Ethiopia FY 2007 Country Operational Plan (COP)

ETHIOPIA

Project Title: Ethiopia Fiscal Year 2007 Country Operational Plan (COP)

Budget Summary:

	Field Programs Funding by Account						Central Programs Funding by Account
	Notified as of March 2007			Notified as of June 2007			Notified as of November 2006
Implementing Agency	GAP	GHAI	Subtotal: Field Programs Funding	GAP	GHAI	New Subtotal: Field Programs Funding	GHAI Central Programs	Total Dollars Allocated: Field & Central Funding
DOD	0	1,563,300	1,563,300	0	1,563,300	1,563,300	0	1,563,300
DOL	0	0	0	0	0	0	0	0
HHS	5,800,000	68,298,235	74,098,235	5,800,000	76,368,985	82,168,985	2,150,000	84,318,985
Peace Corps	0	4,255,000	4,255,000	0	4,255,000	4,255,000	0	4,255,000
State	0	6,533,288	6,533,288	0	8,608,288	8,608,288	0	8,608,288
USAID	0	123,410,447	123,410,447	0	139,385,447	139,385,447	3,642,534	143,027,981
TOTAL Approved	5,800,000	204,060,270	209,860,270	5,800,000	230,181,020	235,981,020	5,792,534	241,773,554

HIV/AIDS Epidemic in Ethiopia:
Estimated Population: 77,431,000^*
HIV Prevalence rate^*: [0.9 – 3.5%]^*
# of HIV infected: [420,000 – 1,300,000]^*
Estimated # of OVCs: [280,000 – 870,000]^*¥
*Figures are from the 2006 Report on the Global AIDS Epidemic, UNAIDS
^Prevalence is in adults only (15-49 years)
^¥Orphans aged 0-17 due to AIDS

Country Results and Projections to Achieve 2-7-10 Goals:

Ethiopia	Total # Individuals Receiving Care and Support	Total # Individuals Receiving ART
End of Fiscal Year 2004*	30,600	9,500
End of Fiscal Year 2005**	264,100	16,200
End of Fiscal Year 2006***	484,100	40,000
End of Fiscal Year 2007****	475,000	75,500
End of Fiscal Year 2008****	810,500	111,000

^*Results. “Engendering Bold Leadership: The President’s Emergency Plan for AIDS Relief.” First Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, March 2005
^**Results. “Action Today, A Foundation for Tomorrow: The President’s Emergency Plan for AIDS Relief.” Second Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2006
^***Results. “Power of Partnerships: The President’s Emergency Plan for AIDS Relief.” Third Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, February 2007
^****Fiscal Year 2007 Country Operational Plan targets

Program Description:

Ethiopia is a populous and culturally diverse country with a population estimated at 74 million. Most recent studies estimate the current HIV/AIDS prevalence to be between 1.4% (EDHS, 2005) and 3.5% (ANC, 2005), with between one and 2.6 million people infected. Ethiopia is one of the world’s poorest countries, and the HIV epidemic is compounded by the chronic food insecurity faced by 10% of the population.

Over the past three years, the Emergency Plan in Ethiopia has made a momentous contribution to the effort to treat and care for people living with HIV/AIDS (PLWHA) and prevent the disease from spreading further. Recent Antenatal Clinic (ANC) and Demographic and Health (EDHS) surveys indicate that the HIV/AIDS epidemic in Ethiopia is leveling off. Given the complexities of the Ethiopian situation, including an ethnically diverse population and extremely poor infrastructure, the USG has made it a high priority to address the unique social, economic, and geographic factors affecting the spread of HIV/AIDS. In fiscal year 2007, the USG program aims to build upon past work, continue the rapid scale-up of treatment services, and develop innovative approaches to address the HIV/AIDS epidemic in Ethiopia.

Additional Funding: In June 2007, an additional $25,450,000 was allocated to scale up TB/HIV activities, renovate additional health centers, increase the quality and reach of PMTCT services, and expand existing care and prevention activities.

Emergency Plan funding will be focused on supporting the following programmatic areas in order to achieve 2-7-10 targets:

Prevention: $39,579,535 ($34,450,811 Field and $5,128,724 Central) (18.5% of prevention, care, and treatment budget)

The USG program includes prevention of mother-to-child transmission (PMTCT), abstinence and being faithful (AB) interventions targeted at youth and adults, and other prevention interventions which work with specific most-at-risk populations (MARPs). Other prevention programs aim to prevent the transmission of HIV through medical injections and blood transfusions.

The USG’s PMTCT programs provide linkages to ART services for HIV-positive women and nevirapine to HIV-positive pregnant women. In fiscal year 2007, USG Ethiopia will train traditional birth attendants in the delivery of single dose Nevirapine.

The AB and other prevention plans for fiscal year 2007 continue building upon the progress of past years. The USG has partnered with faith-based organizations (FBOs) and will continue to work with their extensive networks throughout the country, in order to address social issues such as early marriage and HIV-related stigma. The USG also will fund mass media programs, which provide another forum for addressing stigma.

Based on recent ANC and EDHS survey data, the USG will target several urban “hotspots” for intense prevention activities and expand the high risk corridor initiative (HRCI). Prevention programs also will work with the uniformed services, as well as in Ethiopia’s refugee camps, providing comprehensive HIV/AIDS prevention messages. The USG also engages with the private sector to support workplace prevention programs.

Medical transmission prevention programming works within the public health network, refugee camps, and the uniformed services to ensure safe medical practices and prevent transmission through injections or transfusions of unsafe blood.

The USG is very conscious of ensuring that Emergency Plan interventions are sustainable. To address this, the USG uses annual program statements (APS) and small grants programs to recruit indigenous partners. Through this program, the Emergency Plan will support the Health Extension Workers program, which is designed to increase the numbers of non-professional health personnel.

Principal Partners: Academy for Educational Development, IntraHealth International, JHPIEGO, Abt Associates, Catholic Relief Services, Family Health International, Food for the Hungry, International Orthodox Christian Charities, International Rescue Committee, Johns Hopkins University Center for Communications Programs, Pact, Samaritan’s Purse, Save the Children US, United Nations High Commission for Refugees, and John Snow International.

Care and Support: $62,556,764 ($61,892,954 Field and $663,810 Central) (29.2% of prevention, care, and treatment budget)

The Emergency Plan’s palliative care goals include strengthening human resource capacity, providing high quality services and nutritional support, as well as building the capacity of indigenous organizations to provide sustainable care services. In fiscal year 2006, the Emergency Plan palliative care program began to shift away from focusing on end-of-life care activities toward providing a continuum of care, starting with the diagnosis of HIV/AIDS infection. In fiscal year 2007, continuum of care activities will expand throughout the health network, and the Emergency Plan will increase investments in human resource capacity. For example, case managers will be deployed to help refer patients to community services, and then track them to ensure follow-up.

In order to reach patients who are co-infected with both tuberculosis (TB) and HIV, TB/HIV diagnosis, treatment and care services will be incorporated into the basic care package at all hospitals and health centers supported by the Emergency Plan.

The OVC program will be targeted for increased local capacity building. In fiscal year 2007, the USG will continue efforts to strengthen networks within government and civil society to provide care and increase program and donor coordination. The OVC portfolio will address Ethiopia’s high prevalence of gender-based violence (GBV), including abduction, trafficking, sexual abuse, forced early marriage, female genital cutting (FGC), and other harmful traditional practices.

To enable the scale up of ART services, the Emergency Plan will expand the voluntary counseling and testing program to support provider-initiated counseling and testing services at additional ART hospitals, health centers, workplace clinics, and mobile clinics.

Principal Partners: Catholic Relief Services, International Orthodox Christian Charities, MSCI, Project Concern, Population Services International, World Food Program, Development Alternative Incorporated, Hope for African Children, Save the Children US, World Learning, Family Health International, and JHPIEGO.

Treatment: $112,144,160 (field funded) (52.3% of prevention, care, and treatment budget)

The goal of USG Ethiopia’s ART program is to support the Government of Ethiopia’s (GOE) plan to rapidly scale-up ART treatment, while continuing to ensure quality services. As of August 2006, ART services were being delivered to patients in 132 sites. In 2007, the Emergency Plan will extend ART services to additional sites at both the hospital and health center levels. Peace Corps Volunteers will work to support ART services by promoting adherence to treatment at various levels within the Network Model.

A key element of successful implementation is a supply chain management system that fully supports the entire program at all levels. The Emergency Plan will provide ongoing support and assistance to ensure the high quality of Ethiopia’s supply chain management system. The USG also will support the improvement of Ethiopia’s pharmacy infrastructure in order to improve the quality of drug delivery.

Principal Partners: Ministry of Health, World Health Organization, Johns Hopkins University, Columbia University, University of Washington, University of California at San Diego, Tulane University, JHPIEGO, Ethiopian Health and Nutrition Research Institute, Ethiopian Public Health Association, Supply Chain Management Systems, Management Sciences for Health, Addis Ababa University, Debub University, Mekele University, Alemaya University, Gondar University, and Jimma University, Abt Associates, American International Health Alliance, Crown Agents, American Society of Clinical Pathology, and Association of Public Health Laboratories.

Other Costs: $27,493,095

Recent efforts to develop Ethiopia’s health information system infrastructure have resulted in the creation of a single national monitoring and evaluation (M&E) system. The goal for fiscal year 2007 is to build upon this system by expanding the use of this data for improved policy development, program management, and evidence-based decision making. The Emergency Plan also will continue to support efforts to improve surveillance systems and facilitate targeted evaluations.

In fiscal year 2007, USG support for the national monitoring and evaluation framework will continue. Medical records management (paper-based as well as electronic) will be supported in order to capture and use the vast amount of clinical data generated from facilities. With the advent of ARV treatment for HIV/AIDS, the country has started to monitor patients suffering from this complex chronic disease. While there have been efforts to develop standardized monthly reporting forms, the level of data needed for day-to-day patient monitoring must be strengthened through effective medical records management, and this must be supported by electronic systems.

To enhance data generation and use at facilities, the USG will provide support to the hospitals and health centers providing HIV prevention, treatment, and care services in data management for program improvement. These activities will be linked with the national M&E support activity.

Principal Partners: Ethiopian Public Health Association, Ministry of Health, JHPIEGO, and Tulane University.

Other Donors, GFATM Activities, Coordination Mechanisms:

The Global Fund for AIDS Tuberculosis and Malaria (GFATM) is the largest donor in Ethiopia, with funding from four grants totaling over $645 million.

The USG has a representative on the GFATM Country Coordination Mechanism (CCM), which works to coordinate Global Fund disbursements. To further aid USG-GFATM collaboration, both groups signed a Memorandum of Understanding in fiscal year 2006 that provides the framework for the working relationship at the country level. In fiscal year 2007, the USG will continue working to improve coordination between the GOE and GFATM to provide support for the government’s ART scale-up plan.

A number of UN agencies, including WHO, UNICEF, UNAIDS, UNDP, ILO, IOM, and WFP, are active in Ethiopia. Ethiopia’s Donor Assistance Group is comprised of representatives from the donor nations and has established technical sub-groups. Among these working groups is the HIV/AIDS Donor Group, which links the work of the CCM, the Emergency Plan, and the HAPCO National Partnership Forum. In fiscal year 2007, the Emergency Plan in Ethiopia will continue integrating its activities with the MOH’s Health Sector Development Program.

Program Contact: Emergency Plan Country Coordinator, Jason Heffner

Time Frame: Fiscal year 2007 – fiscal year 2008

Approved Funding by Program Area: Ethiopia