Background The COVID-19 pandemic exposed critical care disparities in low-resource settings. In Ethiopia, intensive care unit (ICU) expansion had begun prior to COVID-19 but accelerated during the pandemic with substantial new investment. This study provides the first nationwide assessment of ICU capacity, service readiness and patient characteristics across both public and private hospitals. Methods A cross-sectional survey was conducted in 2024 across all Ethiopian hospitals with operational ICUs, using site visits and standardised tools to assess facility capacity, staffing, equipment and preparedness. Patient-level data were collected for admissions on the survey day. Results were compared with pre-COVID-19 data to evaluate progress. Findings A total of 159 hospitals (117 public, 42 private) were surveyed, encompassing 1028 ICU beds. Public ICU facilities increased from 51 to 117 since COVID-19, with beds rising from 324 to 762. Private facilities added 266 beds (25.9% of the total). Improvements included 24/7 ICU-trained physician availability (52.1% vs 29.0% pre-COVID-19) and disaster preparedness plans (21.4% vs 6.0%). Persistent gaps were evident in advanced haemodynamic monitoring (available in <10 facilities) and organ support (9/117 public ICUs). Among 279 admissions (mean age 39.1 years; 55.2% male), neurological (32.1%) and respiratory (25.8%) conditions predominated, with sepsis observed in 29.4% of patients. Hypertension (25.1%) and diabetes (17.2%) were common comorbidities. Interpretation Ethiopia’s ICU capacity has tripled since 2019, with a more balanced regional distribution and improved workforce coverage; however, deficits in advanced monitoring, organ support and referral coordination limit the system’s readiness. The high burden of sepsis among ICU patients highlights systemic gaps in early recognition and supportive care; this supports scaling Essential Emergency and Critical Care as a foundational platform, alongside targeted improvements in infection management and antimicrobial stewardship. Strengthening public-private integration, standardised referral systems and cost-effective, high-impact interventions will be key to improving equity and outcomes in Ethiopia and comparable settings across sub-Saharan Africa and other low-resource contexts.
Belachew et al. (Sun,) studied this question.