Kebede Melaku’s frail voice carries the weight of resignation. “There is no other option but to calmly accept the inevitable death,” he says softly, each word punctuated by his circumstances. His eyesreflect the despair of a man who feels cornered by forces beyond his control.
Now in his mid-70s, Kebede battles a host of health issues. For years, kidney disease has tethered him to Tazma Hospital in Gotera Condominium, while high blood pressure and elevated cholesterol levels– an unholy trinity–add to his burden. Yet, a crisis more relentless than his illnesses looms over him: the skyrocketing cost of essential medications.
In late July, the federal government floated its currency, the Birr, in a bid to stabilize a crumbling economy. The decision, part of a deal with the International Monetary Fund (IMF), unleashed a wave of inflation that has left many Ethiopians gasping for relief. For Kebede, the fallout has been catastrophic.
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A month ago, the prices of nearly all his medicines more than tripled. His monthly ACE inhibitor for blood pressure leapt from 140 birr to 580 birr. The cost of his cholesterol medication jumped from 220 birr to 980 birr, and his vitamins, once 1,000 birr, now cost an overwhelming 4,050 birr.
Kebede, whose legs have weakened to the point of needing a walking stick, is overwhelmed. “I don’t have the money for all of this,” he says, his voice cracking with frustration. With no significant savings and dwindling support, each price increase forces him to choose which medications to forego.
For six years, Kebede has managed his conditions with limited resources. Financial aid from his former employer had softened the blow, but that assistance has run dry. His health insurance, like many others in Ethiopia, excludes chronic illness expenses. Now, he is left with grim prospects, increasingly unable to afford the treatments that keep him alive.
A Currency Floating on Uncertainty
Kebede’s plight mirrors that of many Ethiopians since the government floated the Birr in late July 2024. Intended as part of a broader agreement with the International Monetary Fund (IMF) to address Ethiopia’s critical foreign exchange shortage, the currency reform has sent shockwaves through the economy.
Before the float, the official exchange rate was around 57 birr per USD. Today, that rate has more than doubled to roughly 122 birr per USD. The repercussions are stark: essential medications have become prohibitively expensive, and public hospitals are increasingly out of stock, pushing patients toward private pharmacies where prices are even higher.
The IMF-backed reforms included a four-year, USD 3.4 billion Extended Credit Facility (ECF). An initial USD one billion disbursement was meant to stabilize Ethiopia’s foreign exchange reserves, with further installments contingent on the country’s economic progress. The first review of the program in October 2024 unlocked an additional USD 340.7 million.
Pharmaceutical importer Meles Getachew attributes the price surges directly to the depreciation of the Birr. “The immediate impact of the float has been a sharp rise in import costs,” he explains. With foreign exchange rates now dictated by market forces, the cost of importing pharmaceuticals has soared. At public hospitals, medication shortages are routine, while private suppliers, facing their own rising costs, pass the burden onto consumers.
The IMF remains optimistic, framing the reforms as necessary steps toward long-term economic stability. But for patients like Kebede, long-term optimism offers little solace when survival hinges on today’s prescription refill.
Despite the grim reality, Meles remains cautiously optimistic. “Banks are starting to provide foreign currency allocations within ten days,” he says, suggesting that as supply chains adapt, prices could stabilize. For now, though, the adjustments have left patients in limbo, struggling against a tide of uncertainty and financial strain.
Choices No One Should Have to Make
Each price hike forces Kebede into an impossible dilemma- a balancing act. Should he prioritize the medication that keeps his blood pressure in check or the pills that manage his cholesterol? Either choice leaves him exposed to life-threatening complications.
For Adanech Yasin, managing her heart disease has turned into an agonizing ordeal. Once able to afford a monthly supply of medication, she now scrapes together what little she can to purchase her prescriptions weekly, a stopgap measure that compounds her financial strain. “Getting a three-month supply is unthinkable,” she laments, her frustration mirroring that of countless others navigating Ethiopia’s worsening healthcare crisis.
Adanech depends on four critical medications: Warfarin to prevent blood clots, Lasix to reduce fluid retention, Metoprolol to manage blood pressure, and additional life-saving drugs. Public hospitals, once her primary source of affordable medicines, now rarely have these in stock. Private pharmacies, her last resort, charge prices that have soared beyond her reach. A ten-day supply of warfarin, for instance, has climbed from 200 birr to over 750 birr. For Adanech, every day has become a desperate battle for survival.
A Nation at Risk, a Health System under Siege
Heart disease is the leading cause of death globally and a growing crisis in Ethiopia. Annually, it claims 58,000 lives in the country, where over 2.8 million people live with heart conditions. For these patients, medication is not optional—it is a lifelong necessity.
“Heart disease isn’t like other illnesses,” explains Endale Gebre (MD), president of the Ethiopian Heart Association. “These patients depend on permanent, daily medications.” For many, this means juggling a complex regimen of up to six drugs, such as daily benzathine penicillin injections. But the steep rise in medication prices—some increasing by as much as 300 percent—has created an insurmountable barrier for most.
Even short-term prescriptions, meant to last weeks, are becoming prohibitively expensive, Endale explains. For those requiring surgery, the challenges are even greater. While efforts to expand access to cardiac surgeries have made some progress, the procedures remain scarce, complex, and financially out of reach. Endale estimates that 13,000 to 16,000 people are currently on waiting lists for heart surgery in the country, their conditions worsening as they wait.
Health insurance, once a lifeline for heart disease patients, now offers little relief. Government hospitals are struggling to maintain drug supplies, and shortages have rendered insurance benefits nearly irrelevant. “How many people can afford private pharmacies?” asks Endale, highlighting the reality that thousands are dying simply because they cannot afford their prescribed medications.
The crisis extends to institutions like the Children’s Heart Fund of Ethiopia (CHFE), which provides vital cardiovascular surgeries for children. Fasika Kebede, head of the pharmacy department at the Cardiac Center of Ethiopia, describes a dire situation: price hikes have quadrupled the cost of medications, while shortages limit how many patients can be treated. “What used to serve three patients now barely meets the needs of one,” she explains.
The healthcare crisis has extended to critical surgical procedures, with the cost of essential medications spiraling out of control. Heparin, a blood thinner vital for surgeries, has surged from 200 birr to 850 birr. Propofol, a widely used anesthetic, now costs 900 birr, up from 300 birr. Isoflurane, another crucial anesthetic, has seen its price skyrocket from 2,500 birr to an astronomical 12,000 birr per bottle. Even with these exorbitant prices, supply shortages remain a constant hurdle.
At the Cardiac Center, which once prided itself on providing medications free of charge, rising costs are draining resources at an alarming rate. Medication expenses now dominate the Center’s budget, a stark contrast to pre-pandemic days when foreign donors helped subsidize critical supplies. But dwindling donations since COVID-19 have left the Center shouldering the full burden.
The financial strain has also severely impacted the Center’s capacity to treat patients. Where eight surgeries a week were once the norm, the number has dropped to just two or four. This reduction leaves countless children with heart conditions in limbo—many of whom may not survive the long wait for surgery.
The rising cost of essential medications adds to this bleak reality. Beta blockers, indispensable for managing blood pressure and preventing heart attacks, have nearly doubled in price. Atenolol, a commonly prescribed beta blocker, now costs 205 birr for a ten-day supply, up from 100 birr. Metoprolol, another critical drug, has jumped from 250 birr to 410 birr over the same period.
Statins, vital for lowering cholesterol and reducing heart disease risk, have also seen steep price hikes. Atorvastatin, a widely used statin, now costs 500 birr for a ten-day supply, up from 300 birr. These medications are not luxuries; they are lifelines.
The crisis isn’t limited to heart disease. Asthma patients, for instance, are struggling to access montelukast, a drug that controls symptoms and prevents attacks. Once priced at 140 birr for a ten-day supply, it now costs 285 birr.
Kidney patients face an even starker reality. The cost of dialysis, essential for those with kidney failure, has doubled. A single session now costs between 6,000 and 8,000 birr, compared to 3,000 birr previously. “The rising costs are unbearable for most patients,” says Esete Getachew (MD), founder and CEO of Ethiopian Kidney Care. The organization, which focuses on prevention and provides screenings for diabetes and hypertension, is witnessing an alarming rise in kidney disease across the country.
Esete emphasizes the urgency of addressing these trends. “Kidney disease seems to be rising significantly in Ethiopia,” she says, though she cautions that more research is needed to understand the scale of the problem.
The soaring costs of medications are transforming treatable conditions into fatal ones. For patients, the choice is stark: pay unaffordable prices or forgo treatment altogether.
The implications are devastating. The price hikes are not just financial burdens—they are existential threats, leaving countless Ethiopians with no viable path to recovery. It is the voices and lived experiences of patients like Kebede and Adanech that underscore the human cost of Ethiopia’s economic reforms.They echo a sobering truth: without urgent intervention, healthcare will remain out of reach for millions, turning a preventable crisis into an enduring tragedy.
