Background. The importance of service users’ participation in health policy-making has been recognized in the literature. Their participation is necessary if care experiences and health outcomes are to be improved and is called for in laws and strategic and policy documents in Ethiopia. Nevertheless, there is as yet limited service user participation in health policy-making in Ethiopia.

Objective. The primary objective of this study was to survey a national panel of policy-makers, program managers, healthcare providers, researchers and service users to elicit their views about strategies to facilitate participation of service users in health policy-making in Ethiopia. The service users brought both their own experiences and the experiences of other service users they had interviewed after participating in a training on essentials of qualitative research methods. The secondary objective was to assess the feasibility of using e-Delphi in a context with limited Internet coverage and of combining paper-based and e-Delphi.

Methods. We used a combined paper-based and e-Delphi method to build consensus among study participants. Participants were asked to rate strategies to facilitate service users’ participation for their relevance to health policy making in Ethiopia, their feasibility in the Ethiopian health and political systems, and their validity in the eyes of the stakeholders who implement them.

Results and conclusions.  All participants agreed that the strategies identified in the literature were relevant, feasible, and valid in the Ethiopian context, albeit to varying degrees. The top ten strategies identified were consultative rather than collaborative strategies of participation. It was observed that service users could be trained to systematically elicit views of other service users whom they were representing, forming a “pyramid of participation”. It was also possible to combine paper-based and e-Delphi, although the response rate was significantly higher with the paper-based component than with the e-Delphi. It is recommended that interventions be introduced to improve the level of participation of service users and that the strategies be further evaluated for their effectiveness and cost-effectiveness in Ethiopia and other low- and middle-income countries.