Despite measurable national gains in child health, Ethiopia continues to face stark spatial inequalities—particularly in pastoralist and peripheral regions like Afar. These disparities are often attributed to logistical or behavioural challenges, yet such framings obscure the deeper political, institutional, and ideological drivers that sustain inequity. This study employs a political economy lens to critically examine how policy structures, actor dynamics, and dominant narratives contribute to the persistence of child health inequalities in Ethiopia. Using an embedded single-case study design, this research draws on 23 semi-structured interviews with national and regional policymakers, development partners, and civil society actors, as well as a review of 53 national and sectoral policy documents. Data were analysed thematically, guided by Walt and Gilson’s Policy Triangle and Moncrieffe and Luttrell’s political economy framework. Four interrelated drivers of inequality were identified: (1) historical legacies of exclusion and underinvestment in Afar; (2) institutional fragmentation and symbolic decentralisation that limit regional policy autonomy; (3) efficiency-centred policy design that marginalises mobile and hard-to-reach populations; and (4) global donor practices that reinforce centralised, metric-driven planning. These dynamics interact to produce and legitimise structural inequality across space. Child health inequalities in Ethiopia are not technical anomalies but structural outcomes of how public policy is historically framed, institutionally governed, and ideologically justified. Addressing these disparities requires reframing equity as a political and ethical priority—supported by redistributive policy logic, inclusive planning processes, and donor strategies attuned to the needs of marginalised regions. The findings contribute to a growing body of equity-focused health policy literature and offer lessons for other low- and middle-income countries grappling with spatial and structural health inequities.
Anteneh Gebremichael DOBAMO (Wed,) studied this question.