The struggle for good health remains one of the world’s harshest inequalities. For millions of families in low- and middle-income countries, even basic healthcare is a privilege, not a guarantee. Despite breakthroughs in medicine and technology, nearly half the world’s population still lacks essential health services.
In 2023 alone, 14.5 million children missed critical routine vaccines. Another 1.3 million people were newly diagnosed with HIV, and 10.8 million contracted tuberculosis. By 2024, malaria had struck 249 million people — with an overwhelming 90 percent of those cases occurring in low- and middle-income countries.
These sobering numbers set the tone at a recent high-level dialogue hosted by Cordaid and the Embassy of the Kingdom of the Netherlands at the Sheraton Addis on October 14, 2025. Themed “From Local Change to Global Impact,” the event convened policymakers, health experts, and development partners, including Cordaid Country Director Zarir Merat, representatives from the Dutch Embassy, and Ethiopia’s State Minister of Health, Dereje Duguma (MD).
Strengthening Local Systems
At the heart of the event was a shared conviction: sustainable progress in healthcare depends on local leadership. During a panel discussion, speakers emphasized that Cordaid’s work in Ethiopia is rooted in partnership with the Federal Ministry of Health and regional bureaus. Rather than leading projects directly, Cordaid supports local institutions to design and implement solutions.
Officials said the initiative aims to drive long-term improvements through innovative financing models such as Performance-Based Financing (PBF) — an approach that ties funding to measurable results in health outcomes. The program also seeks to foster dialogue among government actors, international partners, and the private sector to secure a stronger national commitment to health system reform.
The broader goal, panelists agreed, is to ensure that advances in global health are not confined to statistics or pilot programs but are felt by families in need — in clinics, homes, and communities across the developing world.
Complementing the discussion was a striking photo exhibition that captured life at the frontline of healthcare delivery. The images portrayed health workers navigating rough terrain, reaching remote communities, and providing care under challenging conditions — a vivid reminder of the people and persistence behind the numbers.
Merat noted that Cordaid has worked in Ethiopia for nearly two decades, primarily in the health sector, while also supporting initiatives in education, livelihoods, agriculture, humanitarian aid, and justice. He described the organization’s approach as holistic: “Each project seeks to connect health and education initiatives, reflecting the interdependence of community needs,” he said.
Smaller, complementary programs, he added, have focused on improving access to education and strengthening resilience through livelihood and humanitarian activities. “This initiative allows us to showcase our work and highlight the long journey we’ve undertaken to help improve Ethiopia’s health sector,” Merat said. “It also reinforces Cordaid’s commitment to prioritizing local leadership in tackling health and social challenges.”
A Call for Partnership
Delivering the keynote address, Paula Schindler, Head of Mission at the Embassy of the Netherlands in Ethiopia, underscored the importance of continued investment in healthcare and collaboration among development actors.
“The photo exhibition serves as a powerful reminder that sustainable progress in healthcare depends on strong partnerships and alignment among all actors,” Schindler said. “When global and national systems successfully converge at the local level, real and visible change takes place.”
She added that the small but steady improvements witnessed within communities are deeply significant. “Effective primary healthcare is built on trust,” she said, “and that trust, once established, safeguards the health of an entire population.”
A Model for Change
When Ethiopia’s Ministry of Health (MoH) first introduced Performance-Based Financing (PBF) in 2015, the goal was simple but ambitious: to improve the quality of care, strengthen accountability, and make data more reliable across the country’s healthcare system.
The pilot phase began modestly, covering 46 health facilities across three distinct regions — Addis Ababa, Central Ethiopia, and Somali. Together, they reflected Ethiopia’s diversity: urban centers, agrarian communities, and pastoralist areas. The results were promising. Quality of care improved, reporting became more consistent, and local health systems began responding better to community needs.
Encouraged by this progress, the MoH expanded the model to the Borena Zone in Oromia — one of Ethiopia’s most remote and pastoralist regions — with support from Cordaid and the Embassy of the Kingdom of the Netherlands. The project again delivered measurable results: stronger accountability, better service quality, and greater access to care. Its success led to further scale-up in the Jimma Zone in 2019 and later into additional regions.
At its core, PBF ties funding to measurable performance. Health centers and hospitals are rewarded for delivering high-quality services, maintaining accurate records, and improving patient outcomes. The system also reinforces governance by requiring verification and linking incentives to data accuracy and transparency.
By aligning with broader national healthcare reforms, the initiative aims to eliminate duplication, improve efficiency, and create a more sustainable financing landscape.
A Model for Reform
Speaking at the event in Addis Ababa, Dereje, the State Minister of Health, praised the collaborative effort. He noted that Cordaid and the Embassy have contributed significantly not only to healthcare but also to water and humanitarian programs that support overall community well-being.
“The pilot in Borena has shown that PBF can make a real difference, even in hard-to-reach areas,” Dereje said. “Based on these results, the government is now working to expand the model to other regions.”
Dereje reflected on the broader transformation within Ethiopia’s health sector — a result of sustained investment and policy focus. Over the past decade, the country has seen declines in maternal mortality and communicable diseases, improved emergency response capacity, and an overall strengthening of primary healthcare.
“These achievements,” he said, “are built on three main pillars: strong government leadership, effective partnerships with development actors, and deep community engagement.”
Even during the turbulence of the COVID-19 pandemic and shifting global funding priorities, Dereje said, Ethiopia’s commitment to maintaining essential services has remained firm. “The government’s commitment is bearing fruit,” he added.
Adapting to Global Shifts
Still, the challenges ahead are formidable. Dereje pointed to a changing global health landscape marked by declining donor assistance, recurrent conflicts, and the mounting effects of climate change. These forces, he said, directly and indirectly threaten health systems, particularly in low- and middle-income countries like Ethiopia.
“We are seeing decreasing financial assistance from donors,” he said. “At the same time, there are more outbreaks, natural and man-made disasters, and conflicts in different parts of the world. These challenges affect the health systems of all countries — especially in Africa.”
Yet he viewed these pressures as opportunities for innovation. Strengthening partnerships, finding new financing mechanisms, and increasing efficiency, he said, will be key to sustaining progress.
In recognition of Ethiopia’s evolving approach, the World Health Organization (WHO) commended the country for aligning its National Action Plan for Health Security and One Health Strategy with the agency’s Triple Billion targets — a global goal to ensure one billion more people benefit from universal health coverage, one billion are better protected from health emergencies, and one billion enjoy better well-being.
WHO described the country’s approach as a “whole-of-government and whole-of-society” effort — a model that builds trust and resilience by ensuring all sectors, from agriculture to education, work together toward a shared vision of health security.
