Applied Health Economics and Health Policy

, Volume 15, Issue 1, pp 33–43 | Cite as

Economic Evaluation in Ethiopian Healthcare Sector Decision Making: Perception, Practice and Barriers

  • Elias Asfaw ZegeyeEmail author
  • Josue Mbonigaba
  • Sylvia Blanche Kaye
  • Thomas Wilkinson
Original Research Article



Globally, economic evaluation (EE) is increasingly being considered as a critical tool for allocating scarce healthcare resources. However, such considerations are less documented in low-income countries, such as in Ethiopia. In particular, to date there has been no assessment conducted to evaluate the perception and practice of and barriers to health EE.


This paper assesses the use and perceptions of EE in healthcare decision-making processes in Ethiopia.


In-depth interview sessions with decision makers/healthcare managers and program coordinators across six regional health bureaus were conducted. A qualitative analysis approach was conducted on three thematic areas.


A total of 57 decision makers/healthcare managers were interviewed from all tiers of the health sector in Ethiopia, ranging from the Federal Ministry of Health down to the lower levels of the health facility pyramid. At the high-level healthcare decision-making tier, only 56 % of those interviewed showed a good understanding of EE when explaining in terms of cost and consequences of alternative courses of action and value for money. From the specific program perspective, 50 % of the prevention of mother-to-child transmission of HIV/AIDS program coordinators indicated the relevance of EE to program planning and decision making. These respondents reported a limited application of costing studies on the HIV/AIDS prevention and control program, which were most commonly used during annual planning and budgeting.


The study uncovered three important barriers to growth of EE in Ethiopia: a lack of awareness, a lack of expertise and skill, and the traditional decision-making culture.


Economic Evaluation Health Sector Program Coordinator Healthcare Decision Health Economic Evaluation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We would like to acknowledge the Health Economics and HIV/AIDS Economics Research Division (HEARD) at the University of KwaZulu-Natal for its supplementary financial/stipend assistance. The Federal Ministry of Health, Ethiopian Public Health Institute, Federal HIV/AIDS Prevention and Control Office, Addis Ababa City Administration Health Bureau, Dire Dawa City Administration Health Bureau, Amhara Regional Health Bureau, Oromia Regional Health Bureau, SNNP Regional Health Bureau and Harari Regional Health Bureau facilitated the data collection and provided the required evidence. We also appreciate the continuous support with English language editing services by Carol Brammage.

Author contributions

Elias Asfaw Zegeye designed the study, prepared the data collection tools, developed the analysis framework, led the data collection, analyzed the data, and drafted and revised the manuscript. Josue Mbonigaba oversaw the data collection, commented on the analysis plan, and reviewed and revised the article. Sylvia Blanche Kaye oversaw the data collection, commented on the analysis plan, and reviewed and revised the manuscript. Thomas Wilkinson commented on the overall qualitative method and revised the article.

Compliance with Ethical Standards

This research was funded by an African Doctoral Dissertation Research Fellowship award offered by the African Population and Health Research Centre (APHRC) in partnership with the International Development Research Center (IDRC). Elias Asfaw Zegeye, Josue Mbonigaba, Sylvia Blanche Kaye and Thomas Wilkinson have no conflicts of interest to disclose.

Supplementary material

40258_2016_280_MOESM1_ESM.docx (82 kb)
Supplementary material 1 (DOCX 81 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Elias Asfaw Zegeye
    • 1
    Email author
  • Josue Mbonigaba
    • 1
  • Sylvia Blanche Kaye
    • 2
  • Thomas Wilkinson
    • 3
  1. 1.Economics Department, School of Accounting, Economics and FinanceUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.School of Public Management and EconomicsDurban University of TechnologyDurbanSouth Africa
  3. 3.PRICELESS SA, School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa

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