Ethiopia is pioneering a multifaceted, first-of-its-kind strategy to transform its public health system, reaching more than 18 million children under the age of five with lifesaving services. The country’s health leaders are using an approach known as the Ethiopian Collaborative Action Strategy (E-CAS), which was supported by The Task Force for Global Health’s Health Campaign Effectiveness Coalition (HCE Coalition), to improve health care coverage, coordination and efficiency.
The Federal Ministry of Health launched the E-CAS to drive coordination and integration across health campaigns. The strategy served as a platform to dramatically improve efficiency and quality of service. At the core of this initiative was the Integrated Health Campaign, an effort that unified measles vaccines, routine immunizations, nutrition services and Maternal and Child Health interventions.
“This campaign reflects our collective effort to protect the health of children and mothers and to strengthen our health system through collaborative and community-centered approaches,” said Dr. Dereje Duguma, State Minister for Health Services and Programs with the Federal Ministry of Health, at the national launch of the E-CAS in May.
Mobilizing more than 20,000 facilities and health workers, this campaign integrates the delivery of measles vaccines, nutrition and maternal and child health services in a single nationwide effort to access even the hardest-to-reach populations.
A Need for Change
Over the last two decades, increased investments in global health programs propelled research and efforts on select issues, but these programs often operated independently without coordination. Running separate campaigns can cause fragmentation, burden health workers and systems, and result in an inefficient use of resources.
Ethiopia’s Ministry of Health recognized that integration and co-delivery would not only enhance efforts to improve children’s health but also make the campaigns more efficient.
In 2020, Ethiopian officials successfully integrated regional services, such as the combination of measles campaigns with nutrition screening, but there was still a need to do this at the national level.
“Ethiopia’s intentions were already there. They’ve always made efforts to integrate programs, but they didn’t have a systematic approach to really take it forward,” said Chi Chi Amadi, HCE Coalition’s Senior Associate Director for Global Health Policy. “The difference now is that they have a more structured approach that’s led by the government. That’s what the CAS did for them.”
Ethiopia’s Ministry of Health recognized that consolidation using the CAS would improve how health campaigns are planned and carried out. The strategy encourages better teamwork and coordination between governments, funders and partners to make campaigns more efficient and impactful. It aims to create a clear and practical way for everyone to work together at all levels—national, state and local—to improve health outcomes and build stronger, reliable and sustainable health systems.
The CAS framework, developed by more than 50 global, regional, and country-level partners, focuses on 12 recommendations aligned with each part of the health campaign lifecycle: planning and implementation; monitoring, evaluation, research, learning and adaptation (MERLA); and financing. It’s essentially a blueprint that offers ministries of health and their partners a pathway for improving health campaign effectiveness and boosting outcomes.
Implementation and Customization
When Ethiopia decided to adopt this strategy in 2024, the HCE Coalition collaborated with government officials to tailor the framework to meet their specific needs.
“We did a customization workshop involving national experts in health campaigns to introduce what the CAS was. Then, it was adapted to the Ethiopian context, where we identified priority health campaigns such as childhood vaccination campaigns, and mass drug administrations to treat and prevent neglected tropical diseases,” said Dr. Teshome Gebre, The Task Force’s Regional Director for Africa.
The Ethiopian government adopted and operationalized this transformative approach in their health campaigns. This innovative strategy bundles multiple high-impact interventions together, delivering services for measles, nutrition (Vitamin A supplementation, deworming, and nutritional screening), and Maternal and Child Health at the same time. This coordinated approach ensures the efficient and widespread delivery of essential services to underserved communities, optimizing resources and reach.
“They have picked up this strategy that came from a global coalition of partners, but it’s the Federal Ministry of Health who’s leading this,” said Allison Snyder, HCE Coalition Associate Deputy Director. “They are already mostly operating it independently.”
“They launched it. They organized it. They used the tool. They are the ones leading it,” said Dr. Gebre.
Measuring progress
The E-CAS is already demonstrating measurable impact in strengthening health campaigns nationwide. More 18 million children under five were vaccinated against measles, achieving a national coverage rate of 99%. The campaign is also reaching children who have never had a vaccine before. Some 609,506 children (3.4%) have received their first measles dose because of the strategy, compared to 2.4% in 2022. Additionally, 194,346 zero-dose and 211,546 under-vaccinated children were identified and provided with a vaccine that protects against five diseases (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type b), reinforcing the campaign’s critical role in closing immunization gaps across regions.
This integrated approach also played a pivotal role in addressing malnutrition. More than 15.6 million children received Vitamin A supplements, and 11 million were treated for parasitic infections. Nutritional screening was also conducted for 4 million pregnant women and new mothers, enabling the early identification of malnutrition risks and referrals to appropriate services. This level of outreach provides the government with stronger, real-time data to improve nutrition services.
Beyond immunization and nutrition, the campaign expanded access to maternal and child health services. Through screening efforts, 1,309 women with serious childbirth injuries were identified and referred to hospitals. Simultaneously, 48,048 sick children were screened, with most of them being referred to health facilities for treatment. These interventions demonstrated how bundling health services can reduce missed opportunities and expand lifesaving care.
A key driver of this success lies in the adoption of robust, real-time data systems that have revolutionized how progress is monitored and reported. The Ministry of Health is using a multi-layered digital reporting approach, combining the country’s information system platform (DHIS2) with other innovative monitoring tools. This reporting system enables routine data submission from health facilities across the country and offers real-time performance trends and quality monitoring. These integrated platforms track daily performance and help officials quickly identify and fix gaps. This not only enhances operational accountability but also promotes transparency from everyone involved – from national coordination teams to frontline workers. Through this digital ecosystem, E-CAS set a new benchmark for data-driven decision-making in public health interventions
“The E-CAS is designed to integrate, streamline, and amplify the impact of health campaigns across Ethiopia,” said Dr. Sarai Malumo, a World Health Organization program officer. “By fostering collaboration among various stakeholders, including government agencies, non-governmental organizations, and partners, we aim to create a more efficient and equitable health campaign framework.”
“This is one of the largest mobilization efforts I’ve seen in my many years working in public health,” said Dr. Gebre.
New, Sustainable Growth on the Horizon
Ethiopia’s integrated campaign is the model for a new, sustainable model for integrated service delivery and health system strengthening
“Today, the global funding landscape faces unprecedented challenges – shrinking resources, competing priorities and economic uncertainties. In this context, integrating health campaigns is not just a strategic choice but a necessity to maximize impact, optimize limited resources and ensure sustainability. The Ethiopia CAS model demonstrates how collaboration can turn these challenges into opportunities by reducing duplication and leveraging shared investments for greater health outcomes,” said Dr. Malumo of WHO.
The success in Ethiopia offers valuable lessons for other countries facing similar challenges. With contextual adaptation and strong government leadership, the Collaborative Action Strategy framework can be tailored to diverse national settings and expanded to address a broader range of health priorities, from emerging infectious diseases to essential preventive care, serving as a roadmap for building resilient and sustainable health systems.
For more information about the Health Campaign Effectiveness Coalition, email campaigneffectiveness@taskforce.org. For details about how to implement the Collaborative Action Strategy, click here.
