Ethiopia Fiscal Year 2008 Country PEPFAR Operational Plan (COP)


ETHIOPIA

Project Title: Ethiopia Fiscal Year 2008 Country PEPFAR Operational Plan (COP)

Budget Summary:

 

Field Programs Funding by Account 

Total Funding

 

 Allocated as of February 2008

Allocated June 2008

Allocated as of June 2008

Implementing Agency

GAP

GHCS - State

Subtotal: Field Programs Funding

GAP

GHCS - State

Subtotal: Field Programs Funding

New Subtotal: Field Programs Funding

Subtotal: GHCS Central Programs

Grand Total:  Field & Central Funding

DOD

                 -

  1,529,000

           1,529,000

              -

                    -

                      -

       1,529,000

                         -

         1,529,000

DOL

                  -

 

                          -

              -

                    -

                      -

                      -

                         -

                        -

HHS

   5,800,000

105,617,314

      111,417,314

              -

     6,278,884

       6,278,884

   117,696,198

          3,500,000

     121,196,198

Peace Corps

                  -

    3,721,000

           3,721,000

              -

                    -

                      -

       3,721,000

                         -

         3,721,000

State

                  -

  10,551,673

         10,551,673

              -

     3,404,925

       3,404,925

     13,956,598

                         -

       13,956,598

USAID

                  -

183,275,453

      183,275,453

              -

  22,621,751

     22,621,751

   205,897,204

          8,239,354

     214,136,558

TOTAL

   5,800,000

304,694,440

    310,494,440

             -

  32,305,560

     32,305,560

   342,800,000

       11,739,354

     354,539,354

HIV/AIDS Epidemic in Ethiopia:

Adult HIV Prevalence Rate: 2.1% (Government of Ethiopia (GOE) Single Point Estimate, 2007)
Estimated number of People Living with HIV: 977,394 (GOE Single Point Estimate, 2007)
Estimated number of Orphans due to AIDS: 898,350 (GOE Single Point Estimate, 2007)

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***

484,100

40,000

End of FY 2007****

726,600

81,800

End of FY 2008*****

810,500

111,000

End of FY 2009*****

1,362,984

168,600

* "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.
** �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.
*** "The 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.
**** "The Power of Partnerships: The President's Emergency Plan for AIDS Relief." 2008 Annual Report to Congress submitted by the Office of the U.S. Global AIDS Coordinator, U.S. Department of State, January 2008.
***** Projections from FY 2008 Country Operational Plan

Program Description/Country Context:

In May 2007 the Government of Ethiopia (GOE) released a revised national HIV prevalence for Ethiopia of 2.1%. This estimate indicates a low-level generalized epidemic for Ethiopia with the majority of infections occurring in urban settings. In 2007, the estimated urban prevalence is 7.7% and 602,740 persons living with HIV and AIDS (PLWHA) and the estimated rural prevalence is 0.9% and 374,654 PLWHA. The GOE�s revised national HIV prevalence calculations also resulted in a revised estimate for orphans; in 2008, Ethiopia will have almost 5.5 million orphans, 16% of whom were orphaned as a result of HIV/AIDS. As a child�s age increases, the likelihood of the child living with both parents decreases. Only 65.2% of 10-14 year-olds and 52% of children 15-17 live with both parents (2005 EDHS).

Ethiopia�s national response to the HIV/AIDS epidemic has made significant progress in the past three years. In 2004, PEPFAR reported that only about 9,500 individuals were on antiretroviral therapy (ART) at 35 hospitals, and no health centers, around the country. As of May 2007, there were 265 ART sites operational throughout the country, including 117 hospitals (92 public hospitals, 13 private hospitals, and 12 military hospitals), 146 health centers and two non-governmental organization (NGO) clinics. The cumulative number of patients that started on ART was 87,697, while 66,973 were currently on ART, of about which 11% were served at health centers.

PEPFAR funding will be focused on the following programmatic areas to achieve the 2-7-10 targets:

Prevention: $61,915,684 ($50,902,330 Field; $11,013,354 Central) (20.2% of prevention, care and treatment budget)

Ethiopia�s single point prevalence data indicate that sexual and medical prevention programs should focus more in urban than rural areas, with due attention to transport corridors, trade hubs, and other areas rural dwellers visit. Population-based EDHS data indicate that HIV prevalence in Ethiopia is driven by risk behaviors among adults, especially those engaged in transactional sex and maintaining multiple, concurrent partnerships. HIV prevalence peaks among women aged 35-39 and men 40-44, suggesting a peak incidence of HIV infections among women in their early 30s and men in their mid-to-late 30s.

Given these data, USG is shifting the Ethiopia sexual prevention behavior change communication portfolio�s focus to adult, urban populations and persons engaged in high risk behaviors, while maintaining an appropriate focus on youth and the general population. PEPFAR prevention partners will ensure that messages about monogamy, reduction of sexual partners, and the risks of concurrence are benefiting adult populations. There will be an increased focus on higher risk populations, in particularly the uniformed service, police, refugees, university students, young married adolescents, and mobile, bridge populations along the transport corridors. In FY 2008, the target populations will also include individuals involved in multiple and concurrent sexual partnerships, including divorced and widowed women who engage in informal transactional sex. PEPFAR partners will continue to focus on prevention and treatment of sexually transmitted infections and will provide information and access to condoms at facility and community levels. Addressing male norms and gender issues such as early marriage, sexual exploitation, and cross generational sex will continue to be a top priority. By September 2009, USG will increase community outreach support and behavior change activities.

Ethiopia�s medical prevention program includes prevention of mother-to-child transmission (PMTCT), injection safety, and blood safety. The PEPFAR PMTCT program will continue to increase ARV prophylaxis for pregnant women with a goal of reaching 80% of HIV positive women attending antenatal care clinics. USG will support the expansion of PMTCT services, including public and private hospitals, health centers and health posts.

In the area of infection prevention and safe blood practices, USG will expand support and training to private, public and military health facilities. Partners will provide infection prevention training for medical doctors, nurses, nurse midwives and laboratorians and will collaborate with the Global Fund for AIDS, Tuberculosis and Malaria (Global Fund) to ensure an adequate supply of infection prevention materials at health facilities. USG will also increase access to post-exposure prophylaxis for victims of rape. USG will support partners to increase blood collection and ensure a safe and adequate supply of blood products. PEPFAR partners will provide training, equipment and supplies to support Ethiopia�s existing blood blanks. For the uniformed services, USG will provide assistance to Ethiopia�s national military hospital as well as new regional safe blood distribution and transfusion centers.

Principal Partners: Abt Associates, Academy for Educational Development, Catholic Relief Services, Columbia University, Crown Agents, EngenderHealth, Ethiopian Public Health Association, Family Health International, Federal Ministry of Health, Federal Police, Food for the Hungry, Geneva Global, International Orthodox Christian Charities, International Rescue Committee, IntraHealth International, John Snow, Inc., JHPIEGO, JHU/Center for Communication Programs, Johns Hopkins University Bloomberg School of Public Health, Management Sciences for Health, Ministry of National Defense-Ethiopia, Nazarene Compassionate Ministries, Inc., Pact, Partnership for Supply Chain Management, Population Council, Samaritan�s Purse, Save the Children US, United Nations High Commission for Refugees, University of California at San Diego, University of Washington, World Food Program, World Learning, Young Men�s Christian Association.

Care: $77,316,607 ($76,590,607 Field; $726,000 Central) (25.2% of prevention, care and treatment budget)

Prior to FY 2006, palliative care support activities in Ethiopia focused mainly on end of life care and distribution of commodities to PLWHA. With the advent of free ART and improved access to HIV/AIDS care services, palliative care is increasingly perceived as a continuum of care. In FY 2008, USG will work with relevant stakeholders and partners to institutionalize the use of opioids for pain management, and will develop and deliver a standard preventive care package for adults and children. Income-generating activities to enable PLWHA to support themselves will be consolidated and expanded in FY 2008.

Priority activities under the TB/HIV collaborative initiative in Ethiopia at public, private and workplace clinics include: 1) screening of all HIV-positive persons attending different clinics for active tuberculosis, 2) provision of TB treatment for cases diagnosed with active tuberculosis, 3) isoniazid preventive therapy for HIV-positive clients found to be free from active TB, 4) screening of all TB patients at the TB clinic for HIV with provider initiated counseling and testing, 5) provision of cotrimoxazole prophylactic treatment for TB/HIV patients, 6) establishing referral linkages to different service areas , and 7) provision of ART for eligible cases and 8) monitoring and evaluation.

Ethiopia has been designated a priority country for food and nutrition programming for PEPFAR. With FY 2008 funding, USG will train and equip service providers to provide nutritional care and support to PLWHA. USG will leverage food resources from USG PL 480 Title II and the World Food Program, and will improve nutrition assessment, counseling and monitoring of HIV-infected persons at all HIV care, ART and PMTCT service sites in the network. PEPFAR Ethiopia will also expand therapeutic feeding by prescription to new facilities.

USG will expand the coverage and depth of services for orphans and vulnerable children (OVC), including leveraging USG PL Title II and the World Food Program food resources. With FY 2008 funding, USG will expand partnerships with parent-teacher associations (PTAs) and Girls� Advisory Committees to increase the number of schools meeting the specific needs of OVC. Additionally, PEPFAR Ethiopia will apply integrated approaches to gender-based violence and impacts of early marriage that will benefit the work of other partners.

Taking into account the current national trend in HIV prevalence, HIV counseling and testing (CT) services will be more focused on most at risk populations. Family centered HIV testing will be widely available to create an opportunity to increase child testing. In FY 2008, PEPFAR will support diverse CT models such as fixed sites, mobile, home-based CT, youth-friendly services, work place, schools, prison, information centers, health integrated, private, etc. Promotion of CT using different media outlets will be strengthened.

Principal Partners: Abt Associates, Academy for Educational Development, Addis Ababa Regional HIV/AIDS Prevention and Control Office, American International Health Alliance Twinning Center, Catholic Relief Services, Columbia University, CARE Ethiopia, Development Alternatives, Inc., Ethiopian Health and Nutrition Research Institute, Family Health International, Federal Ministry of Health, Fintrac, Inc., Geneva Global, International Orthodox Christian Charities, JHPIEGO, Johns Hopkins University Bloomberg School of Public Health, International Rescue Committee, Management Sciences for Health, Nazarene Compassionate Ministries, Inc., Population Council, Population Services International, Project Concern International, Relief Society of Tigray, Royal Netherlands Tuberculosis Association, Save the Children US, University of California at San Diego, University of Connecticut, University of Washington, World Food Program, World Health Organization, World Learning, United Nations High Commission for Refugees, Young Men�s Christian Association.

Treatment: $167,348,578 ($138,803,760 Field; $0 Central) (54.6% of prevention, care and treatment budget)

USG is the major partner supporting Ethiopia�s national ART program and supports a regionalized ART strategy in which USG partners provide coordinated technical support to the health network in their respective operation zone. In FY 2008, USG will continue to support this geographically focused ART services delivery program, and will additionally support facility accreditation for ART services in all 11 regions. PEPFAR partners will strengthen the nurse-centered care model by upgrading nurses� training to include additional core competencies and certification, and will consolidate and expand mainstreaming of ART in health professionals� pre-service training. USG will strengthen private-public partnerships and civil-military alliances and will undertake targeted evaluations to guide program scale up and support improvements in quality of ART services.

In addition to support ART services, with FY 2008 funding, USG will support the provision of ARV drugs to hospitals and health centers. Other HIV commodities will be provided to selected hospitals and health centers throughout the country. FY 2008 funds will be used to expand technical assistance for procurement and logistics of the supply chain for ARV drugs as well as to procure essential HIV commodities for PMTCT and palliative care programs.

USG also provides substantial support to Ethiopia�s national laboratory system. With FY 2008 funds, USG will support and coordinate all laboratory training, quality assurance, and site supervision at ART health networks, and train laboratory professionals on HIV rapid testing, diagnosis of TB and other opportunistic infections, laboratory monitoring of ART and laboratory quality, and information and logistic management systems.

Principal Partners: Abt Associates, African Network for Care of Children Affected by HIV/AIDS, The Carter Center, Columbia University, Ethiopian Health and Nutrition Research Institute, Ethiopian Medical Association, Ethiopian Public Health Association, Federal Ministry of Health, International Rescue Committee, JHPIEGO, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University Center for Communications Programs, Management Sciences for Health, National Association of State and Territorial AIDS Directors, Partnership for Supply Chain Management, Tulane University, University of California at San Diego, University of Connecticut, University of Washington, United Nations High Commission on Refugees, World Health Organization, Association of Public Health Laboratories, American Society for Clinical Pathology.

Other Costs: $47,958,485

With FY 2008 funding, PEPFAR Ethiopia will continue to support activities related to surveillance, health management information systems (HMIS), and monitoring and evaluation. USG surveillance activities will include antenatal, mortality, TB/HIV, sexually transmitted infections and a new effort in HIV case surveillance. In terms of HMIS, USG will strengthen site-level hospital and health center data support by intensifying efforts to fully document information for pre-ART and ART patients, and will provide additional training on data entry, data cleaning, and data analysis techniques for appropriate health facility staff through a variety of venues.

With FY 2008 funds, PEPFAR Ethiopia activities in other health policy and systems strengthening will continue to focus on sustainability, with an emphasis on: 1) systems strengthening, particularly leadership and management of service delivery, 2) human and organizational capacity building; and 3) broadly expanding private sector engagement. USG will continue to participate in and provide support to the Secretariat of the 17 member GFATM Country Coordinating Mechanism (CCM) for Ethiopia�s GFATM awards, and will initiate a new activity to provide TA and other support to build capacity of regions and districts to manage GFATM sub-grants. USG will support a wide range of pre- and in-service training programs for health planners, public health officers, physicians, nurses, health officers, pharmacists and lab technologists for improved service delivery.

Principal Partners: Abt Associates, Columbia University, Ethiopian Health and Nutrition Research Institute, Ethiopian Medical Association, Ethiopian Public Health Association, Federal Ministry of Health, International Rescue Committee, JHPIEGO, Johns Hopkins University, John Snow, Inc., Management Sciences for Health, Tulane University, National Alliance of State and Territorial AIDS Directors, The Carter Center, World Health Organization.

USG management and staffing funds will support the in-country personnel needed for the Department of Health and Human Services/Centers for Disease Control and Prevention (CDC), US Agency for International Development (USAID), Department of Defense, Department of State, and the US Peace Corps. Funds will ensure program monitoring and accountability, ensure USG policy and technical leadership, and cover compensation, logistics, and office and administrative costs.

Other Donors, Global Fund Activities, Coordination Mechanism:

The United States is the largest bilateral donor to Ethiopia�s health sector, providing the majority of funding for HIV/AIDS prevention, care and treatment. In addition to GFATM, other active international donors include WHO, UNICEF, UNAIDS, UNDP, ILO, IOM, and WFP. Important bilateral partners are the United Kingdom, Ireland, the Netherlands, Canada, Japan, and Sweden. There are over 200 national and international NGOs and FBO active in HIV/AIDS,

The GOE has secured $713,053,234 million from the Global Fund to address HIV/AIDS (66%), Malaria (26%), and TB (9%). The USG participates on the Global Fund Country Coordinating Mechanism and has signed a Memorandum of Understanding to guide joint action. The primary HIV/AIDS coordinating body is HIV/AIDS Prevention and Control Office (HAPCO). In addition to working with HAPCO, the USG meets regularly with key officials of individual Ministries (Health, Defense, Education and Finance and Economic Development) to ensure that USG assistance complements and supports the GOE�s plans for prevention, care and treatment.

Program Contact: Deputy Chief of Mission, Deborah Malac

Time Frame: FY 2008 � FY 2009

Approved Funding by Program Area: Ethiopia

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