluate clinical trial protocols before implementation ⁶¹⁵.

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 100

Ethiopia has an expedited process for approving clinical trials for unregistered medical countermeasures during pandemics or epidemics. According to the Ethiopian Food and Drug Authority's "Guideline for Clinical Trial Authorization 2025, Version 005," Ethiopia has established expedited review procedures for clinical trials during public health emergencies (Section 7.3, page 32) ⁶¹⁶. The guideline states that "during declared public health emergencies, EFDA shall implement fast-track clinical trial authorization procedures for investigational products intended to address the emergency, with review timelines reduced from standard 90 days to maximum 30 days" (Section 7.3.1, page 32) ⁶¹⁷. The expedited process includes provisions for: (1) priority review designation for emergency-relevant clinical trials, (2) reduced documentation requirements for well-characterized investigational products, (3) rolling review processes allowing phased submission of application components, and (4) expedited ethics committee review coordination (Section 7.3.2-7.3.5, pages 32-33) ⁶¹⁸. The guideline also provides for mutual recognition of clinical trial results from reference regulatory authorities including WHO-prequalified products and products approved by stringent regulatory authorities during public health emergencies (Section 7.4, page 34) ⁶¹⁹. The Ethiopian Food and Drug Authority, established under Proclamation No. 1263/2021, has regulatory authority to implement these expedited procedures for clinical trial authorization ^{620, Article 66}.

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Ethiopia has a government agency responsible for approving new medical countermeasures for humans. According to the Ethiopian Food, Medicine and Health Care Administration and Control Authority (FMHACA), this agency serves as the national regulatory authority responsible for approval of medicines, vaccines, and other medical products for human use ⁶²¹. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that FMHACA has the mandate to review and approve new medical countermeasures including drugs, vaccines, and diagnostics ^{622, p. 80}. According to the Ministry of Health, FMHACA operates under regulatory frameworks that govern the approval process for medical products intended for human use ⁶²³.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

Ethiopia has an expedited process for approving medical countermeasures for human use during public health emergencies. According to the Ethiopian Food and Drug Authority (EFDA), the former Food, Medicine and Health Care Administration and Control Authority (EFMHACA) published the "Expediting Medicine Market Authorization Strategy" in October 2017, which established multiple expedited approval pathways including priority review processes, conditional approvals, and fast-track registration procedures ⁶²⁴. The strategy specifically provides for conditional approval of "new chemical entities claimed to treat seriously debilitating or life-threatening disease, used in emergency situations," with products designated for "priority review" and eligible for conditional approval for one year ⁶²⁵. According to EFDA's "Guideline for Conditional Approval of Medicines," the authority facilitates conditional approval permitting applicants to obtain time-limited provisional registration for medicines needed during emergency situations ⁶²⁶. The "Guideline for Renewal of Market Authorization" confirms that EFDA maintains an emergency use authorization procedure, stating that "authorization issued under emergency use authorization will remain valid as long as the emergency situation declared by the Ministry of Health is not lifted" ^{627, Section 4.5}. The expedited pathways also include recognition of WHO-prequalified products and medicines approved through the WHO Collaborative Registration Procedure (CRP), allowing for streamlined review where EFDA focal persons confirm sameness of submitted dossiers with prequalified products ⁶²⁸. However, these expedited mechanisms apply primarily to medicines that have undergone assessment elsewhere (such as WHO prequalification) rather than providing a fully independent accelerated domestic review pathway for entirely unregistered medical countermeasures ⁶²⁹.

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Ethiopia has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁶³⁰

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is publicly available evidence that epidemics and pandemics are integrated into Ethiopia's national disaster risk reduction strategy. According to the Government of Ethiopia, the National Policy and Strategy on Disaster Risk Management (2013) identifies epidemics as one of the key disaster risks facing the country and provides a comprehensive framework for disaster risk management that includes health emergencies ^{631, Section 3.2}. The policy specifically mentions disease epidemics among the types of natural and human-induced disasters that Ethiopia faces, alongside drought, floods, and other hazards ^{632, Section 4.1}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms that Ethiopia has integrated health emergencies into its disaster risk management framework ^{633, p. 85}. Additionally, according to the Pandemic Fund, Ethiopia's participation in the "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response" project demonstrates the country's commitment to addressing pandemic risks through coordinated disaster risk management approaches ⁶³⁴. The United Nations Office for Disaster Risk Reduction reports that Ethiopia has developed multi-hazard early warning systems that include health emergencies as part of its comprehensive disaster risk management framework ⁶³⁵.

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

There is evidence that Ethiopia has cross-border agreements, protocols, or memorandums of understanding with neighboring countries or regional groups regarding public health emergencies. According to the Joint External Evaluation of IHR Core Capacities of Ethiopia (2023), Ethiopia participates in regional health security initiatives and has established cross-border health coordination mechanisms with neighboring countries ^{636, p. 88-89}. The JEE specifically notes Ethiopia's engagement with regional organizations such as the East African Community and the Intergovernmental Authority on Development (IGAD) for cross-border health emergency coordination ^{637, p. 89}. According to the Ministry of Health of Ethiopia, the country participates in various African Union health initiatives and regional disease surveillance networks ⁶³⁸. The Africa Centers for Disease Control and Prevention confirms Ethiopia's participation in regional public health emergency preparedness and response frameworks ⁶³⁹. However, while these regional mechanisms exist, the JEE notes that there are gaps in implementation and coordination effectiveness that need strengthening ^{640, p. 89}.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 50

Ethiopia has cross-border agreements, protocols, or memorandums of understanding with neighboring countries regarding animal health emergencies, though with evidence of gaps in implementation. According to regional documentation, Ethiopia has signed and operationalized cross-border animal health cooperation memorandums of understanding (MOUs) with several neighboring countries including Djibouti, Kenya, and Somalia for coordinated management of transboundary animal diseases ⁶⁴¹. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) confirms Ethiopia's participation in regional animal health coordination mechanisms and notes that "Ethiopia has established cross-border veterinary cooperation with neighboring countries through bilateral and multilateral agreements" (Section P2.2, page 90) ⁶⁴². The JEE specifically references Ethiopia's engagement with the Inter-Governmental Authority on Development (IGAD) Livestock Policy Initiative and the African Union Inter-African Bureau for Animal Resources (AU-IBAR) regional frameworks for cross-border animal health emergency coordination (page 90-91) ⁶⁴³. According to the World Organisation for Animal Health (WOAH), Ethiopia participates in regional animal health frameworks including the IGAD Livestock Policy Initiative and Regional Animal Health Centers network that facilitate cross-border disease surveillance and response coordination ⁶⁴⁴. However, the 2023 JEE notes implementation gaps including "inconsistent activation of cross-border coordination mechanisms and limited resource allocation for joint surveillance and response activities," indicating that while agreements exist, their implementation faces challenges (page 91) ⁶⁴⁵.

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Ethiopia has both signed and ratified the Biological Weapons Convention (BWC). According to the United Nations Treaty Collection, Ethiopia signed the Convention on the Prohibition of the Development, Production and Stockpiling of Bacteriological (Biological) and Toxin Weapons and on their Destruction on April 10, 1975, and ratified it on May 26, 1975 ⁶⁴⁶. The Arms Control Association's database confirms that Ethiopia is listed among the 187 states-parties to the BWC ⁶⁴⁷. The convention entered into force on March 26, 1975, and Ethiopia's early ratification demonstrates its commitment to the prohibition of biological weapons development, production, and stockpiling.

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

There is insufficient evidence that Ethiopia has submitted confidence building measures (CBMs) for the Biological Weapons Convention in the past three years (2022-2025). The United Nations Office for Disarmament Affairs (UNODA) database for BWC confidence building measures does not show recent submissions from Ethiopia. ⁶⁴⁸ While Ethiopia is a party to the BWC, participation in the annual CBM reporting process is voluntary, and many countries, particularly developing nations, do not consistently submit these reports due to capacity constraints or other priorities. The absence of publicly available CBM submissions from Ethiopia in recent years suggests the country has not participated in this voluntary transparency mechanism, though this does not affect its legal obligations under the BWC itself. ⁶⁴⁹

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Ethiopia has provided the required report to the United Nations Security Council Committee established pursuant to resolution 1540. According to the United Nations Security Council 1540 Committee database, Ethiopia submitted its national implementation report in 2011, fulfilling its obligation under UNSCR 1540 (2004) to report on measures to prevent non-state actors from acquiring weapons of mass destruction, including biological weapons ⁶⁵⁰. The 1540 Committee website confirms Ethiopia's submission of its national report on implementation measures ⁶⁵¹. While the report was submitted in 2011, UNSCR 1540 does not require periodic re-submission of reports unless significant changes occur in national implementation measures or the Security Council requests updated information ⁶⁵². Ethiopia's submission of the required initial report demonstrates compliance with this binding obligation under UNSCR 1540 ⁶⁵³.

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 50

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Ethiopia does not meet at least two of the specified criteria for membership in international security initiatives. Ethiopia is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction, as confirmed by the Global Partnership's official member list which includes 31 countries and the European Union, but not Ethiopia. ⁶⁵⁴ Ethiopia is also not a member of the Australia Group, which consists of 42 countries that coordinate export controls on dual-use biological, chemical, and related materials, according to the Australia Group's official participation list. ⁶⁵⁵ Additionally, Ethiopia is not listed among the over 100 countries participating in the Proliferation Security Initiative (PSI), which aims to prevent trafficking of weapons of mass destruction, their delivery systems, and related materials. ⁶⁵⁶

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

Ethiopia has completed a Joint External Evaluation (JEE) and published a full public report within the last five years. According to the World Health Organization, Ethiopia completed a Joint External Evaluation of IHR Core Capacities conducted from September 18-22, 2023, with the full report published in 2025 ⁶⁵⁷. The WHO Strategic Partnership Portal confirms the availability of this published JEE report, which represents Ethiopia's most recent comprehensive external assessment of its health security capabilities ⁶⁵⁸. This JEE provides a critical assessment of Ethiopia's capabilities to prevent, detect, and respond to public health threats in accordance with International Health Regulations requirements ^{659, Executive Summary}.

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

There is no publicly available evidence that Ethiopia has completed and published a Performance of Veterinary Services (PVS) assessment in the last five years (2020-2025). According to the World Organisation for Animal Health (WOAH), the database of published PVS evaluation reports does not include a recent assessment for Ethiopia ⁶⁶⁰. The WOAH Status of Missions webpage indicates that while some countries have conducted evaluations but have not made them public, there is no indication that Ethiopia has completed a PVS assessment in the specified timeframe ⁶⁶¹.

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is no publicly available evidence that Ethiopia has completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years (2020-2025). According to the World Organisation for Animal Health (WOAH), the database of published PVS gap analysis reports does not include a recent analysis for Ethiopia ⁶⁶². The WOAH PVS Gap Analysis section indicates that gap analyses typically follow initial PVS assessments, and since no recent PVS assessment was found for Ethiopia, no gap analysis would have been completed either ⁶⁶³.

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is evidence that Ethiopia has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years. According to the Pandemic Fund, Ethiopia's participation in the "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response" project includes national co-financing commitments of approximately $2.5 million, demonstrating government budget allocation toward pandemic preparedness ⁶⁶⁴. According to the Ministry of Health of Ethiopia, the government has allocated funds for strengthening health system infrastructure and emergency preparedness capabilities through the Health Sector Transformation Plan II (HSTP II), which includes provisions for epidemic and pandemic response capacity building with budget allocations totaling $1.2 billion over the plan period ⁶⁶⁵. According to the Ethiopian Public Health Institute, budget allocations for emergency response programs within the Ministry of Health demonstrate ongoing national investment of approximately $15 million annually in pandemic and epidemic threat preparedness during 2022-2025 ⁶⁶⁶.

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 100

Ethiopia's Joint External Evaluation (JEE) report describes funding allocations and commitments from the national budget to address identified health security gaps. According to the Joint External Evaluation of IHR Core Capacities of Ethiopia (2023), the report specifically addresses funding in multiple sections, noting that "Ethiopia has committed to allocating national budget resources to strengthen priority health security capacities" (Section on Resource Mobilization, pages 72-74) ⁶⁶⁷. The JEE describes government commitments to fund surveillance system strengthening, laboratory capacity enhancement, and emergency response mechanisms through the Health Sector Transformation Plan II budget framework (pages 73-74) ⁶⁶⁸. The evaluation notes that "the government has integrated health security priorities into national budget planning processes, with dedicated allocations for PHEM system operations, laboratory network expansion, and workforce capacity building" (page 74) ⁶⁶⁹. While the JEE does not provide specific dollar amounts for all identified gaps, it clearly describes the existence of national budget commitments and the integration of health security funding into national health sector budget frameworks (pages 72-74) ⁶⁷⁰.

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is insufficient evidence that Ethiopia's Performance of Veterinary Services (PVS) gap analysis or PVS assessment allocates or describes specific funding from the national budget to address identified gaps. According to the World Organisation for Animal Health (WOAH), no recent published PVS assessment or gap analysis for Ethiopia was found in publicly available sources, therefore there are no PVS documents to reference for budget allocations ⁶⁷¹. The WOAH database does not show recent PVS evaluation reports or gap analyses for Ethiopia that would contain budget recommendations or allocations ⁶⁷². Without these foundational assessments, Ethiopia lacks the systematic analysis needed to identify funding requirements and budget allocations for addressing animal health system gaps.

5.5.3a Emergency public financing during a public health emergency

Score: 100

Ethiopia has access to a special emergency public financing mechanism through its eligibility for World Bank International Development Association (IDA) crisis response financing. According to the World Bank, Ethiopia is an IDA-eligible country with access to the IDA Crisis Response Window (CRW), which provides rapid financing to IDA countries for response to crises including public health emergencies such as disease outbreaks and pandemics ⁶⁷³. The IDA Crisis Response Window represents an established multilateral emergency funding mechanism that Ethiopia can access in the face of public health emergencies, meeting the indicator's criterion for "an established agreement with the World Bank pandemic financing facility/other multilateral emergency funding mechanism" ⁶⁷⁴. IDA-eligible countries can access CRW financing through expedited procedures during declared emergencies, with funding available within weeks of crisis onset ⁶⁷⁵. While Ethiopia does not have a dedicated national reserve fund for health emergencies documented in publicly available sources, its IDA eligibility and access to the Crisis Response Window provides an established pathway for emergency public financing during public health crises ⁶⁷⁶⁶⁷⁷.

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that senior Ethiopian leaders have made public commitments to improving the country's pandemic or epidemic threats within the past three years, but there is insufficient evidence regarding support for other countries or improvements to global capacity. According to the Prime Minister's Office of Ethiopia, Prime Minister Abiy Ahmed made public statements in 2023 and 2024 regarding Ethiopia's commitment to strengthening pandemic preparedness and response capabilities ⁶⁷⁸. In his 2023 World Health Assembly address, former Minister of Health Dr. Lia Tadesse made public commitments to enhance Ethiopia's health security capacity and improve domestic financing for emergency preparedness ^{679, Section 4}. These statements included specific commitments to strengthen laboratory networks, improve disease surveillance systems, and expand community health worker programs to enhance early detection and response capabilities ⁶⁸⁰. According to The Pandemic Fund, Ethiopia secured funding in 2024 for the "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response" project, which Minister Tadesse publicly committed to implementing through enhanced coordination mechanisms and resource mobilization ⁶⁸¹. However, there is no publicly available evidence that Ethiopian leaders have made commitments to support other countries to improve capacity or address pandemic threats by providing financing or expanding support, or to improve the country's domestic capacity to address pandemic or epidemic threats by supporting financing or expanding support at the regional or global level ⁶⁸².

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Ethiopia has requested financing and technical support from donors to improve the country's domestic capacity to address epidemic threats within the past three years. According to the Pandemic Fund, Ethiopia is a recipient of the "Ethio-Pandemic Multi-Sectoral Prevention, Preparedness, and Response" project, which provides $18.4 million in financial and technical support to strengthen pandemic prevention, preparedness, and response capabilities ^{683, Project Overview section}. This project specifically addresses vulnerabilities to emerging pathogens and critical gaps in pandemic preparedness and response in Ethiopia ⁶⁸⁴. According to the World Health Organization, Ethiopia has received various forms of international health security assistance through WHO programs and other multilateral initiatives totaling approximately $45 million in the past three years ⁶⁸⁵. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) documents multiple instances of technical support requests and receipt from international partners ^{686, p. 92-94}. However, there is no publicly available evidence that Ethiopia has provided financing or technical support to other countries for epidemic threat capacity building.

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Ethiopia has fulfilled its full contribution to the World Health Organization (WHO) within the past two years (2023-2025). According to the World Health Organization's "Statement of Account – Ethiopia, January 2025," Ethiopia's account shows that all assessed contributions for 2023 and 2024 have been paid in full, with the country's outstanding balance reduced to zero for these years ⁶⁸⁷. The statement confirms that Ethiopia has met its financial obligations to WHO as a member state for the specified two-year period ⁶⁸⁸. While earlier in 2023 Ethiopia had outstanding contributions (as noted in the December 2023 overview showing 65% payment rate), the country has since fulfilled these obligations, bringing its account current as of January 2025 ⁶⁸⁹.

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available evidence of a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with associated epidemiological data with international organizations and/or other countries that goes beyond influenza. Searches of the Ministry of Health of Ethiopia website and health policy sections do not reveal any specific policy framework for international sharing of biological materials and genetic data for diseases other than influenza ⁶⁹⁰. The Ethiopian Public Health Institute website and laboratory services documentation do not contain evidence of systematic policies for international sharing of genetic and clinical data beyond influenza ^{691, Laboratory Services section}. The Joint External Evaluation of IHR Core Capacities of Ethiopia (2023) notes gaps in data sharing policies and does not reference comprehensive biological material sharing frameworks beyond influenza ^{692, p. 82}. While Ethiopia may participate in ad hoc sharing arrangements during specific outbreak responses, no systematic policy framework for routine sharing of genetic and clinical data beyond influenza was identified. The absence of such a policy represents a gap in Ethiopia's contribution to global health security surveillance and research efforts.

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Ethiopia has failed to share samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years (2023-2025). According to the World Health Organization's Pandemic Influenza Preparedness (PIP) Framework documentation, there are no public reports or statements indicating non-compliance by Ethiopia with sample-sharing obligations ^{693, Compliance Reports section}. The WHO Global Influenza Surveillance and Response System (GISRS) does not contain any public reports of disputes, complaints, or non-compliance issues involving Ethiopia's participation in the PIP framework during the specified period ^{694, Member State Reports section}. While the absence of negative evidence does not necessarily confirm active compliance, there are no publicly available reports of Ethiopia failing to meet PIP framework obligations. Ethiopia's participation in WHO influenza surveillance activities suggests general engagement with the framework, though specific sample-sharing records are not typically made public ⁶⁹⁵.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that Ethiopia has failed to share pandemic pathogen samples during an outbreak in the past two years (2023-2025). According to the World Health Organization's Disease Outbreak News, reviews of outbreak reports from 2023-2025 did not reveal any documented cases of Ethiopia withholding or refusing to share pandemic pathogen samples during outbreak responses ⁶⁹⁶. The WHO Ethiopia country page does not contain reports of sample-sharing disputes or non-compliance with international sharing expectations during recent outbreaks ⁶⁹⁷. While Ethiopia has experienced various disease outbreaks during this period, there are no publicly available reports of sample-sharing disputes or criticism for non-compliance with international sharing protocols ⁶⁹⁸. The absence of negative evidence suggests that Ethiopia has not been publicly reported for failing to share samples during recent outbreak responses, though the specific details of sample-sharing activities are not typically made public ⁶⁹⁹⁷⁰⁰.

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 37

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 0

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 0

6.1.4a Risk of terrorism

Score: 25

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5a Presence or risk of armed conflict

Score: 25

6.1.6a Government territorial control

Score: 0

6.1.7a International tensions

Score: 25

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 63.99

6.2.2a UNDP Gender Inequality Index score

Score: 41

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 65.66

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 0

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 68.9

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 50

6.3.3a Adequacy of power network

Score: 50

6.4.1a Urban population (% of total population)

Score: 88.84

6.4.2a Change in forest area (percentage points)

Score: 68.69

6.4.3a Natural disaster risk

Score: 25

6.5.1a Total life expectancy (years)

Score: 58.3

6.5.1b NCD mortality rate

Score: 89.81

6.5.1c Population aged 65+

Score: 88.92

6.5.1d Tobacco use (% of adults)

Score: 80.84

6.5.1e Level of adult obesity (%)

Score: 91.68

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 67.63

6.5.2a Access to potable water

Score: 55.94

6.5.2b Access to at least basic sanitation facilities

Score: 9.87

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 79.17

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 1.48

6.5.4a Trust medical and health advice from the government

Score: 100

6.5.4b Trust medical and health advice from medical workers

Score: 50