Ethiopia

Ethiopia is one of the least developed countries in the world, ranking 171 out of 178 countries in the Human Development Index, a measure of health, education, and income. Its population of more than 79.8 million people is 85 percent rural, with poor access to safe water, housing, sanitation, food, and health care. These factors result in a high rate of communicable diseases, including tuberculosis (TB), malaria, HIV/AIDS, respiratory infections, diarrheal diseases, and nutritional deficiencies. Ethiopia has the seventh- highest TB burden in the world. The prevalence estimate for HIV/AIDS is 2.3 percent; more than 1.1 million people in Ethiopia live with HIV. Each year, nearly half a million children under the age of five die, including 120,000 newborns who die within the first month of life. Nineteen- thousand women die from childbirth-related causes. An estimated 50,000 women suffer from obstetric fistula.

Through the Ethiopia GHI Strategy, the U.S. defines its vision for collaboration with the Government of Ethiopia and other local partners, including non-governmental organizations and the private sector, to improve the health status of Ethiopians, specifically, the most vulnerable groups of mothers, newborns, and children under five. To do this, the U.S. will continue to increase Ethiopia’s capacity to deliver essential health services through existing mechanisms, while mainstreaming GHI principles throughout U.S.-supported programs.

Country Leadership: National Health Plan Priorities and Challenges

Consistent with its state of development, Ethiopia has suffered from a dearth of well-trained workers and adequate service delivery infrastructure. Yet over the past decade, the Government of Ethiopia has provided dynamic leadership in addressing the health needs of its population, including doubling the budget for health over the past five years and developing an ambitious national health plan. The Government of Ethiopia’s Health Sector Development Plan IV and budget align with priorities across maternal and child health, prevention and management of communicable diseases, and health systems strengthening. The foundation of the Health Sector Development Plan IV is the Health Extension Program, which promotes primary health care at the community level and is supported by more than 35,000 predominantly female health extension workers. While the private sector is relatively small, it is growing in importance as Ethiopia experiences increased urbanization.

GHI Ethiopia Strategy: Focus areas

Under GHI, and in partnership with the Ethiopian Government, the U.S. has identified opportunities within existing programs to enhance support for Ethiopia’s top health priority: reducing maternal, neonatal, and child mortality. The overarching GHI country goal in Ethiopia is to improve the health status of Ethiopians through increased use of quality health services to protect women, infants, and children from preventable and treatable health conditions. The achievement of this goal depends on the combined success of three highly interdependent results:

1) improved access to health care services

2) increased demand for health services

3) improved health systems

The U.S. contribution to assisting Ethiopia in achieving accelerated results will be realized through implementation of key GHI principles. Specifically, the U.S. is integrating programs to expand coverage of key interventions while taking a more coordinated approach to strengthening health systems and ensuring sustainability. For example, by leveraging existing U.S.-supported programs to prevent maternal-to-child transmission of HIV in hospitals and health centers, the U.S. will expand support for antenatal, maternal, and neonatal services. Under GHI, the U.S. will also increase its coordination of key health system activities, such as working more strategically to address critical human resource constraints. GHI will also increase coordination with other critical investments, such as the U.S. Feed the Future initiative, as well as the education, democracy, and governance sectors. Building upon past successes, efforts to expand access to HIV/AIDS, TB, and malaria services will continue to be accelerated.

Improving Effectiveness and Efficiency through GHI Principles

The Ethiopia GHI Strategy outlines specific steps that will be taken to advance the GHI principles. These steps include:

• Investing in women, girls, and gender equality through support to women-centered initiatives, such as prevention of female genital cutting, care for women experiencing obstetric fistula, and proactive prevention of early marriage.
• Increasing integration in planning and implementation of U.S.-supported activities, including an integrated child survival and safe motherhood program.
• Working in partnership with donors and other partners to build capacity at the regional and district levels to effectively manage and deliver quality health services to communities.
• Supporting strategically aligned systems strengthening across all health programs, including assisting the government of Ethiopia in developing and implementing innovative health financing schemes.
• Increasing linkages with other sector programs, including the U.S. Feed the Future initiative.
• Strengthening monitoring and evaluation to know what works, and what doesn’t, by acting as a lead partner in supporting the introduction of 9,000 new health information technicians.

GHI In Action:

Supporting Health Services Closer to Communities

In Ethiopia, the Health Extension Program is the backbone of the Ministry of Health’s strategy to provide universal coverage for primary health care. To date, more than 35,000 paid, predominantly female Health Extension Workers provide integrated community-based preventive and treatment services to address malaria, HIV, maternal and child health, family planning, and nutrition throughout rural Ethiopia. Through this program, Ethiopia has been on the forefront of demonstrating how community-based delivery platforms can be leveraged to diagnose and treat the leading causes of death among children —pneumonia, malaria, diarrhea, and acute undernutrition. As many children receive care outside of facilities, the important rollout of this innovative integrated program will contribute to significant reductions in under-five mortality over the next five years.

The U.S. government provided key inputs that helped the Government of Ethiopia establish the program and achieve technical proficiency. Most recently, the Integrated Family Health Project (IFHP)—with U.S. support from the President’s Malaria Initiative and child survival funding—will train approximately 13,000 Health Extension Workers in more than 300 districts. These workers will be trained to use a new rapid diagnostic test to determine definitively if a fever is malaria or another infection. With this information, extension workers will be able to treat fever with more precision.

As the role and reach of the Health Extension Workers have expanded, so too have the demands on building a robust and sustainable system. A strong system will support their work in communities and improve the referral mechanisms for clients who need higher levels of care. In alignment with the GHI principles to support country ownership and strengthen health systems, the U.S. is partnering with Ethiopia to address these needs by providing financial and technical assistance for managing the Health Extension Program. This includes embedding experienced public health advisors within the Ministry of Health to build the capacity of local managers in planning, budgeting, analysis, training, and supervision.