Terminal Illness & End-of-Life Planning in Ethiopia: 5-Step Official Checklist

1. 1

   Coordinate Palliative Care, Home Support, and Health Insurance

   • Public hospital palliative care units: Under the National Palliative Care Strategic Plan (2025-2029) issued by the Ministry of Health of Ethiopia, multidisciplinary palliative care, pain relief (including oral liquid morphine), and symptom management are integrated across tertiary referral hospitals (such as Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College in Addis Ababa, as well as regional university teaching hospitals) down to primary health centres [1]. Ask your family member's specialist for a formal referral to the hospital's pain and palliative care clinic [1].
   • Home-based nursing and hospice support: In Addis Ababa and major regional cities, hospital palliative teams coordinate with community health extension workers and specialist non-profit providers (such as Hospice Ethiopia) to deliver home nursing visits, wound care, and family caregiver training [1].
   • Community-Based Health Insurance (CBHI) and coverage: If your family member is enrolled in Ethiopia's Community-Based Health Insurance (CBHI) scheme - overseen by the Ethiopian Health Insurance Service and highlighted by the World Health Organization (WHO) - verify that household membership renewals are up to date at the Woreda CBHI office so inpatient admissions, diagnostics, and essential medicines at public health centres and referral hospitals remain covered [1][5]. Formal-sector employees with private health insurance should submit specialist medical reports to pre-authorise chronic or home-care benefits [1][5].
2. 2

   Record Advance Healthcare Preferences and Designate a Medical Representative

   • Written treatment preferences: Ethiopian law does not yet codify a separate statutory living-will instrument, so medical decision-making is governed by patient autonomy and informed-consent rules under Ethiopia's Food, Medicine and Health Care Administration and Control regulations and the clinical protocols of the Ministry of Health of Ethiopia [1]. While your family member has full capacity, they should sign a written statement of care preferences specifying their wishes on intensive-care escalation, mechanical ventilation, artificial feeding, and comfort-focused care [1].
   • Designating a family medical representative: When an adult patient becomes unable to communicate, Ethiopian hospitals consult the designated family representative or next of kin listed in the clinical chart [1]. Your family member should formally record the name, telephone number, and National ID (Fayda) or Kebele ID details of their primary healthcare spokesperson in their hospital medical record and share signed copies with the treating physician [1][2].
3. 3

   Execute Notarial Powers of Attorney and Bank Mandates

   • Formal Power of Attorney (Wukilna) via DARS: Under the Ethiopian Civil Code rules on agency, any Power of Attorney authorising an agent to manage bank accounts, administer or lease real property, represent the principal before tax or pension offices, or conduct legal proceedings must be executed in writing and authenticated before a notary [2][4]. In federal cities (Addis Ababa and Dire Dawa), powers of attorney are registered through the Document Authentication and Registration Service (DARS), with online appointment booking and document upload available via the Ethiopian Government Electronic Services Portal (eServices) [2].
   • Capacity verification and hospital/home attestation: A Power of Attorney (Wukilna) can only be executed while the principal possesses full mental capacity [2][4]. If your family member is physically frail or hospitalised, check with DARS or the regional Justice Bureau notary office regarding mobile or bedside authentication procedures, and obtain a contemporaneous medical certificate from the attending specialist confirming full mental alertness on the date of signing [1][2].
   • Ethiopian capacity rules and judicial interdiction: Under the Ethiopian Civil Code, a standard agency mandate is subject to revocation or termination if the principal becomes legally interdicted due to severe mental incapacity, at which point a court-appointed tutor/guardian is required [4]. In addition, commercial banks in Ethiopia require an explicit banking clause within the DARS-authenticated Power of Attorney specifying account operations, so ensure the text expressly names the relevant bank and permitted transactions [2][4].
4. 4

   Activate Disability Pensions, Medical Board Assessments, and Caregiver Leave

   • Public-sector invalidity pension claims: If your family member is a public servant or public enterprise employee covered by the Public Employees Social Security Administration (PSSSA) under Proclamation No. 1267/2022, a worker who is certified by an authorised medical board as unfit for any remunerated service due to permanent illness or disability is entitled to an invalidity pension (or invalidity gratuity if service was less than 10 years) [3]. Request a formal Medical Board referral from the treating tertiary hospital early [1][3].
   • Private-sector social security benefits: Employees of private organisations covered by Proclamation No. 1268/2022 can similarly apply to the Private Organizations Employees' Social Security Administration (POESSA) for invalidity pension benefits once a recognised Hospital Medical Board issues its permanent incapacity certificate [1][3].
   • Employment leave and caregiver arrangements: Under Ethiopia's Labour Proclamation No. 1156/2019 and Federal Civil Servants Proclamation, employees are entitled to statutory paid and partial-pay sick leave upon presenting valid medical certificates [1][3]. Family caregivers employed in the formal sector can request paid family-events leave, annual leave, or unpaid compassionate leave arrangements with their employer [3].
5. 5

   Review the Will, Beneficiary Records, and Property Documentation

   • Drafting a compliant Will under the Ethiopian Civil Code: As detailed in official guidance from the Ministry of Justice of Ethiopia, the Ethiopian Civil Code imposes strict formal requirements on wills [4]. Your family member should execute either a Public Will - read aloud and signed in the presence of a notary (such as DARS) or court registrar and four witnesses (or two witnesses if the registrar/notary officiates) - or a Holographic Will, which must be written entirely by the testator's own hand, expressly state that it is a will, and bear the exact date and signature on every page [2][4]. Lodging a Public Will with DARS significantly reduces the risk of later authenticity disputes [2][4].
   • Updating social security and civil registry files: Ensure that the marital status and birth certificates of all children and dependents are properly registered with the Addis Ababa Civil Registration and Residency Service Agency (AACRRSA) or regional vital events office, and that family dependency records filed with the Public Employees Social Security Administration (PSSSA) or POESSA match those civil certificates exactly [3][4].
   • Organising property titles and cross-border mandates: Gather urban land-holding certificates (Karta), vehicle ownership booklets (Libre), tax clearance records, and spousal consent documentation (since property acquired during marriage is presumed common property under the Revised Family Code) [2][4]. If family members reside outside Ethiopia, they can execute powers of attorney at an Ethiopian Embassy abroad and authenticate them through the Ministry of Foreign Affairs and the Ethiopian Government Electronic Services Portal (eServices) [2].

Official Authorities & Verified Contacts

Official Sources Checked by Clarvia

1. [1]
   National Palliative Care Strategic Document (2025-2029) — Ministry of Health of Ethiopia
2. [2]
   Ethiopian Government Electronic Services Portal - Document Authentication and Registration Service (DARS) — Government of the Federal Democratic Republic of Ethiopia
3. [3]
   Public Servants' Pension Proclamation No. 1267/2022 Implementation Directive — Public Employees Social Security Administration (PSSSA)
4. [4]
   Types of Wills and Probate in Ethiopia — Ministry of Justice of Ethiopia
5. [5]
   Community-Based Health Insurance Drives Ethiopia's Bid for Universal Health Coverage — World Health Organization Regional Office for Africa