Public Health - Information Booklet - 2024

2024
Ethiopian Health Professionals Licensing Examination(EHPLE)
INFORMATION BOOKLET
PUBLIC HEALTH
Institute of
Educational Research
Message From the State Minister, Ministry of Health -Ethiopia
Mrs. Frehiwot Abebe

Improving healthcare quality is a global priority for sustainable development, with high quality
healthcare being a key component of universal health coverage. One strategy to maintain health
care standards is through provision of health professional competency assessment. Consequently,
in 2019, the Ministry of Health Ethiopia, initiated the Ethiopian Health Professionals Licensing
Examination (EHPLE) for undergraduates in seven health disciplines, which has since expanded
to include 13 health disciplines.
The main goal of this competency assessment is to identify health professionals with minimal
competencies necessary to perform their duties safely and competently, thus enhancing the
quality of health care services. This initiative is overseen by a dedicated Health and Health
Related Institutions and Professionals’ Regulatory Lead Executive Office (LEO), comprising
four desks, which plays a pivotal role in strengthening the system and enabling the LEO to
conduct the competency exam more extensively and with improved organization and quality.
It is important to note that this competency assessment differs significantly from traditional
academic or employment examinations. Hence, this information booklet has been created to
address the informational needs of both examinees and teaching faculty regarding the Ethiopian
Health Professionals’ Licensure Examination. Additionally, it aims to facilitate the assessment
process, while promoting transparency and ensuring the sustainability of the program.
The preparation of this guideline involved the collaboration of esteemed experts from various
higher education institutions, AAU-IER, the Ministry of Health, JHPIEGO-Ethiopia,
Amref/HWIP, Health Professionals’ Associations, and the Ministry of Education. Their
invaluable contributions are acknowledged with sincere gratitude, alongside appreciation for the
Ministry of Health staff for their unwavering commitment and hard work throughout the project.
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Acknowledgements
This Information Booklet for Ethiopian Health Professional’s Licensing Examinations is a

contribution from several educators, researchers, students and concerned individuals with a
genuine interest to propel Ethiopia’s medical and health sciences education forward.
The Ministry of Health is grateful for the contribution of many individuals and institutions in
realizing this endeavor. Among these are Professional Associations, Student Association, Higher
Education Institutions (both public and private), JHPIEGO-Ethiopia, AMREF/HWIP, MOE
(Ethernet), UNFPA, AAU-IER and all HHRIPR LEOs staff.
EHPLE Information Booklet 2024 Public Health

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Acronyms and Abbreviations
EHPLE Ethiopian Health Professionals Licensing Examination
ETA Educational and Training Authority
HEIs Higher Education Institutions
HHrIPR-LEO Health and Health-related Institutions and Professionals Regulatory Lead Executive
Office
HSTP-II Health Sector Transformational Plan-II
MCQ Multiple Choice Question
MoH Ministry of Health
WHO World Health Organization

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Purpose of the Information Booklet

The Ethiopian Health Professionals’ Licensing Examination (EHPLE)
Information Booklet serves as a comprehensive guide for those individuals
seeking information about the exam. It typically outlines basic information for
candidate registration, exam development and administration processes and
procedures, result notification, and the licensing process. It also includes
information on the exam framework, i.e., the exam domain, sub-domain, content,
process, and task, with sample exam items specific to each profession.
The publication of this Booklet is crucial for the following reasons:
 Clarity and guidance: It provides clear information about the exam by

ensuring candidates understand the necessary information to prepare them.
 Accessibility: It serves as a readily accessible resource for individuals
pursuing to take the exam, consolidating essential information in one
document and facilitating easy access to necessary details. It also helps
other stakeholders who might be interested in such resources.
 Transparency: It promotes transparency in the examination process and
fosters trust among stakeholders about the exam.
In summary, the publication of this Booklet is essential for creating a transparent,
standardized, and accessible framework that guides candidates through the
EHPLE process.

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Contents
Message From the State Minister, Ministry of Health -Ethiopia ................................................................... i
Acknowledgements ....................................................................................................................................... ii
Acronyms and Abbreviations ...................................................................................................................... iii
Definition of terms ....................................................................................................................................... vi
1. Introduction ........................................................................................................................................... 1
1.1. Background ................................................................................................................................... 1
1.2. The Rationale of EHPLE .............................................................................................................. 1
2. Key processes of EHPLE ...................................................................................................................... 2
2.1. Registration of candidates ............................................................................................................. 2
2.2. Task Analysis ................................................................................................................................ 3
2.3. Exam Blueprint ............................................................................................................................. 3
2.4. Item Development ......................................................................................................................... 3
2.5. Item Review .................................................................................................................................. 3
2.6. Standard setting method ................................................................................................................ 4
2.7. Exam Administration .................................................................................................................... 4
2.8. Scoring and post exam analysis .................................................................................................... 5
2.9. Result notification and appeal management ................................................................................. 5
2.10. Licensing ................................................................................................................................... 5
3. Exam Framework .................................................................................................................................. 6
Sample questions ........................................................................................................................................ 13
Sample Reference ....................................................................................................................................... 21
List of contributors ...................................................................................................................................... 22
Contact Us................................................................................................................................................... 23

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Definition of terms
 Domain: a broad category or area of knowledge or skills of a profession
 Sub-domain: a subset of a broader domain that focuses on knowledge or skills related to
the overarching domain
 Content: a more specific subcategory, which is a breakdown of the sub-domain
 Task: the responsibility, knowledge, skill, and attitude of a junior undergraduate
professional in an actual work environment
 Process: a systematic sequence of steps or actions designed to achieve a specific outcome
 Learning outcome: a clear and measurable statement that describes what the examinee is
expected to know or be able to do
 Relative emphasis: the proportional importance or weight assigned to different content
areas or categories within the assessment
 Item: a particular multiple-choice question
 Item developer: a subject matter expert responsible for writing test items or questions that
make up the examination
 Item reviewer: a subject matter expert responsible for reviewing and refining the test items
or questions that make up the examination
 Standard setting: a process of determining a cut-off point or passing score for an exam
 Item difficulty index: a statistical measure that indicates the proportion of examinees who
answered a particular test item correctly
 Discrimination index: a statistical measure that evaluates how well a particular test item
differentiates between high-performing and low-performing examinees
 Admission paper: a printout paper generated by the system after completing registration
that contains the examinee's photo, QR code, and necessary information

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1. Introduction
1.1. Background
Competency assessment is one of the strategies for controlling the standard of healthcare
services provided in healthcare facilities. The World Health Organization (WHO) recommends
all healthcare professionals to have necessary competencies. In Ethiopia, the Health Sector
Transformational Plan-II (HSTP-II) states competency assessment of all graduates before joining
the health workforce as one of the strategic initiatives.
The Ministry of Health (MoH) launched the Ethiopian Health Professionals Licensing
Examination (EHPLE) for undergraduates in 2019. The Health and Health-related Institutions
and Professionals Regulatory Lead Executive Office (HHrIPR-LEO) of the Ministry of Health
was given a mission to implement the ministry’s objective to achieve competency-related goals.
It has the responsibility to ensure that the EHPLE meets technical, professional, and legal
standards, and to protect the health, safety, and welfare of the public by assessing candidates’
abilities to practice competently.
Currently, the exam is given for 13 health professions (Medicine, Nursing, Public Health,
Pharmacy, Medical Laboratory Science, Anesthesia, Midwifery, Dental Medicine, Medical
Radiology Technology, Environmental Health, Psychiatric Nursing, Pediatric and Child Health
Nursing, and Emergency and Critical Care Nursing). Since its introduction until February 2024,
a total of 166293 examinees took the exam in 14 rounds.
1.2. The Rationale of EHPLE

One of the critical functions of the MoH is to guarantee the efficiency, quality, and equity of
healthcare delivery and to protect the public from any undesirable consequences in healthcare
delivery practices. As professionals’ competence is a significant determinant of the quality of
health, evaluation of health professionals’ competence has now been given due attention. The
licensing examination for health professionals serves as a crucial step to ensure that individuals
entering the field meet specific competency standards. The sole aim of the competency
assessment is to safeguard public health by verifying that health professionals have the minimal
basic knowledge, attitude, and skill required to provide safe and effective care.
Licensing exams act as a preventive measure, ensuring that only competent professionals join the
health workforce, which, in turn, contributes to reducing the occurrence of medical errors and
enhancing overall patient safety. By setting standards through examinations, regulatory bodies
strive to minimize the risk of medical errors caused by incompetence.

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2. Key processes of EHPLE

EHPLE involves several key processes to ensure the quality and reliability of the examination.
2.1. Registration of candidates

EHPLE has a mandatory online registration system for both new and repeat candidates, which
can be found at www.hple.moh.gov.et
Please note these important notes during registration.

New Test Takers:
 The list of eligible candidates from governmental and private Higher
Education Institutions (HEIs) will be sent from Ministry of Education (MoE)
to MoH and uploaded to the online registration system by MoH.
 Once the name of the candidate is uploaded to the system and registration has
opened for the current exam round, the candidate must register at
www.hple.moh.gov.etby uploading the necessary documents listed below.
 a scanned original or temporary degree
 a scanned government-issued ID, passport, driving license, or any
other legal ID
 a passport-size photo of the candidate
 For international candidates:
o Equivalence document from ETA
o Completing an externship attachment according to assignment
by the regulatory body
o Externship attachment completion letter
Repeat Test Takers:
 Since the information about re-exam candidates already exists in the system,
the candidate should register by directly going to www.hple.moh.gov.et.
There is no need for re-exam candidates to upload their documents.
Both new and repeat candidates:
 After completing the registration, the candidate must download and print the
admission paper by logging into his/her account using his/her email address
and password
 The candidate can change the exam center by logging into his/her account
only during the registration period
 Once an examinee has selected his/her exam center during the registration
period, an application for center change will not be allowed

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2.2. Task Analysis

The first step of exam development involves conducting a comprehensive task analysis study,
which identifies the tasks, knowledge, skills, and abilities required from a junior undergraduate
professional in the specific profession. The analysis is typically done through surveys,
interviews, or observations of practitioners in the actual work environment, as well as through
the Delphi method with subject matter experts.
2.3. Exam Blueprint

Based on the task analysis findings, a test blueprint is created that outlines the content areas to be
covered in the examination and the weight or emphasis given to each area. This ensures that the
exam reflects the key competencies and knowledge needed for competent practice in that
specific profession. Blueprint or test specification is the matrix or chart that shows the number
and type of test questions represented across the topics in the content area, consistent with the
learning outcome and relative weight of the test given to each content area. The blueprint also
identifies the percentage weighting of cognitive dimensions as the level of competence tested in
each knowledge domain.
Key components of a blueprint are:
 Domain
 Sub-domain
 Content
 Task
 Process
 Learning outcome
 Assessment methods
 Assessment tools/instrument (test format)
 Relative emphasis (in percentage)
2.4. Item Development

The items are developed following specific guidelines to ensure clarity, relevance, and fairness.
Subject matter experts with experience in the field are selected from HEIs to develop test
questions (items) that align with the test blueprint. The exam questions will focus mainly on
“knows how” according to the competency level of the Miller's pyramid. The items are produced
in a secure location on designated computers that are free from internet connectivity. The items
are scenario-based and constructed with stem, lead-in, and four options/alternatives. All items
will have a single-best-answer type of Multiple Choice Question (MCQ) that addresses the
learning outcome defined in each content area. Standard text books, updated guidelines, and
standards are used as reference materials.
2.5. Item Review

Once developed, the items undergo a rigorous review process by item reviewers. The main
purpose of the exam review process is to evaluate content relevance, technical accuracy, clarity,
and sensitivity related to culture and religion. More experienced subject matter experts as well as
psychometric experts will do the review to ensure the items meet psychometric standards.
Subject matter experts shall review the items to confirm that they are accurate, clearly stated, and

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correctly keyed using the checklist. Psychometric experts shall reviews the items to ensure that
they are not technically flawed. They also work on editorial review to check grammar,
punctuation, and spelling errors. This helps ensure the reliability and validity of the items.
2.6. Standard setting method

The standard setting or cut-off point of the EHPLE is determined using the Modified-Angoff
method, which is one of the most widely used and legally defensible standard setting approaches
to set a cut-off point for high-stake competency examinations.
The method involves a panel of subject matter experts who evaluate each test question and then
estimate the probability that a minimally competent examinee would answer each test item
correctly. The average of the experts’ predictions for a test question becomes its predicted
difficulty. The average of the predicted difficulty values across all items on a test is the
recommended cut-off point. This point indicates the minimum level of knowledge and skill
required to pass.
2.7. Exam Administration

The EHPLE is administered following established protocols and guidelines. Proper test
administration procedures, appropriate security measures, and appropriate consideration for test-
takers who need special support will be applied during exam administration at exam centers. The
exam is administered in selected HEIsnationally, where candidates can choose based on their
convenience at the time of registration. The exam schedule will be posted ahead of time on the
MOH website and official Facebook page. Examinees who have a valid admission paper are
eligible to sit for the exam. The mode of exam administration is computer-based testing.
CAUTIONS
 Candidates are allowed

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 Candidates are NOT allowed
2.8. Scoring and post exam analysis

Once the exam is completed, the scoring process begins. The exam scoring process involves
computerized scoring using software.
Post-exam analysis is the process of analyzing examinees’ responses to individual test items in
order to assess the quality of the items and the exam as a whole.This phase helps to identify any
poorly performing items that may need revision or removal from the exam. The item difficulty
index, discrimination index, and reliability coefficient are elements of exam analysis.
2.9. Result notification and appeal management

After scoring and analysis, individual score reports are generated and provided to examinees
through the website www.hple.moh.gov.et.After result notification, examinees can submit their
appeal through phone or email within 10 working days after result notification.
2.10. Licensing
The list of examinees who passed the exam will be sent to regional and city administration
regulatory bodies. A license is obtained from the regional/zonal health bodies where he/she
permanently lives.
Requirements for professional licensing are:
 Passing the EHPLE
 Original or temporary degree
 Educational documents (10th and 12th certificates)
 Medical certificate
 Government issued ID
 Additional prerequisites based on the requirements of regional regulatory
bodies

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3. Exam Framework
The key broader professional roles, also known as domains or main knowledge areas serve as a building
framework for the licensing examination content for Public Health professional. The domains are further
divided into discrete professional attributes that constitute sub-units (also referred to as sub-domains)
defining the professional identity of Public Health profession Tasks specifying the performance level of
each sub-domain serve as the final characteristic of the professional duties on which the licensing exam
focuses.
The contents of the licensing examination are presented below, structured into key roles (domains), sub-
units (sub-domains), and tasks. The examination emphasis for each domain and sub-domain, out of the
total 100% questions, is indicated in brackets.
Key professional roles/ domains

 Patient Care (53.0%)
 Scholar (9.0%)
 Professionalism (7.0%)
 Leadership and management (11.0%)
 Health promotion and disease prevention (20.0%)
Key role/ domain 1: Patient care roles/ domains (53.0%)

Description: This domain encompasses the professional roles of Public Health professional in the
provision of high-quality, safe, and patient-centered care within their scope of practice. The provision of
up-to-date, ethical, and resource-efficient care requires the application of integrated knowledge of
biomedical, clinical, behavioral, and social sciences. As patient care providers, Public Health
Professionals shall collect and interpret information, make clinical decisions, carry out diagnostic and
therapeutic interventions, and evaluate interventions. To demonstrate competence in this domain,
candidates shall apply such integrated knowledge in the following sub-areas:
 Internal Medicine (12.0%)

 Surgery (9.0%)
 Pediatrics (9.0%)
 Gynecology and Obstetrics (10.0%)
 Dentistry (2.0%)
 Ear Nose and Throat (3.0%)
 Psychiatry and Mental Health (3.0%)
 Ophthalmology (2.0%)
 Dermatology (3.0%)

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Key role/ domain 2: Scholar (9.0%)

Description: This domain encompasses the professional roles of Public Health profession in generating
and utilizing scientific data to improve the health and well-being of Ethiopians and broaden their
scientific knowledge within the healthcare system and community setting. Providing this service requires
the application of integrated knowledge in research methods, measurements of health and disease,
biostatistics, epidemiology, clinical audit, evidence-based practice, and research ethics. To demonstrate
competence in this domain, candidates must possess applied knowledge in planning, problem
identification, data collection, analysis, interpretation, report write-up, and dissemination of research
outputs.
Key role/ domain 3: Professionalism (7%)

Description: This domain encompasses the professional commitment of Public Health professional to
promoting the health and well-being of individuals and society through adhering to ethical standards,
maintaining personal integrity, and upholding high standards of competence in all areas of practice. To
exhibit competence in this domain, candidates must possess applied knowledge of ethical principles,
medicolegal practices, effective communication, accountability to the profession and society,
maintenance of professional excellence and personal health, and professional values such as compassion,
respect, integrity, honesty, altruism, and humility. To demonstrate competence in this domain candidate
shall possess essential applied knowledge of the following sub-areas.
 Professional ethics and medico-legal practice (3.0%)

 Principles of professionalism (2.0%)
 Communication and Collaboration (2.0%)
Key role/ domain 4: Leadership and management (11.0%)

Description: This domain encompasses the professional roles of Public Health professional in
envisioning a high-quality healthcare system through self-awareness, active participation in healthcare
teams, leading teams, and managing health systems. Providing this service requires the application of
integrated knowledge in continuous quality improvement, effective health system leadership,
management, and healthcare ethics. To demonstrate competence in this domain candidate shall possess
applied knowledge to plan, organize, staff, lead, execute, monitor, and control healthcare resources and
activities.
Key role/ domain 5: Health promotion and disease prevention (20.0%)

Description: This domain encompasses the professional roles of Public Health professional in enhancing
the health and well-being of patients, communities, and the larger populations they serve through health
advocacy, disease prevention, health promotion and the promotion of health equity. Providing this service
takes an integrated understanding of determinants of health, health informatics, epidemiology,
communicable disease control, and health education. To demonstrate competence in this domain
candidate shall possess essential applied knowledge of the following sub-areas.
 Community diagnosis (10.0%)

 Community based intervention (10.0%)

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Table 1:Exam Content For Public Health Profession

Domain 1: Patient Care
Sub-domain 1.1: Internal Medicine
Content Sub-content
TB
HIV
Protozoal infections
Infectious diseases
Helminths
Acute febrile illnesses
Tetanus
Peptic ulcer disease
Gastrointestinal system Infectious diarrheal diseases
Liver diseases
Respiratory infections
Respiratory system Pleural effusion
Asthma and COPD
Heart Failure
Rheumatic fever and RHD
Cardiovascular system Infective endocarditis
Hypertension
Ischemic heart disease
Nephritic and nephrotic syndrome
Nephrology CKD
UTIs
CNS infections
Seizure disorders
Neurology Cerebrovascular accident
Headache
Paraparesis/paraplegia
Rheumatoid arthritis
Rheumatology
Gout
DM
Endocrinology Hyperthyroidism
Hypothyroidism
Hematology Anemia
Shock
Emergency medicine
Poisoning
Sub-domain 1.2: Surgery
Content Sub-content
Wound, wound management and surgical site infections
General surgery Thyroid surgery
Benign and malignant breast conditions
Hernias
PUD and its complications
GI surgery Acute abdomen
GI malignancies
Perianal conditions
Urinary tract stones
Acute and chronic urinary retention
Urologic surgery
Urologic Emergencies (Testicular torsion, Epididymo-orchitis)
Acquired and congenital diseases of the male genitalia (Hydrocele,

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Undescended testis)
Urologic Traumas
Urologic malignancies
Neurologic surgery Head injury and raised ICP
Bone and joint infections (osteomyelitis, septic arthritis)
Fracture, dislocation and compartment syndrome
Orthopedics & Traumatology
Bone tumors
Spinal Cord Injury
Cardiothoracic surgery Chest injury (Hemothorax, Pneumothorax, Rib fracture)
Plastic surgery Burn injury
Acute limb ischemia
Vascular surgery
Varicose veins
Pediatrics surgery
Sub-domain 1.3: Gynecology & Obstetrics (GYN/OBS)
Content Sub-content
Normal pregnancy
Early pregnancy complications
Late pregnancy complications
Normal labor
Abnormal labor
Normal and abnormal puerperium
Menstrual cycle and its abnormalities
Gynecologic infections
Family Planning
Infertility
Gynaecologic Oncology
Pelvic organ prolapse and Urinary
incontinence
Sub-domain 1.4: Pediatrics and Child health
Content Sub-content
Classification and care of new born
Neonatal resuscitation
Prematurity and Low birth weight (LBW)
Hemorrhage
Congenital infections
Neonatal tetanus
Neonatology
Jaundice
Congenital malformations
Respiratory distress in newborns
Hypothermia and hypoglycemia
Neonatal seizure
Necrotizing entero colitis(NEC)
Preventive Pediatrics Immunization practice
Diarrheal diseases
Urinary tract infection
Tuberculosis
Infectious diseases
HIV/AIDS
Acute febrile illness (AFI)
Malaria
Protozoal diseases/helminthes
Gastrointestinal disorders
Acute hepatitis

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Congestive heart failure

Cardiology Congenital heart diseases
Rheumatic heart disease and acute rheumatic fever
Upper respiratory tract infection (URTIs)
Respiratory Disorders Community acquired pneumonia
Wheezing, bronchiolitis and bronchitis
Nephrotic/Nephritic syndrome
Nephrology
Acute kidney injury
Seizure disorders
Neurology
CNS infections
Anemia
Hematology
Leukemia
Protein energy malnutrition
Malnutrition
Micronutrient deficiency
Growth and development Principles of development
Upper airway obstruction (Epiglottitis...)
Pediatrics emergencies Shock
Coma
Allergy and immunology Bronchial asthma
Hypoglycemia beyond neonatal age
Endocrinology
Diabetes mellitus
Sub-domain 1.5: ENT (Ear, Nose and Throat)
Content Sub-content
Otitis Externa
Disease of external and internal ear Acute otitis media and chronic otitis media
Foreign bodies
Acute rhino sinusitis
Disease of nose
Epistaxis
Acute and chronic tonsillitis
Adeno-tonsillar Hypertrophy (ATH)
Pharynx and Salivary gland disorders
Peritonsillar abscess
Deep neck space infection(Ludwig’s angina, submandibular abscess)
Sub-domain 1.6: Dentistry
Contents Sub-content
Basics of dentistry Nomenclature
Diseases of the hard tissues of the tooth Dental caries
Diseases of the dental Pulp Pulpitis
Gingivitis
Periodontal disease
Periodontitis
Tooth extraction Tooth extraction
Dental trauma Dental trauma
Oral health care Preventive Dentistry
Sub-domain 1.7: Psychiatry
Generalized anxiety disorder(GAD)
Anxiety disorders Phobias
Panic disorder
Trauma and stress relate disorders Post-traumatic stress disorder(PTSD)
Obsessive-Compulsive and related
Obsessive-Compulsive disorder(OCD)
disorder
Psychiatric Emergencies Suicide

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Substance related and addictive

Dependency and withdrawal states for various drugs (alcohol, etc..)
disorders
Psychotic Disorders Schizophrenia
Major depressive disorder(MDD)
Mood disorders
Bipolar disorders
Sub-domain 1.8: Ophthalmology
External Eye diseases Orbital cellulitis
Red eye Conjunctivitis
Cataract
Community Ophthalmology Trachoma
Vitamin A Deficiency
Chemical burn
Eye injuries Blunt and penetrating eye ball injuries
Foreign body
Thyroid eye disease
Sub-domain 1.9: Dermatology
Bacterial infection of the skin
Superficial Fungal infections of the skin
Viral infections
Parasitic infections
Eczemas
Acne
Domain 2: Health Promotion and Disease Prevention
Sub-Domain 2.1: Community Diagnosis
Content
Nutritional assessment methods
Behavioral models
Institutional health assessment
Disaster preparedness
Environmental health assessment
Child and Maternal health assessment
Public Health Screening
Surveillance
Outbreak investigation and management
Domain 3: Scholar
Sub-domain 3.1:Research and evidence based practice
Content
Problem identification
Setting objective
Study design
Sampling techniques
Sampling procedure
Sample size determination
Data collection tools
Data collection method
Data quality assurance
Ethical consideration
Data summarization and presentation

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Measure of morbidity
Hypothesis testing
Measure of association
Domain 4: Leadership and management
Content
Concepts and principles of management
Management function
Types of planning
Steps of planning
Organizing
Staffing
Leading
Decision making
Resource management
Primary health care(PHC) and Ethiopian health policy
Teamwork
Health care financing
Monitoring and Evaluation
Domain 5: Professionalism
Sub-domain 5.1: Professional ethics and medico-legal practice
Sub-domain 5.2: Principles of professionalism
Sub-domain 5.3: Communication and collaboration

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Sample questions
1. A 45-year-old female patient comes to a health center with a complaint of productive cough
with scanty whitish sputum of one-month duration. She claimed that the cough exacerbates
during night time and gets complete relief when she uses Salbutamol puff. She also has chest
tightness and pain, and shortness of breath. Her pulse rate is 92/min, respiration rate are
24/min, and temperature is 36.40C. Respiratory examination shows that there is scattered
wheeze all over the chest.
What is the most likely clinical diagnosis of this patient?

(A) Pneumonia (C) Bronchitis
(B) Tuberculosis (D) Asthma
Answer Key: The answer is D

Explanation: The patient’s symptoms of chest tightness and pain, nocturnal cough which
relieves with Salbutamol use, and the presence of wheeze are suggestive of asthma. The
characteristic symptoms of asthma are wheezing, dyspnea, and coughing, which are variable,
both spontaneously and with therapy. Symptoms may be worse at night and patients typically
awake in the early morning hours. Typical physical signs are inspiratory, and to a greater extent
expiratory wheeze throughout the chest. The diagnosis of asthma is usually apparent from the
symptoms of variable and intermittent airways obstruction, but must be confirmed by objective
measurements of lung function. On the other hand, Pneumonia (option A), Tuberculosis (option
B), and Bronchitis (option C), cannot be the most likely clinical diagnosis in this case as they
have different symptoms.
2. A 31-year-old male patient comes to a clinic with complaints of fever and abdominal pain of
five days duration. The fever has a characteristic of stepladder increment. He also has
headache, joint pain and anorexia. His pulse rate is 64/min, temperature is 39.60C, blood
pressure is 120/70mmHg and respirations rate are 20/min. On examination, there is no
remarkable systemic finding. His CBC result shows WBC count of 2500/mm 3, and
hematocrit level of 43%.
What is the most likely diagnosis of the patient?

(A) Typhoid fever (C) Cerebral malaria
(B) Relapsing fever (D) Bacterial meningitis
Answer Key: The answer is A

Explanation: The patient’s symptoms of high grade fever with stepladder increment, abdominal
and joint pain, headache, anorexia, and presence of relative bradycardia and leucopenia are
suggestive of typhoid fever (enteric fever), which is a systemic disease caused by dissemination
of S.Typhi or S. Paratyphi.

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3. A 28-year-old female comes to an OPD with recurrent left side headache of three-day
duration. She had similar history of headache for most of the days of the month for the last
two years. The pain worsens when she works over night at duty hours. She also has nausea,
vomiting and fear of light accompanying the headache. Her mother has also similar
complaints. Her vital signs are in the normal range. There is no pertinent physical finding on
examination
What is the most likely diagnosis of the patient?

(A) Cluster headache (C) Traction headache
(B) Tension headache (D) Migraine headache

Explanation: The patient’s symptoms, recurrent left sided headache which accompanied by
nausea, vomiting and fear of light, the presence of similar illness for the past two years, and the
presence of family history are more suggestive of migraine headache unlike the other primary
headaches. The other options (A, B. & C) cannot be the most likely diagnosis of the patient in
this case. In the case of tension and traction headaches (options B & C), the headache is bilateral
and do not accompany by nausea, vomiting or fear of light against their diagnosis. In the case of
cluster headache (option A), the pain is retro-orbital and characterized by its periodicity.
4. A 52-year-old female, who was working standing seven-hour per-day for the last three-years,
comes to a clinic with a complaint of leg pain of one-week duration. She also has aching and
heaviness over both legs. On musculoskeletal examination, there is bluish colored, multiple
tiny threads like distended veins over both legs.
What is the most appropriate initial management for the patient?

(A) Compression stocking (C) Surgical venous stripping
(B) Multiple venous ligations (D) Endovenous leaser ablation
Answer Key: the answer is A

Explanation: From the history, the patient was working with prolonged standing, leg pain;
aching and heaviness of both legs and the presences of tiny threads like dilated veins and bluish
discoloration suggest the diagnosis of varicose vein. The most appropriate initial management is
compressive elastic stocking or bandage. For this patient, the history and physical examination
findings do not suggest the need of surgical intervention at this stage.

15
5. A 28-year-old known RVI male patient on HAART comes to a clinic with a complaint of a
painful swelling around his anus of four days duration. He also has fever, chills and rigor. On
examination, there is 3x2cm sized very tender, hot to touch and smooth surfaced mass on
lateral side of anal verge. When it is tapped, frank pus is aspirated.
What is the most appropriate management for the patient?

(A) Incise and drain the pus, and then put on broad spectrum antibiotics
(B) Put him on oral broad spectrum antibiotics and send him home
(C) Needle aspiration and oral broad spectrum antibiotics
(D) Give potent anti-pain and send him home

Explanation: The patient’s symptoms, painful swelling around the anus and the presence of
tender, hot to touch mass on the lateral side of the anal verge and the tap revealing frank pus are
suggestive of perianal abscess. The appropriate management for perianal abscess is incision and
drainage of the abscess to prevent severe necrotizing infections. Antibiotics would not be
recommended in all perianal abscesses and in most of the cases incision and drainage would
suffice. But, for this patient the presence of immunocompromisation (known RVI on HAART)
and systemic manifestations (fever, chills and rigor) indicate the need for initiation of broad
spectrum antibiotics in addition to incision and drainage of the abscess. Therefore, the most
appropriate management for the patient is incising, draining, and then putting on broad spectrum
antibiotics.
6. A three-month-old male infant come with his mother to a health center with poor feeding,
failure to thrive and sweating while feeding. Physical examination is remarkable for
cyanosis, tachypnea, tachycardia, a gallop rhythm and hepatomegally.
What is the most appropriate initial management of the infant?

(A) Put on oxygen and refer (C) Start diuretics and send home
(B) Put on antibiotic and refer (D) Start antibiotics and send home

Explanation: From the symptoms and physical findings, the age of the infant, the presence of
poor feeding, failure to thrive & sweating while feeding, cyanosis, tachycardia, tachypnea, gallop
and hepatomegally are suggestive of cyanotic heart disease with respiratory distress. The most
appropriate initial management is support the infant with oxygen until he gets definitive
managements. The definitive managements will be medical or surgical. Therefore, the most
appropriate immediate step for the infant at the health center level is to put on oxygen and refer
for the definitive management.

16
7. A two-year-old child is presented with cough of one-day duration and worsening of

respiratory difficulty. The family reported that the child was playing with other children in
the compound before the incident and then had chocking episode. On examination, vital
signs are in the normal range and wheezing on the right lung field.
What is the most appropriate initial step in the management of this case?
(A) Foreign body removal (C) Antibiotics
(B) Intranasal oxygen (D) Steroids

Explanation: From the symptoms and the physical findings, the presence of cough, worsening
of respiratory difficulty, choking episodes and localized wheeze on the right lung field supports
the diagnosis of foreign body aspiration than other possible causes of wheezing. The removal of
the foreign body is the most appropriate management to prevent the subsequent complications
associated with foreign body aspiration. Intranasal oxygen can be the answer but the vital signs
are in the normal range and the child is not in need of intranasal oxygen support. Antibiotics are
not recommended in a child with foreign body aspiration unless the foreign body results
localized infections and there are no symptoms. Steroids are mostly used for the management of
croup (laryngeotracheobronchitis) after the child is presented with upper airway obstructions
than for foreign body aspiration.
8. A 16-year-old female student was brought by her mother to the gynecologic OPD with a
complaint of pain during menses of one-year duration. The pain is severe and subsequently
she missed school many times. She claimed that she visited different health facilities for her
complaint but no problem was identified. Physical examination and investigations were all
unremarkable.
What is the most likely diagnosis for the patient?

(A) Endometriosis (C) Secondary dysmenorrhea
(B) Primary dysmenorrhea (D) Membranous amenorrhea
Answer Key: The answer is B

Explanation: From the history the client’s age, the presence of cyclic pain during menses & the
absence of any underlying problem and the unremarkable findings from the physical and
investigations support the diagnosis of primary dysmenorrhea. The clinical presentation of
primary and secondary dysmenorrheal will be similar but usually clients with secondary
dysmenorrheal have underlying pathology such as endometriosis, adenomyosis, PID that results
the symptoms of secondary dysmenorrheal. Amenorrhea is the absence of menses but the client
already has menses, hence membranous amenorrhea cannot be the answer

17
9. A 22-year-old G-II P-I woman presented to a labor ward at 38 weeks of gestation with gush
of fluid per vagina of two hours duration. She has associated lower abdominal pain that
comes every three minutes. Her blood pressure was 100/70mmHg, pulse rate was 86/min and
temperature was 37oC. FHB was 144/min. Pelvic examination revealed cervical dilatation of
3cm and station of -1 and adequate pelvis. Her laboratory results were within a normal range.
What is the most appropriate management for this woman of the lady?
(A) Admit her and follow labor (C) Encourage her to ambulate
(B) Augment her with Oxytocin (D) Start her on Antibiotics

Explanation: From the history, the woman is pregnant at her 38weeks of GA presented with
gush of fluid per vagina and associated lower abdominal pain, which comes every 3 minutes,
indicating the rupture of the membrane and beginning of labor. As well, on physical
examination the cervical dilation of 3cm and station of -1 reveals she is in latent first stage of
labor. The presence of maternal and fetal normal vital signs and the adequacy of the pelvis show
the labor is normal. The most appropriate management is admitting her and follows labor.
10. A 40-year-old Gravida VI Para V woman, whose gestational age is 39 weeks, is presented to
health center with complaints of lower abdominal and back pain of six hours duration. On
physical examination, vital signs are in the normal range, had 3 mild contractions and FHB
was 145/min. On per-vaginal examination, cervix was 3 cm dilated, position was left occiput-
transverse, station was -1 and membrane was intact.
What is the most likely diagnosis of this woman?

(A) Third stage of labor (C) Active first stage of labor
(B) Second stage of labor (D) Latent first stage of labor

Explanation: From the history and physical examination, the lower abdominal & back pain of
six hours and the presence of 3 mild (stays for 20-40 seconds) uterine contractions, indicate the
onset of labor. The per-vaginal examination also reveals cervical dilatation of 3 cm which is
latent first stage of labor.

18
11. A nine-month-old infant comes with his mother for a complaint of cough and fast breathing
of one-week duration. The infant has no pervious immunization history. After a thorough
evaluation, he was diagnosed with pneumonia.
What is the most appropriate intervention to prevent recurrence of the disease?

(A) Zinc supplementation (C) TT immunization
(B) Measles vaccination (D) Antibiotics
Explanation: - From the history, the child is nine-months-old with cough and fast breathing
supports the diagnosis of pneumonia. The child also unvaccinated or no history of immunization
since birth, which will contribute for development of pneumonia or recurrent pneumonia.
According to the expanded program for immunization / EPI/, most of the vaccines used for
pneumonia prevention directly or indirectly. Out of the ten vaccines, which are given for children
according to the Ethiopian EPI schedule, BCG, pneumococcal conjugated vaccine (PCV),
pertussis, diphtheria and measles vaccines contribute for the prevention of pneumonia.
Therefore, the child unvaccinated for measles has a high risk for recurrent disease or pneumonia.
12. A farmer working at the edge of a river experienced repeated insect bite by insects coming
from the river. Two weeks later, he became febrile and started developing papules, which
then changed to ulcer.
What is the most likely vector that transmitted this disease?

(A) Black fly (B) Sand fly (C) Flesh fly (D) Fruit fly
Explanation: From the history, the farmer is working at the edge of the river, which is one of the
breeding sites for sand flies. The presence of repeated insect bite and the development of fever
and papular lesions which later change to ulcer favors the diagnosis of cutaneous leishmaniasis,
which is transmitted by the bite of a vector sand fly.

19
13. While performing physical examination, a health officer found small tumor on the patient’s
left lower extremity. The procedure was on the next keeping exact order of patient flow. On
the date of operation, the health officer did incision and removes the tumor without patients
consent.
What ethical principle did the health officer violated?

(A) Non-Maleficence (C) Autonomy
(B) Beneficence (D) Justice
Answer Key: The answer is C
Explanation: Respect for autonomy is one ethical principle where clients exercise their own
self-determination. In the scenario the client was not given a choice to choose between treatment
options and the procedure done without consent. Therefore, this is a clear breach of patient
autonomy. On the other hand, non-maleficence (Choice A) is an act of avoiding harm was not
discussed in the scenario directly. In the same manner, Beneficence (choice B), which is also an
act of doing for benefit of patient was not discussed directly in the scenario. Again, justice
(choice D) is not violated since all patients were treated in their order of arrival.
14. A manager at a district health office delegate’s position for different departments under his
scope of management, and he applied his own leadership style for the success of his
organization. For this, he maintains strong control over people within each department and
focuses on tasks rather than people and he makes all the decisions by himself and
communicates the decision for his subordinates.
What is the most appropriate leadership style is followed by a manager in this case?
(A) Participatory (C) Leizas-fair
(B) Democratic (D) Autocratic

Explanation: The autocratic leader maintains strong control over people in the group. This
control may be paternalistic leadership or it may be dictatorial, with the complete disregard for
the needs and feelings of group members. Authoritarian leaders unlike participatory and
democratic leaders give orders and expect group members to obey these orders. Directions are
given as commands, not suggestions. This approach generally results in passive resistance from
team members and requires continual pressure and direction from the leader in order to get
things done.

20
15. A spontaneous rupture of unscarred uterus in a primigravid patient is extremely rare clinical
condition. However, a 34-year-old primigravid woman came to an emergency OPD with
sudden acute abdomen. An emergency laparatomy was performed and a uterine rupture was
found as the cause of the event.
What is the most appropriate study design for this scenario?

(A) Case series (C) Case control
(B) Case report (D) Cross sectional
Explanation: Case report is detail reporting of unusual/rare events on the single case by one or
more physicians. In the above scenario we have the information that indicates unscarred uterus in
a primigravid patient which is extremely rare clinical condition and observed on this woman.
Hence, case report is the best answer for the scenario. But, choice A is detail reporting on a
single case with number (5-12) of individuals, choice C is for identifying the risk factors of
disease from previous exposure status, and choice D is a method of studying the prevalence of
diseases.

21
Sample Reference
 Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry

Jameson, Joseph Loscalzo . (2018). Harrison's Principles of Internal Medicine (Vol. 1 &
Vol. 2) (20th ed.). McGraw-Hill Education
 M.D. Ashley, Stanley W. (2004). ACS Surgery (7th ed.). Ontario, Canada. Decker
Intellectual Properties.
 Courtney M. Townsend, JR,MD, R. Daniel Beauchamp, MD, B. Mark Evers, MD and
Kenneth L. Mattox, MD. (2017). Sabiston Textbook of Surgery (20th ed.). Elsevier.
 Karen Marcdante, Robert M. Kliegman, Richard E. (2005). Nelson Essentials of
Pediatrics (5th ed.). Saunders.
 Robert M. Kliegman, Joseph W. St. Geme III. (2019). Nelson Textbook of Pediatrics
(21st ed.).Elsevier.
 Barbara L. Hoffman, John O. Schorge, Karen D. Bradshaw, Lisa M. Halvorson, Joseph I.
Schaffer, Marlene M. Corton. (2016). Williams Gynecology (3rd ed.). McGraw-Hill
Education.
 Federal Ministry of Health. (January 2010). Management Protocol on Selected Obstetrics
Topics.
 Teklebrhan Tema. Tsegaye Asres. (2003). Pediatrics and Child Health Lecture Note.
Jimma University.
 World Medical Association. (2009). Medical Ethics Manual (2nd ed.).
 Suzanne Salamon, EDD. (2001). Cliffs Quick Review Introduction to Health Service
Management. Cliffs Notes
 Dennis L. Kasper, Anthony S. Fauci, Stephen L. Hauser, Dan L. Longo, J. Larry
Jameson, Joseph Loscalzo. (2015). Harrison’s Principles of Internal Medicine (19th ed.).
McGraw-Hill Education.
 Cherie, A., & Gebrekidan, B. (2005). Nursing Leadership and Management Lecture Note
(pp. 86-88).
 Porta, M. (2008). A Dictionary of Epidemiology (5th ed.). Oxford University Press

22
List of contributors
Mr. Endalkachew Tsedal MoH/ HHRIPR LEO

Dr. Meron Yakob MoH/ HHRIPR Exam Development and Administration Desk Lead
Ermias G/Yohannes MoH/ HHRIPR
Bethelhem Buzuayehu MoH/ HHRIPR
Dr. Wudasie Teshome MoH/ HHRIPR
Dr. Melese Achamo MoH/ HHRIPR
Tsedale Tafesse MoH/ HHRIPR
Mekonnen Desie MoH/ HHRIPR
Abera Bezabih MoH/ HHRIPR
Fikadie Dagnaw MoH/ HHRIPR
Lemeneh Wondimu MoH/ HHRIPR
Melkamu Gereme MoH/ HHRIPR
Tadele Asefa MoH/ HHRIPR
Nibretie Chalachew MoH/ HHRIPR
Demeke Getu MoH/ HHRIPR
Mebrat Tadesse MoH/ HHRIPR
Neway H/Michael MoH/ HHRIPR
Mebrahtu Tarekegn MoH/ HHRIPR
Milkoman Ayele MoH/ HHRIPR
Bethelhem Shikabew MoH/ HHRIPR
Amanuel Tesfay MoH/ HHRIPR
Dr. Alemseged Woretaw Jhpiego/HWIP
Dr. Yohannes Molla Jhpiego/HWIP
Bekalu Assamnew AMREF HWIP project
Dr. Equlinet Misganaw AMREF HWIP project

23
Dr Belay Hagos AAU- IER

Dr Birhanu Abera AAU- IER
Dr Girma Lema AAU- IER
Dr Daneal Desta AAU- IER
Dr Firdisa jebessa AAU- IER
Dr Wessenu Yimam AAU- IER
Dr. Abdnasir Ahmed AAU- IER
Tamirat Tekilu Ethiopian Health Students Association
Zelalem Negash Yekatit 12 Hospital and Medical Collage
Wassie Negash Debre Birhan University
Sisay Shunie Debre Birhan University
Agezegn Asegeid Wachemo University
Contact Us
Ministry of Health – Ethiopia
Street Address: - 1234 Sudan Street, Addis Ababa – Ethiopia
Telephone: +251-118275936
Hotline service: - 952
Website: https://www.moh.gov.et
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2024

Ethiopian Health Professionals Licensing Examination(EHPLE)

Mrs. Frehiwot Abebe

This Information Booklet for Ethiopian Health Professional’s Licensing Examinations is a

EHPLE Information Booklet 2024 Public Health

Acronyms and Abbreviations

EHPLE Ethiopian Health Professionals Licensing Examination

ETA Educational and Training Authority

HEIs Higher Education Institutions

HSTP-II Health Sector Transformational Plan-II

MCQ Multiple Choice Question

MoH Ministry of Health

WHO World Health Organization

EHPLE Information Booklet 2024 Public Health

Purpose of the Information Booklet

 Clarity and guidance: It provides clear information about the exam by

EHPLE Information Booklet 2024 Public Health

EHPLE Information Booklet 2024 Public Health

EHPLE Information Booklet 2024 Public Health

1.2. The Rationale of EHPLE

EHPLE Information Booklet 2024 Public Health

2. Key processes of EHPLE

2.1. Registration of candidates

Please note these important notes during registration.

Repeat Test Takers:

Both new and repeat candidates:

EHPLE Information Booklet 2024 Public Health

2.2. Task Analysis

2.3. Exam Blueprint

2.4. Item Development

2.5. Item Review

EHPLE Information Booklet 2024 Public Health

2.6. Standard setting method

2.7. Exam Administration

EHPLE Information Booklet 2024 Public Health

 Candidates are NOT allowed

2.8. Scoring and post exam analysis

2.9. Result notification and appeal management

EHPLE Information Booklet 2024 Public Health

Key professional roles/ domains

Key role/ domain 1: Patient care roles/ domains (53.0%)

 Internal Medicine (12.0%)

EHPLE Information Booklet 2024 Public Health

Key role/ domain 2: Scholar (9.0%)

Key role/ domain 3: Professionalism (7%)

 Professional ethics and medico-legal practice (3.0%)

Key role/ domain 4: Leadership and management (11.0%)

Key role/ domain 5: Health promotion and disease prevention (20.0%)

 Community diagnosis (10.0%)

EHPLE Information Booklet 2024 Public Health

Table 1:Exam Content For Public Health Profession

EHPLE Information Booklet 2024 Public Health

EHPLE Information Booklet 2024 Public Health

Congestive heart failure

EHPLE Information Booklet 2024 Public Health

Substance related and addictive

EHPLE Information Booklet 2024 Public Health

EHPLE Information Booklet 2024 Public Health

What is the most likely clinical diagnosis of this patient?