Ethiopia

The Constitution is the supreme law in the country (Article 9) and establishes that Ethiopia is a federal and democratic state (Article 1), where states and religion are separate (Article 11).

Chapter Three (articles 13 to 44) incorporates the fundamental rights that should be respected and enforced at all levels of the state (Article 13). Those rights include, among others, the right to life (Article 15), the prohibition against inhuman treatment (Article 18), and the right to equality (Article 24). Democratic rights and economic, social and cultural rights are included in the second part of the chapter. They include, under article 41, the obligation of the state to allocate the ever increasing resources to provide to the public health, education and other social services (Article 41.4).

Chapter Ten (article 85 to article 92) states the political, economic and social objectives of the government, one of those objectives is that the government shall endeavour to protect and promote the health, welfare and living standards of the working population of the country (Article 89) as well as that policies shall aim to provide all Ethiopians access to public health and education, clean water, housing, food and social security (Article 90).

The Community Based Health Insurance Proclamation No. 1273/2022 defines key terms (section 2), sets up insurance pools at regional and federal levels (section 5), and outlines the roles of implementing bodies (part III, sections 7 to 12). The proclamation details membership requirements (section 13), contributions (section 15), and benefit packages (section 16), and specifies sources of finance, including registration fees and subsidies (section 17). It also introduces a referral system for accessing health services (section 21) and mandates audits to ensure proper payment and service delivery (section 22). Additionally, it covers responsibilities of health facilities and members, confidentiality of information, and administrative actions for violations (part VII, sections 23 to 29).

The Ethiopian Proclamation No. 1263/2021 defines the powers and duties of the executive organs of the Federal Democratic Republic of Ethiopia. It outlines the organizational structure, roles, and responsibilities of various ministries and government agencies. The proclamation includes detailed descriptions of the functions and duties of each ministry, including agriculture, industry, trade, health, and others.

Section 35 of the proclamation outlines the competencies of the Ministry of Health. The ministry is responsible for overseeing several key health-related institutions, including the Ethiopian Public Health Institute, the National Blood and Tissue Bank Service, the Armauer Hansen Research Institute, the Ethiopian Health Insurance Service, the Ethiopian Pharmaceutical Supply Service, the Ethiopian Food and Drug Authority, and several specialized hospitals such as St. Peter’s Comprehensive Specialized Hospital and St. Paul’s Hospital and Millennium Medical College. The Ministry of Health's duties include ensuring the provision of quality health services, managing public health initiatives, regulating pharmaceuticals and medical supplies, and overseeing health insurance services. It also plays a crucial role in coordinating research and development in the health sector, supporting mental health services, and ensuring the availability of essential medicines and medical equipment.

The mandatory health insurance is for employees, pensioners, and their families. The contributions are made by the employees and their employers, as well as by the government for pensioners (art. 7 and art.9).

The health service package shall include essential health services and other critical curative services. This package is implemented by the Social health Insurance Scheme Council of Ministers Regulation n°271/2012.

The Proclamation is structured around 11 parts: part one sets general provisions including definitions, part two addresses executive organs and inspectors, part three addresses food safety and quality administration and control, part four addresses administration and control of medicine, part five addresses narcotic drugs, psychotropic substances or precursor chemicals, part six addresses hygiene, environmental health and control of communicable diseases, part seven governs health professionals, part eight addresses health and controllable health related institutions, part nine regulates traditional and complementary alternative medicine while part ten provides for administrative measure and complaints handling. The last part includes miscellaneous provisions.

Part two provides the powers and duties of the executive organ (article 4) which are defined as a body to be established by regulations of the Council of Ministers to implement food, medicine and healthcare administration and control activities at the federal level (part one, article 2). These powers are broad and include, among other, to prepare health regulatory standards for quality of medicines, competence and practice of health professionals, hygiene and environmental health, competence of health and controllable health related institutions and where in place to oversee their implementation; to initiate policies and legislation to strengthen the quality of food and medicines and the competence of health professionals and health institutions; and submit the same for government approval; to evaluate and register medicines on the basis of registration requirements, and renew, suspend and revoke such registrations; etc. (non-exhaustive list).

Part Four on the administration and control of medicines governs registration, quality standards, clinical trial, packaging and labelling.
Part Six addresses hygiene, environmental health and control of communicable diseases including occupational health and safety, dangerous chemicals, constructions, health control at entrance and exit ports, communicable diseases, zoonosis, disposal and transport of dead body, waste handling and disposal, availability of toilet facilities, control of bathing places and pools. part seven governs health professionals including licensing requirements, standards of care and scope of practice, code of conduct, duty to report, information of patients and obligations of health institutions, emergency treatment and referral, prescribing and dispensing of medicines.