Summary
- IHI’s Chief Impact Officer reflects on more than a decade of work in Ethiopia, marking 10 years of IHI’s in-country office and the partnerships, leadership, and learning that have shaped lasting health system change.
When I stood on stage in Addis Ababa last year at a national conference convened by Ethiopia’s Ministry of Health, the Ministry of Innovation and Technology, IHI, and other international partners, I was deeply moved. That moment was more than recognition and celebration for IHI; it was a powerful symbol of what many years of trust, alignment, co-creation, persistence, and shared purpose can make possible.
Ethiopia’s journey reminds us that true system transformation is never quick — and that is precisely its strength. Transformational change begins with priority setting and creating an enabling environment for big and bold ambitions to be articulated and operationalized. For IHI, this has meant partnering with the national government early on to co-create Ethiopia’s first National Health Care Quality and Safety Strategy, which provided the roadmap for IHI’s ensuing work with federal, regional, and district leaders and health care practitioners around the country.
This transformation has endured and evolved through building improvement science capability so deep and wide that it becomes part of the health system’s fabric, alongside driving towards strategic and visible improvements in maternal and newborn health at scale. Prioritizing capability building alone results in a training program without assurance of improvements while prioritizing visible results alone risks generating impressive results that cannot be sustained. IHI believes it is crucial to invest in both strategies, so we are incredibly pleased and honored to celebrate our 12-year journey with all our partners in Ethiopia, in particular the Ministry of Health and the Gates Foundation.
IHI’s Roots in Ethiopia
Ethiopia became part of IHI’s global journey in 2013, when we began working closely with the Ministry of Health, Regional Health Bureaus, and local health offices. A turning point came in 2016 when we opened IHI’s Ethiopia office, with support from the Gates Foundation. From a single staff member, the office grew into a team of 30 supported by strong operational systems, in-country partnerships, and investments from major funders including the Gates Foundation, the Margaret A. Cargill Philanthropies, Elsa & Peter Soderberg Charitable Foundation, and the US government through USAID. Even as funding shifted and conflict disrupted services, the IHI Ethiopia team adapted, making difficult financial choices, forging new partnerships, and keeping program impact at the center. IHI is honored to have had the opportunity to train thousands of health professionals in improvement science, and to support peer-to-peer networks that facilitate learning and data-driven improvement.
IHI’s work to improve the quality of care for mothers and newborns has contributed significantly to Ethiopia’s notable maternal mortality reduction to 141 per 100,000 live births, and neonatal mortality to 25 per 1,000 live births. In districts supported by IHI through its Networks of Care project, perinatal mortality fell by 31 percent (from 20.8 to 14.3 per 1,000 live births). In one high-volume hospital where maternal deaths occurred every two weeks at baseline, data-driven improvement methods reduced the frequency of maternal deaths to approximately one every six weeks. These outcomes create momentum to further apply improvement science at a broader scale in support of the country’s efforts to achieve the United Nations’ Sustainable Development Goal targets.
Central to this success over the last decade is the Ethiopia team, led by Dr. Abiyou Kiflie. They are a group of passionate, technically skilled professionals whose energy, commitment, and relationship management skills inspire partners at every level of the health system. They have leveraged local data, empowered providers to use it for learning and improvement, and fostered the translation of local ideas into solutions for real-world health care challenges. I am inspired by how thoroughly and consistently they have engaged partners at every level from frontline health workers to national policymakers. Their work reflects the best of Joseph Juran’s Quality Trilogy: planning with purpose, improving through learning, and sustaining through policy and quality control.
Major Milestones
Locally Inspired, Globally Relevant
The lessons we’ve learned in Ethiopia are shaping how we think about impact across IHI’s work globally. They challenge us to be more intentional about how we design for sustainability and scale from day one, invest in local leaders who carry the work forward, and choose long-term sustainable impact over short-term wins. Most importantly, we are applying our experience in Ethiopia to other countries and contexts. We are taking the discipline of partnering early with the government, the focus on data for learning, and the patience to build lasting local capability in improvement science deep and wide in the health system. By doing so, what has worked so powerfully in Ethiopia becomes a catalyst for better health outcomes everywhere we work.
Looking ahead, our work in Ethiopia inspires us to dream bigger. It reminds us that bold partnerships and patient commitment are how we will achieve Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages. We can — and must — build health systems where quality is not an aspiration but a guarantee, a future where every person, in every setting, has the care they need to live not just longer, but healthier and more fulfilling lives.
This post is adapted from Enat Ethiopia: 12 Years of Saving Lives. Read the full report to explore the depth and breadth of IHI’s quality improvement work in Ethiopia.
Dr. Nana A. Y. Twum-Danso, MD, MPH, FACPM, is IHI’s Chief Impact Officer.
Photo by Bezawit L, IHI Ethiopia
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