Moving from Fragmented, Program-specific Interventions to Building Truly Resilient, People-centered, Community-led Health Systems

If the health system doesn’t reflect the community’s values or respond to its needs, people disengage. But when communities feel heard, respected, and empowered, they become the biggest champions of health.

With more than two decades of experience at the intersection of medicine, public health, and policy reform, Addis Tamire (M.D) is one of Ethiopia’s foremost voices in health systems strengthening. Currently serving as the Senior Director for Integrated Health System Investments at Amref Health Africa in Ethiopia, Addis brings a wealth of experience from national leadership roles and global advisory work.

A Harvard-trained deliverologist and transformation specialist, he has advised multiple African governments on major reforms in health, education, and economic development. His previous roles include Director General and Chief of Staff at Ethiopia’s Ministry of Health and Head of the Tax Transformation Office, along with a senior advisory position at McKinsey & Company, where he led high-impact initiatives in Ethiopia’s healthcare and public sectors.

Addis also serves as an Expert Faculty Member for the Harvard Ministerial Leadership Program, mentoring senior leaders across the continent. He is widely published in peer-reviewed journals, including The Lancet, and co-author of two books on health and governance reform.

In this exclusive interview Shega Media, Addis shares his insights on leadership, innovation, and what it takes to build resilient, people-centered health systems in Africa and beyond.

Shega: Could you tell us a bit about yourself and your upbringing? What sparked your passion for health? 

Addis: I was born and raised in Ethiopia. My childhood was shaped by a deep sense of community, neighbors helping one another, extended family playing an active role in each other’s lives, and a constant awareness of how tightly woven people’s lives were. Even as a child, I sensed that health wasn’t just an individual concern; it was something that impacted entire families and communities.

My father was an educator, and he instilled in me a strong sense of purpose early on, education wasn’t just a way out, it was a way forward. He always said, “Knowledge should be shared, not just kept.” That idea stuck with me.

There were a few defining experiences that shaped my path, most vivid ones being seeing mothers lose their lives during childbirth and many neighbors die of malaria and other preventable illnesses. It wasn’t because the conditions were untreatable; it was because they didn’t have access to basic healthcare, and help came too late. Those moments stayed with me. I remember thinking, “These shouldn’t happen. They don’t have to happen.”

Later, as I got into medical school, graduated as a junior medical doctor and started practicing medicine in one of the most precarious places in Ethiopia called AlemKetema. Scarce transport, no power, no reliable water supply!  The contrast between the potential of modern medicine and the reality on the ground was stark. I realized that the science of medicine was only part of the equation, the delivery, the access, the trust, and the systems behind it all were just as crucial.

On a personal level, I’m someone who finds energy in collaboration. I love sitting at the table with people from different backgrounds - policy makers, clinicians, community leaders; and finding common ground. Outside of work, I’m a big fan of taking long walks, reading books and engaging in social events.

Health, for me, has always been about justice, dignity, and the chance for every person to live a full life. That’s what continues to fuel my work every day.

Shega: Can you walk us through your journey from studying medicine in Gondar to becoming a global expert in transforming health systems? Was it always your dream to become a doctor, or did that interest develop over time? What were some of the major turning points or defining moments along the way?

Addis: Let me start out in Gondar. I began studying medicine at the then Gondor College of Health Sciences, now University of Gondar, with a motivation from my father and myself. Growing up, I witnessed firsthand how health disparities affected my community. Illness often meant more than just a personal struggle. It could devastate families. At first, becoming a doctor seemed like the most direct way to make a difference.

Then the shift to systems thinking happened. During my clinical training, I started noticing patterns: the same preventable diseases recurring, patients coming back again and again not because of a lack of treatment, but because of larger structural issues: lack of clean water, lack of health and health system literacy, poor health education, broken supply chains. That’s when I started asking not just “how do we treat this patient, but why are so many patients ending up here in the first place?”

A Defining Moment…

One pivotal experience was during my first assignment as a medical doctor to a rural health center in Alem Ketema, where I was facing several challenges on health financing, lack of essential health commodities and no clear network of care. I realized then that no matter how skilled or compassionate a doctor is, if the system behind them is failing if the supply chains are broken, if the data is missing, if the policy doesn’t support access, then the impact will always be limited.

I pursued further training in public health and later health systems management to expand the vision globally. My goal shifted from individual care to transforming how care is delivered, making it more equitable, efficient, and sustainable. Collaborating with governments, international organizations, and local leaders opened my eyes to how health systems can be redesigned, not just patched. Even though I dreamed to be a doctor initially, over time, I came to realize that while clinical medicine is incredibly powerful, my calling was to operate at a systems level, to influence change for entire populations rather than just individuals.

When I look back, it’s been a journey from the bedside to the boardroom, so to speak. But I carry the voices of those early patients in Gondar and Alem Ketema with me. They remind me why this work matters. Every system is built for someone, and too often, the most vulnerable are left out. That’s what I’m committed to changing.

Shega: Were there any early influences, mentors, personal experiences, or moments that helped shape your personal or professional journey? 

Addis: Yes, definitely. There have been several key people and moments that shaped both who I am and the path I chose. To start with my early influences, growing up, one of my earliest role models was my father. He wasn’t a doctor or a health worker. He was a college English instructor, but the way he approached people, with deep empathy and a quiet determination, made a lasting impression on me. He believed in the power of small acts done with consistency. Whether it was helping a struggling student or checking in on a sick neighbor, he taught me that change starts close to home.

In medical school, I was fortunate to have a professor named Dr Mesfin who introduced me to public health in a way that was both rigorous and deeply human. He used to say, “A good doctor treats the illness. A great one asks why the illness exists in the first place.” That quote stuck with me. He encouraged me to look beyond the clinic; to explore the social, political, and economic layers that shape health outcomes.

Later in my career, I had the opportunity to work with global health leaders who had spent decades reforming health systems across Africa and globally. They didn’t just bring expertise; they brought humility. Watching them navigate high-level strategy while always centering community voices showed me what leadership grounded in values really looks like.

Each of these people and experiences helped me see that the path to better health isn’t just paved with knowledge. It’s paved with relationships, trust, and the courage to question the status quo. And they taught me that leadership isn’t about having all the answers; it’s about asking the right questions and making space for others to lead, too.

Shega: You have served as Chief of Staff at the Ministry of Health, advised through McKinsey & Company, and now support leadership through the Harvard Ministerial Program and lead health system strengthening at Amref Health Africa. Across these roles, what do you consider some of the key milestones or reforms in Ethiopia’s health system that you’ve been most proud to help shape?

Addis: It’s been an incredible journey, and I feel honored to have been part of Ethiopia’s health system transformation across different roles and stages. As Chief of Staff at the Ministry of Health, one of the most meaningful milestones was supporting the design and rollout of the Health Sector Transformation Plan (HSTP). That process wasn’t just about drafting a document, it was about aligning the vision, priorities, and strategies for the entire country’s health agenda. We emphasized equal access to quality healthcare, innovation, and sustainability, and we pushed hard to embed data-driven decision-making at every level, address the supply chain, human resource for health and healthcare financing bottlenecks. Being part of that kind of national alignment, bringing together regional leaders, partners, and communities, was deeply fulfilling.

Another reform I’m especially proud of was the institutionalization of community health systems, including scaling and strengthening the Health Extension Program. We focused on improving supervision, training, and support for health extension workers, who are truly the backbone of rural health in Ethiopia. These frontline workers aren’t just delivering care; they’re building trust in the system.

During my time at McKinsey & Company, I had the opportunity to step back and view Ethiopia’s progress within a broader global context. While supporting ministries of health across several African countries, I was able to bring fresh insights back to Ethiopia. One project I’m particularly proud of involved conducting a holistic diagnostic of the health commodity supply chain in Ethiopia and providing transformative recommendations.

Another key engagement was reconfiguring the ministerial delivery unit to enhance its structure and impact. I also had the privilege of offering executive coaching to senior health system leaders, linking health outcomes more directly to leadership accountability and operational efficiency. These experiences reinforced my belief that leadership is a powerful lever for systemic change.

As the Senior Director for Health System Investments at Amref Health Africa in Ethiopia, I have had the privilege of leading strategic initiatives aimed at strengthening Ethiopia’s primary health care (PHC) system. Our focus has been on improving health service delivery, enhancing system governance and financing, and ensuring that communities, especially those in rural and underserved areas, have access to quality, equitable, and affordable care. This involves working closely with the Ministry of Health, Regional Health Bureaus, and other partners to design scalable, sustainable interventions that can truly transform how health services are accessed and delivered.

One of the most rewarding aspects of this work has been seeing how thoughtful investments in systems, whether through multisectoral approaches, PHC Governance and Financing, Supply Chain Optimization or health workforce development can directly impact lives and build trust in public health institutions.

In addition, I have also served as expert faculty with the Harvard Ministerial Leadership Program. In this role, I’ve had the opportunity to work alongside senior government officials and ministers across Africa, supporting them in shaping reform agendas in health, education, and economic development. We work on big-picture strategy, helping leaders connect policy ambitions with the operational realities of delivery. It’s about enabling them to drive results with the resources they have, while fostering innovation and political alignment.

These dual roles of operating both at the national implementation level and in global policy support have given me a unique vantage point. I’ve come to firmly believe that leadership is not just about vision; it’s about execution. When empowered with the right tools, support systems, and accountability frameworks, leaders can catalyze deep systemic change that outlasts any single project or political cycle. My work continues to be driven by this belief, and by a commitment to equity, sustainability, and long-term impact in the health and development space.

What I’m most proud of…

Honestly, it’s not any single reform. It’s being part of a broader movement, seeing Ethiopia evolve from tackling basic access to now focusing on quality, resilience, and sustainability. It’s watching homegrown leaders rise, innovate, and lead with courage. That’s what gives me hope for the future—not just in Ethiopia, but across Africa.

Shega:Having worked in Ethiopia’s health system through policy, research, consulting, and implementation, what disconnects or challenges have you observed between strategy and execution? From your perspective, what are the root issues in the health system that still need to be addressed?

Addis: This is something I’ve thought about a lot, especially having worked across different layers of Ethiopia’s health system from national policy to frontline implementation.

On the strategy-execution gap…

One of the biggest disconnects I have seen is between ambition and absorption capacity. Ethiopia has never lacked bold strategies. We had visionary health plans and policies. But too often, the capacity at the point of delivery—human resources, logistics, infrastructure, management systems—hasn’t been ready to absorb or operationalize those ideas at scale.

There is also an alignment gap between levels of the system. Policies developed at the federal level don’t always translate well at the regional or woreda level, not because of bad intent, but because of limited consultation, resource constraints, and sometimes, differing incentives. Strategy documents might focus on integration, for example, while programs on the ground remain siloed due to vertical funding streams or fragmented accountability.

Some of the root issues that still need attention include: Leadership and Management at the Middle Tier, Data Use and Feedback Loops, Workforce Motivation and Retention, Community Ownership and Trust, Healthcare Financing, Supply Chain Management, Cross-Sectoral Coordination. 

Moving forward…

We need to focus more intentionally on execution science, not just asking “what should we do, but how do we get it done, sustainably, and at scale?”  That means investing in people, systems, and local innovation. It also means embracing learning, failure, and iteration as part of the process, not signs of weakness, but signs of a maturing system.

Shega: At Amref Health Africa, you now lead the Integrated Health System Strengthening initiative. Can you tell us more about this initiative? What makes it transformational?

Addis: The Integrated Health System Strengthening (IHSS) initiative at Amref Health Africa is about moving from fragmented, program-specific interventions to building truly resilient, people-centered, community-led health systems.

For too long, health systems in Africa, and globally have been shaped by vertical programs and short-term targets. What IHSS aims to do is bring everything together into a coherent, country-led approach that strengthens the system as a whole, not just one disease or service area.

At its core, the IHSS initiative is built on seven foundational pillars: leadership and governance, sustainable health financing, supply chain optimization, health workforce strengthening, data and digital health, service integration, and community engagement.

Together, these pillars aim to create a more resilient, efficient, and equitable health system — one that empowers leaders to make data-driven decisions, ensures sustainable financing and reliable supply chains, builds a motivated and capable workforce, and delivers integrated, people-centered care close to communities.

At the end of the day, the goal is to develop a costed Health System Strengthening (HSS) package that prioritizes high-impact, cost-effective interventions, demonstrating a breakthrough shift in how we approach integrated health system strengthening in Ethiopia and across Africa. 

What makes this initiative transformational is that we’re not just implementing projects. We’re working alongside the government to shift how systems function. Rather than stepping in with parallel solutions, IHSS supports the MoH and RHBs to lead their own reforms, with Amref acting as a strategic partner and capacity builder.

The initiative is already making an impact across several woredas in Afar, Amhara, Oromia, Sidama and Somali, helping to enhance PHC Governance, financing, and improve health system inputs, and digitize primary health systems in ways that are scalable and sustainable.

Ultimately, this is about building health systems that not only survive the next crisis but deliver quality care every day, for every person. That’s the kind of transformation we’re committed to.

Shega: How do you approach localization and making sure the changes you support are sustainable and owned at the community level? And can you speak to the importance of leading health with this localized and community-supported approach?

Addis: Localization isn’t just a strategy. It is a mindset shift, reflecting on years of health system work across Ethiopia. If change isn’t owned locally, it won’t last. Full stop.

At Amref Health Africa, we believe that sustainability starts with listening, and staying accountable to the people the system is meant to serve.

We start by asking, not assuming. That means co-designing programs with the Ministry, RHBs, facility managers, and most importantly, with communities themselves. They know what’s working, what’s broken, and what change looks like in their context—not ours.

A critical part of this approach is investing in local leadership, not just at the national level, but at every tier. In practice, this might mean building the management capacity of district health teams, supporting peer learning between health facilities, or strengthening community health committees so they can truly hold the system accountable.

When people see themselves in the solution, when they help shape it, lead it, and adapt it to their reality, they fight for it, they protect it, and they sustain it.

Another key to localization is working through existing systems, rather than creating parallel structures. Whether it’s supporting governments to improve planning and budgeting tools, or integrating with local supply chains and information systems, the goal is to reinforce what’s already there, and make it stronger, more equitable, and more responsive.

Why it matters…

Health is personal. It’s deeply tied to trust, culture, and relationships. If the health system doesn’t reflect the community’s values or respond to its needs, people disengage. But when communities feel heard, respected, and empowered, they become the biggest champions of health.

Leading with a localized, community-driven approach isn’t just good practice; it’s a moral imperative. It’s how equity becomes real. It’s how systems evolve to serve everyone, not just those with power or access.

Ultimately, sustainable change doesn’t come from outsiders ‘delivering’ solutions. It comes from communities reclaiming ownership of their health and shaping the systems that support it. That’s the kind of change we want to leave behind.

Shega: What does sustainability look like for the IHSS initiative, and how do you ensure its continuation? 

Addis: Sustainability for the IHSS initiative is about creating systems that don’t just work for today, but endure for generations, ensuring that every gain we make is rooted in local context and powered by local leadership.

For Amref, sustainability is not a project phase; it is our way of working. It means building health systems that can stand, adapt, and thrive long after external support ends. We do this by empowering local leaders and institutions to own their health agendas, aligning our efforts with national systems, and strengthening resilience through data-driven decisions and adaptive learning.

True sustainability is built on trust by engaging communities as partners, not recipients, so they become stewards of their own health.

Our ultimate goal is to leave behind systems that are stronger, fairer, and more resilient, transforming short-term projects into lasting change, and demonstrating that locally led, costed, high-impact health system strengthening can reshape Ethiopia and inspire the continent.

Shega: What would you say to young professionals in Ethiopia or across Africa who want to contribute to health, policy, and systems transformation? What advice would you offer someone just starting their journey?

Addis: To young professionals in Ethiopia and across Africa, my first advice is simple: start with curiosity, stay grounded in the needs of the people you serve, and remember that health system strengthening is never about the individual. It’s about the collective good and the dignity of communities.

Understand the bigger picture. Health is not just about hospitals or vaccines. It’s about people, governance, and the social and economic systems that shape their wellbeing. The more you see these connections, the better equipped you’ll be to drive real change.

Be a lifelong learner. The health landscape is constantly evolving. It embraces new ideas, technologies, and ways of thinking. Listen deeply to communities; no reform succeeds unless it reflects real needs and local realities.

Build partnerships across sectors. Education, finance, governance, and the private sector. Transformation happens when we collaborate beyond our silos. 

And above all, embrace challenges as learning opportunities. Find your passion, stay patient, and remain persistent. Change takes time, but every step contributes to a stronger system and a healthier future.

The future of health in Africa will be shaped by your vision, resilience, and commitment. Don’t just contribute to transformation—be the generation that creates it.

Shega: Looking ahead, what should Ethiopia’s health investments look like to ensure long-term sustainability and meaningful impact? And what initiatives or changes are you most hopeful to see, or be part of, in the future?

Addis: Looking ahead, Ethiopia’s health investments must be focused on building a resilient, people-centered, community-led health system that can evolve over time, adapt to new challenges, and address the root causes of health inequities.

Strengthening PHC remains the cornerstone of a resilient health system. Ethiopia’s progress through the Health Extension Program provides a strong foundation, but further investment is needed to empower local health workers, integrate services, and ensure that PHC facilities are fully equipped and supported. Reliable infrastructure, supply chains, and workforce training are essential to sustain quality care at the community level.

A skilled and motivated health workforce is the backbone of the system. Beyond training, Ethiopia must invest in retention and well-being, addressing issues such as fair compensation, professional growth, and living conditions, particularly in rural and pastoralist areas. A healthy, supported workforce means better service delivery and sustainable outcomes. 

Investing in digital health and data systems is critical to enhance efficiency, transparency, and accountability. Building on recent progress, Ethiopia must expand digital solutions that enable real-time decision-making, effective patient tracking, and improved supply chain management across all levels of care.

Reforming health financing is equally important to ensure long-term sustainability and equity. Expanding health insurance, mobilizing domestic resources, and innovating with private-sector engagement will create a more predictable and inclusive funding base, especially as non-communicable diseases and urbanization reshape health demands.

The growing burden of non-communicable diseases (NCDs) and mental health conditions calls for their full integration into PHC, ensuring comprehensive, continuous, and equitable care. Addressing these challenges early will prevent long-term costs and enhance system responsiveness.

Finally, community engagement and accountability must remain at the heart of the system. When communities are informed, empowered, and involved, health systems become more trusted, transparent, and effective.

Together, these investments will build a more resilient, equitable, and people-centered health system capable of sustaining progress and inspiring transformation across Africa. 

Hope for the Future

What excites me most about the future of Ethiopia’s health system is the potential for systemic change that is both bottom-up and top-down. I’m hopeful that Ethiopia will continue to focus on strengthening local governance and accountability, ensuring that decisions are made closer to the communities they affect. I also hope to see Ethiopia become a leader in health innovation, not just in adopting new technologies, but in creating homegrown solutions that reflect our unique challenges and strengths. I would love to be part of an effort where we see health systems that are more equitable, inclusive, and resilient. In the future, Ethiopia’s health system will be able to respond to emerging challenges, whether climate-related, disease-related, or social, because it’s adaptive, community-driven, and underpinned by strong data and governance. The time to invest in that future is now.