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Essential Medicine Availability in Ethiopia and Africa: What the Facility Surveys Actually Show

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In 2013 the World Health Organization set a voluntary target: 80 percent availability of affordable essential medicines for major non-communicable diseases, in public and private health facilities alike. Ethiopia’s own facility data, pooled across 46 surveys published through August 2025, puts public-sector availability at 64 percent and private-sector availability at 54 percent (meta-analysis, 2025（https://pmc.ncbi.nlm.nih.gov/articles/PMC12617824/）). Neither sector reaches the target, and Ethiopia is not unusual there. What varies, city to city and disease to disease, is by how much.

This is what the facility surveys actually show: which medicines run short, where, and by how much; what a course of treatment costs in days of a government salary; and how Ethiopia’s numbers sit against the rest of the continent. Foreign exchange access, shipping lead times and demand forecasting sit upstream of a pharmacy shelf, and all three show up in the data below.

What the WHO’s 80 percent target actually measures

The 80 percent figure comes from the WHO Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013 to 2020, endorsed by the World Health Assembly that year. It asks two things at once: that a defined basket of medicines, mostly for diabetes, cardiovascular disease and respiratory disease, is in stock on the day of the survey, and that the price is affordable against local wages. A facility only counts as meeting the target if both hold (WHO Access Indicators（https://www.who.int/tools/monitoring-and-evaluation/access-indicators）).

Almost nowhere hits it. A secondary analysis of 54 low- and middle-income countries found that in low-income countries only 15.2 percent of public facilities and 18.9 percent of private facilities met the combined availability-and-affordability bar for the cheapest generic version of each medicine (Lancet Global Health, 2024（https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00442-X/fulltext）). WHO retired the old survey-based version of SDG indicator 3.b.3 in 2025 for a composite Health Product Access Index, partly because too few countries had run a recent, comparable survey to measure against the 80 percent line. Ethiopia has kept generating that survey data anyway, through a steady stream of university-led studies using the WHO/Health Action International (WHO/HAI) methodology, which is what makes a comparison across studies possible here.

Ethiopia’s own studies, side by side

No single Ethiopian survey covers the whole country at once. Each one samples a city or zone, picks a basket of medicines tied to a specific disease group, and reports availability as the share of facilities that had the item in stock on the day of the visit. Put seven of them next to each other and a range appears that no single study shows on its own.

Study location Year Sector Medicine class Availability

Addis Ababa 2024 Public Cardiovascular disease 33.7%

Addis Ababa 2024 Private Cardiovascular disease 40.6%

Arba Minch, Southern Ethiopia 2023 Public Non-communicable disease 16.3%

Arba Minch, Southern Ethiopia 2023 Private Non-communicable disease 38.3%

Central Ethiopia 2022 Public and private combined Diabetes 34.6%

Addis Ababa 2022 Public Antiseizure 62.9%

Addis Ababa 2022 Private Antiseizure 30.0%

Shegaw Motta General Hospital, Amhara 2021 Public, hospital General tracer list 80.0%

Motta Health Centre, Amhara 2021 Public, health centre General tracer list 93.3%

Nationwide, pooled (46 studies) to 2025 Public All essential medicines 64.0%

Nationwide, pooled (46 studies) to 2025 Private All essential medicines 54.0% Source: Masresha et al., Scientific Reports 2024; Arba Minch WHO/HAI survey 2023; Central Ethiopia diabetes survey 2022; Addis Ababa antiseizure survey 2022; Shegaw Motta stock-out study 2021; Ethiopia-wide meta-analysis of 46 studies, 2025. Two things stand out. First, the range is wide: from 16.3 percent for non-communicable disease medicines in Arba Minch’s public facilities to 93.3 percent for a general tracer list at Motta Health Centre. A single number for “Ethiopia’s medicine availability” hides more than it tells. Second, which sector does better flips by disease. Private outlets beat public ones for cardiovascular and NCD medicines in three of the four disease-specific studies, by 7 to 22 points. Public facilities beat private ones for antiseizure medicines by almost 33 points, and the largest, most rigorous study, the 46-study meta-analysis, finds public sector ten points ahead overall. Neither sector wins consistently, which argues against treating public-versus-private as a fixed hierarchy and for checking the specific therapeutic category a buyer needs. Availability swings by as much as 33 percentage points between public and private facilities depending on the disease category surveyed. Stock-outs: what “available today” hides

A survey taken on one day tells a buyer whether the shelf was stocked that morning. It says nothing about whether it stayed stocked. The Shegaw Motta study tracked that separately, reviewing 15 tracer medicines over the six months before the survey. At the general hospital, 60 percent of those medicines had been stocked out at least once in that window, for an average of 38.8 days and as long as 157 days for the worst-affected item, ferrous salt with folic acid. At the neighbouring health centre, only 20 percent of medicines stocked out, for an average of 11.2 days (Amhara stock-out study, 2021（https://pmc.ncbi.nlm.nih.gov/articles/PMC9481020/）).

That gap between a hospital and a health centre a few kilometres apart is the more useful finding than either number alone. It points at ordering frequency, storage capacity and distance from a distribution point, rather than at national supply as one undifferentiated problem. A hospital ordering large volumes less often absorbs a supply interruption differently than a health centre restocking in smaller, more frequent batches. For a buyer weighing an Ethiopian partner, the practical question is which of those patterns a given supplier’s own buffer stock is built to survive.

What a course of treatment actually costs

The WHO/HAI method measures affordability in one unit: the days’ wages a country’s lowest-paid government worker needs to buy one month’s standard treatment. It is a blunt tool, but it makes different price levels comparable.

Cardiovascular disease, Addis Ababa, 2024: in the worst case, a one-month course cost the equivalent of 352.44 days’ wages, and median price ratios ran from 2.84 to 7.24 times the international reference price depending on the outlet (Masresha et al., 2024（https://pmc.ncbi.nlm.nih.gov/articles/PMC11682450/）).

Diabetes, Central Ethiopia, 2022: a month’s medicines cost 0.3 to 3.1 days’ wages in public outlets and 1.0 to 11.0 days’ wages in private ones; 84.6 percent of lowest-priced generics were unaffordable in the public sector and 58.8 percent in the private sector (Central Ethiopia survey, 2022（https://pmc.ncbi.nlm.nih.gov/articles/PMC10723550/）).

Non-communicable disease medicines, Arba Minch, 2023: every medicine surveyed in the private sector was unaffordable, and 70.4 percent were unaffordable even in the public sector (Arba Minch survey, 2023（https://pmc.ncbi.nlm.nih.gov/articles/PMC11292716/）).

Antiseizure medicines, Addis Ababa, 2022: every medicine surveyed was unaffordable, with a worst case above six months’ wages for one month of treatment (Addis Ababa antiseizure survey, 2022（https://pmc.ncbi.nlm.nih.gov/articles/PMC10472410/）).

Nationally, the 46-study meta-analysis puts the pooled share of unaffordable medicines at 62 percent, with public-sector median price ratios averaging 1.45 times the international reference price and private-sector ratios averaging 3.66 times (meta-analysis, 2025（https://pmc.ncbi.nlm.nih.gov/articles/PMC12617824/）). Availability and affordability move together more often than not: a medicine that is hard to find is usually also expensive where it can be found, because scarcity and thin distribution both push up the retail price. Ethiopia’s pooled public-sector figure sits above the wider African average, though the study baskets are not identical. How Ethiopia compares with the rest of Africa

The largest single comparison point is a 2026 systematic review that pooled 52 studies across 34 African low- and middle-income countries, published from January 2014 to December 2025. It found pooled public-sector availability of 48.1 percent and private-sector availability of 70.3 percent continent-wide, with a sharp split by disease type: 59.1 percent availability for communicable disease medicines in the public sector against 37.4 percent for non-communicable disease medicines in the same sector (Albagir, BMC Public Health , 2026（https://pmc.ncbi.nlm.nih.gov/articles/PMC13041421/）). The same review found that 24.1 percent of households faced catastrophic health expenditure from medicine purchases alone.

Country or scope Sector Availability

Ethiopia, nationwide pooled Public 64.0%

Ethiopia, nationwide pooled Private 54.0%

Ghana, three municipalities Government 67.2%

Ghana, three municipalities Private 54.6%

Nigeria, Abuja Private pharmacy 59.9%

Nigeria, Abuja Private hospital pharmacy 28.4%

Africa, 34-country pooled average Public 48.1%

Africa, 34-country pooled average Private 70.3% Source: Ethiopia meta-analysis (PMC12617824, 2025);