Ethiopia

Flag of Ethiopia

Ethiopia is a landlocked nation in the Horn of Africa covering roughly 1.1 million km², bordering Eritrea, Djibouti, Somalia, Kenya, South Sudan, and Sudan. Its topography ranges from cool central highlands and mountains to hot, arid lowlands. The capital is Addis Ababa, and health governance is organized subnationally across 14 health administrative units.

Healthcare System in Ethiopia
Ethiopia’s healthcare system is largely publicly financed and decentralized across federal, regional, and woreda (district) levels. Primary care relies heavily on community health posts and health centres—supported by the Health Extension Program and health extension workers—while secondary and tertiary services are delivered by referral hospitals.

Cervical cancer burden and HPV in Ethiopia
Cervical cancer is the leading cause of cancer death among women in Ethiopia and one of the most common malignancies overall. Each year, an estimated 7,400–8,200 women are diagnosed and 5,300–6,000 die from the disease, with many presenting at advanced stages due to limited screening and late care-seeking. HPV 16 is the dominant high-risk type, but Ethiopia also shows a relatively high contribution from non-16/18 genotypes such as HPV 52, 35, 58 and 31, which together account for a substantial share of invasive cancers. Although HPV vaccination was introduced in 2018 and expanded through catch-up campaigns, coverage and series completion remain uneven, especially in rural areas, and awareness of cervical cancer and screening is still low.

What we do in Ethiopia
Ethiopia is ETiCCS’s longest-standing field site. Since 2015, we  collaborate with the Public Health and OBGYN departments of the  University of Gondar to improve cervical cancer control in northwest Ethiopia. In BMBF- and BMZ/EKFS-supported projects, we established HPV testing (careHPV) and dual-stain cytology, introduced digital data management for screening, and helped set up a dedicated colposcopy clinic at the University of Gondar’s OBGYN department. More recent work includes a community-wide, home-based screening program in Dabat District using HPV self-sampling, as well as the introduction of VIA-enhanced digital imaging (VIA-DC) with thermocoagulation and training of nurses in three rural health centers. We have facilitated numerous mentoring visits by German gynecologists over eight years and supported multiple study visits for Ethiopian gynecologists to German dysplasia clinics. In parallel, we collaborate with local laboratories including the Ethiopian Public Health Laboratory, and the Department of Microbiology, Immunology and Parasitology at Addis Ababa University on advanced HPV diagnostics (cobas4800, AID HPV-DNA array). These activities aim to create a scalable, digital, HPV-based screening and treatment pathway tailored to rural Ethiopian realities.

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