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BACKGROUND: A devastating drought is ravaging Africa, with Ethiopia being the worst-hit country. Ethiopia’s economy is predominantly reliant on rain-fed farming and livestock. The agriculture sector contributes up to 85% of the country’s livelihoods. The drought has threatened agro-economy and health of over 15 million agro-pastoralist population who herd the largest livestock in Africa. Some governments announced its commitment in the UN to extend support for the drought-affected people. The Sendai framework for Disaster Risk Reduction prioritizes proactive rather than reactive relief response that can promote health resilience. Applying population health matrices can serve the purpose by exploring the determinants of health, their impacts on the differential health outcomes for population sub-groups and to improve the overall health of the population by addressing the health inequity. OBJECTIVE: This study aims to identify the critical population health outcomes, underlying determinants, and the leverage points for actions that can guide effective policies and interventions for building health resilience for the vulnerable agro-pastoralist population in Ethiopia. METHODS: Two researchers searched nine academic and grey literature bibliographic databases for drought literature and related health interventions. We used the PRISMA checklist to synthesize data and Hamilton tools to evaluate individual study quality. We analyzed data employing disaster vulnerability and WHO’s social determinants of health and health equity frameworks. Socioeconomic, political and cultural backgrounds are examined to identify policy and leverage points for effective population health interventions. RESULTS: Health issues are diverse that revolve around the major determinants of health such as food security, infrastructure, health systems, disaster preparedness, household productivity-income, livestock dependence and access to the market economy. These determinants are further affected by socioeconomic, political and cultural contexts. Despite dire vulnerability and health inequity, some potentials evolved from recent public health field practices as the leverage points for policy actions and interventions. CONCLUSION: The recommended interventions can be implemented through an interdisciplinary population health approach to get the maximum impacts on health resilience. Evidence gathered from the worst drought niche in Africa can be useful to tackle similar droughts induced health issues in other parts of the continent. Future intervention research on the ground can generate robust evidence for action to build health resilience.

Drought in Ethiopia: A Population Health Equity Approach to Build Resilience for the Agro-Pastoralist Community