Ethiopia

Ethiopia is one of the most populous countries in sub-Saharan Africa. Approximately 80 percent of its people live in rural areas. The country is one of the least developed countries in the world with an estimated per capita income of $130 US. Nearly half of the population lives below the poverty line.

Health Care System
Ethiopia's health care system is among the least developed in sub-Saharan Africa. The country has only 2,115 physicians and 17,845 nurses (2005). Widespread poverty, poor nutrition, low education levels, and limited access to health services have contributed to the high burden of ill health in the country.

Current life expectancy is estimated at 54 years, but is expected to decline as a result of the HIV pandemic. As much as 80 percent of the health problems in the country are due to preventable diseases, most notably HIV and malaria. In 2005, the Government of Ethiopia, with support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), embarked on an ambitious program to provide universal access to care and treatment for people living with HIV/AIDS (PLWHA).

HIV/AIDS in Ethiopia
Ethiopia’s HIV seroprevalence rate is estimated at 2.1 percent. Seroprevalence rates are more than three times higher in urban areas at 7.7 percent. In Addis Ababa, the country’s capital, seroprevalence is estimated at 7.9 percent in 2008 and is expected to rise to 8.5 percent in 2009. Among pregnant women attending antenatal clinics, seroprevalence rates are estimated at 2.2 percent. An estimated 754,000 children have been orphaned by HIV/AIDS.

ICAP in Ethiopia
Since September 2005, ICAP has been working in partnership with the Federal Ministry of Health (FMOH) and Regional Health Bureaus (RHBs), to support comprehensive HIV/AIDS services at hospitals in the Oromia, Somali, Harari, and Dire Dawa regions of Ethiopia. As the only implementing partner supporting care and treatment at the hospital level in these regions, ICAP works in a geographic area with a combined population of nearly 30 million. Hospitals are largely rural or semi-urban, far from well-resourced urban areas. ICAP provides comprehensive support to all HIV/AIDS-related activities at these facilities with the overarching goals of enhancing service delivery and building capacity. ICAP support consists of: infrastructure development, renovations of clinics and laboratories, and provision of equipment and supplies clinical training and supportive supervision of multidisciplinary teams assistance with laboratory, pharmacy, and medical records systems and the establishment of services and programs to enhance enrollment, follow-up, and adherence.

Support for Programmatic Activities
Since 2005, ICAP’s programmatic support have grown from a focus on HIV/AIDS care and treatment to support for the full range of HIV/AIDS services, including:

  • Antiretroviral therapy (ART) services (adult and pediatric)
  • Prevention of mother-to-child transmission (PMTCT) of HIV
  • Tuberculosis (TB)/HIV integration
  • Palliative care
  • HIV counseling and testing (HCT)
  • Malaria/HIV integration
  • Adherence support
  • Prevention and treatment of sexually transmitted infections
  • Laboratory Support

While site-level support is the major focus of programming in Ethiopia, ICAP also provides substantial central- and regional-level assistance to the FMOH, RHBs, and regional laboratories. At the request of PEPFAR-Ethiopia, ICAP is the national technical lead in the following areas:

  • Pediatric HIV/AIDS care and treatment
  • Infant diagnosis
  • TB/HIV integration
  • Involvement of PLWHA in program activities
  • Malaria/HIV integration

In its role as a national leader in these areas, ICAP works with the FMOH and other partners to support the development of national guidelines, “minimum service packages,” national training curricula, data recording and reporting forms, and provider job aids and clinical tools.

Partnerships
ICAP collaborates with and supports the FMOH and RHBs in Oromia, Somali, Dire Dawa, and Harari, as well as Jimma and Haramaya Universities where it supports activities to enhance HIV/AIDS training expertise and capacity. ICAP also works with the Ethiopian Health and Nutrition Research Institute in infant diagnosis activities, and supports RHBs to strengthen regional capacity to implement HIV/AIDS programs. In addition, ICAP supports capacity-building activities of the Association of Ethiopians Living with HIV/AIDS Network.

Goals
ICAP continues to expand its comprehensive support for HIV/AIDS-related activities. Focus areas include:

  • Implementation of the network model, where hospitals, health centers, and community-based programs are well-linked and complementary
  • Continued scale-up of infant diagnosis and pediatric care and treatment services
  • Enhancement of PMTCT activities and linkages between PMTCT and HIV/ART
  • Continued provision of integrated TB and HIV services
  • Continued provision of integrated malaria and HIV services, particularly for children and pregnant women
  • Expansion of counseling and testing services through provider-initiated HCT and the initiation of mobile voluntary counseling and testing
  • Support of RHBs to develop provider retention strategies, expand cadres of HIV/AIDS providers, and encourage task-shifting
  • Expansion of peer educator programs and mothers’ support groups
  • Infrastructure improvements including renovations, equipping and providing supplies for HIV/ART services and laboratories.                       

Map of ICAP-supported Sites in Ethiopia

For more about the Ethiopia program, visit http://www.columbia-icap.org/ethiopia/.