The Surge Approach in Ethiopia

Ethiopia’s health system is structured by three levels (tertiary, secondary and primary). The CMAM Surge pilot was implemented at the primary level in 2018, coordinated through woreda health offices and delivered through health centres and their linked health posts. Health posts are staffed by Health Extension Workers (HEWs) who serve as the frontline providers under Ethiopia’s Health Extension Program (HEP). They deliver a package of essential primary health services, including disease prevention, health promotion, maternal and child health, family planning, hygiene and sanitation, and management of uncomplicated conditions such as acute malnutrition. HEWs work closely with community volunteers to extend outreach, conduct routine screenings, educate households, and facilitate access to health services, ensuring that preventive and curative care reaches both urban and rural communities.

The CMAM Surge approach was approved for pilot implementation in 2017 following a stakeholder workshop with the Ministry of Health (MoH), and the global CMAM Surge Operational Guide was adapted to the Ethiopian context. Since initiation, the approach has been introduced in 90 health facilities in Somali region and 135 in Amhara region. However, sustained support has been uneven: as of May 2024, only 25 facilities were being supported in each region, and an assessment found that 28% of supported facilities in Somali and 26% in Amhara were ‘surge operational’.

This learning paper presents the key learnings from Concern Worldwide’s support to the Surge Approach in Ethiopia, drawing on implementation experience in Somali and Amhara regions and a national consultative workshop held in July 2025.