The Ethiopia National Center of the Africa Health Observatory Platform on Health Systems and Policies (AHOP), in close collaboration with the Federal Ministry of Health (FMoH) and the World Health Organization (WHO), successfully conducted a "Policy Dialogue on Engagement of the Private Health Sector in the Delivery of Tertiary Healthcare Services in Ethiopia."

Despite its advantages, numerous barriers and challenges hinder the private sector's engagement in investing in health sector development and healthcare service delivery to optimize tertiary healthcare services, as revealed by the policy dialogue held in Addis Ababa, Ethiopia, on March 21st.

The policy dialogue was graced by the presence of esteemed dignitaries, including Dr. Asnake Wakjira, the Ministry of Health's management chief executive officer; Dr. Samuel Kifle, the President of Addis Ababa University; senior officials from the WHO African Regional Office and the WHO Ethiopia Country Office; Representatives from the Health Ministries of Ethiopia, Nigeria, and Rwanda; and the London School of Economics. 

The policy dialogue aimed at understanding how private sector engagement impacted the provision of health services generally and tertiary care specifically. It sought to identify changes to enabling environments such as policy and regulatory frameworks, advocacy, implementation of the policy framework, access to physical space, finance, and foreign currency, which have improved the interest and motivation of the private health sector for optimizing and engaging in the scale-up of tertiary healthcare service delivery. 

Moreover, the policy dialogue is set to make significant contributions to the ongoing development of the Ethiopian National Strategy for Private Sector Engagement in the Health Sector. This strategic alignment with the priorities of the Ethiopian Health Sector Mid-term Development and Investment Plan is a promising step towards enhancing healthcare services through effective public-private partnerships.

Speaking at the occasion, Dr. Dawit Wondimagegne, Director of the Ethiopian National Center of AHOP, emphasized that the policy dialogue aimed to foster inclusive discussions, networking opportunities, and strategic collaborations to enhance healthcare systems and services through effective public-private partnerships.

Based on the dialogue's recommendations, the MoH will reshape strategies and enabling environments for effective private sector engagement in the health sector, strengthening approaches to enhance the capacities of the private sector. The policy dialogue holds significant importance for policymakers, the FMoH, and the private sector, Dr Dawit added.

Dr. Asnake, the Chief Executive Officer of the Ministry of Health, outlined the core priorities of the health sector over the next three years, which include restoring and establishing services in conflict-affected areas, enhancing the provision of medical supplies and equipment, increasing greater private sector engagement, and enhancing the quality and equity of health services.

He affirmed that the Health Sector Medium-Term Development and Investment Plan (HSDIP) will lead to a healthier and more prosperous Ethiopia. He also highlighted the development of a 10-year Specialty and Subspecialty Service Roadmap in Ethiopia to improve availability and access to tertiary healthcare services and ensure the quality of specialty and subspecialty services in both the public and private health sectors.
"The evolving nature of mixed health systems, where 33% of health facilities and healthcare providers in Ethiopia belong to the private sector, underscores the critical role of both public and private sectors in achieving universal health coverage," said Dr.  Bejoy Nambiar, representing WHO-Ethiopia at the dialogue. He acknowledged that while the involvement of private sector players has increased access to healthcare services, significant challenges remain.

According to Dr. Bejoy, private health facilities and providers are predominantly concentrated at the primary level of service delivery, with only one out of 28 tertiary health facilities being privately owned. He stressed the importance of continuously collecting and analyzing data to align priorities for action and fostering relationships with the main actors to ensure effective private sector engagement.

WHO Regional Office for Africa and the WHO Country Office for Ethiopia have supported the Ethiopian Ministry of Health in reshaping the National Strategy on Private Sector Engagement to ensure equitable access to quality health services for all Ethiopians. Dr. Bejoy reiterated WHO's commitment to working with the Government of Ethiopia and other partners, including the private sector, to ensure universal access to quality healthcare and improve health outcomes.

The private sector exerts significant influence in most of the world's health systems, including through direct provision of health services, medicines and medical products, health insurance, health workforce training, information technology, infrastructure, and support services. As a result, most countries have "mixed health systems" where a mix of public and private providers deliver health services and health-related goods.
The Ethiopian Health Sector Mid-Term Development and Investment Plan recognizes the role of the private sector in expanding the health sector's resource base and delivering specific services. Policy and regulatory frameworks have also been developed to encourage private-sector engagement. 

However, due to the limited engagement of the private health sector in tertiary healthcare service delivery, the public sector remains the primary source of such services (80%). In 2023, out of the 28 comprehensive specialized hospitals for tertiary healthcare service delivery across the country, only one was owned by the private sector.