Ethiopia: Focusing our Program for Impact & Efficiency Jocelyn Felter Brown

1. Ethiopia: Focusing our Program for Impact & Efficiency Jocelyn Felter Brown Acting Coordinator, PEPFAR Ethiopia

2. Ethiopia – Important Features • Population 90 million • Predominantly rural agrarian country • Growing economy with large infrastructure development projects • Low/decreasing national HIV/AIDS prevalence: 1.4% • Has reached the “Tipping Point” • Significant Urban to Rural HIV/AIDS disparity: mixed epidemic • Government is the primary service provider • Strong political commitment to health & equity of services • Significant Global Fund investment, but expected to decline with New Funding Model

3. Ethiopia: Three Ways of Looking at HIV Distribution: Prevalence, No. Infected, and Density, 2011

4. PEPFARExpenditures by Geographic Location &HIV Burden with Adult Prevalence Source:HIV Related Estimates and Projections for Ethiopia – 2012. Excludes National and Above National Spending

5. Focusing the Program: Start with Clinical Care & Treatment Adoption of 2013 WHO Guidelines *Source: Spectrum HIV Related Estimates and Projections for Ethiopia, 2014

6. Focus on Clinical Care & Treatment • Historically…US University treatment partners led clinical care & treatment efforts • Partners accomplished what they were brought to Ethiopia to do; time to move more responsibility to Government of Ethiopia • Promising results from transition of University partners to Regional Health Bureaus in 3 regions demonstrated success and ability to manage funding • Assumption is that we can achieve same treatment goals, at same level of quality, but more efficiently – across all regions

7. Achieving Efficiency in Clinical Care & Treatment USD, in millions PEPFAR/HHS-Ethiopia Funding, by Partner Type * 2014 reflects the COP14 submission, new funds only

8. Defining Our Core We adapted the UNAIDS Investment Case Framework to further focus and rationalize our PEPFAR program in Ethiopia • Understand: • Current state of epidemic—and how it’s expected to change • National Response: What is USG’s current role -- how might or should it change? • What are roles of other HIV Donors, Global Fund, Government, private sector -- how might they change? • Design: • What are the core program elements/critical enablers required to Save Lives and Prevent New Infections? • What are the core program elements /critical enablers USG is uniquely qualified to deliver? • How and when and to whom should non-core programs/non-critical enablers transition or end? • What is the cost of the core program?

9. Prioritizing Activities

10. Defining the Core: Results • Economic Strengthening (non-OVC) • TA In-school Youth prevention • Low-risk prevention (GPY) • PPP TA • Infection Prevention • Cross-border • Cervical cancer screening Non-Core • Blood Safety • TA to Private Sector Health Svcs • VMMC • In-School Youth funding to MOE • Leadership and Governance (w/ transition plan) • Community/Peer Support • Ongoing Construction Commitments Near-Core • Treatment • Prevention (High & Med Risk) • Targeted Testing • Supply Chain TA • HIV/AIDS Commodities • Evidence Base (SI, SS, M&E) • HC Financing/Insurance • Training • HMIS • OVC (incl. ES) Core

11. Using Data to Maximize Program Investment

12. Geographic Analysis:HIV+ yield distribution across PMTCT sites 80% (14,260) of patients in 22% (371) of 1,668 sites Key: High Yield = >1 patient/month Low Yield = <1 patient/month

13. Stakeholder Coordination • With a more focused PEPFAR program, on-going stakeholder alignment is key to sustain gains and • prevent service gaps

14. ETHIOPIA HAS A REAL CHANCE AT AN AIDS FREE GENERATION Thank You