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USAID Programs Impact on Health Services Delivery in Ethiopia

This article examines the impact of USAID programs in Ethiopia, focusing on challenges and progress in health service delivery. It discusses the USAID approach to health programming and highlights the accomplishments of USAID-supported programs. The article also discusses the importance of donor coordination in achieving health system strengthening and addresses the HIV epidemic in Ethiopia. It concludes by discussing USAID's objectives and strategic approaches in its assistance to Ethiopia.

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USAID Programs Impact on Health Services Delivery in Ethiopia

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  1. The Impact of USAID programs on ID • Background • Challenges and progress in health service delivery • USAID approach to health programming • USAID supported programs’ accomplishments • Donor Coordination

  2. Background - Population • Second most populous country in Sub-Saharan Africa (ca. 80 million people) • Population characterized by: - Rapid population growth (doubled in less than 25 years ) - High fertility rate (TFR = 5.4) - Skewed age curve - 45% are <15 years of age - Large proportion living in rural areas (84%) - High unmet family planning need (34%)

  3. Health systems - Challenges Need for health system strengthening • Fragile health human resources management • Weak service delivery infrastructure • Limited health financing mechanisms: low per capita health expenditure ($16 as compared to WHO recommended $40) • Weak supply chain management and logistics information systems • Nascent health information management systems

  4. The HIV Epidemic in Ethiopia: Statistics (2009) • HIV/AIDS Prevalence: 2.3% • Urban: 7.7% • Rural: 0.9% • PLHIV: 1,116,216 • HIV positive Pregnant Women: 84,189 • ART Needs: 336,160 • Orphans: 5.5 Million (855,720 due to AIDS) DHS 2010 will be a DHS+ with HIV markers, underway

  5. HIV EPIDEMIC IN ETHIOPIA • CHARACTERISTICS • Mixed epidemic • Varies geographically • Hot spots (urban areas, small towns and market centers) • Mixed sexual behavior patterns • SOURCES OF NEW HIV INFECTION • 85% due to sexual transmission • 10% due to mother-to-child transmission • 5% due biomedical transmission

  6. Health Status – Infectious Diseases • Approximately 10 million annual cases of clinical malaria (first cause of outpatient visits, health facility admissions and in-patient deaths) • Over 1.1 million persons live with HIV (58,000 annual deaths) • Ethiopia is seventh among the 22 TB high burden countries – with an estimated 300,000 new cases per annum

  7. USAID Approach • We have strategies • We target • Map • Work with others • Evidence based interventions

  8. Objective: Investing in People HAPN HEALTH HIV/AIDS MALARIA SOCIAL SERVICE & PROTECTION- VULANERABLE GROUPS EDUCATION Integration and coordination platforms Program Areas

  9. USAID Assistance to Ethiopia (2006 – 2010)

  10. USAID Health, AIDS, Population and Nutrition

  11. Coordination with GoE’s Ministry of Health • Global Health Initiative (2010–2014) • Maternal and Child Health • Human Resources for Health • Learning Agenda • Health Sector Development Plan (2010-2014/5) Priorities include MCH, ID, HSS

  12. Coordination with Government HIV and AIDS Prevention and Control Coordination Office • Partnership Framework (2010–2014) • Goal I: Reduce the national HIV incidence by 50% by 2014 • Goal II: Reduce morbidity & mortality & improve the quality of life for people living with HIV by expanding access to quality care, treatment & support by 2014 • Goal III: Health systems necessary for universal access are functional by 2014 • Goal IV: Multi- sectoral response in place to prevent the spread of HIV & mitigate its impacts by 2014 • Strategic Plan for Intensifying Multi-Sectoral HIV/AIDS Response (2010-2014)

  13. Strategic Approaches • To support the GoE’s Growth and Transformation Plan (GTP) • HSDP-III, • HSDP-IV • SPM-II • To enhance health seeking behavior and improve access to quality health services among underserved rural populations • To strengthen the health system

  14. Enhancing health-seeking behavior and improve Access to Quality Health Services Community-based primary healthcare • 7M children reached by nutrition programs • 60,000 community health workers trained • FP and Integrated management of maternal, newborn and child health program reaching about 40% of the population Flagship Integrated Family Health Project supports GOE Health Extension Program’s

  15. HIV/AIDS Program achievements • Primary Health Care (Five Major Regions) • 550 Health Centers: Voluntary Counseling and Testing, Care and support, TB/HIV, PMTCT • 350 Health Centers: Comprehensive Antiretroviral Treatment and PMTCT • Prevention • Standardized HIV education in schools • 28 million condoms distributed per year • More targeted activities to most-at-risk groups to match epidemic • Orphans & Other Vulnerable Children (OVC) • 485,912 OVC served by OVC programs (SAPR10) • Network of 550 local partners

  16. Private Health Sector Program • 5 year program • Goal: • support the GOE effort to influence the private health sector to achieve public health goals

  17. Private Health Sector Program Achievement • Supported GOE in the creation of policy framework to allow private clinics to deliver TB services • The program supports 95 private clinics in Oromia , Amhara , SNNPR and Dire Dawa city to help them deliver quality and affordable TB / HCT services • Supported 20 medium and large private companies to establish work place HIV policy and create an army of peer educators at work place

  18. Private Health Sector Program Achievement • 7, 609 TB patients diagnosed in private facilities • More than 2,000 TB patients treated in the private clinics • More than 60, 000 high risk individuals received free mobile HCT services

  19. Private Health Sector Program Achievement • More than 500 health workers in private clinics received short term TB HIV trainings • 120 private clinic owners trained on business and finance management skills • 200 peer educators trained in medium and large private companies • work place policy established in more than 20 medium and large private firms

  20. Private Health Sector Program-Challenges • barriers to access to commercial loan for the private institutions • the development of well organized regulatory scheme

  21. Private Health Sector Program-Way Forward • Pilot and expand ARV , PMTCT , FP , STI and Malaria services in selected private facilities • Facilitate commercial loan to private facilities through loan guarantee mechanism • Support the GOE in the implementation of the new regulatory standards • Support pre service education in private medical colleges

  22. Health Systems Strengthening Health Sector Finance Reform (HSFR) • National Health Accounts conducted 4 times • Governance: establishment of hospital and health center boards, health management teams and improvement of management skills at all levels • Revenue Retention • Insurance schemes – private/govt employers and community-based health insurance

  23. Other infectious diseases

  24. Achievements • Supported GoE in development of National Malaria Prevention and Control Strategic Plan 2011-2015 and other technical policy guidelines (e.g. case management) • Re-established entomologic monitoring capacity; provided evidence for FMOH to discontinue use of DDT • Introduced environmental compliance in IRS operations • Strengthened the pharmaceutical management system • Implemented district-level micro-planning to procure, distribute and track malaria commodities • Supported FMOH in Global Fund Round 7, 8, & 10 grant applications; successful Round 8 application ($276 M) • Coordinating the National Malaria Control Support Team and co-chairing Technical Advisory Committee • Evidence based approaches

  25. Wrap Around Programs Within Health programs: • TB (Health) • Malaria (PMI) • Health (IFHP) • Education (BES) • Food Security (ALT) • Health Care Financing (Health) • Economic Strengthening (BEAT)

  26. Wrap-around programs Pastoralist livelihoods • Maternal health/FP services Education • Health messages incorporated into BES programming Improved Access to Safe Water, Hygiene and Sanitation • Reducing women’s domestic workload (e.g. of fetching water) • Increasing school attendance and retention of girls

  27. Donor Coordination • Global Fund • DAG TWG • Bill and Melinda Gates • Clinton Foundation • World Bank • Packard

  28. How do we know programs are working • Monitoring and evaluation • DHS • USAID new evaluation policy • GHI

  29. For more information • www.usaid.gov • www.grants.gov • www.fedbizopps.gov • Meri Sinnitt: msinnitt@usaid.gov

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