Despite significant progress over the past decades, Ethiopia continues to face a high burden of malnutrition, with rates of child stunting and wasting above the average across Africa. At the 2025 Nutrition for Growth (N4G) Summit, the Government of Ethiopia committed to mobilizing $638 million USD for nutrition by 2030, 25% of the $2.55 billion Seqota Declaration funding requirement, and to establishing a robust system to ensure the effective allocation, tagging, and tracking of nutrition-related financial resources.

The Framework provides a shared understanding of the full resource need to end malnutrition in Ethiopia, estimated at an average of ETB 26 billion annually from 2026–2030, roughly 2.7% of the country’s total approved federal budget, and lays out a roadmap of priority actions to help the government meet the financing and governance commitments it made at N4G.

The Framework is organized around seven pillars for sustainably financing food and nutrition, each with their own set of concrete actions mapped to Ethiopia’s FNS or N4G commitments:

1. Set Financial Direction
2. Strengthen Sectoral Nutrition Planning
3. Ensure Active Nutrition Review by Planning Commissions
4. Enhance Multi-sectoral Accountability
5. Advocate to Senior Officials and Parliament
6. Mobilize Additional Innovative Financing
7. Establish the Next Decade of Action (2031–2040)

With the Framework validated by all key government sectors and partners, the next phase of work will focus on cascading national guidance to the regional level through costed Regional Food and Nutrition Investment Plans to guide implementation of the framework’s recommended actions.

FCDP is a SUN Movement resource available to all 67 SUN Countries. The platform aims to transform the nutrition financing landscape by inspiring and igniting government leaders to elevate nutrition financing as a priority and accelerate impact across sectors.

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Across low- and middle-income countries, governments are making bold commitments to strengthen primary health care as the foundation for universal health coverage (UHC). At the same time, foreign aid cutbacks and tightening fiscal space are increasing pressure on governments to do more with fewer resources. Translating national ambition into practical, actionable plans remains a persistent challenge.

Through the Advancing Realistic Health System Design and Planning (HSDP) for PHC program, R4D is working alongside governments to help redesign health systems so that financing, workforce, and service delivery decisions are aligned with real-world constraints such as population needs, institutional capacity, and political context.

This work builds on prior research and analysis conducted by R4D with support from the Gates Foundation to understand what enables realistic health care reform. Through a cross-country analysis of exemplar health systems, R4D examined how countries achieved transformational change. The findings showed that countries that successfully strengthen PHC over time tend to sequence reforms deliberately, align short-term operational plans with a longer-term system vision, and use strategic policy levers to maximize impact within available resources.

Phase 2 builds on these findings to deepen learning and support implementation in select countries currently undertaking major PHC reforms. This work is already underway in Ghana, and Tanzania has now been selected as an additional country partner. Through a structured learning approach, the previously identified enabling factors for realistic health system design and planning will be validated and further refined. The initiative will also generate practical tools, analytical frameworks, and global public goods to support policymakers in other countries to apply these lessons in their own contexts.

Additionally, R4D will provide strategic advisory and coaching support to Ghana and Tanzania, working alongside government leaders as they embed more realistic, evidence-informed approaches to system design and planning within ongoing PHC reform efforts — translating commitments into feasible implementation.

“Making rational, results-oriented investment decisions across health system building blocks, especially at the primary health care level, is critical for realizing improvements in population health services and health outcomes,” said Gemini Mtei, R4D Tanzania country director. “Building on more than a decade of collaboration, we’re excited to partner with the Government of Tanzania at this pivotal moment for strengthening delivery of primary health care services in the context of Universal Health Insurance reform implementation. Our work will help turn national commitments into plans that are ambitious and truly achievable, leading to real improvements in access to quality health services, improving health outcomes, and making progress towards Universal Health Coverage.”

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