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ETHIOPIA
Activity Data Sheet
>> AFR Regional Overview >> Ethiopia Overview PROGRAM: ETHIOPIA
TITLE AND NUMBER: Increased Use of Primary and Preventive Health Care Services, 663-002
STATUS: Ends in 2001
PLANNED FY 2001 OBLIGATION AND FUNDING SOURCE: None
PROPOSED FY 2002 OBLIGATION AND FUNDING SOURCE: None
INITIAL OBLIGATION: FY 1995 ESTIMATED COMPLETION DATE: FY 2001Summary: Ethiopia is the second most populous nation in sub-Saharan Africa, with an estimated population of 64 million. With a 2.76% growth rate, Ethiopia's population will approach 84 million by the year 2010. Approximately one-fifth of Ethiopian children dies before their fifth birthday. An estimated 70% of these deaths are caused by some combination of Acute Respiratory Infection (ARI), diarrhea, malaria, measles and malnutrition. Poor nutritional status, infections, and a high fertility rate (5.9 children per woman) contribute to one of the highest maternal mortality rates in the world, estimated at five to eight maternal deaths per 1,000 live births.
Ethiopia has one of the lowest contraceptive prevalence rates (CPR) in sub-Saharan Africa, currently estimated at 8% by the Demographic and Health Survey in 2000. Various surveys register a high level of unmet need for family planning services. Additionally, 51.2% of children under the age of five are stunted, 22% are iodine deficient, and 44% Vitamin A deficient. Stunting refers to low height for age, which is a sign of long-term malnutrition.
Preventive primary health care (PPHC) is addressing these problems, hence USAID's focus on increasing the use of PPHC services. Current activities focus on increasing resources dedicated to the health sector, particularly primary and preventive health care. These activities are increasing access to and demand for modern contraceptives in focus areas; enhancing capacity of Ethiopian society to expand access to and use of STI/HIV/AIDS services in response to the epidemic; and increasing use of PPHC services in the heavily stressed Southern Nations, Nationalities and Peoples Region.
Key Results: The use of modern contraceptives has increased from a baseline of 2% in 1995 to over 13% in 2000 (a six-fold increase) nationally. The number of condoms sold annually increased from a baseline of 20 million in 1995 to over 49 million in 2000.
The long-term goal of USAID's health sector activities in Ethiopia is to improve the population's access to, and utilization of, quality health care services. The initial baseline estimated the use of health services to range from 20 - 40% in 1995. The Ministry of Health's CY 1999 statistics has use of primary health care services at 50.71%.
Performance and Prospects: As indicated above, performance in the area of reproductive health has been very encouraging. Increased access to modern family planning services through support to local non-governmental organizations (NGOs) has been a crucial factor in the increase in CYPs. To date, the private sector marketed over 49 million condoms and over one million cycles of oral contraceptives, both of which contribute to the increase in CYP. In one of the focus areas (North Wollo), community-based reproductive health activities supported by USAID helped increase contraceptive prevalence to 44.5% vs. a baseline of just 12.2% in 1995. In addition, the contraceptive method mix in this particular area shifted towards the use of long term methods, with the use of injectables increasing to 36.2% from 13.4% in 1996.
After intense negotiations, the first Ethiopian DHS was conducted in 2000 and every public institution, donor (both multilateral and bilateral), and international and local organization involved in health service delivery are currently using the preliminary data from this survey. The DHS was vital in defining the health situation of Ethiopia and will be the basis for policy makers in shaping the health agenda in coming years.
USAID's design and launch of the Ethiopian Multisectoral AIDS Control Program, mainly funded by the World Bank, was a significant achievement. Ethiopia hosted the African Development Forum 2000, "HIV/AIDS - the Greatest Leadership Challenge," where six heads of state and over 1,500 international participants pledged their support to battle the epidemic in Africa. The Policy Environment Score, an index of favorable HIV/AIDS policies, increased from a baseline of 46% in 1998 to 55% in FY 2000. The percentage of men reporting condom use increased from a baseline of 47.5% in 1993 to 69.7% (FY 2000) nationally. This related to a corresponding increase in condom sales. Grants provided to faith-based organizations provided outreach services in HIV/AIDS to over 10 million people.
In FY 2000, USAID forged major child survival partnerships. UNICEF received a grant to support national micronutrient programs with a special focus on revitalizing the salt fortification program. WHO received polio funding to assist the Government's polio eradication efforts. National Immunization Days (NIDs) in FY 2000 reached over 11 million children. However, fully immunized rates among children declined overall. In view of the low rates of coverage, the need for "routine" immunization services was evident. USAID is working with WHO via a grant to strengthen routine immunization services.
The Government's budgetary allocation to the health sector was affected by the border conflict with Eritrea. Nonetheless, results were still encouraging. USAID assisted in the creation of the Health Care Financing Secretariat. USAID funded studies such as the "Willingness to Pay for Health Care" and the "Private Sector Expenditure and Delineation" helped direct the implementation of the Health Care Financing Reform. Other inputs such as the "National Health Account Survey" and the revision of the licensing guidelines for private health care providers allowed the Government to critically address the constraints to service delivery within the Health Sector Development Program.
Possible Adjustments to Plans: All on-going activities under this SO not completed by the end of FY 2001 will be subsumed into the new SO 8, Improved Family Health. In the coming year there will be a shift from strengthening systems to a strong focus on access to quality services and the expansion of activities into the regions of Oromia and Amhara. An additional change is the multisectoral programming of both the nutrition and HIV activities across all SOs.
Other Donor Programs: The United States is the largest bilateral donor to the health sector, followed by Italy and the Netherlands. WHO and UNICEF are the two major international organizations supporting this sector. USAID works collaboratively with the Government and other donors to implement an ambitious $600 million Health Sector Development Program (HSDP). Other major donors in the health sector include the World Bank, the African Development Bank, the Netherlands, Ireland, Sweden, Norway, UNICEF, the United Nations Family Planning Association and the World Health Organization. USAID is the only bilateral donor to sit on the Central Joint Steering Committee for the HSDP and the parallel Education Sector Development Program.
Principal Contractors, Grantees, or Agencies: John Snow, Pathfinder, Population Service International, WHO, UNICEF, John Hopkins, Family Health International and the Consortium of Family Planning NGOs in Ethiopia.
FY 2002 Performance Tables
Performance Measures:
Indicator FY97 (Actual) FY98 (Actual) FY99 (Actual) FY00 (Actual) FY00 (Plan) FY01 (Plan) FY02 (Plan) Indicator 1: Number of Couple Years Protection (CYP) generated 244,567 364,362 400,682 477,100 468,156 540,455 NA Indicator 2: Government budget allocated to the health sector. 6.2 6.2 6.1 4.5 >=6.5 >=7.0 NA Indicator 3: Reported condom use with non-regular sex partners NA NA 47.5 69.7 50 55 NA Indicator 4: Government budget allocated to PPHC 35.1 51.7 51.3 53.4 55 55 NA Indicator 5: Changes in the Policy environment for HIV/AIDS, as measured by the Policy Environment Score (PES) 37.2 44.3 55 55 48.4* 52.1* NA Indicator Information:
Indicator Level (S) or (IR) Unit of Measure Source Indicator Description Indicator 1: IR Number Pathfinder Quarterly and Annual Reports PSI/DKT Monthly, Quarterly and Annual Reports CYP calculated as: 14 OC = 1CYP 4 Depo = 1 CYP 1 IUD = 2.5 CYP 1 Norplant = 3.5 CYP 1 ML = 10 CYP 150 VFT = 1 CYP 150 condoms = 1 CYP Indicator 2: IR Budgetary allocations attributable to health as a percent of the total government budget--Budgetary allocation to health centers and health stations was taken as a measure of PPHC up to 1997. Negarit Gazetta; MOG & MEDAC budget documents. Budgetary allocations indicate the government's commitment ot provide resources to the sector. Indicator 3: IR Percentage (%) Evaluation reports of DKT/ISAPSO and Bi-Annual Assessment Results Percentage of men (15-49 years) reporting the use of a condom during the most recent act of sexual intercourse with a non-regular sex partner. Indicator 4: IR Allocations to PPHC as a percent of total government budget attributable to health--Budgetary allocation to health centers and health stations was taken as a measure of PPHCup to 1997. A more realistic measure defined as follows is used starting 1998. Health centers and health stations sub-head; 90% of allocations to regional training centers; 50% of allocations to central training centers allocations to malaria control, family health, AIDS prevention control of communicable diseases, TB, IE&C programs and the nutrition institute. Negarit Gazetta; MOF & MEDAC budget documents Budgetary allocations indicate the government's commitment to provide resources to the sector. Indicator 5: IR Percentage (%) Annual Policy environment assessment Percentage score change in PES; i.e. degree of support provided by the national AIDS Policy area, as assessed using the broad areas listed in the "comments" section.
U.S. Financing
(In thousands of dollars)
Obligations Expenditures Unliquidated Through September 30, 1999 21,521 DA 4,568 DA 16,953 DA 37,361 CSD 18,396 CSD 18,965 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 18,307 DFA 16,521 DFA 1,786 DFA Fiscal Year 2000 5,900 DA 5,340 DA 11,646 CSD 8,842 CSD 0 ESF 0 ESF 0 SEED 0 SEED 0 FSA 0 FSA 0 DFA 445 DFA Through September 30, 2000 27,421 DA 9,908 DA 17,513 DA 49,007 CSD 27,238 CSD 21,769 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 18,307 DFA 16,966 DFA 1,341 DFA Prior Year Unobligated Funds 0 DA 1,540 CSD 0 ESF 0 SEED 0 FSA 0 DFA Planned Fiscal Year 2001 NOA 0 DA 0 CSD 0 ESF 0 SEED 0 FSA 0 DFA Total Planned Fiscal Year 2001 0 DA 1,540 CSD 0 ESF 0 SEED 0 FSA 0 DFA Future Obligations Est. Total Cost Proposed Fiscal Year 2002 NOA 0 DA 0 DA 27,421 DA 0 CSD 0 CSD 50,547 CSD 0 ESF 0 ESF 0 ESF 0 SEED 0 SEED 0 SEED 0 FSA 0 FSA 0 FSA 0 DFA 0 DFA 18,307 DFA
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Last Updated on: May 29, 2002 |
