Expanding Comprehensive HIV & AIDS Services in Ethiopia
Ethiopia is the oldest independent country in Africa. Despite having limited resources and a high disease and illness burden in the country, Ethiopia has made a strong commitment to improving health by investing a significant share of its gross domestic product—6 percent—on health care.
MSH spoke with Haile Wubneh, Deputy Chief of Party for the US Agency for International Development (USAID)-funded HIV/AIDS Care and Support Program, led by MSH, about the HIV challenges in Ethiopia and how the Government and its partners are making major efforts to improve health.
What is the HIV & AIDS situation in Ethiopia?
Ethiopia is a country of over 80 million people. This country has a vast geographic area, mountain terrains, and poor infrastructure. The undeveloped economy had to face the challenges of HIV & AIDS epidemic starting in the mid 1980s. HIV & AIDS took the lives of thousands of a productive workforce. The situation continued to worsen through the 1990s and beyond.
Currently, over 1.2 million HIV positive people live in Ethiopia.
Until 2005, most of the HIV & AIDS programs focused on prevention activities. Despite all the efforts of the government, supported by international and local partners, the impact was insignificant compared to the losses the country had to bear. Many children were orphaned and grandparents were left responsible for young, often also ill, children.
As a result of the overwhelming numbers of people affected by the disease, the Government of Ethiopia introduced free treatment to all patients as part of the overall health development programs of the country effective in 2005. The program was introduced primarily to selected hospitals, but later rolled out to heath centers.
As a result of introducing treatment, the number of people dying from HIV related causes was halted significantly and thousands of AIDS victims enrolled themselves into treatment programs. The infection rate at the beginning was very high, but with the rapid scale up of the treatment programs, it slowed down considerably.
Currently there are close to three hundred thousand individuals on treatment. The HIV/AIDS Treatment and Care Program, funded by the United States Agency for International Development (USAID) and led by MSH, is expanding at a very fast rate so that the lives of thousands can be spared.
What challenges does the health system in Ethiopia have in addressing HIV?
The Ethiopian health system faces all the challenges that any developing country does. Most, if not all, health facilities are overcrowded with patients suffering from a variety of infectious diseases.
All health facilities built prior to 2005 never considered the structures that HIV & AIDS programs require. Private sections for counseling and testing are needed. Internal facilities, like simple furniture, are close to non-existent, or are in short supply almost everywhere.
The training of health workers at all levels was in adequate to address the HIV & AIDS issues. Changing the training curricula in the institutions was not easy and still is taking time. As a result, massive retraining programs have to be carried out every year. There are still too few health providers in Ethiopia.
To implement HIV & AIDS programs properly, recording and reporting are essential elements. In most cases, registration books and accredited Health Management Information System materials are inadequate. This is a major roadblock in providing service.
What approaches worked successfully in Ethiopia?
Three main approaches have worked successfully in Ethiopia.
- Task shifting: The initial idea adopted by the Government was to treat AIDS cases in hospitals using physicians. In a country like Ethiopia where the number of hospitals and medical doctors is limited, it was proved wrong. As a result, the Government approved the shifting of the task from hospitals to health centers and from doctors and prescribers to mid-level health workers. Counseling and testing was also shifted to non-professional counselors. The introduction of Case Managers and Data Clerks has significantly contributed to the overall successes.
- Rapid scale up. The treatment of AIDS using antiretroviral (ART) drugs had to be scaled up rapidly to selected health centers outside hospitals. This activity required furnishing health centers and massive re-training of health workers on ART. Equipping such number of heath centers with computers and HMIS materials was a big task. The introduction of regular mentorship program was a very successful initiative and significantly contributed to the quality of services rendered.
- Decentralization: The HIV & AIDS program was decentralized for several regions. The regions have taken the responsibility in managing their programs from within with minimum support from the Federal government. Local partners and the use of volunteers has significantly contributed to the programs.
What is MSH doing in Ethiopia to address HIV & AIDS and other health challenges in Ethiopia?
The HIV/AIDS Care and Support Program started during the period of decentralization and the task shifting era. MSH took the responsibility of rapidly scaling up the treatment programs in health centers and provided support to patients at the community level.
The program supports over 500 health centers found in Amhara, Oromiya, Southern Nations, Nationalities, and People’s Region (SNNPR), Tigray, and Addis Ababa. This covers almost 80% of the country. This program has equipped 500 health centers, trained over 22,000 heath workers, and provided close mentorship support over the past four years. The impact had been demonstrated by the number of AIDS cases treated in health centers. These grew from nine thousand to ninety thousand (9000- 90,000) in four years. The number of health centers grew from about 125 to more than 500.
In addition to HCSP, MSH has several programs including the Supply Chain Management Systems (SCMS) procuring ARVs and other supplies, and the Leadership Management Sustainability (LMS) program where a number of health workers have been trained in leadership skills. There is also a malaria control program coupled with a Tuberculosis-Control Assistance Program (TB-CAP).
What are your hopes for Ethiopia’s health sector in the future?
The overall economy of the country is just taking off the ground. As a result, the health sector is benefiting from the overall development. Ethiopia is a country devastated by long wars and drought. The entire social services sector has been seriously affected. With the current trend of economic deployment and peace, the country will hopefully develop significantly in the coming years.
The health sector needs improvements in infrastructure, equipments and supplies. The focus should continue to be on infectious diseases control as well as on chronic illness. In the foreseeable future, the inputs and support from international donors and other sources are vital.