The Ethiopian Orthodox Tewahedo Church became autocephalous (fully self-governing) in 1959, when the Coptic Orthodox Church of Alexandria granted it the right to elect its own Patriarch. Prior to that, the head of the Ethiopian church (the Abuna) was always a Coptic bishop sent from Alexandria—a situation maintained for over 1,600 years. The current head of the church is the Patriarch (Abune) of Addis Ababa and All Ethiopia, elected by the Holy Synod.

The church is governed by the Holy Synod of bishops, which has supreme authority in doctrinal and canonical matters. The three Ecumenical Councils accepted by all Oriental Orthodox churches (Nicaea I, Constantinople I, and Ephesus) are the formal doctrinal norm. The Patriarch holds a position of primacy within the Ethiopian church but governs in collegial consultation with the Synod. The Ethiopian church's close historical association with the Ethiopian state—it was the state church until the communist Derg regime (1974–1991)—has shaped its institutional identity.