Running out Before having Enough
- Zebeaman Tibebu
- May 9
- 5 min read
The Story Begins:
It has been just over a century since Ethiopia formally entered its relationship with modern medicine. Instead of a story of steady progress, this story has been one of growing pains and unmet needs. Like many low- and middle-income countries, Ethiopia`s healthcare system has struggled under the weight of financial limitations and systemic inefficiencies. Since the inception of this relation, there has always been a critical shortage of essential resources.
The climax
Most pressing among these was the lack of life-saving medications. Even the medicines that are available come at a price far beyond the reach of the average Ethiopian. Budget deficits, foreign currency shortages, and a lack of comprehensive, effective health insurance make the situation worse. Hence, the ability to afford the most basic drug remains elusive for many Ethiopians.
Compared to the world, Medications are cheaply available in Ethiopia. This has been true due to the intervention of local and international organizations that work in concert to alleviate the problem. Subsequently, many medications have been donated to Ethiopia over the years. Local Pharmaceutical sellers source most medications from the cheapest available international markets. But even then, the prices are too high for most.
Yet, the supply is far from enough!
Patients in Ethiopia face multiple hurdles before acquiring medications. The best medications might not be available in the first place. At times, essential drugs are simply not stocked in local pharmacies or hospitals. When Medicines are available, they are not equitably distributed, creating disadvantaged groups. For those privileged enough to acquire the medications, the cost can be crippling.
It`s not uncommon for patients to forego basic needs-foods, school fees, and transportation, to pay for a treatment. Alas! The cost of medications is the minimum expense. If they want full treatment, they have to add doctors' fees, diagnostic fees, etc.
In this brutal arithmetic of survival, medicine becomes a luxury, while health is a privilege.
The Resolution: A Pharmacy Clinic
This unfair reality has given birth to a new trend. Pharmacies have become de facto five-minute clinics. A patient walks in, lists a few symptoms, and walks out with a cocktail of medications, in most cases, broad-spectrum antibiotics or pain killers. No physical exam. No diagnostic test. No proper consultation.
For pharmacists, it's often out of necessity. For patients, it is the cheapest and shortest path to their cure. Their symptoms relieved, their illnesses resolved at times.
Win-Win solution, it seems!
Even in the most advanced healthcare systems, diagnostic errors are inevitable. In Ethiopia, the picture is even more dire: studies suggest that over 50% of hospitalized patients are exposed to medication errors.
What will be the margin in this pharmacy clinics, where one person is the doctor, the lab technician, the nurse, the prescriber, and the dispenser—all in under five minutes, with no tests ?
The story of antibiotic resistance begins
This is the perfect storm for antibiotic resistance.
Though not necessary, bacteria are repeatedly exposed to these drugs. These bacteria learn to fight back. They evolve. And one day, the medicine stops working.
Antibiotic resistance—the phenomenon where bacteria evolve to withstand the drugs designed to kill them. Due to this, antibiotic resistance is rising in Ethiopia at an alarming rate.
The Alarming Statistics
Soaring Resistance Rates: The Majority of bacterial isolates in clinical setups are becoming resistant to commonly used antibiotics.
Multidrug-Resistant Bacteria: Across clinical isolates, 62.9% to 87.4% show resistance to three or more antibiotic classes. in Dessie isolated E. coli species was resistant to Ampicillin, tetracycline, & trimethoprim-sulfamethoxazole. Similarly, Pseudomonas and Proteus species were resistant to almost all antibiotics.
Environmental Red Flags: In Diredawa Multiple Antibiotic Resistance Index (MARI) has significantly increased the wastewater’s course treatment process, showing the proliferation of resistance in the wastewater treatment system
These aren’t just numbers—they are red alerts flashing across our public health radar.
Running Out Before We Ever Had Enough
This is truly a cruel paradox! Ethiopia may be entering an age of “no medication” before ever achieving widespread access to adequate medication. Despite reforms and ambitious national plans, over 80% of Ethiopia’s pharmaceutical supply is still donor-dependent, making the system fragile and unsustainable. Locally manufactured medicines make up a small fraction of the total need and are often limited in scope, with few antibiotics among them.
While high-income countries battle resistance with cutting-edge alternatives and research funding, Ethiopia is struggling to provide first-line drugs, let alone advanced options.
Common antibiotics like amoxicillin, ciprofloxacin, and ceftriaxone—once mainstays of care—are becoming useless in more and more cases. Doctors are forced to treat critically ill patients with medications they know may not work.
We are running out before we ever had enough.
Imagine watching your loved one suffer from a once-curable infection—powerless to help, powerless to heal, with no effective medication.
What’s Fueling the Resistance?
Several dangerous dynamics are propelling this crisis forward:
Inappropriate Antibiotic Use: 6 in 10 adults in Ethiopia self-medicate or use medications not prescribed by a physician.
Substandard and Falsified Medicines: 1 in 6 medicines in Africa are substandard.
Lack of Awareness: In Amhara, only 39.8% of patients understood what antibiotic resistance meant.
Agricultural Misuse: The use of antibiotics in livestock to boost growth and prevent disease is widespread and poorly regulated, facilitating resistant bacteria from farm to fork.
What’s Being Done?
Despite the crisis, Ethiopia is not standing still. There are various efforts undertaken by the government and stakeholders to address this issue. There have been programs to address antibiotic resistance, regulate medication prescription, and dispensing. Even through the one-health approach, various sectors are working together. Initiatives like the Ethiopian AMR Surveillance System (EARS-Net) are now collecting data from sentinel sites. While these are crucial steps, we have a long way to go.
Stories behind the statistics:
The impact is not theoretical—it’s tragically real. Across Ethiopia, stories are emerging of infants dying from sepsis that didn’t respond to treatment, young adults losing limbs from treatable infections, and routine surgeries becoming life-threatening due to ineffective prophylactic antibiotics. These are not isolated cases—they are the early tremors of a much larger quake.
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