Ethiopia: Numbers Don’t Lie – the Disconnect Between Professional Growth and Financial Reward in Ethiopia’s Health Sector Is a Systemic Crisis

Addis Abeba — Summary of career earnings in real terms

“We save lives but can’t afford rent.” This powerful slogan echoed through the compound of Tikur Anbessa Specialized Hospital in Addis Abeba on Monday morning as health professionals gathered in a peaceful pre-strike demonstration.

As one of Ethiopia’s leading public referral institutions, Tikur Anbessa became a symbolic starting point for what is shaping into a nationwide movement. Health workers across the country are calling for more than just incremental change, they are demanding dignity, fair compensation, and safe working environments. The strike, scheduled to begin today, is the latest in a growing wave of coordinated protests and public outcry aimed at a government that many health professionals say has ignored their pleas for far too long.

From regional states hospitals to online platforms fueled by hashtags like #HealthWorkersMatter and #PayHealthWorkersFairly, the movement is gaining momentum. Demonstrators have raised banners proclaiming, “Healthy Citizens Build a Strong Economy” and “Stop Harassing Health Workers. We Deserve Protection.” Their message is clear: while they uphold their oath to care for others, they can no longer endure the financial and emotional strain of being undervalued and overburdened. Their demands include overdue salary increases, housing allowances, proportional overtime pay, and safeguards against harassment – issues that have festered unaddressed for over five years.

Despite their commitment to protect emergency and critical care services during the strike, tensions are escalating. The arrest of EHPA president Yonatan Dagnew and several other doctors over the weekend has sent shockwaves through the medical community. “We really care for our people,” said one health professional, “but if authorities do harm to those involved in the partial strike, we’ll be forced into a full strike.” The movement’s leaders have made it clear: the health system’s collapse is not their goal, but if pushed, they will not stand idle while their rights are trampled. In their words, this isn’t just about better pay, it’s about reclaiming their humanity.

A consultant physician with nearly two decades of service in Ethiopia’s public health system, and who has witnessed firsthand the widening cracks as the system has been pushed to its limits, shares the following account. The argument is “not an abstract policy critique; it is my lived experience,” in the words of the writer.

A structural imbalance

Ethiopia’s healthcare system is facing a profound structural imbalance: the absence of a meaningful link between professional advancement and financial compensation. Despite the rising demands on physicians – particularly specialists and subspecialists – real incomes have collapsed over the past two decades. This misalignment threatens not just the livelihood of healthcare professionals, but the future viability of the national health system itself.

Salary trends: Nominal gains, real losses

While nominal salaries for Ethiopian physicians have risen significantly over decades, this increase has been entirely outpaced by currency devaluation. I here share my personal salary history, beginning as a medical intern in 2004/05 and progressing to a consultant physician in 2025.

In 2005, as a medical intern, I earned 861 ETB, which was almost $100. After graduating, I worked as a general practitioner in a rural hospital where I received a basic salary of 1435 ETB (~$169) and was provided with free housing. I also received duty payments for a full month and remote-area allowances. In 2008, the government implemented a 70% salary increase, raising my basic salary to 2435 ETB (~$254).

Since then, my salary in ETB continued to rise, reaching 21,491 ETB in 2025 – an almost 25-fold increase. However, my real income (USD equivalent) has declined by more than 80% over the same period due to the significant devaluation of ETB – from 8.7 to 124 ETB/USD.

A loaf of bread or a liter of fuel that once cost 10 ETB now exceeds 100 ETB, while rent in Addis Abeba has surged by over 500%

Now, with nearly two decades of experience, and specialty and subspecialty training, I earn the equivalent of $173/month, roughly what a junior doctor earned two decades ago. This trajectory underscores the alarming erosion of real income for Ethiopia’s most experienced health professionals.

Inflation and the cost-of-living crisis

Currency devaluation is not the only factor eroding real income. Ethiopia has also experienced persistent double-digit inflation, particularly in housing, food, fuel, and transportation. Salaries are not indexed to inflation, leading to a dramatic erosion in purchasing power.

Physicians are grappling with a dual burden: rapidly declining dollar-equivalent incomes and sharply rising domestic costs.

Over the past decade, the cost of living in Ethiopia has skyrocketed, placing immense strain on public-sector professionals. A loaf of bread or a liter of fuel that once cost 10 ETB now exceeds 100 ETB, while rent in Addis Abeba has surged by over 500%. The prices of basic goods and essential services have soared across the board, making it increasingly difficult – if not impossible – for public-sector doctors to maintain a decent standard of living.

Physicians are grappling with a dual burden: rapidly declining dollar-equivalent incomes and sharply rising domestic costs.

Until recently, I was practicing at a tertiary hospital in Ethiopia. However, due to mounting economic challenges, I was compelled to relocate. In the months leading up to my departure, I had not received duty payments or other allowances for over six months. This, combined with the effects of currency depreciation and rising local inflation, made it increasingly difficult to sustain my livelihood. Even with supplementary income from private practice, I struggled to keep up with the escalating cost of living and to provide adequately for my family. Under these circumstances, I had no choice but to leave my country in search of a more stable means of survival.

Regional Comparison: Ethiopia at the Bottom

Ethiopia’s physician compensation ranks among the lowest on the continent, despite comparable or greater demands on its health professionals. In contrast:

• Kenya: Specialists earn $1,500-$3,000/month plus allowances.
• Botswana & South Africa: Specialists typically earn $4,000-$6,000/month.
• Rwanda & Ghana: Targeted retention schemes and salary adjustments have been implemented.

Ethiopia stands out as a country that demands high service from its doctors while offering minimal material reward.

Implications and urgency of reform