By David Yeh
Eritrea’s health sector has undergone a remarkable transformation over the past several decades. From traditional healing practices to a modern, comprehensive health system, the country has demonstrated sustained commitment, strategic planning, and equity driven policies aimed at improving the well being of its citizens. Despite the challenges of colonialism, war, and resource scarcity, Eritrea has developed a robust health infrastructure, a skilled workforce, and specialized services, positioning it among the leading health systems in Africa.
Historical Foundations: From Traditional Medicine to Modern Health Services
Traditional medicine has a long history in Eritrea, with local communities relying on indigenous healing practices for centuries. The introduction of modern medical care came with Italian colonialism in the late 19th and early 20th centuries. However, these services were largely urban centered, limited in scope, and catered primarily to the settler population.
During the British Military Administration, several clinics and dispensaries were established, but economic crises and infrastructure reductions caused many to close. Following the federation with Ethiopia, the Eritrean administration attempted to expand health facilities, renovate hospitals, and open training centers. However, these initiatives were systematically undermined by Ethiopian resource cuts and bureaucratic constraints, leaving the population with limited access to care.
Amid the armed liberation struggle, health services faced unprecedented disruption. Many hospitals were destroyed, and trained personnel were either forced into exile or drawn into the independence movement. Yet, the Eritrean liberation forces developed an innovative health delivery system, emphasizing two principles: reaching remote populations and prioritizing preventive care over curative measures due to resource constraints.
Mobile and stationary clinics, regional hospitals, and a central hospital in Orotta were established, alongside underground facilities for essential drug production. Training units prepared barefoot doctors, midwives, paramedics, laboratory assistants, and dental technicians. Despite scarce resources and the challenges of conflict, emergency services, primary care, and preventive programs were delivered efficiently, earning recognition as among the most effective in Africa at the time.
Post-Independence Health Expansion
After independence in 1991, Eritrea inherited a severely limited and fragmented healthcare system. The country embarked on an ambitious program to reconstruct and expand health infrastructure while simultaneously developing its human resources. Today, Eritrea boasts approximately 350 health facilities nationwide, including hospitals, health centers, health stations, and clinics a 231% increase from 1991.
Eritrea’s health system is organized into a three-tier structure:
1- Community Based Services: Village health agents serve populations of 500–2,000, focusing on health promotion, disease prevention, and management of conditions such as tuberculosis.
2- Primary Healthcare Facilities (Health Centers and Community Hospitals): Health centers serve 5,000–10,000 people, while community hospitals cover 100,000–200,000, offering inpatient care, maternity wards, surgical theaters, diagnostic laboratories, and radiology services.
3- Referral Hospitals: Regional and national referral hospitals provide advanced and specialized care, including tertiary services, research, and professional training.
Through this system, over 80% of the population is within a 10-kilometer radius of a health facility, and more than 70% within 5 kilometers—an extraordinary improvement in access over just three decades.
Modern Health Achievements
Infrastructure and Human Resources
The expansion of health facilities has been complemented by substantial investment in human resources. From 1991 to 2021:
Hospitals more than doubled.
Health centers increased nearly tenfold.
Health posts and clinics nearly tripled.
The number of healthcare
Professionals has similarly grown:
Nurses: 625 → 1,474
Assistant nurses: 1,220 → 2,918
Dental therapists: 11 → 165
Pharmacists and pharmacy technicians: 97 → 486
Laboratory technicians: 99 → 517
Radiologists: 28 → 132
Physiotherapy technicians: 6 → 140
Specialized doctors: 5 → 74
This workforce growth has been driven by government supported training programs, full coverage of education costs, and strategic recruitment of lecturers and specialists.
Specialized Services
Eritrea has made significant strides in expanding specialized care:
Medical Laboratories: Advanced automated equipment is now standard in hospital labs, enabling rapid HIV diagnosis in infants, cancer markers testing, and comprehensive blood analyses.
Blood Transfusion Services: The National Blood Bank ensures safe blood supply through modern technology and volunteer donations, achieving international accreditation.
Intensive Care Units: Pediatric and infant ICUs have expanded from a single unit to 16 hospitals, covering 57% of facilities.
Ophthalmology: Advanced imaging and surgical equipment have improved eye care, including cataract surgeries and glaucoma management, while anti-trachoma campaigns align with WHO guidelines.
Cancer Care: Specialized services in Asmara allow for domestic diagnostics and treatment, reducing the need for overseas referrals.
Physiotherapy Services: Technicians increased from 6 to 140 between 1991 and 2020, providing rehabilitation for musculoskeletal and neurological conditions.
Quality Medical Education for Securing Society’s Health
A strong pillar of Eritrea’s health sector success is its investment in quality medical education. The Orotta College of Medicine and Health Sciences (OCMHS), established in 2018 through the merger of the Orotta School of Medicine and the Asmara College of Health Sciences, exemplifies this commitment. The college offers undergraduate and postgraduate programs across 11 academic departments and focuses on producing competent, compassionate, and socially responsive health professionals.
OCMHS operates on three guiding principles:
1- Producing new health professionals through robust infrastructure and qualified faculty.
2- Providing specialized training abroad or via distance education for fields not available domestically.
3- Ensuring continuing professional development for health workers to maintain scientific and technological competence.
Since its establishment, the college has graduated thousands of health professionals:
5,727 high- and mid-level health professionals from diploma and degree programs
556 doctors (473 general practitioners and 83 dentists)
Postgraduate specialists in pediatrics, obstetrics and gynecology, surgery, internal medicine, radiology, pathology, and ophthalmology
The college employs 96 faculty members, 75 of whom are Eritreans, ensuring a sustainable local academic capacity.
Asmara University’s Vital Role
Asmara University complements OCMHS by providing advanced academic programs, research, and training in health sciences, biomedical sciences, and public health. Its partnership with OCMHS and the Ministry of Health ensures:
Evidence based education: Health curricula are aligned with international standards and tailored to Eritrea’s population needs.
Research and innovation: Studies in epidemiology, medical sciences, and public health inform policy and clinical practices.
Graduate preparation: University graduates enter postgraduate programs at OCMHS or serve directly in the health system, enhancing workforce capacity.
Interdisciplinary training: Programs in laboratory sciences, public health, and biomedical sciences supply critical personnel for hospitals and community health services.
Together, OCMHS and Asmara University form a comprehensive ecosystem that produces highly trained, locally rooted health professionals capable of sustaining and advancing national health achievements.
Preventive Care and Community Health
Eritrea emphasizes prevention as the cornerstone of its health system. Immunizations, growth monitoring, pre- and postpartum care, nutritional supplementation, and health education are universally free. Chronic diseases including tuberculosis, HIV/AIDS, hypertension, diabetes, and mental disorders are managed at no cost to patients, reflecting the country’s equity driven policies.
The government’s engagement, community participation, and domestic resource allocation have produced notable successes, including the near elimination of HIV/AIDS and malaria, and progress toward eradicating tuberculosis.
In Conclusion
Eritrea’s health sector exemplifies resilience, innovation, and long term vision. From the foundations of traditional medicine to a modern health system with specialized services, the country has achieved impressive improvements in access, quality, and outcomes. Strategic investments in infrastructure, human resources, specialized care, and medical education supported by institutions like OCMHS and Asmara University ensure that Eritrea continues to strengthen its healthcare system while training the next generation of professionals.
The journey of Eritrea’s health sector highlights what is possible when equity, community participation, and sustained government commitment converge, creating a system capable of meeting both present and future health challenges. Eritrea’s experience serves as a model for other developing nations seeking to achieve universal access, high quality care, and sustainable health development.
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