Health Service Quality Directorate

Equity and quality, which is one of the four transformation agendas, is the core goal of the health sector transformation plan. Ethiopian National Healthcare Quality Strategy, which was launched in March 2016, builds on the plan laid out in HSTP to further align key stakeholders across prioritized interventions that will drive large-scale improvement in quality of care delivery over five years. The ultimate aim is to consistently improve the outcomes of clinical care, patient safety, and patient-centeredness, while increasing access and equity for all segments of the Ethiopian population, by 2020. 

Informed by the National Healthcare Quality Strategy a quality structure was established at federal level; the Health Services Quality Directorate to set the quality agenda across Quality Planning, Quality Control, and Quality Improvement, and drive this quality agenda forward.

N.B: A similar structure is being established in all regional health bureaus as per their context. All public hospitals currently have a clinical governance and quality improvement unit leading Quality Improvement in the facilities.



Duties and responsibilities

  1. The directorate will play a crucial role in leading the Quality agenda throughout the sector, and in grounding the concept of quality in all its forms at the all levels in the healthcare system, and in doing so:
    • Design and implement national initiatives that will improve the quality of the health service delivery.
    • Develop standards, protocols, manuals and implementation guidelines for the services provided in health facilities.
  2. The Quality Directorate will test, refine, and finalize quality indicators across all levels of the health care system. Using the principles of quality improvement, the proposed quality indicators outlined in the following section should be tested and further prioritized by the Quality Directorate and multi-disciplinary Quality Steering Committee.
  3. The Directorate will facilitate the selection of facilities to develop their own QI capacity, providing guidelines and a roadmap for achieving this, as well as building a learning system for facilities to improve.
  4. Health Services Quality Directorate, of the Federal Ministry of health now promotes the Model for Improvement & Kaizen, quality improvement methodologies to be adopted across multiple sectors in the country, and as such the Directorate will be responsible for advocacy as well as capacity building around these models.


  1. The Directorate will be instrumental in ensuring quality is linked with the expansion of health coverage. Linking quality explicitly with expanding health care coverage and access is perhaps the largest opportunity to create impact in the next 3-5 years.
  2. Beyond linkage with the expansion of health coverage, the Quality Directorate would more broadly engage with stakeholders who are doing work on other initiatives linked with quality.
  3. Participating in and holding different national and international conferences, meetings, training and other collaborative experience sharing sessions



Priority areas


     The   National Healthcare Quality Strategy   focuses   on   improving   quality   across   the   spectrum of   the   health   care   system   with   special    emphasis    on    5    priority       areas:


      ·     Maternal, Neonatal & child health, specifically reducing maternal & neonatal mortality

      ·     Malnutrition, especially   prevention/management of severe acute malnutrition

      ·     Communicable diseases, particularly Malaria, HIV & TB

      ·     Non   communicable   diseases   prevention/management, particularly DM, Epilepsy, Breast and Cervical Cancer, cardiovascular diseases, mental health, and chronic respiratory diseases

      ·     Clinical   & Surgical services




EHAQ: The Ethiopian Hospitals Alliance for Quality (EHAQ) is a platform that is meant to transform our healthcare system into one that works better for the Ethiopian people.

EHAQ is learning collaborative where health facilities are clustered in small groups to exchange knowledge, best practice and resources with each other. This initiative will empower all health facilities to develop quality improvement initiatives.  

Each network consists of a Lead hospital (selected based on performance in the last cycle of the EHAQ), a Co-Lead Hospital (usually a university hospital) and a group of member hospitals to which the Lead and Co-Lead hospitals provide direct assistance in implementing health service quality improvement initiatives.

So far two cycles, focusing on improving patient satisfaction and MNCH services, have been successfully completed and many public hospitals have tremendously improved their healthcare services delivery through graduating, (being recognized and awarded as best performing hospitals and clusters across the country). The current cycle focuses of Quality of Care and Saving Lives Through Safe Surgery.


EHSTG: The Ethiopian Hospital Services Transformation Guidelines (EHSTG) builds on and expands the Ethiopian Hospital Reform Implementation Guidelines (EHRIG) and are consistent with the Health Sector Transformation Plan (HSTP). The EHSTG, which is consistent with the national focus on quality improvement in health care, contains a common set of guidelines to help hospital Chief Executive Officers, medical directors, managers, and clinicians (care providers) in steering the consistent implementation of these transformational systems and processes in hospitals throughout the country. It has been availed

HSTQ: The Health Sector Transformation in Quality (HSTQ) document is developed to facilitate and sustain the implementation of the HSTP, and in particular, the transformation agenda of quality and equitable health care in health facilities and community as a whole.  Accordingly, this guideline is composed of four sections which are; QI Guideline, Quality Structure, Clinical Audit Guideline and Health Service Quality Standards. The HSTQ manual in synergy with the EHSTG guidelines, are going to be the main tools to transform the administrative and clinical process of hospital functions. Using these tools, the Ministry of Health has launched nationwide quality improvement initiatives which is going to be operationalized and catalyzed through the EHAQ platform.

SaLTS: In response to the huge unmet need for essential surgical and anesthesia care in Ethiopia and as a result of the World Health Assembly resolution on surgery, the FMOH designed a national flagship program: Saving Lives Through Safe Surgery (SaLTS). The development of this initiative has been informed by critical discussions with relevant stakeholders, and available evidence has been explored to enrich the concept of the SaLTS. SaLTS is designed to make essential surgical and anesthesia care available and accessible to all segments of the population of Ethiopia. Designed to perfectly align with the national quality strategy and the HSTP, the SaLTS initiative will build on the existing reform agendas including but not limited to the Ethiopian Hospitals Reform initiative and utilizes the EHIAQ as a platform for rapid scale-up. The SaLTS program will build on existing successful approaches of the Ethiopian Health Sector Plan, and priority will be given to identify local best practices for rapid scale-up using the EHAQ platform for scale of best practices. The initiative will also embolden the successful approach of strengthening the health system building blocks/pillars.