Table 3.

Institutions’ plans to reduce the impact of OOP payment in Ethiopia, 2021

Institution	Planned actions	Quotes from participants
EHIA	Implement SHI system	‘……The SHI system is already in the planning stages for its introduction. I’m hoping it (SHI) will be implemented as soon as possible. We (EHIA) are just waiting for the government to give us directions to proceed.’ (Male, health officer 4, EHIA.)
	Expand the CBHI coverage	‘……we have prepared different strategies to increase the CBHI coverage and to extend its membership across the country.’ (Male, health officer 1, EHIA.)
	Implement medicine specific strategy for CBHI	‘…We intended to boost medicine availability and reduce OOP exposure for our members. The policy, titled “Ethiopian drug selection, pricing, and reimbursement policy,” was prepared by us (…). As a result, we have prepared an action plan and are awaiting approval. Then, during the next six months of this year, we expected to begin implementing it (Ethiopian medication selection, price, and reimbursement strategy).’ (Female, pharmacist 3, EHIA.)
Healthcare service providers (Hospitals)	Improve the quality of data used in forecasting medicine	‘…currently, we are converting it (the medicine supply system) to a computerised system, and I believe this will yield positive results in the future.’ (Male, pharmacist 7, Saint Paul Hospital Millennium Medical College.)
	Make service price revisions	‘…If the current trend of budget deficits continues, the hospital is anticipated to go bankrupt within the next 5 to 10 years. As a result, we are attempting to boost our revenue in a variety of ways. One method we have in mind is to undertake a ‘fee review’ for our healthcare service.’ (Male, physician 1, Tikur Anbesa Specialised hospital.)
EFMOH	Establishing a lending agency that offers emergency medical care	‘…Emergencies are currently being monitored as a major agenda item. As a result, the ministry (FMOH) is attempting to establish a loan funding agency for emergency cases and plans to execute it as quickly as possible.’ (Female, pharmacist 2, FMOH.)
EPSA	Procure pharmaceuticals regardless of data from health facilities Enhancing collaboration with potential stakeholders	‘…Our organisation intends to distribute medicines in a centralised manner. We can generate data from a central location. We have a lot of data and experience over the years. As a result, health institutions will only be involved as a buyer and not as primary data providers. Because the data provided by the health institutes could not be trusted enough. We intend to implement this strategy by next year.’ (Male, pharmacist 5, EPSA.) ‘…one issue is a lack of collaboration among our stakeholders to make the purchase and distribution process more efficient. We intend to build a special forum with our stakeholders to discuss and assist us in the supply process regularly. After all, we believe we are both working for the same country.’ (Male, pharmacist 4, EPSA.)

CBHI, community-based health insurance; EFMOH, Ethiopian Federal Ministry of Health; EHIA, Ethiopian Health Insurance Agency; EPSA, Ethiopian Pharmaceutical Supply Agency; FMOH, Federal Ministry of Health; OOP, out-of-pocket; SHI, social health insurance.