Eritrea’s Quiet Revolution in Health Care

Building Access, Equity, and Resilience 

Part I

By Ghidewon Abay Asmerom

Few measures reveal the moral priorities of a nation more clearly than how it cares for people when they are most vulnerable: a mother in labor, a child awaiting vaccination, an elderly patient seeking treatment, or a remote village confronting disease far from paved roads and urban hospitals. In much of the developing world, access to health care is still shaped by geography, income, and inequality. Eritrea has worked to build a different model, one anchored in social justice, grounded in equity, prevention, public ownership, community participation, and universal access.

For Eritrea, independence in 1991 was not simply the birth of a state. It created the opportunity to build institutions designed to serve the entire population, including communities long neglected or excluded from educational and health services. Eritrea’s health progress over the past three and a half decades is not a story of perfection or effortless success. It is a story of deliberate state-building, one clinic, one health worker, one village, and one saved life at a time.

Building Health Service Foundations

At independence, Eritrea inherited a fragile and severely weakened health system. In 1991, the country had 16 hospitals, 5 health centers, and 53 health stations, many poorly equipped, unevenly distributed, and inaccessible to large sections of the population. Rebuilding that system became a national priority.

Since then, Eritrea has steadily expanded its public health infrastructure. By 2025, the number of health facilities had grown to 354, helping bring basic health services within a five-kilometer radius for more than 70 percent, and more than 80 percent of the population lives within a 10km radius of a health facility. This is a significant achievement in a country marked by mountains, semi-deserts, scattered settlements, and difficult terrain.

To make this expansion effective, Eritrea organized its health services into a three-tier delivery system: community-based primary care through health stations, health centers, and community hospitals; secondary care through regional referral hospitals; and tertiary care through  national referral hospitals, mainly in Asmara. This structure allows routine care to reach communities directly while ensuring complex cases move efficiently through an integrated referral system.

Infrastructure alone, however, does not save lives. Eritrea has also invested heavily in human capital. The Ministry of Health now employs over 10,000 workers, supported by institutions such as the nursing schools in Ghinda, Mendefera, and Barentu, and the Orotta College of Medicine and Health Sciences (OCMHS). By 2024, the Asmara College of Health Sciences has graduated 5,727 high and mid-level health professionals. Of these graduates, 2,917 were from the degree program, while the remaining 2,810 were from the diploma program. The Orotta School of Medicine and Dentistry also graduated 556 doctors including 83 doctors of dentistry and 473 doctors of general medicine. 

Additionally in 2025 the Orotta College of Medicine and Health Sciences, awarded postgraduate, first degree, and diploma qualifications to 391 graduates, of whom 55 percent were women—reflecting the institution’s continued commitment not only to expanding the nation’s medical workforce, but also to advancing women’s participation in the health sciences.

The postgraduate graduates specialized in critical areas, including Clinical Medicine, Obstetrics and Gynecology, General Surgery, Internal Medicine, and Pediatrics and Child Health; fields essential to strengthening Eritrea’s specialized healthcare capacity.

Graduates receiving first degree and diploma completed studies including Doctor of Medicine, Pharmacy, Pharmacy Technician, Clinical Laboratory Science, Medical Laboratory, Dental Technology, Radiology, Adult Health Nursing, Anesthesia, Emergency and Critical Care, Midwifery, Ophthalmic Nursing, Comprehensive Nursing, and Environmental Health.

This represents another significant investment in Eritrea’s long-term vision of building a resilient, self-reliant, and increasingly specialized healthcare system capable of serving communities across the nation.

We don’t have the latest breakdown numbers by specific areas of medicine but the  growth in health personnel has been substantial. For example 1997 and 2021, medical doctors increased from 100 to 291, including specialists rising from 5 to 74. Dentists grew from 6 to 59, nurses from 625 to 1,474, associate nurses from 1,220 to 2,979, laboratory personnel from 99 to 517, pharmacy staff from 97 to 486, dental therapists from 11 to 165, radiologists from 28 to 132, physiotherapy technicians from 6 to 140. Notably, the government covers the full costs of education, training, and salaries for all health workers. This expansion of infrastructure and trained personnel created the foundation for measurable improvements in public health. 

Orotta College of Medicine and Health Sciences  graduates an average of about 40 to 60 medical doctors and dentists annually, and on average another 250 other health professionals every year.

Building a Smarter, More Resilient Health System

Eritrea’s health transformation is no longer measured only by the number of clinics built or patients treated. It is increasingly defined by the country’s ability to anticipate, detect, and respond to health threats while delivering more equitable and technologically enabled care.

The introduction of Eritrea’s Digital Health Policy and Health Information and Communications Technology Strategic Plan (2026–2030) marks an important step toward a more connected, data-driven, and nationally owned health system. Health workers will increasingly be able to make evidence-based decisions using reliable, locally generated health information.

Public health preparedness has also entered a new era. For the first time, Eritrea now possesses in-country genomic sequencing capacity, allowing national scientists to identify and monitor viruses and bacteria without sending samples abroad. Fifteen Eritrean specialists have been trained in genomic sequencing, data analysis, and interpretation, significantly reducing turnaround times for outbreak detection and antimicrobial resistance surveillance. 

Routine childhood immunization remains one of the strongest pillars of this system. In 2025, DTP3 coverage remained above 95 percent, while more than 160,000 children under two received their full schedule of essential vaccines, and 44,500 adolescent girls were vaccinated against HPV. For the first time, newborns also began receiving Hepatitis B protection within 24 hours of birth, protecting thousands from mother-to-child transmission from their first day of life.

Vaccine delivery itself has become more resilient. Through solar-powered refrigeration and supply-chain improvements, vaccine cold-chain performance reached an 80 percent Effective Vaccine Management score, up from 71 percent in 2021, ensuring safe storage even in remote communities.

Perhaps nowhere is Eritrea’s integration of health and renewable energy more visible than at Mendefera Referral Hospital in Debub. Once vulnerable to power outages that threatened oxygen supply for premature newborns and emergency patients, the hospital now operates a hybrid solar-powered oxygen system serving a catchment population of over one million people, supplying 65 health facilities and distributing more than 30 oxygen cylinders daily. By securing power where it matters most, Eritrea is building a health system that is digital, climate-resilient, and increasingly self-reliant.

Saving Mothers and Children

Maternal and child health in Eritrea has undergone a profound transformation. By 2025, treatment coverage for pregnant women had reached an exceptional 99.5 percent nationwide, while the share of births attended by skilled health personnel rose from 81 percent in 2024 to 85 percent in 2025, accounting for 66,505 facility deliveries supervised by trained professionals. Nearly 9,000 women benefited from Maternity Waiting Homes, more than 4,000 emergency referrals were carried out through ambulance services, and 1,900 women and girls received treatment for obstetric fistula—further strengthening safe motherhood and access to lifesaving care, particularly in remote communities.

These investments have translated into measurable improvements in survival and life expectancy. Infant mortality has fallen from 35 deaths per 1,000 live births in 1991 to 18 in 2024. Under-five mortality has declined even more dramatically, from 153 deaths per 1,000 live births in 1990 to 35.4 in 2025. Maternal mortality, once a staggering 998 deaths per 100,000 live births in 1991, dropped to 291 by 2025—one of the clearest indicators of the country’s long-term progress in healthcare delivery.

Maternal and child health in Eritrea has undergone a profound transformation. By 2025, treatment coverage for pregnant women had reached an exceptional 99.5 percent nationwide, while the share of births attended by skilled health personnel rose from 81 percent in 2024 to 85 percent in 2025, accounting for 66,505 facility deliveries supervised by trained professionals. Nearly 9,000 women benefited from Maternity Waiting Homes, more than 4,000 emergency referrals were carried out through ambulance services, and 1,900 women and girls received treatment for obstetric fistula—further strengthening safe motherhood and access to lifesaving care, particularly in remote communities.

These investments have translated into measurable improvements in survival and life expectancy. Infant mortality has fallen from 35 deaths per 1,000 live births in 1991 to 18 in 2024. Under-five mortality has declined even more dramatically, from 153 deaths per 1,000 live births in 1990 to 35.4 in 2025. Maternal mortality, once a staggering 998 deaths per 100,000 live births in 1991, dropped to 291 by 2025—one of the clearest indicators of the country’s long-term progress in healthcare delivery.

Eritrea’s gains extend well beyond maternal care. By 2025, immunization coverage had reached 98 percent, while malaria-related mortality had fallen by more than 99 percent, reflecting sustained investments in preventive medicine, disease control, and community-based healthcare. These achievements are mirrored in broader human development indicators: life expectancy at birth has risen to 68.6 years, the total fertility rate stands at 3.65 births per woman, adult literacy has reached 76.6 percent, and youth literacy among those aged 15 to 24 has climbed to 93.25 percent.

Eritrea’s quiet healthcare revolution is therefore measured not merely in facilities built or statistics improved, but in mothers who survive childbirth, children who live beyond infancy, communities once isolated but now served, and a nation steadily building a health system grounded in equity, resilience, and human dignity.

Regional Comparisons 

The table below compares Eritrea’s estimated percentage of infants, children, and youth who die before reaching specific age milestones with those of the seven IGAD member states in East Africa, as well as the continental average for Africa. The data are drawn from Our World in Data.

While the ultimate objective everywhere must be to drive these numbers to zero, comparative trends still matter. And viewed in that broader regional and continental context, the data tell an important story: Eritrea’s infant, child, and youth mortality indicators are moving in the right direction, reflecting sustained progress in child survival, maternal care, immunization, nutrition, and primary healthcare over the past three decades.

The table below compares Eritrea’s estimated percentage of infants, children, and youth who die before reaching specific age milestones with those of the seven IGAD member states in East Africa, as well as the continental average for Africa. The data is drawn from Our World in Data.

While the ultimate objective everywhere must be to drive these numbers to zero, comparative trends still matter. And viewed in that broader regional and continental context, the data tell an important story: Eritrea’s infant, child, and youth mortality indicators are moving in the right direction, reflecting sustained progress in child survival, maternal care, immunization, nutrition, and primary healthcare over the past three decades.

https://ourworldindata.org/profile/health/eritrea#child-health

Table 1. Comparative Overview of Estimated Percentage of Infants, Children, & Youth Who Die Before Reaching Key Age Milestones in Eritrea Relative to the 7 Member States of IGAD

Source: https://ourworldindata.org/profile/health/eritrea#maternal-health and https://ourworldindata.org/profile/health/eritrea#vaccinations

Table 2. Comparative Overview of Eritrea’s Key Health Indicators—Maternal Mortality, Life Expectancy, Childhood and Vaccination Coverage—Relative to the 7 Member States of IGAD

To be continued …

In Part II we will examine Eritrea’s record in combating persistent public health challenges such as malaria, TB, and other major diseases, as well as its handling of the COVID-19 pandemic.