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Ethiopia

MEASURE Evaluation’s activities in Ethiopia initially focused on monitoring the number of malaria cases, but has expanded to include a broad array of activities, such as helping health systems better respond to HIV and AIDS and other health issues by improving the quality of data through the health information system.

 

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DEMOGRAPHY

Population
93,877,025 (July 2013 est.)

Population Growth Rate
2.9% (2012 est.)

Age Structure
44.6% (0-14 years)
52.6% (15-64 years)
2.8% (65 years and over)

Death Rate
9.3 deaths/1,000

HIV-RELATED DATA
HIV Prevalence
1.4% of adults 15-49 years
About .7% of total population

Number of people living with HIV
790,000

MALARIA-RELATED DATA

Malaria Mortality

Est. annual malaria deaths: 10/100,000 of the population

OTHER RELEVANT DATA

Infant Mortality Rate

60.9 deaths/1,000 live births

Total Fertility Rate
5.31 children born/woman

Maternal Mortality Ratio
350 deaths/100,000 live births

Ethiopians face several significant health risks, often made worse by high levels of poverty and food shortages. Malaria and HIV pose particularly high health threats to this east African nation. Malaria is considered the leading communicable disease in Ethiopia; it was the number one cause of outpatient visits and health facility admissions in the years 2009 and 2010. The nature of the epidemic exacerbates the disease’s impact. Malaria in Ethiopia is mainly seasonal and transmission is unstable throughout the country, inhibiting the build-up of protective immunity. Therefore, all age groups face a high risk of infection.

Since its initial reported case in 1984, HIV has also become a major public health concern in Ethiopia, compelling the country’s government to declare a public health emergency in 2002. With an estimated adult prevalence rate of 1.4 percent in 2011 Ethiopia has a low-level, generalized epidemic. According to its Country Progress Report on HIV/AIDS Response, 2012, the populations most at-risk of becoming infected with HIV include couples in which only one partner already has the virus, sex workers, men in uniformed services, long-distance truck drivers, mobile workers, and cross-border populations. 

MEASURE Evaluation in Ethiopia

MEASURE Evaluation began working in Ethiopia in 2008. Initially, the work focused on monitoring the number of malaria cases, but has since expanded to include a broad array of activities, such as helping health systems better respond to HIV and AIDS and other health issues by improving the quality of data through the health information system.

“Ethiopia is a country of very high potential,” says Tariq Azim, MEASURE Evaluation’s resident advisor in the country since 2009. According to Azim, Ethiopia is open to new development and health programs, and this makes it an ideal place to conduct highly innovative work while at the same time using well-tested approaches.

As of 2013, there were four primary areas in which MEASURE Evaluation provided technical assistance to improve health systems, decrease HIV infections and offer related care, and move towards the goal of a malaria-free population:

  • building health management information systems,
  • conducting and disseminating results from an organizational network study,
  • building capacity among the staff of local agencies, and
  • ensuring data quality and accurate record keeping to enhance data demand and use.

MEASURE Evaluation’s activities incorporate monitoring and evaluation (M&E) to assess whether programs are functioning correctly as they are being carried out. Continuous M&E means that if problems in the work arise, they can be identified earlier and solved more quickly, to keep the programs on track to achieving their goals.

Health Management Information Systems

Working to support the efficient functioning of health programs is a cornerstone of MEASURE Evaluation’s work in Ethiopia. A key component of this work is assessing the country’s routine health information system (RHIS). Routine health information systems are designed to collect data related to health status, interventions, and services on a continual basis. In 2010 in Ethiopia, this work expanded to include a focus on the health management information system (HMIS), a data collection system specifically designed to support planning, management, and decision making in health facilities and organizations throughout Ethiopia’s Southern Nations, Nationalities, and Peoples' Region (SNNPR). Another component of this work is the community health information system (CHIS), which organizes information on individuals and families—information related to vaccines, family planning, maternal and child health, HIV treatment and support, and other services—and makes it available all in one place, such as a family folder. In 2012 alone, 4,143 health workers from SNNPR were trained in HMIS, and 340 participants from the region were trained in its electronic data management component, eHMIS.

By the end of 2012, all 22 hospitals, 658 health centers, and 3,835 health posts in SNNPR were implementing the HMIS. The Ethiopian Ministry of Health (MOH) has learned of its success and is replicating it in other regions.

According to Azim, one of the key achievements of the MOH is that the HMIS is now “seen as the core information system” of the national M&E plan. The HMIS project is “a good example of how MEASURE Evaluation is providing technical assistance at the regional and federal levels and this is an HMIS approach that can be implemented in other countries,” he said.   

Organizational Networks Study

The Organizational Networks Study, which began in 2010, is a study of health care networks comprised of managers and providers at health facilities and at the community level. Implemented in Kolfe Keranyo and Kirkos, two cities outside the capital of Addis Ababa, the study examines how improvements in the network occur, and if the improvements positively affect clients’ care.

For the study, interviews with health workers and those providing home-based care were conducted in 2011, and the results of these interviews were shared with all stakeholders. The goal of the study is to encourage more networking among HIV and AIDS service providers throughout Ethiopia. The study findings “can contribute a lot to helping other organizations to come together in ways that maximize their resources,” Azim says. The study was first implemented in Ethiopia, but given the positive effects observed on client care with increasing network connections, the study has now been expanded to other countries.

Training and Capacity Building

As part of its HMIS work, MEASURE Evaluation provides training to health workers and other leaders to build competency and long-term capacity to carry out health related M&E work after the project ends. Training has expanded to include support to the Addis Continental Institute of Public Health (AC-IPH) for conducting workshops related to M&E and population, health, and nutrition. The AC-IPH training program began with a two-week workshop in early 2012, for which MEASURE Evaluation provided technical assistance and training materials, including a curriculum. Participants from Ethiopia and throughout East Africa attended the workshop. The long-term goal of this training is for AC-IPH to become a reference center for M&E in the region.

MEASURE Evaluation also launched a network of regional training partners in June 2012, bringing together faculty and colleagues from Addis Ababa University and AC-IPH. Other countries represented in this network are Senegal, Mexico, Thailand, Ghana, and South Africa.

Data Demand and Use

A large component of MEASURE Evaluation’s work is aimed at ensuring that data are accurate and are used to improve programs. The data demand and use (DDU) activities—which include Performance of Routine Information Systems Management (PRISM) and data quality audits—help meet this aim. The MOH has identified these activities as key to the success of their programs and continues to request additional training in this area.

Assessments under the PRISM framework were conducted in 2012 in SNNPR to look at organizational and data quality factors. The findings were shared with the SNNPR regional health bureau (RHB). As a result, the SNNP RHB has established performance review teams in all administrative health units in the region. According to Azim, data use is now happening at every level of the health system in SNNPR, from health facility to district health offices to the regional health bureau, and they all conduct routine performance meetings.

Malaria Surveillance and Additional Programs

In Ethiopia, 67 percent of the population is at risk of malaria.1 In an effort to reduce malaria incidence, MEASURE Evaluation began providing technical assistance in 2008 to the country’s National Malaria Control Program in Oromia, the country’s largest and most populous region. Much of this assistance focused on conducting on-site surveillance to determine the number of malaria cases, including an SMS component to gather and communicate timely data to help identify emerging epidemics. Under an Associate Award led by our Tulane University partner, MEASURE Evaluation worked with the national program and other USAID partners to establish a network of health facility sites located throughout Oromia to track malaria morbidity and mortality. Tulane University is now spearheading work to expand the surveillance project to other regions.

Similar surveillance activities are being conducted to examine how geographic information systems (GIS) can be used to treat and provide care for tuberculosis (TB) in the country.

Through its efforts to address TB, HIV and AIDS, and malaria, MEASURE Evaluation’s portfolio in Ethiopia aims to support the existing health information systems, and ensure they are equipped with trained staff and adequate resources to effectively identify and care for their patients’ health needs. Azim also says the current high level of interest among health leaders and government officials in meeting health and development goals is beneficial to achieving a myriad of long-term objectives. “This is a place where a lot of things can be done, and they have a lot of interest in improving health,” he says.