Issue No. 291

Healthcare workers across Ethiopia launched unprecedented strikes in 2025, bringing an already fragile system to its knees. Beginning mid-May, over 15 ,000 doctors, nurses and other health workers across the country conducted a strike to protest chronic low wages and deteriorating working conditions. By late May, the strikes had spread nationwide, paralysing whatever was left of the public hospitals and clinics. 

The government’s response to the unrest in the health sector has been heavy-handed and counterproductive. Instead of negotiation and accommodation, the government opted to crack down, sending the police to raid homes and threatening to revoke licenses of healthcare workers. Hundreds of striking medical professionals, arrested without warrants, are still incarcerated.

The government is also using lawfare to intimidate and criminalise the protests. On 19 June 2025, the country’s High Court sentenced a health worker to seven years in prison for “anti-government propaganda”, a stark warning signal to critics of the government. This came just days after the suspension of the Ethiopian Health Professionals Association (EHPA) by the Authority for Civil Society Organisations. Other medics were beaten or threatened; for example, local Fano militias in Amhara detained a physician after he led a short work stoppage.  In Oromia and elsewhere, protesters were vilified as “anti‐peace” or accused of aiding armed groups. 

These crackdowns have only fuelled the paralysis of services. The country’s healthcare system, already stretched thin by years of underfunding and conflict, is tottering. Patients report overcrowded wards and skipped treatments, while hospitals ration even basic supplies. Meanwhile, the government’s failure to negotiate has left many clinics effectively non-functional, pushing Ethiopia’s health indicators sharply backward overnight. The result is a healthcare system literally collapsing under multiple crises. Fields hospitals and mobile clinics run by NGOs are overstretched trying to fill the gaps. A recent UN brief cautioned that unless fighting stops and services resume, Ethiopia risks a secondary “pandemic” of preventable disease and death. 

Ethiopia’s health workers have long complained that even after decades of service and specialty training, their salaries barely cover rent or food. Senior doctors earn roughly USD 80–100 per month on average. In raw Birr terms this figure may seem to rise each year, but rampant inflation and currency collapse have wiped out the gains. Meanwhile, everyday items have become unaffordable. In a recent address to Parliament, Prime Minister Abiy Ahmed appeared to dismiss the increasingly desperate pleas of healthcare professionals for a liveable wage, suggesting that their demands were politically motivated and urging them instead to “accept suffering” in the interest of national stability.
 
Why are Ethiopia’s doctors so poorly paid? In part it reflects long-term austerity and spending priorities. In 2022 Ethiopia’s healthcare budget fell to a post-Meles low: just 2.85% of GDP, according to World Bank data. This is far below the 15% Abuja target for African nations. The government also employs a large patronage machine that crowds out wages. Additionally, the Prosperity Party has built up an oversized public bureaucracy distributed along ethnic lines.  Every region, zone and district has elaborate health and development committees and thousands of party cadres, a structure dating back to the late Meles era but expanded under Abiy.  By some counts the public sector now employs far more people than the economy can productively absorb. Because the state is effectively a monopoly in healthcare, salaries are artificially compressed.  In effect, to spread payroll over an inflated workforce, the government keeps doctors on par with senior administrators or even clerks.  

Another facet is that in the late 2010s as Ethiopia’s new prime minister, Abiy Ahmed, launched an ambitious programme of liberalising the economy promising to dismantle the old developmental state model. Soon after, the COVID-19 pandemic hit and global inflation and persistent foreign-currency shortages exposed the weaknesses of these new policies. Under pressure from creditors and the IMF, Addis Ababa agreed to a $3.4 billion loan and debt-restructuring plan in mid-2024, contingent on deeper market reforms. Now Ethiopia is spending roughly 37 percent of its 2025/26 federal budget - that has a 22% deficit - on debt service and the military.  By contrast, health – once one of the “pillar sectors” under the Zenawi government – languishes.  In the current budget, military and police were among the few line items to see real increases - reflecting the state of emergency and counter-insurgency in Oromia and Amhara. 

The healthcare strike comes amid broader public discontent. Ordinary Ethiopians face rising prices, declining services, and a sense that the government is indifferent to their plight. This economic squeeze has also sharpened petty corruption. Cash-strapped hospitals struggle to pay suppliers, so some doctors complain that bribes are expected for appointments or referrals.  The government’s austere stance has coincided with stories of officials embezzling or renting out clinics. Any leftover resources that might have gone to salaries have instead leaked into private pockets or into private clinics patronised by the well-connected.  

Ethiopia was the development poster child in the 2000s under the EPDRF’s developmental state, with healthcare receiving massive investments. Infant mortality saw a steady decline as the government expanded immunisation services and health clinics to remote rural areas. Ethiopia had slashed child mortality rates by half  between 2000 and 2012.  Mortality for children under five dropped from over 200 per thousand births in 1990 to well below 70 by the mid-2010. Today, those gains are reversing. Malaria and measles cases are rising in places where vaccines ran out. Skilled-birth attendants have fallen again to levels from decades ago.  Rural health extension programmes, once a model for Africa, are collapsing as staff go unpaid. In many conflict zones, child vaccinations have all but ceased. Health indicators are beginning to slide backwards: under-5 mortality is rising in Tigray and Amhara, and maternal deaths are climbing even in peaceful regions as hospitals overload.

The malaise in Ethiopia’s health sector speaks to a broader reality: the steady unravelling of Ethiopia’s ‘developmental state’ gains. The proliferation and surge in deadly armed conflicts misallocates state priorities and starves public services of funds. With prospects of peace still remote and the likelihood of a renewed border war with Eritrea looming, Ethiopia’s deteriorating  health services could worsen. The suspension of USAID activities, funding and support in crucial areas of healthcare, no doubt, also aggravates the crisis. 

Ethiopia’s multiple crises stem from its inability to restore peace and find non-militarised and peaceful means of addressing localised conflicts and popular discontent. Only an Ethiopia at peace with itself can work consistently and sustainably in improving healthcare. Still, the Abiy government must prioritise genuine negotiation with doctors and nurses; accommodate their grievances; stop criminalising their protest; increase investment in public services, healthcare and work towards a long-term solution to chronic low salaries for health workers.