Strengthening primary health care in Ethiopia
A scoping review of successes, challenges, and pathways towards universal health coverage using the WHO monitoring framework
Bibliographic Data
| ID | 19594107 |
|---|---|
| Authors | Tesfaye S Mengistu (0000-0001-8276-5143, The University of Queensland), Aklilu Endalamaw (0000-0002-9121-6549, The University of Queensland), Anteneh Zewdie, Eskinder Wolka (0000-0003-1720-7561), Yibeltal Assefa (0000-0003-2393-1492, The University of Queensland) |
| Editors | Damen Haile Mariam (0000-0002-3229-5259) |
| Year | 2025 |
| Volume | 5 |
| Issue | 4 |
| Pages | e0004470 |
| Publication date | 2025-04-17 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0004470 |
| PMID | 40244967 |
| OpenAlex | W4409561732 |
| Language | EN |
| References cited | 122 |
Introduction The ultimate goal of primary health care (PHC), as a whole-of-government and whole-of-society approach, is to achieve the highest level of health by bringing health services closer to the users. This entails that PHC should be viewed as the all-inclusive strategy to achieve universal health coverage (UHC) of the sustainable development goals (SDG). Ethiopia has been implementing PHC since the Alma-Ata Declaration. The World Health Organization (WHO) has recently released a PHC Monitoring Framework to support the monitoring of progress in PHC implementation. However, an evidence gap highlights the need for studies investigating PHC progress towards UHC using this progress monitoring framework. This study aims to evaluate Ethiopia’s PHC system using the WHO PHC monitoring framework and identify successes and challenges towards UHC and health security. Method This scoping review was conducted and structured based on Arksey and O’Malley’s methodological framework. We searched five databases (PubMed, Scopus, Embase, Web of Science, CINAHL) and hand-searched for relevant articles. We used the WHO PHC monitoring conceptual framework to summarise findings qualitatively. We reported our findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. Results We included a total of 110 papers – 56 cross-sectional/national surveys, 19 qualitative studies, 16 mixed-method studies, five fiscal/cost/formative or project model analyses, three ecological/ethnographic studies, three longitudinal/quasi-experimental studies, and two each of implementation/participatory research, cohort studies, and case studies. The Ethiopian PHC system has achieved encouraging success in improving healthcare access and coverage, driven by growing political and leadership commitments through implementing a national health extension package (HEP), service integration and multisectoral approaches to achieve UHC. However, Ethiopia’s efforts to achieve UHC have faced many challenges, including inadequate service integration, lack of resources and budgets, uneven distribution of health workers and infrastructure, gaps in priority setting, service innovation, stakeholder engagement and funding PHC research. These are affecting access to affordable care and hindering the progress towards UHC. Conclusion Ethiopia’s PHC system has achieved significant progress in expanding infrastructure and improving access to health services towards UHC. However, challenges remain, particularly in underserved rural areas, with inequitable access, weak governance, and limited integration of essential services. Hence, by improving resource allocation, addressing rural inequities, systemic and infrastructural challenges and fostering stronger governance and service integration, Ethiopia can further improve and build on the successes of the PHC system, making it more resilient and better equipped to meet the health needs of its population
Business · CINAHL · Conceptual framework · Health care · Implementation research · Medical education · MEDLINE · Monitoring and evaluation · Political science · Process management · Psychological intervention · Scopus · Sociology · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Primary Care and Health Outcomes
Scoping reviews
A systematic review of task- shifting for HIV treatment and care in Africa
Scoping studies
Costs and resource needs for primary health care in Ethiopia
Facilitators and barriers to integration of noncommunicable diseases with HIV care at primary health care in Ethiopia
Organizational commitment of health professionals and associated factors in primary healthcare facilities of Addis Ababa, Ethiopia
Health infrastructure development and its impact on health security in Ethiopia since the 20 th Century
Health system capacity and readiness for delivery of integrated non-communicable disease services in primary health care
Involvement of people with schizophrenia in decision-making in rural Ethiopia
Analyzing efforts to synergize the global health agenda of universal health coverage, health security and health promotion
Community health extension program of Ethiopia, 2003–2018
Research for universal health coverage
The impact of community-based health insurance on universal health coverage in Ethiopia
Policy and practice suggestions to improve performance on the Unaids 90‐90‐90 targets
HIV and family planning service integration and voluntary HIV counselling and testing client composition in Ethiopia
Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia
Co‐coverage of reproductive, maternal, newborn and child health interventions shows wide inequalities and is associated with child nutritional outcomes in Ethiopia (2005–2019)
Barriers and facilitators to the implementation of nutrition interventions at primary health care units of Ethiopia
We All Work Together to Vaccinate the Child’
Structural Quality of Services and Use of Family Planning Services in Primary Health Care Facilities in Ethiopia. How Do Public and Private Facilities Compare
Effect of integrating maternal health services and family planning services on postpartum family planning behavior in Ethiopia
What factors are associated with maternal undernutrition in eastern zone of Tigray, Ethiopia? Evidence for nutritional well-being of lactating mothers
Spatial distribution and associated factors of community based health insurance coverage in Ethiopia
Social innovation in health
Capacity of the Ethiopian primary health care system to achieve universal health coverage
Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia
The origins of Ethiopia's primary health care expansion
Aiming for Universal Health Coverage through insurance in Ethiopia
Scoping studies
Understandings of depression among community members and primary healthcare attendees in rural Ethiopia
| Citation velocity | historical |
|---|---|
| Highly cited | No |