Expanding ICU capacity in Ethiopia, and why essential care still matters most

A new nationwide study provides the most comprehensive picture to date of intensive care in Ethiopia, and its findings carry an important message for the future of critical care globally.

The study was conducted by the collaborators behind Ethiopian National Critical Care Assessment (ENCCA) and was led by Fitsum Kifle who directs the EECC Hub in Ethiopia, and supports EECC implementation and national critical care initiatives.

Published in BMJ Global Health, the study assessed ICU capacity, service readiness, and patient profiles across 159 hospitals, covering both public and private sectors.

The headline finding is striking: Ethiopia’s ICU capacity has expanded rapidly. Since before the COVID-19 pandemic, the number of hospitals with ICUs has more than doubled, from 51 to 117, and total ICU beds have nearly tripled.

This reflects significant national investment, accelerated during the pandemic, including infrastructure, oxygen systems, and workforce training. Encouragingly, there have also been improvements in staffing, with the proportion of ICUs having 24/7 trained physicians rising from 29% to over 50%.

On paper, this is substantial progress.

But the deeper findings reveal a more complex reality.

Despite this expansion, critical gaps remain. Advanced monitoring and organ support (such as dialysis or invasive haemodynamic monitoring) are still available in only a small minority of facilities. Referral systems are inconsistent, and many hospitals lack the coordination needed to move critically ill patients safely and efficiently through the system.

Most importantly, the study highlights the nature of critical illness itself.

Patients admitted to ICUs were relatively young (average age 39), and many were suffering from conditions like sepsis, respiratory illness, and neurological emergencies. Sepsis alone was present in nearly one-third of patients.

“These findings show that while expanding ICU capacity is important, many patients are still becoming critically ill without receiving timely basic care,” says Fitsum Kifle, lead author of the study. “If we are to reduce preventable deaths, we must strengthen early recognition and ensure essential supportive care is available in every hospital.”

This leads to the study’s most important conclusion: even as ICU capacity grows, many deaths are driven by gaps in early recognition and fundamental care.

As the authors state, these findings “highlight systemic gaps in early recognition and supportive care; this supports scaling Essential Emergency and Critical Care as a foundational platform.”

This aligns closely with what we see across EECC programmes globally.

Most critically ill patients are not treated in ICUs, they are in general wards, emergency departments, and smaller hospitals. And too often, they miss out on simple, life-saving interventions: oxygen, fluids, airway support, and monitoring.

The implication is clear.

Expanding ICUs is important. But it is not enough.

Health systems must also ensure that every critically ill patient, wherever they are, receives essential care. EECC provides a practical, scalable way to do this: strengthening early recognition, standardising basic interventions, and embedding life-saving processes across all hospital settings.

Ethiopia’s progress shows what is possible with investment and leadership.This study shows what must come next.

To truly reduce preventable deaths from critical illness, ICU expansion must be matched with system-wide delivery of Essential Emergency and Critical Care.

Because for most patients, survival does not begin in the ICU. It begins with getting the basics right.