Ethiopia has achieved particularly notable reductions in maternal mortality, made possible through deep engagement with communities that drove demand for services as the health system grew. 

London School of Hygiene & Tropical Medicine: Neil Spicer University of Manitoba: Dessalegn Melesse University of Manitoba: Ties Boerma Ethiopian Public Health Institute: Ashenif Tadele Ethiopian Public Health Institute: Theodros Getachew Institute for International Programs, Johns Hopkins Bloomberg School of Public Health: Shelley Walton African Population and Health Research Center: Yohannes Wado Ethiopian Ministry of Health: Shegaw Mulu


Exemplars in Global Health program

The Exemplars in Global Health program aims to learn from countries that have made rapid progress in improving health outcomes and disseminate this evidence to inform health policy and funding decisions. Our aim is to research success stories from low- and middle-income countries and share findings that can be useful for leaders looking to act in comparable contexts.

In selecting Exemplar countries, we review evidence to identify countries that outperformed their peers in vital areas of public health, controlling for factors such as economic growth. In this way, we aim to provide more actionable, policy-relevant insight for stakeholders about how health progress can be made despite resource limitations.

Together with research partners and technical advisers, we conduct quantitative and qualitative analyses to validate our initial assessments and assess factors that contribute to a country’s exemplary performance.

Research in and across Exemplar countries could help ministries, nongovernmental organizations, and multinational bodies better deploy finite resources to address key public health issues in low- and middle-income countries.

By studying proven strategies to prevent disease, malnutrition, and other conditions that burden populations of low- and middle-income countries, we aim to create a list of data-driven narratives that can serve as resources for leaders looking to improve health within their own countries. The following narrative focuses on factors that contributed to rapid reductions in neonatal and maternal mortality in the Exemplar country of Ethiopia.

Introduction to Ethiopia

Located in East Africa, Ethiopia is the second most populous country on the African continent. According to UN estimates, the country was home to 123 million people in 2022, and is characterized by its diversity in terms of language, religion, ethnicity, and lifestyle.1 The country includes one of Africa’s largest cities, Addis Ababa, which serves as the headquarters of the African Union and other international organizations. This hub of over 5 million people presents a starkly different environment than the rural regions of Ethiopia, which have large pastoralist populations that are generally mobile.2 Ethiopia over the years has made remarkable efforts to expand its health infrastructure and workforce into rural areas – where almost 80% of its population lives.3 It has thus achieved success across many indicators, as also seen in the under-five mortality reduction, community health workers and stunting reduction Exemplar studies.

A health extension worker makes home visits by bicycle, traveling to reach families in rural areas.
A health extension worker makes home visits by bicycle, traveling to reach families in rural areas.
©Nathalie Bertrams

As of the completion of this study, Ethiopia is divided into twelve regions and two city administrations – Addis Ababa and Dire Dawa. Regions are further divided into zones, woredas (districts), kebeles in rural areas, as well as municipalities in urban areas. These regions vary in size and population, with the large regions of Oromia and Amhara alone consisting of over half the country’s population as highlighted in Figure 1. In contrast, smaller regions such as Gambela and Harari have populations below half a million. This wide range in size is because regions have been generally classified on the ethnicity and language of local populations.

Figure 1: Population Density by Administrative Region of Ethiopia, 2000 and 2020

Figure 1: Population Density by Administrative Region of Ethiopia, 2000 and 2020

Ethiopia has seen enormous economic growth in recent decades, with gross domestic product per capita increasing from US $259 to US $835 (2015 US dollars) from 2000 to 2021.4 This reflects a 222% relative increase in gross domestic product per capita over that span, the largest growth seen for any African nation.4 In line with this economic advancement, the percentage of people in Ethiopia living in poverty (i.e., living on less than US$2.15 per person per day) decreased from 29.3% in 2000 to 8.5% in 2019.5

While this economic progress is remarkable, our country selection analysis found that it does not entirely explain Ethiopia’s progress in reducing neonatal and maternal mortality in recent decades. Additional details about Ethiopia are included in the Context section. The majority of this narrative will highlight key indicators, interventions, policies, and programs that contributed to rapid neonatal and maternal mortality reductions in Ethiopia over the period of 2000 to 2020.

  1. 1
    World Bank. Population, total [data set]. Accessed June 6, 2023. https://data.worldbank.org/indicator/SP.POP.TOTL
  2. 2
    World Bank. Population in largest city [data set]. Accessed June 6, 2023. https://data.worldbank.org/indicator/EN.URB.LCTY
  3. 3
    World Bank. Rural Population (% of total population) [data set]. Accessed June 6, 2023. https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS
  4. 4
    World Bank. GDP per capita (constant 2015 US$) [data set]. Accessed June 6, 2023. https://data.worldbank.org/indicator/NY.GDP.PCAP.KD
  5. 5
    World Bank. Poverty headcount ratio at $2.15 per day (2017 PPP) (% of population) [data set]. Accessed November 29, 2022. https://data.worldbank.org/indicator/SI.POV.DDAY

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