In Ethiopia, FHIR is in the early stages of adoption. It is being used for a small number of healthcare data exchange use cases, but it is not yet the main standard in the country.

The version of FHIR currently in use is R4. This is the most widely adopted version of FHIR globally.

Looking ahead, we expect a moderate increase in FHIR adoption over the coming years. Work is underway to build the foundations for broader use.

Rules and Support

Ethiopia has regulation in place for electronic health data exchange. Here is what you need to know:

  • Regulation mandates the use of standards in health data exchange.
  • FHIR is advised (not mandated) by the regulation.
  • There is no deadline for compliance.
  • There are no fines for missing compliance.
  • Government-linked funding is available, mainly through the Global Fund, to support adoption of SMART guidelines.

A national Digital Health Interoperability Framework has been developed and is close to being officially endorsed.

National Setup

Ethiopia is building the foundations for national FHIR standards:

  • Standards organization: There is no dedicated national organization yet for health data standards.
  • Core implementation guide: A national base FHIR implementation guide is under development. You can follow progress at fhir.et.
  • Terminology server: A national FHIR terminology server is not yet available, but it is in the planning stage.
  • FHIR Community Process (FCP): There is no known FCP activity yet, but within 2–3 years we expect to have one or more approved FCP participants.

A few specific FHIR specifications are also being developed, including for terminology and location data.

Active Use Cases

Ethiopia is starting to develop FHIR specifications for specific needs. Current focus areas include:

  • Terminology
  • Locations (such as facility data)

These national specifications build on well-known international standards:

  • International Patient Summary — a shared format for key patient information.
  • IHE profiles — internationally agreed patterns for sharing health data.

Who's Using FHIR

The main groups adopting FHIR in Ethiopia are:

  • Government agencies
  • Researchers

The main reasons driving adoption are:

  • Regulation and grants
  • Patient data access
  • Innovation

In terms of how FHIR is used, the country relies most on the FHIR REST API (a web-based way to request and share health data). FHIR Messaging and FHIR Documents are also used to some extent. More advanced tools like SMART on FHIR, CDS Hooks, Bulk Data, and Subscriptions are not yet in active use.

Software in use is almost entirely open source.

Success Stories and Challenges

Success story

A clear success is the data exchange between the Master Facility Registry (MFR) and DHIS2 (a widely used health information system). This work has delivered:

  • Improved healthcare outcomes
  • Better access to information

Main challenges

  • High investment cost
  • Unclear regulations
  • Lack of FHIR knowledge in the country

Future Plans

Progress in the last year was less than expected, but key building blocks are now in place. The biggest achievement was the development of the National Digital Health Interoperability Framework.

Despite slower progress, satisfaction with the current direction is positive. Planned next steps include:

  • Developing a national FHIR data model
  • Creating new FHIR standards for specific use cases
  • Expanding FHIR adoption across the healthcare ecosystem
  • Adapting national digital health standards based on the new framework

There is strong confidence that within three years, Ethiopia will see real benefits from FHIR adoption, including better care coordination and a stronger digital health ecosystem.

Contributors

  • Habib Bushira, JSI/MoH — Senior Digital Health Interoperability Lead

The above summary is based on the answers to the State of FHIR Survey 2026, organized by Firely and HL7 International.