Photo: Laika ac from UK, Wikimedia Commons, CC BY-SA 2.0Social health insurance in Ethiopia (SHI)
Who must join, who pays and where it stands in 2026
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What social health insurance is
Ethiopia has two public health insurance schemes, both run by the Ethiopian Health Insurance Service (EHIS). Community-based health insurance (CBHI) is for households in the informal economy — farmers, traders, the self-employed. Social health insurance is for the formal sector: people on a salary and people on a pension. The EHIS expects CBHI to cover about 80% of Ethiopia's population of more than 115 million and SHI the remaining 20% (EHIS, August 2025).
The law is short: the Social Health Insurance Proclamation No. 690/2010 has twelve articles. It was published in the Federal Negarit Gazeta on 19 August 2010 and came into force one year later (Art. 12). Its objective is 'quality and sustainable universal health care coverage' through pooling of risks and reducing financial barriers at the point of service (Art. 4). The details — the contribution rate, the benefit package — are left to regulations of the Council of Ministers (Arts. 8–10), the main one being Regulation No. 271/2012.
SHI is not private medical insurance: it is not sold by the insurers supervised by the NBE, and it is run by a public body. For how it fits with CBHI and private cover, see health insurance in Ethiopia.
Who must join
Under Art. 5, employees and pensioners shall be members. The definitions in Art. 2 decide who that is:
| Term | What the Proclamation says (Art. 2) |
|---|---|
| Employer | A public office, a public enterprise, or any person employing at least ten employees |
| Employee | Anyone with three months or more of service, including public officials, management staff, judges, prosecutors, police, members of the House of Peoples' Representatives, salaried members of the House of the Federation and salaried trade-union officials — but not members of the Defence Forces |
| Pensioner | Anyone receiving a monthly pension from the Social Security Agency, including a pensioner's survivors |
| Child | A natural, adopted or stepchild under 18, or a child under the member's legal guardianship |
| Family | The spouse and children, plus children over 18 who cannot support themselves because of a mental or physical impairment |
Every employer must register all its employees with the agency (Art. 5(2)); the Social Security Agency registers pensioners (Art. 5(3)). A pensioner who is re-employed while keeping the pension counts as an employee (Art. 9(5)).
Who pays, and how much
Art. 9 sets the rules; the amounts are left to a regulation:
- Members and employers both pay a monthly contribution (Art. 9(1)).
- Employee and employer pay an equal percentage, calculated on the employee's salary — the monthly pay for regular working hours (Arts. 2(6) and 9(2)).
- The employer deducts the employee's share from the salary and transfers it to the agency on time, together with its own matching share (Art. 9(3)).
- For pensioners, the government adds a contribution, and the Social Security Agency transfers both (Arts. 9(1) and 9(4)).
- The employer must give the agency each employee's salary details on request (Art. 9(6)).
What rate applies in 2026? When the scheme started for public health workers, the press reported that the government pays 6% and employees 3% of the premium (Addis Fortune, press report). That split is not equal, while the Proclamation requires equal percentages from employee and employer; we could not open the text of Regulation 271/2012 or the EHIS directive that would settle it. Check the deduction on your payslip and ask your HR office or the nearest EHIS branch which rate applies to you.
What it covers
Art. 8 says the package includes 'essential health services and other critical curative services', with the particulars fixed by regulation according to the contributions collected. Beneficiaries are the members and their families (Art. 7(1)), and treatment is given in health facilities that have signed an agreement with the agency (Art. 2(4)).
For the 2026 start, the press reported cover at primary, secondary and tertiary levels in government health institutions: health-sector employees are treated at their own workplace and referred for services it does not offer; other government employees use registered public facilities near them (Addis Fortune).
The Proclamation keeps any extra medical benefits granted by a collective agreement under the labour law, and the extra benefits police health institutions give to members of the police (Art. 11(2)). If your employer already offers group medical insurance, SHI does not cancel it.
Members must give accurate information about their family and use the service properly (Art. 7(2)).
Where it stands in 2026
| Date | Step |
|---|---|
| 19 August 2010 | Proclamation 690/2010 published; in force one year later |
| 2010 | The health insurance agency set up by Regulation 191/2010 (Ministry of Health) |
| 2012 | Council of Ministers Regulation 271/2012 on the SHI scheme |
| 9 January 2026 | Roll-out began for registered members who received an SMS confirmation (press) |
| 22 January 2026 | Coverage took effect for government employees of the health sector, as a pilot (press) |
According to the same press report, about 181,000 staff had registered, with 474,958 digital beneficiaries including family members, and 65% of public health centres were contracted to provide services. The EHIS plans to extend cover to non-government sectors, in towns and rural areas, by integrating with the existing community-based schemes.
In practice: if you work in the public health sector, you should already have been registered and see a deduction. If you work for another employer, the law already applies to you, but the roll-out has not reached you yet according to what was published by October 2026. Keep any private medical cover until it does.
The Ethiopian Health Insurance Service
The agency collects and administers the monthly SHI contributions and studies revisions of the benefit package and of contribution amounts. The Ministry of Health lists 24 branch offices across the country. Contact details published by the EHIS: Gotera, around the Pepsi factory, Woreda 7, Nifas Silk Lafto sub-city, Addis Ababa; phone (+251) 011 557 6721/23 or 011 557 6758/36; information desk 9060; ehis@ehis.gov.et.
For other questions about your cover, read health insurance in Ethiopia and the health insurance checklist. How neighbouring countries do it: Kenya's SHA, Tanzania's NHIF and South Africa's medical schemes are compared on public health insurance across Africa.
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Frequently asked questions
What is social health insurance in Ethiopia?
A compulsory health insurance scheme for employees and pensioners created by Proclamation 690/2010 and run by the Ethiopian Health Insurance Service. Employers and employees contribute monthly, and members and their families are treated in contracted health facilities.
Who must join social health insurance in Ethiopia?
Employees with at least three months of service of public offices, public enterprises and any employer with at least ten employees, and pensioners of the Social Security Agency. Members of the Defence Forces are excluded (Proclamation 690/2010, Arts. 2 and 5).
How much is the social health insurance contribution in Ethiopia?
The Proclamation says employee and employer pay equal percentages of the salary, with the amount set by regulation. For the January 2026 start, the press reported that the government pays 6% and employees 3%. Check your payslip and ask your HR office or the EHIS.
When did social health insurance start in Ethiopia?
The law dates from 2010, but implementation was postponed for years. The press reported that cover took effect on 22 January 2026 for government employees of the health sector, as a pilot.
Does SHI cover my family?
Yes. Beneficiaries are the member, the spouse, children under 18 (natural, adopted, step or under guardianship) and older children who cannot support themselves because of an impairment (Arts. 2 and 7).
Is SHI the same as CBHI?
No. CBHI is community-based health insurance for households in the informal sector, with contributions set by each region. SHI is for salaried employees and pensioners, with contributions deducted from salary. Both are run by the EHIS.
Sources
- Social Health Insurance Proclamation No. 690/2010, Federal Negarit Gazeta No. 50, 19 August 2010 (WHO legislation database copy)
- Social Health Insurance Scheme Council of Ministers Regulation No. 271/2012 — WHO legislation database record
- Ethiopian Health Insurance Service — 'Ethiopia and Zimbabwe Connect on Universal Health Coverage' (22 August 2025)
- Ethiopian Health Insurance Service — community-based health insurance results (5 July 2025)
- Ethiopian Health Insurance Service — About us and contact details
- Ministry of Health — Ethiopian Health Insurance (agency profile, Regulation 191/2010, branch offices, contacts)
- Addis Fortune, January 2026 — 'Social health insurance takes effect for public health sector employees' (press report)