Marburg Outbreak Tests A Health System Grappling With Financial Constraints

‎When the first man collapsed in the town of Jinka in early November and died of severe hemorrhaging, residents did not suspect that Ethiopia was about to face a deadly viral outbreak.

‎Residents of the market town located in the southern part of Ethiopia, around 750 kilometers away from the nation’s capital, told The Reporter that the shock and fear slowly sneaked into their hearts when within days, two health workers, church leaders, and a police officer also died.

‎Each of them were reportedly linked by a chain of exposure that spread across Jinka General Hospital and surrounding communities. Heavy blood loss, severe hemorrhaging, and rapid deterioration marked the deadly pattern.

‎And yet, residents say that the families of the first victims were left to move around freely.

‎On November 12, the Ministry of Health confirmed that the country was facing its first recorded Marburg virus disease outbreak, a deadly hemorrhagic fever related to Ebola, known for fatality rates that range anywhere from 24 to 88 percent.

‎However, unlike previous epidemics such as COVID-19, cholera, or measles, this emerging outbreak arrives at a moment when Ethiopia’s health sector struggles with an increasingly fragile financing environment characterized by declining donor contributions, audit gaps, procurement backlogs, and mounting pressure from a healthcare workforce fatigued by low wages, high workloads, and years of layered crises.

‎Analysts contend that the question is no longer whether Ethiopia can diagnose Marburg, trace contacts, or deploy rapid response teams. Rather, it has evolved into whether the system can sustain the response and do so largely without the external financing that buffered previous health crises.

‎Speaking with The Reporter, a young farmer residing in Jinka, provided a chronology of events as they unfolded in the town’s hospital and surrounding neighborhoods. His name is being withheld for his safety.

‎“On November 7, the first person who died was an employee of a bank. Then, the doctors who treated him and other people from a church that had direct contact with the man also died,” he said. “A total of six people. First, the bank employee. Three people from the church. One police officer who lived in the same neighborhood as the first man, and another person.”

He described the atmosphere of fear that had gripped Jinka in the days preceding a statement from the Ministry of Health, confirming the disease and outlining steps to prevent infection.

‎“Almost everyone was silent and shaken,” he told The Reporter, “but since the Ministry made the statement so that we know about the issue, there hasn’t been anything unusual. But the fear was very real.”

‎The concern deepened as new cases emerged in Male, a neighboring district in South Omo Zone.

‎“Three people with the same problem have been admitted to Jinka Referral Hospital this week,” he said.

He says the most alarming failure was one of public health fundamentals.

‎“The wife, children, and close family of the first victims—they weren’t isolated as soon as the first person passed away. They were moving around the town. That has really worried us,” he told The Reporter.

‎The farmer underscores the level of worry.

‎“We have heard that the case has an incubation period of two to 21 days. If within that window they don’t show symptoms and go to hospitals, we worry that controlling the situation may become very difficult. At the very least, they should have been isolated so that any sign of symptoms could be quickly identified. That is what people in town are most worried about,” he said.

‎On November 12, Health Minister Mekdes Daba (MD) publicly confirmed the outbreak.

The Minister stated that the Marburg Virus Disease outbreak in Jinka town was confirmed through laboratory testing and that at the time of the press briefing, 17 individuals suspected to have the disease had undergone testing while another three had died.

‎The Minister also disclosed that 129 people who had close contact with the suspected cases are under self-isolation being closely monitored by medical professionals.

Mekdes underscored Ethiopia’s upgraded diagnostic capacity and said that a mobile laboratory with advanced diagnostic capacity, as well as rapid response teams, had been deployed to Jinka while emergency coordination centers had been established, and medical supplies were being distributed.

‎Mesay Hailu (PhD), head of the Ethiopian Public Health Institute (EPHI), also stated that screening at border points and key transit hubs was being strengthened.

‎The Ministry’s message issued earlier this week echoed one of readiness and rapid mobilization but the outbreak arrives as the country enters a new era of financial tightening.

Officials maintain that the country can and will contain the outbreak using its own means, but behind the scenes a more difficult truth looms. Donor and global funding is shrinking, and the Ministry itself came under parliamentary scrutiny for financial irregularities just last week.

‎Speaking with The Reporter anonymously on whether Ethiopia has the capacity to contain the outbreak amid reduced donor funding, a medical doctor and senior health-sector analyst who also has experience working in international aid organizations offered a cautiously optimistic assessment.

‎“The health sector’s budget this year has increased. Due to various emergency outbreaks in the past, the country has enough cumulative experience, and this has strengthened its readiness,” said the medical professional.

‎The Doctor maintains that Ethiopia has built a formidable preparedness system over the past decade.

‎“From health posts upward, there is daily reporting. Weekly and monthly reporting systems as well. In terms of preparedness, our country has a relatively strong system—stronger than some more developed countries,” he told The Reporter.

‎Still, he acknowledges global headwinds.

‎“Regarding the budget, it is true globally that health sector budgets are decreasing. Donors also have a tendency to reduce funding,” he said.

‎The analyst believes that while the fall in donor funding could weigh on Ethiopia’s health system, it will not affect the country’s ability to deal with the ongoing outbreak.

‎”Despite [the donor decline], in the current fiscal year the Ministry of Health’s budget increased. The funds allocated from the national treasury have increased. So even though there are budget challenges, Ethiopia still has preparedness, response capacity, experience, and a system that trains professionals for this type of work. So I don’t believe this will be a heavy burden on the country. Ethiopia has faced worse challenges and responded well. I do not believe this outbreak will overwhelm us,” he told The Reporter.

‎On the question of Marburg’s severity compared to COVID-19, he provides a sobering comparison.

‎“Scientifically, the fatality rate of Marburg varies from about 24 percent to more than 80 percent. COVID-19 had a fatality rate around one to five percent. Marburg is highly deadly, but its transmissibility is much lower,” he noted.

‎What worries him is not the lethality but the global political economy surrounding outbreaks.

‎“I do not expect significant external support. Countries invest in these issues mostly for their own global health security—not to rescue others,” he said.

‎The analyst contends that with declining donor flows, Ethiopia must rely more heavily on domestic systems.

‎“The system exists, the structure is in place… experience has accumulated from COVID, cholera, anthrax, measles, yellow fever,” he said.

‎But in a quarter-year performance review held earlier this month, Parliament appeared unconvinced by Ethiopia’s capacity to respond to health crises.

‎‎A week before the Marburg outbreak was confirmed by the Ministry, Parliament’s Standing Committee on Health confronted its officials over widespread concerns regarding audit irregularities, weakened disease surveillance, and gaps in emergency readiness.‎‎

Lawmakers opened with 7.24 billion Birr in unresolved audit findings, describing the volume as “evidence of systemic weaknesses.”‎‎

During the performance review, MPs asked pointedly, “What is being done to safeguard government and public resources and ensure operations follow the law and regulations?”

‎‎Officials responded that procurement during epidemic emergencies has generated documentation gaps, insisting the transactions were legitimate.

‎‎However, MPs expanded their scrutiny beyond finances.‎‎They pointed to weaknesses in epidemic preparedness. Committee members grilled health officials about slow responses and rising burdens in regard to epidemics and outbreaks.‎

MPs last week highlighted worrying trends in cholera outbreaks and regression in the fight against malaria, and questioned the health officials’ preparedness and ability to mount an effective response. ‎In response, EPHI chief Mesay outlined extensive preparedness measures, including vulnerability and risk assessments conducted in more than 1,300 woredas, and weekly surveillance and reporting for 36 priority diseases.

Despite this, analysts who spoke to The Reporter expressed uncertainty over whether Ethiopia could withstand a fast-moving, high-fatality outbreak if donor funding continues to decline. The Marburg outbreak has now become the first real-world test of that question.‎‎

Ethiopia grapples with this outbreak under a very different global financing climate than during COVID-19. At the height of the coronavirus pandemic, the country received extraordinary volumes of external support—vaccines, PPE, ventilators, test kits, and broad budget assistance that helped sustain the national response. That era has now visibly shifted dramatically.‎‎

For the current fiscal year, the Ministry of Health operates with a budget of almost 61 billion Birr, with 48 billion Birr set aside for capital spending. US global health funding is contracting, European donors have tightened their aid portfolios, and the Africa CDC is overstretched across simultaneous emergencies on the continent.

The World Health Organization (WHO) has so far released only USD 300,000 in emergency financing and analysts contend that though helpful, the amount is modest when contrasted with the multi-million-dollar inflows of previous crises. ‎‎

WHO Director-General Tedros Adhanom Ghebreyesus stated that his organization is “collaborating closely with the Ministry of Health and the Ethiopian Public Health Institute,” but the global climate has unmistakably changed. ‎‎

‎‎On Wednesday, November 19, the Health Minister held discussions with US Ambassador Ervin Masinga on Ethiopia’s response to the Marburg virus.

The meeting reportedly focused on the country’s comprehensive and rapid intervention efforts in the southern region, with the Minister outlining the measures already deployed. ‎‎The Ambassador Masinga praised Ethiopia’s swift and coordinated response and stated that Washington is ready to provide the necessary support in preventing and controlling Marburg virus disease.

His reassurance stands out against the broader backdrop of global donor retrenchment offering a diplomatic signal of partnership even as international health financing becomes increasingly constrained. But, any substantial aid from the US has yet to come.

For many observers the implications are clear. Ethiopia will have to rely primarily on its own systems including domestic budget allocations, internal laboratory capacity, nationwide surveillance infrastructure, and local procurement mechanisms. ‎‎

On the other hand, health professionals argue that the country’s health budget is expanding on paper but still constrained in practice.‎‎

The ‎‎Ministry’s own reports indicate that medicine availability remains stuck at around 81 percent, still short of national targets. The Ethiopian Pharmaceutical Supply Agency (EPSA) reports that while 4,978 health facilities are now enrolled in digital supply contracts, 15 percent have not collected a single consignment of medicines despite submitting procurement requests valued at 25.5 billion Birr.

Revenue collection, meanwhile, stands at a mere five percent, far below what the system requires.‎‎For analysts these systemic gaps matter profoundly especially at a time when an outbreak like Marburg demands fast procurement, strict accountability, reliable supply chains, and immediate liquidity.‎

‎Despite the grim financial realities, officials contend that Ethiopia enters this outbreak with a list of advantages that would have been unimaginable 20 years ago.

‎The list includes domestic molecular testing capacity, a nationwide reporting system, rapid response infrastructure, post-COVID institutional memory and multi-layered coordination.

‎Still, residents of the town where the Marburg virus outbreak was first reported two weeks ago mention weaknesses compounding community enforcement, procurement gaps, and declining trust. ‎The testimony from the resident of Jinka reveals that despite strong systems, implementation gaps persist, and this raises questions about Ethiopia’s ability to withstand the Marburg outbreak or other potential future epidemics.

The analyst says the answer depends on three variables: containment, system resilience and financial sustainability.

‎“The system exists,” he says. “Experience has been accumulated. For politically sensitive health agendas, the government allocates its budget and responds before anything else.”

‎Whether that will hold true through a prolonged outbreak is the real test.