Critical care capacity in Africa: Post-pandemic ICU capacity, service readiness, and patient profiles across public and private hospitals in Ethiopia

BackgroundThe COVID-19 pandemic highlighted critical care disparities in low-resource settings. Ethiopia implemented interventions to strengthen ICU capacity post-pandemic, yet gaps persist. This study evaluates national ICU capacity post-COVID-19, including private facilities, and identifies challenges for equitable critical care delivery. MethodsA cross-sectional nationwide assessment was conducted in public and private hospitals across Ethiopia. Data were collected through site visits and standardized questionnaires, assessing ICU capacity, staffing, equipment, protocols, and emergency preparedness. Patient-level data were also collected to assess common admission characteristics. Findings were compared with pre-COVID-19 baseline data to evaluate progress and identify gaps following the implemented interventions. FindingsA total of 159 hospitals across Ethiopia were surveyed, achieving a 93% response rate, with 117 out of 159 (73{middle dot}58%) being governmental and 42 out of 159 (26{middle dot}42%) being private facilities, assessing a total of 1028 beds. Post-COVID-19, public ICU facilities increased from 51 to 117, with beds increasing from 324 to 762. Private facilities contributed 266 beds (25.9% of national capacity). Improvements included 24/7 ICU-trained physician availability (52.1% vs. 29.0% pre-COVID) and disaster preparedness plans (21.4% vs. 6.0%). Persistent gaps included advanced hemodynamic monitoring (5/117 public, 3/42 private 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 accounting for 29.4% of cases. Hypertension (25.1%) and diabetes (17.2%) were the most common comorbidities. InterpretationThis study reveals significant growth in Ethiopias ICU infrastructure and workforce following the COVID-19 pandemic, with a threefold increase in ICU beds and improved distribution. However, gaps in advanced monitoring, organ support, and referral coordination reveal systemic issues in critical care readiness. The high incidence of sepsis among mostly young patients underscores the need for targeted investment in essential emergencies and critical care (EECC) at all facility levels. Strengthening public-private integration, standardizing referral protocols, and scaling low-cost, high-impact interventions are crucial for enhancing equity and outcomes in resource-limited settings.