The Impact of USAID programs on ID

2. 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

3. 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%)

4. 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

5. 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

6. 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

7. 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

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

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

10. USAID Assistance to Ethiopia (2006 – 2010)

11. USAID Health, AIDS, Population and Nutrition

12. 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

13. 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)

14. 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

15. 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

16. 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

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

18. 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

19. 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

20. 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

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 Dz 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

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

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

28. For more information • www.usaid.gov • www.grants.gov • www.fedbizopps.gov