Progress towards Universal Health Coverage in Ethiopia: National achievement and regional disparities

Progress towards Universal Health Coverage in Ethiopia: National achievement and regional disparities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Progress towards Universal Health Coverage in Ethiopia: National achievement and regional disparities Shegaw Mulu Tarekegn, Mesoud Mohammed, Agumasie Semahegn, Helina Worku, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9312615/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Regular and timely measurement provides the basis for evaluating how effectively health systems are advancing toward universal health coverage (UHC). In Ethiopia, comprehensive and recent assessments that measure UHC progress across both national and subnational levels remain limited. This study aims to estimate Ethiopia’s UHC Service Coverage Index for 2024 at national and regional levels and identify regional disparities. Methods UHC service coverage was estimated using WHO’s UHC measurement framework. The UHC Service Coverage Index (SCI) was computed using standard 14 tracer indicators, categorized into four domains consistent with global UHC monitoring framework. Data from 2024 national surveys and administrative sources were used. Estimation of the UHC SCI was computed from geometric mean of tracer indicators. Sub-national analysis was done to determine regional disparity in UHC progress Results The overall UHC SCI for Ethiopia in 2024 was 44%, substantially far from Ethiopia’s target of 58% by 2026 and global target of 80% by 2030. It ranges from 23% in Somali region to 64% in Addis Ababa. By domain, the national UHC SCI for infectious diseases was 66%, ranging from25% in Somali to 71% in Dire Dawa. Reproductive, maternal, neonatal and child health (RMNCH) domain scored 53%, ranging from 17% in Somali to 78% in Addis Ababa. The national service capacity and access domain scored 39%, and the non-communicable diseases (NCDs) scored the lowest at 27%. Conclusion The UHC SCI of Ethiopia was found to be low in 2024 and highlights both progress and critical gaps in the delivery of essential health services. The overall and domain specific UHC SCI scores differs at sub-national levels. Ethiopia has achieved progress in infectious disease control and RMNCH, but significant gaps persist in NCDs and service capacity and access. The low performance in NCDs, along with capacity challenges such as limited health workforce density and uneven facility readiness constrains the country’s journey toward equitable and comprehensive health coverage. There are substantial regional disparities, urban administrative areas demonstrating markedly higher service coverage compared to rural settings. Addressing these inequities will require integrated and context-specific strategies that simultaneously strengthen health system capacity, improve geographic access, expand NCD management, and address underlying socioeconomic and cultural barriers. Universal health Coverage Service Coverage index health systems Ethiopia Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 29 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 14 Apr, 2026 Editor assigned by journal 06 Apr, 2026 Submission checks completed at journal 06 Apr, 2026 First submitted to journal 03 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9312615","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626735841,"identity":"e4bb299b-13c3-4011-ac21-07763883fa27","order_by":0,"name":"Shegaw Mulu 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In Ethiopia, comprehensive and recent assessments that measure UHC progress across both national and subnational levels remain limited. This study aims to estimate Ethiopia’s UHC Service Coverage Index for 2024 at national and regional levels and identify regional disparities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUHC service coverage was estimated using WHO’s UHC measurement framework. The UHC Service Coverage Index (SCI) was computed using standard 14 tracer indicators, categorized into four domains consistent with global UHC monitoring framework. Data from 2024 national surveys and administrative sources were used. Estimation of the UHC SCI was computed from geometric mean of tracer indicators. Sub-national analysis was done to determine regional disparity in UHC progress\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe overall UHC SCI for Ethiopia in 2024 was 44%, substantially far from Ethiopia’s target of 58% by 2026 and global target of 80% by 2030. It ranges from 23% in Somali region to 64% in Addis Ababa. By domain, the national UHC SCI for infectious diseases was 66%, ranging from25% in Somali to 71% in Dire Dawa. Reproductive, maternal, neonatal and child health (RMNCH) domain scored 53%, ranging from 17% in Somali to 78% in Addis Ababa. The national service capacity and access domain scored 39%, and the non-communicable diseases (NCDs) scored the lowest at 27%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe UHC SCI of Ethiopia was found to be low in 2024 and highlights both progress and critical gaps in the delivery of essential health services. The overall and domain specific UHC SCI scores differs at sub-national levels. Ethiopia has achieved progress in infectious disease control and RMNCH, but significant gaps persist in NCDs and service capacity and access. The low performance in NCDs, along with capacity challenges such as limited health workforce density and uneven facility readiness constrains the country’s journey toward equitable and comprehensive health coverage. There are substantial regional disparities, urban administrative areas demonstrating markedly higher service coverage compared to rural settings. Addressing these inequities will require integrated and context-specific strategies that simultaneously strengthen health system capacity, improve geographic access, expand NCD management, and address underlying socioeconomic and cultural barriers.\u003c/p\u003e","manuscriptTitle":"Progress towards Universal Health Coverage in Ethiopia: National achievement and regional disparities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-22 16:12:10","doi":"10.21203/rs.3.rs-9312615/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-29T07:58:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228422725149794481798457194329207625049","date":"2026-04-17T04:45:20+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-14T18:42:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-06T17:40:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-06T17:39:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal for Equity in Health","date":"2026-04-03T11:37:59+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-equity-in-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijeh","sideBox":"Learn more about [International Journal for Equity in Health](http://equityhealthj.biomedcentral.com)","snPcode":"12939","submissionUrl":"https://submission.nature.com/new-submission/12939/3","title":"International Journal for Equity in Health","twitterHandle":"@equityhealthj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5cc8e52f-a9d3-432f-8efb-c8004e985300","owner":[],"postedDate":"April 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-04-29T07:58:43+00:00","index":41,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-22T16:12:10+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-22 16:12:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9312615","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9312615","identity":"rs-9312615","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}