Ethiopia has pursued supply chain reforms for over eight decades to improve access to essential medicines. While Strategic Health Purchasing (SHP) interaction with health systems and provider performance is well-documented, its specific application to the availability of essential medicines and supplies, particularly within Central Medical Stores (CMS), remains under-explored. However, evidence reveals persistent systemic gaps: fragmented governance, unsustainable financing with high facility debts, inconsistent updates to the essential medicines list, limited provider autonomy and weak links between payments and health systems performance.
Implications: These systemic weaknesses undermine progress towards Universal Health Coverage (UHC) goals. To address them, the Ethiopian Pharmaceutical Supplies Services (EPSS) must deliberately apply Strategic Health Purchasing (SHP) principles, prioritizing the integrating of information systems, financial discipline, refined governance and performance linked provider payments.