Ethiopia FY 2006 Country Operational Plan (COP)


ETHIOPIA

Project Title: Ethiopia FY 2006 Country Operational Plan (COP)

Budget Summary:

 
Field Programs Funding by Account
Central Programs Funding by Account
 
 
Notified as of May 2006
Current Notification August 2006
Current Notification August 2006
 
Implementing Agency

GAP

GHAI

Subtotal:
Field Programs Funding by Account

GHAI

GAP

New Subtotal: Field Programs Funding by Account

GHAI Central Programs

Total Dollars Allocated: Field & Central Funding

DOD

-

822,000

822,000

-

-

822,000

-

822,000

DOL

-

-

-

-

-

-

-

-

HHS

5,800,000

40,264,000

46,064,000

2,850,000

-

48,914,000

1,026,440

49,940,440

Peace Corps

-

-

-

-

-

-

-

-

State

-

819,000

819,000

-

-

819,000

-

819,000

USAID

-

59,895,000

59,895,000

4,850,000

-

64,745,000

6,631,307

71,376,307

TOTAL Approved

5,800,000

101,800,000

107,600,000

7,700,000

-

115,300,000

7,657,747

122,957,747

HIV/AIDS Epidemic in Ethiopia:

Adult HIV Prevalence Rate: [0.9-03.5%] (UNAIDS 2006)
Estimated Number of HIV-infected People: [420,000- 1,3000,000] (UNAIDS 2006)
Estimated Number of AIDS Orphans: [280,000-870,000] (UNAIDS 2006)

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

Ethiopia Total # Individuals Receiving Care and Support Total # Individuals Receiving ART
End of FY 2004* 30,600 9,500
End of FY 2005** 264,100 16,200
End of FY 2006*** 338,000 60,000
End of FY 2007*** 475,000 100,000

*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
***Projections from FY 2006 Country Operational Plan

Program Description:

Ethiopia is the second most populous country in sub-Saharan Africa with a current population estimate of 77 million from 83 ethnic groups and languages, in an area almost twice the size of Texas. There are nine ethnically based regions and two special administrative areas, one of which is the capital, Addis Ababa. Approximately 4% of the population lives in Addis Ababa, and another 11% in scores of much smaller urban areas throughout the country. Approximately 85% of the population lives in rural areas. Religion plays a major role in the lives of most Ethiopians.

The national adult HIV seroprevalence rate for 2003 was estimated at 4.4%, with a 12.6% urban rate and a 2.6% rural rate. The data show some expected variation among the regions. Although rates are higher in urban areas, the large percentage of population living in rural areas means that a significant proportion of the total HIV positive population lives in those areas. While the urban rates seem to be leveling off, there appears to be a continued increase in the rural areas. General �drivers� of the epidemic are the overall high population growth (2.7%); the low access to public health services (below 62%); low literacy rates (32.8% total, with only 26.4% for females and 39.3% for males); and the overwhelming poverty of most of the population, with gross domestic product (GDP) per capita under USD 100. Maternal mortality rates are 871 per 100,000 live births, reflecting low utilization rates for antenatal care and labor and delivery services important to prevention of mother-to-child HIV transmission (PMTCT). Half of Ethiopia�s children are underweight for their age and over half are stunted, with recent surveys indicating that orphans affected by HIV and AIDS are relatively more vulnerable. The per capita expenditures for health care from all sources (Government, donors, and out-of-pocket) is low, USD 5.60 versus an average of USD 12.00 per person in the Africa region.

There is little disaggregated data, but experience from other countries and the limited data on Ethiopia suggest that the groups engaging in high-risk behavior or at risk in Ethiopia are the same as in many other countries. These include transport workers and other mobile men, commercial sex workers, men with disposable incomes, internally displaced people and refugees, in- and out-of-school youth, university students, police, and the military. Ethiopia has a very limited injecting drug user population, and there are no data on men who have sex with men or prisoners. Data from small-scale hospital based studies show Tuberculosis (TB)/HIV co-infection rates ranging from 25% to 47%. It is conservatively estimated that at least 30% of TB patients are currently co-infected with HIV. Two-thirds of the adult population in the country is estimated to have latent TB infection and hence, latent TB is widespread among HIV-positive individuals, thereby significantly increasing their risk of developing active TB significantly.

The following programmatic areas will be supported with FY 2006 funds and are included in the Country Operational Plan to mitigate the impact of the epidemic in Ethiopia.

Prevention: $22,609,238 as of August 2006 ($16,645,000 Field and $5,964,238 Central) (20.8% of prevention, care, and treatment budget)

The Emergency Plan�s (EP) prevention goal in Ethiopia is that by 2008, the Government of Ethiopia (GOE) will be achieving its aim of reduced HIV transmission. HIV incidence will be decreasing in urban areas and will have stabilized in rural areas. The EP in Ethiopia will contribute to the GOE�s efforts through programs that reduce sexual and medical transmission of the virus.

With FY 2006 funds, the EP will continue to focus on maintaining no/low risk behavior among the general population and reducing risk behaviors among most at risk populations to reduce sexual transmission of HIV. Population groups identified as being most at risk in Ethiopia include youth, the uniformed services (federal police, the military), men with mobility/money, commercial sex workers, domestic workers and refugees. Community and faith leaders will continue to be targeted to encourage individual and community behavior change by supporting young men and women in their decision-making regarding sexual relationships, addressing harmful social practices such as early marriage and reducing stigma and discrimination. Increased attention will be given to identifying and addressing the risk factors faced by domestic workers and refugee populations. Abstinence and be faithful (AB) and other prevention (OP) activities will be age and context appropriate. With FY 2006 funds, the EP will reach 13,000,000 people with AB messages, 3,700,000 youth with abstinence messages, and 116,000 people will have been trained in AB programming. In other prevention, 8,300,000 people will have been reached with interventions addressing Abstinence, Faithfulness and Correct and Consistent Condom Use, 93,000 people will have been trained and there will be 650 targeted condom service outlets.

To reduce medical transmission of HIV in Ethiopia, the EP will continue to focus on three main strategies; PMTCT, the prevention of medical transmission through unsafe blood supplies and the prevention of transmission through unsafe medical injections. FY 2006 central funding will support program expansion to all sites within the 89 health networks. Additional funds will be used to expand blood safety and injection safety programs to all military sites within the network and to support broader infection prevention programming within the network. By September 2007, 200 people will be trained in blood safety in 32 health facilities and 3,115 will be trained in injection safety in 356 health facilities.

The USG PMTCT program has been operational since 2004 and with FY 2006 funding will be expanded to all 89 hospitals and 267 health facilities in the health network. Two major foci will be to increase participation in PMTCT services through community mobilization and outreach and to improve referrals from PMTCT to treatment and to care and support. By September 2007, it is expected that 189,800 pregnant women will have received PMTCT services and that 4,748 women will be receiving ART through PMTCT services.

In the May 2006 notification an additional $300,000 was allocated for prevention activities. The additional funds will support other prevention programs that look at the overlap between individuals at risk for alcohol abuse and HIV infection. These funds will support a targeted evaluation, anti-alcohol promotional materials and materials to incorporate alcohol counseling into established counseling services.

In August 2006, an additional $1,300,000 was allocated for prevention activities. $300,000 will address low antenatal uptake in Ethiopia and $1,000,000 will go towards the procurement of condoms for high risk groups.

Principal Partners: Health Communications Programs/The Johns Hopkins University, International Orthodox Christian Charities, Save the Children USA, The Johns Hopkins University/Center for Communications Programs, National Defense Force of Ethiopia, Pact, ABT Associates, Samaritan�s Purse, Catholic Relief Services, and Food for the Hungry International.

Care: $31,963,809 as of August 2006 ($30,270,300 Field and $1,693,509 Central) (29.3% of prevention, care, and treatment budget)

Care activities of the EP in Ethiopia include counseling and testing (CT), basic palliative care, support for integration of TB and HIV programs, and support for orphans and vulnerable children (OVC).

As a key entry point to care and treatment, voluntary counseling and testing (VCT) is a critical component of the USG program. The CT strategy for 2006 will build on an earlier scale up. New activities will facilitate better access to VCT in rural areas. The shift in MOH policy introduces provider initiated counseling and testing for TB, STI, in-patients and out-patients who would most benefit from VCT and lay counselors. With FY 2006 funds, the quality of VCT services will be strengthened in 596 VCT centers including 89 ART hospitals, 392 health centers and another 88 service outlets to reach 880,125 clients.

The EP in Ethiopia is implementing a standardized, simple and doable preventive care package for HIV-positive clients at USG-supported Ethiopian hospitals, health centers and communities. Elements of the package include bed nets to prevent malaria in endemic areas, cotrimoxazole prophylaxis, screening for active TB among PLWHA, prevention for positive counseling, condoms, referral of household contacts for VCT, safe water supply, nutrition counseling and multivitamin supplementation. In addition, appropriate palliative and preventive care services will be actively offered for HIV-positive clients.

Also with the 2006 funding, the EP will begin linking the community and home, health center, and hospital palliative care programs as part of a major move towards strengthening and scaling up a comprehensive continuum of care and the Anti-Retroviral Therapy (ART) health network. The EP will deploy Community Oriented Outreach Workers (COOWs) who will represent the communities from where health center clients originate and will interface with one of the five health posts linked to their health center. The COOWS will work in partnership with community and faith-based organizations, community leaders, non-governmental organizations (NGO) and community volunteers.

Using FY 2006 funds, the USG will continue its collaboration with the Ministry of Health (MOH) and the World Health Organization (WHO) to integrate Ethiopia�s TB and HIV/AIDS programs in 89 hospitals, 392 health centers and in 45 service outlets in private sector programs working with the largest employers. Activities include provider-initiated clinical and diagnostic HIV counseling and testing for all persons with TB as part of standard TB care and screening of all HIV-positive persons for active TB disease as part of routine care.

The EP in Ethiopia will also continue to leverage use of P.L. 480 Title II resources to provide care and support to OVC in high-prevalence areas within the ART health networks, and to provide non-food subsistence, psychosocial, spiritual, and education/skills development support to OVC nationwide through faith based organizations (FBO) and NGO. The USG team will continue to provide advocacy and education to the nascent OVC Task Force to promote development of guidelines, norms, and standards for OVC care and support in Ethiopia. Activities launched under two centrally-funded awards in 2004 are expected to complement these efforts.

In the May 2006 notification an additional $2,930,000 was allocated for care activities. The additional funds will expand efforts to strengthen the capacity of local HIV/AIDS organizations to provide OVC activities and HIV CT, including four additional service outlet/programs to provide CT. The number of individuals who receive CT and receive their test results will increase by 43,800. Training in caring for OVC will be provided for an additional six hundred individuals, and training in CT will be provided for 32 individuals. OVC programs will serve an additional 5,000 OVC.

In August 2006, an additional $1,225,000 was allocated for care activities. These activities will increase access to voluntary counseling and testing in rural communities and support a safe water component of the preventive care package for people living with HIV/AIDS.

Principal Partners: U.S. Department of State Office of Population, Refugees and Migration (PRM), International Rescue Committee (IRC), JHPIEGO, International Training and Education Center on HIV/AIDS (ITECH), International Orthodox Christian Charities, CRS, Relief Society of Tigray (REST), Management Sciences for Health, Save the Children Federation/US, Columbia University, University of Washington, The Johns Hopkins University, WHO, WFP, Development Alternatives, Inc., CARE, and Hope for African Children Initiative. OGAC Central Funding awards to: Save the Children and Project Concern International.

Treatment: $54,382,700 as of August 2006 ($54,382,700 Field and $0 Central) (49.9% of prevention, care, and treatment budget)

The GOE has embarked on an ambitious free ART program, which has targeted some 250,000 patients to be put on treatment by 2008. The EP in Ethiopia, in collaboration with the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), provides support to program activities, including systems and infrastructural capacity building, procurement and distribution of antiretroviral (ARV) drugs and other essential commodities, and organization and delivery of comprehensive clinical, pharmacy and laboratory services.

Utilizing FY 2006 funding, the USG will support hospitals and health centers to provide ART services. Based on recent policy decisions by the Ministry of Health, both PEPFAR-Ethiopia and the GFATM will be supporting all 58 ART sites. The GFATM will be responsible for the procurement of first-line adult ARV drugs and the EP for second-line adult and all pediatric drugs. By the end of FY 2006, the USG in Ethiopia will support delivery of ART to 60,000 patients that will be provided through health networks of 89 hospitals and 267 health centers. Communities will be increasingly involved in ART through public awareness activities at all levels of the network to assure treatment uptake and adherence to treatment. Expanded private sector engagement in the ART program will be encouraged.

The Emergency Plan will continue to work with and strengthen Ethiopia�s Drug Administration and Control Authority (DACA, the equivalent of the U.S. Food and Drug Administration); the MOH�s Pharmaceutical Administration and Supplies Service (PASS), which handles HIV test kits and TB drugs; and the parastatal Pharmaceuticals and Medical Supplies Import and Wholesale Sales Company (PHARMID), which will manage distribution of EP supported ARV and PMTCT supplies. The USG will also work to strengthen the capacity of the National HIV/AIDS Laboratory in order to support quality assurance and complex diagnosis, including resistance to ARV drugs.

In the May notification an additional $2,600,000 was allocated for treatment activities. The additional funds will improve hospital infrastructure and operations and allow 193 hospitals to increase their capacity to provide ART.

In August 2006, an additional $5,175,000 was allocated for treatment activities to fund rapid expansion of access to ART in health centers and to improve lab services at these health centers. Please note that pediatric AIDS funding that is attributed to OVC programs is included in the care program area total and is deducted from the treatment program area total.

Principal Partners: Management Sciences for Health, International Training and Education Center on HIV, Columbia University, Johns Hopkins University, University of California at San Diego, Addis Ababa University, Debub University, Mekele University, Alemaya University, Gondar University, and Jimma University. Defense University, NASTAD, World Health Organization, Ministry of Health, JHPIEGO, Ethiopian Health Nutrition Institute, Ethiopian Public Health Association, American Society of Clinical Pathology and the American Public Health Laboratories.

Other Costs: $14,002,000 as of August 2006

With FY 2006 funds, strategic information (SI) services will focus on support for programmatic activities in the context of the ART health network, such as strengthening the national HIV/AIDS/Sexually Transmitted Infection (STI)/TB surveillance systems and providing support to improve quality of care and patient record systems; human capacity development in SI (including strengthening of SI leadership within relevant Ministries and providing SI related training courses at the regional level); and strengthening of the national, as well as U.S. government monitoring and evaluation (M & E) systems.

Policy and system strengthening efforts will focus on supporting the implementation of GFATM activities. The EP will also work to increase the number of new partners, particularly indigenous, which can be involved in EP supported activities. In addition, the USG will work through the ART health network to support the continuum of care for HIV/AIDS infected and affected persons across both the formal health care delivery system and communities. In Ethiopia, the government is working to address the human capacity issues through a major expansion of its Health Officer program and the implementation of a Health Extension Worker program. Health Officers are responsible for health center operations while Health Extension Workers are community-based and will provide the critical link between the community and the health sector. The USG in Ethiopia is supporting HIV/AIDS focused training for both of these cadres.

Administrative Costs will support the program and technical assistance required to implement and manage the EP�s activities. U.S. Agency for International Development, U.S. Centers for Disease Control and Prevention, U.S. State Department, and Department of Defense personnel, travel, management, and logistics support in country will be included in these costs. In August 2006, there was no change in the amount of funding allocated for other costs.

Principal Partners: The Carter Center, JHIEGO, Ministry of Health, the World Health Organization, Internews, HIV/AIDS Prevention and Control Office (HAPCO), Ethiopian Public Health Association, The Johns Hopkins University, Tulane University, and ORC/MACRO.

Other Donors, GFATM Activities, Coordination Mechanisms:

The GFATM is the largest donor in Ethiopia, with funding from four grants totaling USD 645.16 million. The EP in Ethiopia is the second largest HIV/AIDS donor. Integration of GFATM and EP activities occurs at the technical, working level and through the country coordinating mechanism (CCM). This is a key working relationship particularly in FY 2006 as GFATM and the EP-Ethiopia will support the GOE�s scale up plan for ART in Ethiopia. The World Bank�s Multi-Country HIV/AIDS Program (MAP) provided USD57.9 million in its first phase, which has been extended until June 30, 2006. Other active international donors include WHO, UNICEF, UNAIDS, UNDP, ILO, IOM, and World Food Program. Important bilateral partners are the United Kingdom, Ireland, the Netherlands, Canada, Japan, and Sweden. There are over 200 national and international NGO and FBO active in HIV/AIDS, at the national level and in the regions. The primary body to assure donor coordination is the HIV/AIDS Prevention and Control Office (HAPCO), with offices at the federal and, regional levels. Ethiopia�s Donor Assistance Group, the most senior donor-government body, established technical sub-groups, including the HIV/AIDS Donor Group, which links to the GFATM�s Country Coordinating Mechanism (CCM), PEPFAR Ethiopia, and the HAPCO National Partnership Forum. During 2006, the EP will increase the integration of its HIV/AIDS activities with the Health Sector Development Program, including the Human Capacity Development Program, the Master Pharmaceutical Plan, and the Health Monitoring and Information System.

Program Contact: Charge d�Affaires Ambassador Vicki Huddleston and Interagency Emergency Plan Coordinator Jason Heffner

Time Frame: FY 2006 � FY 2007

Approved Funding by Program Area: Ethiopia

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