Ethiopia, the second most populous nation in Africa, has a total burden of disease, as measured by premature death from all causes, of approximately 350 deaths per year (D/Y) per 1,000 persons. This disease burden is significantly higher than in neighboring Kenya (estimated at 170 D/Y per 1,000) and East Africa as a whole, with 280 D/Y per 1,000 persons.
Ethiopia’s burden of disease is dominated by prenatal and maternal conditions and acute respiratory infection (ARI), followed by malaria, nutritional deficiency, diarrhea and AIDS. The top ten causes of mortality account for 74 percent of all deaths, and 81 percent of D/Ys lost. Diseases that affect children under the age of 5 years include ARI, diarrhea, nutritional deficiencies and measles, accounting for 33 percent of child deaths.
Founded in 2003, PSI/Ethiopia has developed national results-based programs for malaria, HIV/AIDS and child survival. These programs are creating realistic opportunities for both private and public sector partners to make long-term investments that help Ethiopia’s most vulnerable lead healthier lives.
PSI/Ethiopia estimates that since its opening in December 2003 to December 2013, its products and services helped:
- Avert over 2 million DALYs, preventing malaria, diarrheal disease, maternal mortality, and HIV and STI infections,
- Treat over 16 billion liters of drinking water
- Distribute over 500,000 STI treatment kits, 200,000 preventive care package kits, 75,000 thousand pneumonia treatment kits, and 50,000 diarrhea treatment kits.
The HIV prevalence among the general population in Ethiopia is estimated at 1.5 percent (DHS 2011). PSI/Ethiopia’s HIV/AIDS prevention programming targets most-at-risk populations (MARPs), such as female sex workers, their clients and partners, and other highly vulnerable populations. PSI/Ethiopia is currently the prime partner for USAID’s flagship HIV/AIDS combination prevention program among MARPs. This $50 million, 5-year cooperative agreement, named MULU/MARPs (mulu means “comprehensive” or “complete” in Amharic), uses an evidence-based and targeted approach to prevent the next 1,000 infections among MARPs and other vulnerable populations using a combination of biomedical, behavioral and structural interventions.
MULU/MARPS is responsible for reaching 80 percent of sex workers with a fully integrated combination prevention package at the community level, and for strengthening local NGO and government partners. The program entered its second year on October 1, 2013 and is currently scaling-up its geographic reach from 55 to 170+ epidemiologically priority towns in 9 regions of the country, in partnership with 25 Local Implementing Partners (LIPs) and 11 Regional HIV Prevention and Control Offices (RHAPCOs) and Regional Health Bureaus (HBs).
PSI/Ethiopia is also implementing the biomedical component of the MULU award – MULU/Worksite, through a 5-year $3.6 million subaward from WorldLearning. Through the MULU/Worksite program, PSI/Ethiopia has trained healthcare providers at 44 large-scale worksites in mining, manufacturing, agricultural and textile sectors to provide HIV and sexually transmitted infections (STIs) prevention and family planning services.
With support from the U.S. Centers for Disease Control and Prevention (CDC), PSI/Ethiopia has been implementing the “Community Outreach and Social Mobilization for the Prevention of Sexual HIV Transmission (COSM)” and “Demand Creation and Promotion of STI Treatment Kits (DCP/STI)” projects since 2008, with $4.6 million in funding to date.
- Freely distributed male condoms
- Freely distributed female condoms
- AddisCure, AddisCure+, Ulcure prepackaged STI treatment kits
Since 2007, Proctor & Gamble and the Greater Cincinnati Foundation have supported PSI/Ethiopia in expanding the use of household water treatment products in different parts of Ethiopia with turbid, unimproved water sources. Current awards, which began in 2011, total approximately $2.2 million. Beginning in June 2014, the program will be sustained entirely with Program Income from the sale of PUR/P&G Purifier of Water. To date, the program has distributed 64 million sachets of PUR/P&G through commercial and institutional sales, has developed educational and promotional materials, and has conducted numerous community-level trainings, market day promotions, religious day events, sales outlets activation activities, and water vendor mobilization activities.
PSI/Ethiopia is also working with UNICEF under a one-year, $620,000 award to contribute to the increased production, distribution and consumption of Iodized salt to combat Iodine Deficiency Disorders (IDD) in Ethiopia. The program objective is to increase knowledge and awareness of salt producers, transporters, distributors and government officials about newly enacted iodized salt legislation and the health benefits of using iodized salt.
Finally, PSI/Ethiopia is launching a pilot project to create market solutions to improve Ethiopians’ access to sanitation in urban areas using PSI’s total market approach. Existing solutions have relied heavily on public sector subsidy and, to date, only 21 percent of Ethiopia’s 92 million people have access to improved sanitation facilities. PSI is seeking to fill the urban sanitation market gap in Ethiopia by facilitating social entrepreneurship activities through a social franchising approach that will offer differentiated, end-to-end sanitation services. PSI is planning to launch a pilot in early 2014 with internal and matching funds.
- Wuha Agar household water treatment solution
- PUR (P&G Purifier of Water) household water treatment solution
- Federal HIV/AIDS Prevention and Control Office, Ministry of Health
- 11 Regional HAPCOs & Health Bureaus
- Ethiopian Public Health Association
- 25 local NGOs and community-based organizations serving as local implementing partners under the MULU program in all regions of the country
- Task-Sharing of Implant Insertion to Community Health Workers:The Ethiopia Experience
Task-sharing can be an important strategy in increasing access to long-acting contraceptives at the community level, but commitment from all levels of the MOH is essential. Competency-based training and follow-up mentorship/supervision are critical to quality services with task-sharing, and ensuring adequate implant removal services can be accomplished with multi-pronged strategies.
- An Effective Model for the Integration of Modern Family Planning Services into Community-Level HIV Programming for Female Sex Workers in Ethiopia
Despite significant improvements in access to and voluntary uptake of modern family planning (FP) methods in Ethiopia, certain marginalized groups, including female sex workers (FSWs), remain underserved. Integrating voluntary, modern FP services into ongoing HIV prevention programs that reach FSWs can be an appropriate and cost-effective means to address this important coverage gap.
- Centers Drive Higher Yield and Better Linkage to Treatment for FSWs in Ethiopia
The project established 54 drop-in centers (DICs) in areas with a high density of female sex workers (FSWs) in towns with more than 500 sex workers. A total of 25,068 FSWs received HIV testing services at DICs between Oct., 2014-Sept, 2015. Altogether 802 women were diagnosed with HIV, for a yield of 3.2%.
- Simplified Asset Indices to Measure Wealth and Equity in Health Programs: a Reliability and Validity Analysis Using Survey Data from 16 Countries
Many program implementers have difficulty collecting and analyzing data on program beneficiaries' wealth because a large number of survey questions are required to construct the standard wealth index. We created country-specific measures of household wealth with as few as 6 questions that are highly reliable and valid in both urban and rural contexts.
- Integrating Family Planning into MULU/MARPs HIV Prevention project
Overview of a USAID funded national HIV prevention flagship project targeting most-at-risk populations in 168 Ethiopian towns.
- MULU/MARPS HIV Prevention Project
MULU/MARPs, a USAID-funded HIV prevention flagship project, is in its third year of implementation, reaching 168 towns selected following an epidemiologic criteria to reach most at risk populations like sex workers, clients of sex workers and waitresses. MULU reaches these targets through behavioral, biomedical and structural components, and by nurturing strong partnerships with stakeholders at all levels. Year three
- Direct and Indirect Methods for Estimating the Size of the Female Sex Worker Population in Addis Ababa, Ethiopia
This presentation discusses a study that used three different approaches to provide broader insights into estimating the size of female sex worker (FSW) populations in Addis Ababa, Ethiopia in 2012 and the comparative advantages of each method. The presentation was created for 2014 International AIDS Conference in Melbourne, Australia.
- Geographic Coverage of Comprehensive Clinical Services for Female Sex Workers in Ethiopia
This presentation discusses findings from a study that aimed to assess the geographic accessibility of comprehensive SRH service facilities and their friendliness to female sex workers (FSWs). The presentation was created for 2014 International AIDS Conference in Melbourne, Australia.
- Gaterkeepers’ Influence on Female Sex Workers’ HIV Prevention Behaviors in Ethiopia
This presentation was created for the 2014 International AIDS Conference in Melbourne, Australia. It discusses MULU/MARPs, a five year combination HIV prevention project implemented by PSI/Ethiopia and supported by PEPFAR/USAID. The project is designed to contribute towards a 50% reduction in HIV infections among key populations, including female sex workers (FSWs), by the end of 2017.
- ETV Interview with Karl Hofmann on Family Planning
PSI's President and CEO, Karl Hofmann, is interviewed by ETV after the 2013 International Conference on Family Planning. The conference was held in Addis Ababa, Ethiopia.