The Role of a Mission Organization in Building a Sustainable Government Hospital in Southern Ethiopia




mission history, mission hospital, sustainability, Ethiopia


In 1950, the Norwegian Lutheran Mission (NLM) began holistic mission work, including health work in Yirga Alem in Sidama in Southern Ethiopia.  The hospital, which had served as a military hospital during the Italian war (1936-41), became a mission hospital.  This paper presents some historical developments of a government hospital managed by a mission organization, the story of its medical work, and how the NLM functioned under varying political regimes and societal environments in Southern Ethiopia.  At the same time, societal changes occurring in Norway with the weakening of mission organizations and the Norwegian government’s policy that influenced external financial support for the hospital are presented and discussed.  The key message of the paper is that it is possible under challenging external politics for a mission organization to collaborate with government entities even with difficult regimes.  In the area of Yirga Alem Hospital, this was done without compromising the basics of mission, but rather readjusting comparative strategies while ensuring sustainability and local ownership.  The uniqueness of this work is that it explores a mission, i.e., the NLM, which developed health work within the context of a nationally owned health service.  Moreover, this fruitful collaboration persists until this day and previous missionaries still work to strengthen public health programs that target such major areas as tuberculosis and HIV control, maternal health, childcare, and nutrition.

Author Biography

Bernt Lindtjorn, University of Bergen

Professor in International health at the Centre for International Health, University of Bergen in Norway and at Hawassa University in southern Ethiopia. He still works in the Sidama area, including the YAH. For almost 40 years he was a missionary doctor with the NLM, and from 1997 – 2011 I was leading the organization’s work at the YAH.

He is a medical doctor and surgeon with extensive experience in hospital work, research, disease control, institutional development, research management, and teaching and work in developing countries. My professional profile includes surgery in developing countries, population studies, health services research, maternal and child health, and control of tuberculosis, HIV and AIDS, malaria and malnutrition.


Lausanne Committee for World Evangelization. Evangelism and social responsibility: an evangelical commitment [Internet] [LOP 21]. Lausanne Committee for World Evangelization/World Evangelical Fellowship. 1982. Available from:

Norwegian Lutheran Mission. Constitution of NLM Oslo [Internet]. NLM. 2018 [cited 2020 Feb 5]. Available from:

Markakis J. Ethiopia: the last two frontiers [reprint]. Woodbridge: Boydell & Brewer Ltd; 2011.

Sandved J. I Herrens tjeneste. Misjonssambandet i Afrika: Lunde; 1966.

Lunde S. Legemisjonæren personlig: kirurgen og radiologen Magnus Tausjø i samtale med biskopSigurd Lunde. Oslo: Lunde; 1992. [226 s].

Tolo A. Change in society. Church planting and Church growth in Sidamo, South Ethiopia [PhD dissertation]: Uppsala University; 1993.

Donham DL. Marxist modern: an ethnographic history of the Ethiopian revolution. Univ of California Press; 1999.

Lende S. Dobbel ild. Dramatiske høydepunkter fra misjonsleges hverdag i Etiopia Oslo: Lunde; 2002.

Lende S, Lindtjørn B. A hospital in a developing country. Experiences from the Sidamo Regional Hospital in southern Ethiopia. Tidsskr Nor Laegeforen. 1991;111(9):1118-22.

Møgedal S, Godal T, Lende S, Lindtjørn B, Sanna S, Sæterøy R. Report on NORAD supported health services through Norwegian Lutheran Mission in Ethiopia [Report]. Oslo: Norwegian Lutheran Mission; 1985.

Lindtjørn B. Essential drug list in a rural hospital: does it have any influence on drug prescription? Trop Doct. 1987;17:151-5. PubMed PMID: 688.

Lindtjørn B, Setegn D, Niemi M. Sensitivity patterns of bacteria isolated from patients at Sidamo Regional Hospital. Ethiop Med J. 1989;27(1):27-31. PubMed PMID: 2920709.

Lemma E, Niemi M, Lindtjorn B, Dubrie G. Bacteriological studies of tuberculosis in Sidamo Regional Hospital. Ethiop Med J. 1989;27(3):147-9. PubMed PMID: 2502390.

Henriksen TH, Nysaeter G, Madebo T, Setegn D, Brorson O, Kebede T, et al. Peptic ulcer disease in south Ethiopia is strongly associated with Helicobacter pylori. TransRSocTropMedHyg. 1999;93(2):171-3. PubMed PMID: 1623.

Madebo T, Lindtjørn B, Henriksen TH. High incidence of oesophagus and stomach cancers in the Bale highlands of south Ethiopia. Trans R Soc Trop Med Hyg. 1994;88(4):415.

Ødegaard T. Tuberkulose-problem i Sidamo provins, Etiopia. Tidsskr nor Lægeforen. 1967;87:2027-33. PubMed PMID: 1277.

Vecchiato N. Culture, health, and socialism in Ethiopia: the Sidamo case [PhD dissertation]: University of California; 1985.

Dangisso MH, Woldesemayat EM, Datiko DG, Lindtjørn B. Long-term outcome of smear-positive tuberculosis patients after initiation and completion of treatment: a ten-year retrospective cohort study. PLoS One. 2018;13(3):e0193396. Epub 2018/03/13. PubMed PMID: 29529036; PubMed Central PMCID: PMCPMC5846790.

Dangisso MH, Datiko DG, Lindtjørn B. Spatio-temporal analysis of smear-positive tuberculosis in the Sidama Zone, southern Ethiopia. PLoS One. 2015;10(6):e0126369. PubMed PMID: 26030162; PubMed Central PMCID: PMCPMC4451210.

Dangisso MH, Datiko DG, Lindtjørn B. Low case notification rates of childhood tuberculosis in southern Ethiopia. BMC pediatrics. 2015;15:142. PubMed PMID: 26428086; PubMed Central PMCID: PMCPMC4589978.

Datiko DG, Lindtjørn B. Cost and cost-effectiveness of smear-positive tuberculosis treatment by Health Extension Workers in Southern Ethiopia: a community randomized trial. PLoS One. 2010;5(2):e9158. Epub 2010/02/23. PubMed PMID: 20174642; PubMed Central PMCID: PMC2822844.

Datiko DG, Lindtjørn B. Health extension workers improve tuberculosis case detection and treatment success in southern Ethiopia: a community randomized trial. PLoS ONE. 2009;4(5):e5443. Epub 2009/05/09. PubMed PMID: 19424460; PubMed Central PMCID: PMC2678194.

Lindtjørn B, Madebo T. The outcome of tuberculosis treatment at a rural hospital in southern Ethiopia. Tropical doctor. 2001;31(3):132-5. PubMed PMID: 11444329.

Madebo T, Nysaeter G, Lindtjorn B. HIV infection and malnutrition change the clinical and radiological features of pulmonary tuberculosis. Scand J Infect Dis. 1997;29(4):355-9. PubMed PMID: 9360249.

Klungsøyr P, Kiserud T. Rupture of uterus treated with suture. Acta obstetricia et gynecologica Scandinavica. 1990;69(1):93-4. PubMed PMID: 2346086.

Henriksen TH, Brorson O, Schoyen R, Thoresen T, Setegn D, Madebo T. Rapid growth of Helicobacter pylori. EurJClinMicrobiolInfectDis. 1995;14(11):1008-11. PubMed PMID: 1625.

Lindtjorn B. Risk factors for fatal diarrhoea: a case-control study of Ethiopian children. Scand J Infect Dis. 1991;23(2):207-11. PubMed PMID: 1853169.

Lindtjørn B. Cancer in southern Ethiopia. J Trop Med Hyg. 1987;90(4):181-7. PubMed PMID: 3656495.

Lindtjørn B, Olafsson J. Burkitt's lymphoma in South Ethiopia. Afr J Med Med Sci. 1985;14(3-4):181-4. PubMed PMID: 3004178.

Federal Ministry of Health. Implementation manual for health care financing reforms. Addis Ababa, Ethiopia: Federal Ministry of Health; 2005.

King M. Medical care in developing countries. A symposium from Makerere. Nairobi, Lusaka, Addis Ababa, London: Oxford University Press; 1966.

World Health Organization. Declaration of Alma-Ata: International Conference on Primary Health Care [Internet]. Geneva: WHO; 1978. Available from:

Feachem RG, Kjellstrom T, Murray CJ, Over M, Phillips MA. The health of adults in developing countries [Internet]. Oxford: Oxford University Press; 1992. Available from:

Abraham E. Reminiscences of my life. Oslo: Lunde; 1995.

Deressa SY. Church and development in Ethiopia: the contribution of Gudina Tumsa’s holistic theology. Lutheran Mission Matters. 2017:150.

Vecchiato NL. Ethnomedical beliefs, health education, and malaria eradication in Ethiopia. Int'l Quarterly Commun Health Ed. 1991;11(4):385-97. PubMed PMID: 1397.

Aadland O. Introducing a tuberculosis control programme in Sidama: a case study in cross-cultural communication [PhD dissertation]. Chicago: Northwestern University; 1996.

Borde MT, Loha E, Johansson KA, Lindtjorn B. Utilisation of health services fails to meet the needs of pregnancy-related illnesses in rural southern Ethiopia: a prospective cohort study. PLoS One. 2019;14(12):e0215195. Epub 2019/12/05. PubMed PMID: 31800574.

Dangisso MH, Datiko DG, Lindtjorn B. Trends of tuberculosis case notification and treatment outcomes in the Sidama Zone, southern Ethiopia: ten-year retrospective trend analysis in urban-rural settings. PLoS One. 2014;9(12):e114225. PubMed PMID: 25460363; PubMed Central PMCID: PMCPMC4252125.

Schaller KF, Kuls W. Ethiopia. Geomedical Monograph No 3. Berlin: Springer; 1972.

Hodes RM, Kloos H. Health and medical care in Ethiopia. N Engl J Med. 1988;319:918-25. PubMed PMID: 560.

Lindtjørn B. Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death among children. BMJ. 1990;301(6761):1123-7. PubMed PMID: 2252922; PubMed Central PMCID: PMC1664269.

Kloos H, Lindtjorn B. Malnutrition and mortality during recent famines in Ethiopia: implications for food aid and rehabilitation. Disasters. 1994;18(2):130-9. PubMed PMID: 8076157.

Mehari W-A, Zein AZ, Kloos H. Demography and health planning. The ecology of health and disease in Ethiopia. Addis Ababa: Ministry of Health; 1988.

Golding N, Burstein R, Longbottom J, Browne AJ, Fullman N, Osgood-Zimmerman A, et al. Mapping under-5 and neonatal mortality in Africa, 2000–15: a baseline analysis for the Sustainable Development Goals. Lancet. 2017;390(10108):2171-82.

Dangisso MH, Datiko DG, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern Ethiopia. Global health action. 2015;8:29443. Epub 2015/11/26. PubMed PMID: 26593274.

Tekle M. State-society relations and traditional modes of governance in Ethiopia: a case study of Sidama [PhD dissertation]. Addis Ababa:Addis Ababa University; 2014. Available from:

Belayneh M, Loha E, Lindtjorn B. Food insecurity, wasting and stunting among young children in a drought prone area in South Ethiopia: a cohort study (P04-040-19). Current Develop Nutr. 2019;3(Supplement_1).

Central Statistical Agency. Ethiopian population and housing census. Addis Ababa, Ethiopia: Central Statistical Agency; 2007 [cited 2015 Nov 20]. Available from:

Haile G, Lande A, Rubenson S. The missionary factor in Ethiopia: papers from a symposium on the impact of European missions on Ethiopian society. Lund University, August 1996. Peter Lang Pub Inc; 1998.

Møgedal S, Bergh M. Challenges, issues and trends in health care and the church's mission. Int Rev Mission. 1994;83(329):257-76. PubMed PMID: 1469




How to Cite

Lindtjorn, B. (2020). The Role of a Mission Organization in Building a Sustainable Government Hospital in Southern Ethiopia . Christian Journal for Global Health, 7(2), 133–146.