A Medium Clinic in Ethiopia is the next level to primary level of the healthcare in ambulatory health service that provide mainly curative but also preventive services. A medium clinic gives a vast service which in Ethiopian standards Agency is stated below

1. Outpatient Medical Service

  • The medium clinic shall Provide outpatient care (diagnosis & treatment) for ambulatory patients including acute conditions and referral of ambulatory patients with common and chronic conditions including TB, HIV to appropriate level;
  • The medium clinic shall have clinical protocols for management of at least common disease entities like malaria, hypertension and locally significant diseases, common dental, eye, ENT and mental health problems
  • The service shall avail national guidelines for malaria, TB/Leprosy, VCT, trachoma, pain management, STI and other common illnesses.

2. Minor Surgical service at outpatient level.

The Medium clinic shall provide minor surgical services under aseptic technique for the following conditions:

  • Circumcisions,
  • Lipoma and simple cyst excisions,
  • abscess drainages,
  • suturing of lacerated wounds,
  • external immobilization of closed and open fractures,
  • foreign body removal and
  • other minor interventions under local anesthesia

3. Nursing care service

shall be availed for patients unable to support themselves, and other clients who need the care by licensed nurses.

4. Emergency service

shall be available during 24 hours. Lifesaving management of emergency cases shall be provided without any prerequisite and discrimination. The emergency service shall provide basic life support as indicated for any emergency cases, which may include at least the followings:

a) Airway management,

b) Bleeding control

c) Fluid resuscitation

d) Cardiopulmonary resuscitation (CPR)

Protocols for initial management of at least the following emergency cases:

a) Shock

b) Severe Bleeding

c) Fracture and injuries

d) Coma

e) Burn

f) Poisoning

g) Seizure disorder

h) Hypertension emergencies

i) Cerebrovascular accident

j) Acute diarrhea (Severe dehydration)

k) Acute abdomen

l) Tetanus

m) Meningitis

n) Severe & complicated malaria

  • If referral is needed it shall be done after providing initial stabilization and if the patient needs to be attended by a health professional during the transfer process, the Medium clinic has the responsibility of assigning the accompanying professional.

5. Delivery Service (optional)

For spontaneous normal deliveries. There shall be a reliable referral system for high-risk mothers and complicated deliveries. . Assisted deliveries are prohibited in medium clinic MCH service. The medium clinic shall provide MCH services that include ANC, PNC, Family Planning, Growth monitoring, VCT and PMTCT services being compliant with the current guidelines prepared for the respective services. The medium clinic comprehensive abortion care may provide less than 12 weeks.

6. Pharmaceutical service

Medium clinics shall have emergency medicines at all times. emergency medicines must be from suppliers licensed by EFDA ONLY.

7. Laboratory service

Medium clinic shall have a laboratory service during working hours. The following list of lab tests shall be available in the medium clinic:

  • Hematology: complete blood count (CBC) which includes white blood cell count, platelet, hemoglobin, ESR(Erythrocytic sedimentation rate), hematocrit, differential count, blood group and Rh, Hemoparasite
  • Clinical chemistry: Glucose, Aspartate Aminotransferase (AST), Uric Acid, Alanine Aminotransferase (ALT), Creatinine, Bilirubin, Urea/ BUN, Alkaline Phosphatase
  • Urine: Urine chemical test, Urine Microscopy, Pregnancy test
  • Parasitology: Direct Stool Examination
  • Bacteriological/ Fungal examination: Gram Stain, KOH, AFB Stain, Wet mount, Indian ink
  • Serological tests: HBsAg, HCV, H.pylori, RPR/ VDRL (syphilis), HIV Ab test

Rooms required for a Medium Clinic in Ethiopia

Premises required No. of rooms required Area required
Reception, Registration/Recording & Waiting area 1 16 sq.m
Examination room 1 12
Laboring room(optional) 1 12
Delivery room(optional) 1 16
Postnatal rooms(optional) 1 12
Shower room and toilet if have

delivery service (optional)

1 8


Duty room if the emergency service is 24hs 1 8


MCH room 1 12
Ultrasound room(optional) 1 12
Treatment/ procedure/ injection room 1


Laboratory room 1 24
Sample collection room 1 4 include

in 24

X-ray room as per ERPA (optional )
  • Conventional X-ray room
1 24
  • Dark room (if necessary)
1 6
  • Toilet with hand washing basin
2 8
  • Patient dressing cubicle inside x-ray room


  • sub waiting area
1 12
Emergency resuscitation room with two beds 1 16
Instrument processing room 1 12
Staff room 1 9
Toilet (Male &Female) 2 8
Staff toilet with shower 1 4 1 4
Area for placenta pit

Professionals needed for a Medium Clinic in Ethiopia

The medium clinic shall be directed by a licensed

  • General Practitioner with a minimum of 3 years of experience or
  • Generic Health officer or generic BSc Nurse with a minimum of 5 years of experience or
  • Nurse Practitioner or Post basic BSc nurse or
  • Post Basic Health Officer with a minimum work experience of 3 years.

The medium clinic shall have at a minimum the following staff:

Staffs required Number required
GP/HO/Nurse Practitioner/BSc Nurse 1
Nurse, Diploma 1
HO or GP 1
Midwife 1
If delivery service available BSC midwife 1
Lab technician or lab technologist 2
Radiology technologist if ultrasound available 1
Radiology technologist/Radiographer 1
Receptionist 1
Cleaner 1

Equipment and supplies required for a medium clinic in Ethiopia

a) Diagnostic Equipment

  • Stethoscope
  • Ophthalmoscope
  • Sphygmomanometer
  • Reflex hammer
  • Thermometer
  • Fetosthetoscope
  • Weighing scale
  • Snellen`s Chart
  • Infanto-meter and height scale
  • Tuning fork, 500 Hz
  • Otoscope

b) Medical Equipment

  • Mobile examination lamp
  • Examination couches
  • Steam Sterilizer
  • Refrigerator #2, (LAB & Treatment room)

c) Delivery Equipment

  • Neonatal resuscitation
  • Delivery coach

d) Instruments

  • Dressing set
  • Instrument tray
  • Minor surgical set
  • Instrument trolley
  • Delivery set
  • Ear irrigation syringe
  • Enema set
  • Packing nasal forceps,
  • Speculum of different sizes
  • Steri-strip for steam autoclave
  • Pickup forceps with jar
  • Lumbar puncture set (optional)
  • Sterilization drums
  • IV Infusion stand
  • Kidney dishes

e) Laboratory equipment:

  • Binocular Microscope
  • Chamber
  • Differential counter
  • Tally counter
  • Centrifuge
  • Timer
  • Refrigerator with thermometer
  • Test tube rack
  • ESR rack of five
  • ESR tubes
  • Spirit lamp
  • Slides,
  • Cover Slides,
  • Reagents,
  • Dry oven/ autoclave (can be shared with general clinic service)
  • Spectrophotometer (semiautomated)
  • Fully automated hematology machine
  • Shaker
  • Roller (optional)

f) Imaging equipment(optional)

  • Standard conventional x-ray machine,
  • X-Ray viewing boxes,
  • Ultrasound
  • Radiation protection equipment’s: lead gloves, lead apron, lead goggle gonad shields
  • Dark room film processing baths if necessary
  • Drier (optional)

g) Others

  • Tourniquet
  • Kick buckets
  • Drapes
  • Tongue depressors
  • Surgical cape
  • Cabinets and shelves
  • Surgical mask
  • Time clock

N.B: All equipment of medium clinic shall be in good working order, routinely quality controlled, and precise in terms of calibration

So what steps should one take to open a medium clinic in Ethiopia?

  1. Acquire a professional license
  2. Find a place that fulfills the requirements listed
  3. Have the place inspected by a local standards agency officer
  4. Renovate the place
  5. Have a second round inspection
  6. Get clearance and business license
  7. Get all equipments required
  8. Finally, launch the clinic.




Also see, How to open a Medical Office Practice in Ethiopia


This article is based on the guide published by the Ethiopian Standards Agency (ESA) 2020 edition.

For further information contact through the following address

Phone numbers: 011- 646 06 85, 011- 646 05 65, 011-646 08 80

Postal: 2310 Addis Ababa, Ethiopia



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