Ethiopia
A large, low-income federal country that started and then lost domestic oral morphine production, which tests how durable a single-manufacturer supply is.
8 domains reviewed · 8 high-confidence · 2 dated estimates · 9 material gaps
WHO region: Africa. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 8 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 12
- Sources behind this dossier
- 13
- Newest source 2026
Lessons from Ethiopia
- Ethiopia and Nepal both show a single domestic manufacturer can stop and take national supply with it. Supply is safer with more than one licensed producer and a reserve.134
- A national target for palliative care in half of public facilities was set while morphine was running out and staff did not know the guideline. Targets need supply and dissemination attached.136,134
- Physician-only prescribing left rural facilities with no prescriber at all. Any system that limits prescribing to physicians faces the same rural gap.135
- Hospice care from a single NGO in the capital depends on donors and volunteers and cannot keep up with demand without formal referral links from public hospitals.293,136
- Where holy water and healers are a first step in care seeking, trusted religious and traditional institutions may be partners for earlier referral and psychosocial care.427,428
- Enforcing prescription-only dispensing of tramadol and pethidine in retail outlets and easing regulatory barriers to morphine for palliative care can be pursued together.614,138
Palliative care
Is morphine available in Ethiopia?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
A 2009 working group of the ministry, supply agency, regulator and industry led to local oral morphine syrup from 2009. The single manufacturer stopped in 2012, facility stocks ran out by 2014, and imports did not meet demand as cancer services expanded.134
What is national consumption, and has any manufacturer resumed production?
Help answer it:Search PubMedHow does Ethiopia regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
Morphine is on the essential medicines list and distributed through the government supply agency. A national guideline made palliative care a pillar of the health sector transformation plan, but front-line staff were often unaware of it.134,136
Which regulation governs controlled-substance stocking and dispensing, and when did it last change?
Help answer it:Search PubMedWho can prescribe morphine in Ethiopia?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
Only physicians may prescribe morphine, even in rural facilities with no physician, which nurses contrast with Uganda and Tanzania.135
Has any move been made to extend prescribing to nurses or health officers?
Help answer it:Search PubMedHow does palliative care reach patients in Ethiopia?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
- 50 percentSOURCE-CHECKED · 2020 DATA
National target for public health facilities offering palliative care by 2020, Ethiopia, 2020136
Last checked 2026-09-24.
Cite this figure: - 24 centresSOURCE-CHECKED
Oncology centres, expanded from one, Ethiopia, 2023134
Last checked 2026-09-24.
Cite this figure:
Services remain concentrated in Addis Ababa, with NGO hospice provision, while cancer treatment expanded to many oncology centres. The national target for palliative care in public facilities was set without the drug supply to support it.136,134
How many palliative services operate, and in which regions?
Help answer it:Search PubMedWho pays for palliative care in Ethiopia?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Services are largely donor-dependent, private home care is unaffordable for most, and community-based health insurance helps access where patients are enrolled.138
Does community-based health insurance cover opioids and palliative visits?
Help answer it:Search PubMedHow are palliative care clinicians trained in Ethiopia?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
- 7 physiciansSOURCE-CHECKED · 2020 DATA
Pain medicine and palliative care fellowship, first class, Ethiopia, 2020137
Last checked 2026-09-24.
Cite this figure:
A two-year pain and palliative care fellowship was piloted in Mekelle, with plans for other university hospitals. Undergraduate teaching is largely theoretical.137,135
Has the fellowship been recognised as a subspecialty, and how many have graduated?
Help answer it:Search PubMedHow does Ethiopia prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
In a simulated-client study in one town, community drug outlets dispensed tramadol and pethidine without prescription, filling 60.5% of direct requests by name. Patients and key informants in Addis Ababa and Sidama described opioid shortages and restrictive opioid regulations that undermine palliative care for women with breast and cervical cancer.614,138
Does Ethiopia offer methadone or buprenorphine treatment or naloxone, and how are retail dispensing rules enforced without cutting morphine supply to palliative care?
Help answer it:Search PubMedHow do children get palliative care in Ethiopia?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
How many children with life-limiting conditions in Ethiopia receive palliative care, which facilities provide it, and are child-appropriate oral morphine formulations stocked?
Help answer it:Search PubMedHospice care in Ethiopia
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Ethiopia?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Hospice in Ethiopia centers on Hospice Ethiopia, a non-governmental organization in Addis Ababa that runs day care and home-based hospice services with community volunteers. The same sources describe it as the main palliative care NGO, and palliative care entered the government system in 2015, so hospice and palliative care overlap in this literature.292,293
When was Hospice Ethiopia founded, and do any faith-based or public inpatient hospices exist?
Help answer it:Search PubMedWho can get hospice care in Ethiopia?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
Community volunteers help Hospice Ethiopia find patients at home, and hospital staff rarely link patients to home-based care centers because of high workload. These findings come from one qualitative study in Addis Ababa and report no formal admission criteria.293
What diagnosis, prognosis or residence criteria does Hospice Ethiopia use for enrollment, and at what disease stage do patients arrive?
Help answer it:Search PubMedWho pays for hospice care in Ethiopia?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
NGOs such as Hospice Ethiopia that provide home-based palliative care are described as fully donor-dependent. NGO and faith-based coordinators report fewer donors supporting patients than in earlier years.136,294
How many people reach hospice in Ethiopia?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
The few palliative care and hospice services are mostly in Addis Ababa, and services in one rural region were largely limited to people with HIV. The enrollment capacity of the home-based center limited access in the capital (qualitative data).136,293
How many patients does Hospice Ethiopia serve each year, and what share of people dying in Ethiopia does that represent?
Help answer it:Search PubMedWhat fills the gap in Ethiopia
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Lung cancer patients at three tertiary hospitals described family encouragement as a trigger for seeking care. Families sold assets, borrowed money and took on debts to pay for treatment.427
Subnational evidence- Faith communities
Ethiopian patients with lung or breast cancer often used holy water, herbal remedies or traditional healers before or alongside hospital care. In a survey of 1177 adults starting HIV treatment in Oromia, many believed holy water could cure HIV, a belief linked to Orthodox Christian religion.427,428,429
Subnational evidence- Volunteers and compassionate communities
Three home-based palliative care programs in Addis Ababa and Yirgalem relied on voluntary caregivers alongside family caregivers. Patients and caregivers said the programs focused on symptoms, with limited psychosocial, spiritual and economic support.430
Subnational evidenceSelf-reported- Community health workers and home-based care
In Addis Ababa, the link from facility to household care was weakened by opioid scarcity, a lack of community volunteers and health extension workers not linking patients to services. Home-based centers had limited enrollment capacity.293
Subnational evidenceSelf-reported
Sources cited here
- 134Fentie AM, Belete A, Selam MN.
Challenges of access to oral morphine medicine: palliative care at a crossroads for cancer patients in Ethiopia. Journal of Pain Research 2023;16:1829-1833. DOI 10.2147/JPR.S410944. A 2009 technical working group of the health ministry, supply agency, regulator and industry; local oral morphine syrup produced from 2009 until the manufacturer stopped in 2012; stock ran out by 2014; imports insufficient; expansion of cancer care to many oncology centres. Full text read.
- 136Aregay A, O'Connor M, Stow J, Ayers N, Lee S.
Perceived policy-related barriers to palliative care implementation: a qualitative descriptive study. Palliative Care and Social Practice 2023;17:26323524231198542. DOI 10.1177/26323524231198542. A national palliative care guideline, palliative care as a pillar of the health sector transformation plan, a target of palliative care in half of public facilities by 2020, and front-line staff unaware of the guideline. Full text read.
- 135Aregay A, O'Connor M, Stow J, Ayers N, Lee S.
Perceptions of barriers to using opioid analgesics: a mixed methods study. Palliative Medicine Reports 2023;4(1):249-256. DOI 10.1089/pmr.2023.0021. Survey and interviews with nurses in one region in 2018: only physicians may prescribe morphine, even where no physician is present, in contrast to Uganda and Tanzania. Full text read.
- 138Deribe KS, Shewaye S, Habtamu NS, Wondimagegnehu A, Azmera YM, Addissie A, et al.
Multi-level determinants of comprehensive palliative care delivery for breast and cervical cancer patients in Ethiopia: using the socio-ecological model as an analytical framework. BMC Palliative Care 2026;25(1). DOI 10.1186/s12904-026-02300-z. Abstract read. Donor-dependent services, unaffordable private home care and community-based health insurance as an enabler of access.
- 137Abdi S, Dmitrovsky E.
Building an interdisciplinary pain medicine and palliative care program in Ethiopia. Journal of Global Health 2020;10(1):010317. DOI 10.7189/jogh.10.010317. A two-year pain medicine, palliative care and hospice fellowship piloted at Ayder Specialty Hospital, Mekelle, with a first class of physicians and plans to expand to other university hospitals. Full text read.
- 614Zeleke TK, Worku MC, Tegegne BA, et al.
Simulated client study on the dispensing practices for narcotic and psychotropic medications in community drug outlets in Ethiopia. Drugs Context 2025;14. Simulated client study of 38 community drug outlets in Debre Markos; high non-prescription dispensing of tramadol and pethidine; single-town scope. Abstract read.
- 430Kaba M, de Fouw M, Deribe KS, et al.
Palliative care needs and preferences of female patients and their caregivers in Ethiopia: A rapid program evaluation in Addis Ababa and Sidama zone. PLoS One 2021;16(4):e0248738. Rapid qualitative evaluation of three home-based palliative care programs including 15 voluntary caregivers; a co-author is affiliated with Hospice Ethiopia, which runs home-based care, so this is partly a program self-evaluation. Abstract read.
- 292Carey N, Abathun E, Maguire R, et al.
Co-design and prototype development of the 'Ayzot App': A mobile phone based remote monitoring system for palliative care. Palliat Med 2023;37(5):771-781. App co-design study with Hospice Ethiopia and one Addis Ababa hospital that also describes Hospice Ethiopia's day care and home-based hospice services; co-authors are Hospice Ethiopia staff. Full text read.
- 293Abate Y, Solomon K, Azmera YM, et al.
Barrier analysis for continuity of palliative care from health facility to household among adult cancer patients in Addis Ababa, Ethiopia. BMC Palliat Care 2023;22(1):57. Qualitative study (25 participants) at two Addis Ababa hospitals and Hospice Ethiopia on barriers to linking facility and home-based care; one co-author is from Hospice Ethiopia. Full text read.
- 294Negasa EH, Human SP, Roro AG
Challenges in Palliative Care Provision in Ethiopia: An Exploratory Qualitative Study. J Pain Res 2023;16:3405-3415. Qualitative study (29 interviews, 5 focus groups) in Ethiopia including hospice managers and NGO coordinators; reports falling donor support. Full text read.
- 427Estifanos N, Egata G, Addissie A, et al.
Pathways to lung cancer diagnosis and treatment among patients in Ethiopia: A qualitative study. Sci Rep 2026;16(1). Interviews with 33 lung cancer patients at three tertiary hospitals describing self-management with home remedies, herbal treatment or holy water before care seeking, and families selling assets or borrowing to pay for care. Abstract read.
- 428Gebremariam A, Addissie A, Worku A, et al.
Perspectives of patients, family members, and health care providers on late diagnosis of breast cancer in Ethiopia: A qualitative study. PLoS One 2019;14(8):e0220769. In-depth interviews with 23 participants at one Addis Ababa oncology clinic describing use of holy water and traditional healers alongside or before hospital care. Abstract read.
- 429Tymejczyk O, Hoffman S, Kulkarni SG, et al.
HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia. AIDS Behav 2016;20(5):998-1008. Survey of 1177 adults starting ART in Oromia region measuring beliefs about holy water and HIV care, with belief in holy water linked to Orthodox Christian religion. Abstract read.