Ethiopia has one of the world's worst health care systems and despite efforts to improve it, it remains inadequate. The average life expectancy is only 43 years. Only 6% of deliveries are done with trained professionals (doctor, nurse or midwife), compared to a 42% average across Sub-Saharan Africa. The infant mortality remains high at 77 per 1000 live births.

There remains a heavy burden of communicable infectious diseases caused by poor sanitation and nutritional deficiencies. The HIV/AIDS rate in Ethiopia is, however, low compared to many Sub-Saharan countries. Rates have been estimated at 4-7%.

The healthcare system is two-tiered in that there are government and private facilities. Obviously, the majority of people cannot afford private care. The Federal Ministry of Health implemented the Health Sector Development Plan to increase immunization coverage and decrease mortality under 5 years of age. Their Health Extension Program aims to deliver health promotion, immunization and other disease prevention measures plus a small number of curative interventions. Despite these efforts, results are extremely variable. For example, children in urban areas have a 40-70% chance of vaccination, compared to only 20% nationwide, so vaccination rates in rural areas are abysmal.

There are a multitude of problems/challenges contributing to the state of healthcare in Ethiopia. The rest of this article will discuss most of them.

The majority of the population in Ethiopia lives in rural areas. There is also widespread illiteracy and, therefore, dissemination of information is poor. There is relative isolation of large segments of the population from the modern sector. And furthermore, the population is large (second most populous in Sub-Saharan Africa) making it more expensive to take care of healthcare needs.

Funding for healthcare is grossly insufficient. The government spends only $1.00 US per capita on healthcare. Having said that, this is 5% of GDP which fares well compared to many other countries. The problem is the large population and small GDP that make spending on healthcare inadequate. Out-of-pocket expenditures were approximately 85% of private health spending. So there is very little insurance as well.

Healthcare facilities are lacking as well. In Ethiopia, 30% of households live more than 6 miles from the nearest hospital, health center or health station. Urban areas have 4-6% of the total population but 44% of all health facilities. Unfortunately, all facilities, urban or rural, are usually short on equipment, drugs and supplies.

Globalization is seriously affecting this country, with many educated professionals leaving Ethiopia for better economic conditions in better-developed countries, leading to a high turnover of healthcare professionals. There is currently an estimated 2-3 doctors per 100,000 people in Ethiopia. Physician salaries are considered to be the lowest in Sub-Saharan Africa which are low to start with. One government response was to increase the number of medical students training each year but this has not helped significantly yet. The government also introduced a new form of worker, the health extension worker or HEW's, with training in preventive care. In 2005, World Bank reviewed this program and concluded there were skill deficiencies amongst the first group of workers sent into the field.

All things considered, the Ethiopian healthcare system needs serious improvements. The government needs to set this as a higher priority although GDP for the country obviously has to be raised also. In the meantime, Ethiopians need our help desperately. They are extremely grateful for our presence and really take nothing for granted, which is a novel, rewarding environment to work in.