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Ethiopia, the second-largest country in Sub-Saharan Africa by population, has made significant strides in improving healthcare and advancing gender equality over the last two decades. These achievements are fueled by sustained economic growth, effective political leadership, targeted investments, and comprehensive health sector planning. Consequently, the country’s Human Development Index (HDI) increased by 73.5% from 2000 to 2021 (1). During this time, infant mortality was reduced by 50%, life expectancy grew by 14.4 years, the expected years of schooling rose by 5.3 years, and gross national income per capita saw a 225% increase (1). Maternal mortality decreased by 61%, and the poverty rate dropped from 44.2% to 23.5%, supported by social protection programs (1) (2),
Despite these significant gains, Ethiopia continues to face deep-rooted health challenges. Communicable diseases remain widespread, while the burden of non-communicable diseases grows. High levels of malnutrition, often compounded by conflict and natural disasters, persist. The health system also contends with limited-service coverage, workforce shortages, gaps in surveillance and preparedness, and an unsustainable financing model.
The Role of CAAP in Ethiopia’s Health Landscape
Against this backdrop, the Collaborative Advocacy Action Plan (CAAP) initiative serves as a strategic mechanism which aims to unify partners, sharpen focus, and enhance accountability across Ethiopia’s health sector. Coordinated by the Clinton Health Access Initiative (CHAI) and with strong leadership from the Federal Ministry of Health, the CAAP plan was developed through a participatory, multi-constituency process that brought together stakeholders from across the health ecosystem.
In September and December 2024, CHAI convened two major consultative meetings to scope and assess national commitments as well as to co-develop the CAAP. The first meeting included representatives from the Ministry of Health, Regional Health Bureaus, UN agencies, academia, donors, youth-led organizations, the private sector (including the Ethiopian Healthcare Federation), and civil society. These sessions laid the groundwork for a common vision and shared ownership.
The second convening, held in December 2024, refined and finalized the advocacy goals and activities based on partner inputs. The process culminated in a strategic document with clearly defined advocacy goals, developed through consensus, and aligned with Ethiopia’s national development priorities. The CAAP plan was officially finalized in April 2025.
Participants at the CAAP Validation Meeting in Addis Ababa
Scoping Review and Assessment of Commitments
To accelerate progress toward global and national health goals, Ethiopia has made 108 commitments across three domains: Maternal, Newborn, and Child Health (MNCH); Sexual and Reproductive Health (SRH); and Adolescent Health and Well-being (AHWB). These commitments align with global, and regional frameworks such as the Sustainable Development Goals, FP2030, the Global Financing Facility, Immunization Agenda 2030, the African Union’s Agenda 2063 and the Maputo Plan of Action. Nationally, they are embedded in Ethiopia’s Health Sector Transformation Plan II, the Health Sector Development and Investment Plan 2022/23–2025/26, the National Reproductive Health Strategy, and the National Nutrition Program, to name a few. These commitments aim to improve the health and well-being of women, children and adolescents (among other population groups) through targeted and integrated interventions addressing key drivers of maternal, child, newborn and adolescent mortality and morbidity. The interventions range from delivery of quality maternal health services to community-based nutrition programs to address severe and acute malnutrition.
Progress has been made in tackling the main factors contributing to maternal, newborn, and child mortality, as well as in improving care quality and increasing government health spending, however, significant disparities in healthcare access remain—especially in pastoralist, rural, and conflict-affected regions. For example, the prevalence of modern contraceptive use is higher in women in urban areas (48%) compared to rural areas (38%). While the national total fertility rate is 4.6 births per woman, it ranges from 2.3 in urban areas to 5.2 in rural areas, where 77% of the population of the country resides. As a result, Ethiopia is not on track to meet the SDG 3 targets.
Ethiopia’s Six Advocacy Goals
The CAAP outlines six advocacy goals (each underpinned by key activities) aimed at mobilizing political will, increasing financing, and accelerating measurable improvements in health outcomes:
Maternal Health: Increase the allocation and efficient use of federal, regional, and global resources for maternal health commodities by 50% from baseline by 2025. The ultimate aim is to reduce maternal mortality from 267 to at least 140 per 100,000 live births by 2030—on the path to the SDG target of 70.
Immunization (EPI): Boost domestic and international funding for immunization by 10% from baseline to reduce the number of zero-dose children by 50% by 2030.
Child Health: Reduce the prevalence of pneumonia and diarrhea among children under five to below 3 per 1,000 by 2030. This goal focuses on strengthening integrated management of childhood illness (IMNCI) and scaling up community-based interventions.
Newborn Health: Expand access to quality Level 2 special newborn care units (SNCU), Kangaroo Mother Care (KMC), and essential newborn care across all public facilities by 2030, ensuring equitable care for small and sick newborns.
Sexual and Reproductive Health (SRH): Advocate for increased funding for family planning commodities, aiming to raise domestic allocations from $1.82 million in 2022/23 to $10.3 million by 2030 through engagement with the Ministry of Finance and Parliament.
Adolescent Well-being (AWB): Reduce teenage pregnancy rates from 13% to 7% by 2030 by delivering tailored information and services to adolescents and enhancing coordination among the Ministry of Health, Ministry of Education, and Ministry of Women and Social Affairs.
These goals provide a results-driven framework for collective action and accountability, with the aim of helping to align stakeholder efforts with national priorities.
Notable Features of Ethiopia’s CAAP Process: Country Owned and Civil Society Coordinated
Several elements make the CAAP process in Ethiopia especially conducive to drive change:
Strong Leadership by the Federal Ministry of Health: The MoH —especially the Minister’s Office, Maternal, Child & Adolescent Health Lead Executive Office and key departments such as Maternal, Newborn and Child Health, SRH and Adolescent Health—played a central role. A scoping review and assessment of commitments, led by the MoH was shared with partners for validation, ensuring transparency and collaboration, and the MoH actively shared its expertise and insights to develop the CAAP goals and activities.
Structured Multi-Constituency Engagement: CHAI conducted a systematic partner mapping to ensure broad representation across the 10 constituencies (including youth led organizations, academic, health care professionals) outlined in the Multi-Stakeholder Platform checklist.
Consultative and Inclusive Approach: The CAAP plan was developed through participatory workshops that encouraged input and consensus-building among all stakeholder groups. This inclusive process aims to ensure shared ownership of the advocacy goals and corresponding activities.
Focus on Feasible Implementation: From the beginning, the CAAP activities were designed to be actionable as well as aligned with ongoing efforts and therefore conducive to joint execution—these positions to the plan well to translate quickly from paper to practice.
Targeted Sub-National Implementation: Given the decentralized nature of Ethiopia’s health system, the plan aims to prioritize engagements with the Regional Health Bureaus to implement key activities.
A Platform for Sustainable Change
As an Ethiopian proverb wisely puts it, “When spider webs unite, they can tie up a lion.” The CAAP initiative in Ethiopia embodies this wisdom. The CAAP plan aims to not only serve as an advocacy framework but also as a collaboration platform for multisectoral coordination and collaboration, transparency and mutual accountability. It prioritizes bringing together government actors, development partners, civil society stakeholders, academic leaders, health care professionals, and youth voices, creating space for new collaborations while reinforcing existing partnerships.
By fostering inclusive dialogue and joint action, the CAAP process reinforces Ethiopia’s ability to sustain and scale progress in MNCH, SRH, and adolescent health and well-being outcomes — even amid economic constraints and evolving donor landscape.
An Invitation to Collaborate
We invite partners to join in implementing the CAAP goals by collaborating on planned and emerging activities.
To express interest in participating in the CAAP initiative, please join the Ethiopia Digital Advocacy Hub and contact: pmnch@who.int
References
1. UNDP. 2022. Ethiopia 2030: A Country Transformed? Options for A Next Generation of Reforms
2. Ethiopian Public Health Institute (EPHI). (2022). Building on Ethiopia's success to accelerate survival of mothers and newborns: More actions needed. Addis Ababa, Ethiopia: Ethiopian Public Health Institute