Expanding dermatology services in Ethiopia: insights and experiences from the national residency expansion programme

Postgraduate medical education is vital for addressing global health disparities, particularly in low- and middle-income countries (LMICs). Dermatology residency training programmes in Ethiopia commenced in 2006 to address a critical shortage of specialists and improve access to care for skin-related conditions, including neglected tropical diseases. This study explores the progress, achievements and challenges of Ethiopia's dermatology residency programmes.

To evaluate the development, outcomes and lessons learnt from dermatology residency training in Ethiopia, offering insights for scaling specialist training programmes in LMICs.

A mixed-methods approach was employed, combining quantitative analysis of training outputs and regional distribution of dermatologists with qualitative key informant interviews. Data were collected through an online survey involving members from the Ethiopian Dermatovenerology Society. Semi-structured interviews were also conducted with senior dermatologists involved in programme development initiation. Thematic content analysis was performed to identify barriers, facilitators and recommendations for programme sustainability.

Between 2008 and 2023, Ethiopia graduated 194 dermatologists across five institutions. The annual output increased from 6 to 31 specialists trained each year. Overall, 78 of 108 (72%) dermatologist respondents worked full time in the public sector. There were 51 of the 108 (47%) respondents who were involved in academic institutions. However, 66 of 110 (60%) of dermatologists are concentrated in urban areas. Key facilitators of the residency programme included the Addis Ababa University commitment to expanding postgraduate education, partnerships with the All Africa Leprosy Rehabilitation and Training Center Hospital and full government sponsorship. Challenges included limited infrastructure, shortages in subspecialty training and an urban-centric workforce distribution. Interviewees highlighted the importance of thorough nationally coordinated planning and commitment to address these barriers.

Ethiopia's dermatology training programmes have significantly strengthened the specialist workforce, but inequities in service distribution and gaps in training capacity remain. Strategies to enhance rural service incentives, expand subspecialty training and integrate telemedicine are critical for improving healthcare equity. Lessons from Ethiopia's experience underscore the value of Ministry of Health local leadership and ownership in postgraduate programme expansion.