Ethiopia
About Ethiopia
The situation in Ethiopia is urgent. As many as 20 million people are in need of humanitarian assistance in Ethiopia as conflict and historic drought have led to widespread hunger and a lack of access to health care.
The United States Agency for International Development has warned that Ethiopia is facing a “perfect storm” of drought, COVID-19, and skyrocketing food and commodity prices. The number of displaced Ethiopians tripled in 2021 as conflict spread across regional states like Afar, Ahmara, Oromia, and Tigray. Today, millions of women and children are in need of humanitarian care as violence and drought continue.
In 2018, Ethiopia had the fastest-growing economy in the region, yet agriculture and pastoralism are still the backbone of the country’s economy. 85% of the workforce depends on farming and livestock to make a living. But life in the agriculture industry is anything but stable — success is entirely subject to the weather. Millions of small farmers are feeling the effects of the warming climate, as shifting seasons, flooding, and droughts jeopardize their crops, the health of their livestock, and their own health and well-being. When the rainy season is dry and harvests fail, families are often forced to leave home in search of better work, food, water, or greener pastures for their cattle.
The main health concerns in the country include maternal mortality, tuberculosis, and HIV/AIDS, all of which are exacerbated by malnutrition and lack of access to clean water. But in 2021, Ethiopians also faced an increase in violence that upended the lives of millions of people. The country is currently facing its worst drought in 40 years and skyrocketing costs of food and commodities due to Russia’s invasion of Ukraine have put it on the brink of a humanitarian emergency.
The Challenges
Violent conflict, drought, and inflation
Ethiopia is facing a humanitarian emergency due to the worst drought in four decades and widespread conflict that has displaced millions of people. The United Nations has warned that “hunger is tightening its grip” around Ethiopia; in Tigray, one-in-five children under 5 and half of all pregnant and breastfeeding women are malnourished, according to the World Food Programme. With many people living on the edge of crisis, inflation has had a devastating impact: food prices climbed 43% in one year, with the cost of staples like vegetable oil and cereals skyrocketing.
>> READ MORE: Project HOPE Sounds Alarm for Humanitarian Crisis in Ethiopia
Maternal, neonatal and child mortality in developing states
One in 15 children in Ethiopia dies before turning 5, and most of these deaths occur during infancy. Maternal mortality is just as much of a concern. In 2016, there were 412 maternal deaths per 100,000 births in the country — a rate 25 times higher than in the U.S.
Despite significant reductions in mortality rates and increased coverage of primary care services in recent years, women and children remain at high risk in the more remote regions of Ethiopia. These four geographic regions make up over half of the country (by land mass) – Afar, Benishangul-Gumuz, Gambella and Somali – and are known as Developing Regional States (DRS), with a combined population of over 8 million people.
The prevalence of HIV/AIDS among women, and the stigma of discordance
Ethiopia has made significant strides in reducing HIV incidence and HIV/AIDS-related mortality over the last several decades. Despite progress in controlling the epidemic, however, there remain significant disparities between affected populations across the country.
Women are disproportionately affected by HIV. There’s a social stigma surrounding the virus as well — so much so that those who are HIV-positive often keep their diagnosis from their own partners.
Protecting marginalized communities from COVID-19
Project HOPE is strengthening COVID-19 prevention, preparedness, and case management for health systems in Somali Regional State and Dire Dawa city administration, with support from USAID’s Bureau for Humanitarian Assistance. The project aims to support 327 outpatient health facilities and 68 inpatient facilities across the Fafan, Sitti, Jarar, and Erar Zones as well as Dire Dawa City.
The COVID-19 situation in these areas is complex, as they host high numbers of internally displaced people in communities where the risk of transmission is high. Somali Regional State also borders three countries, and there are high cross-border movement and direct transport routes, making it particularly susceptible to the virus.
Learn more in the full situation report on our COVID-19 response in Ethiopia.
Our Work
Project HOPE established an office in Addis Ababa in 2017 to support HIV/AIDS prevention, care, and treatment, and to increase access to maternal and child health services. Today, Project HOPE continues to work with a range of stakeholders to improve outcomes for HIV, maternal, newborn, and child health, global health security, health information systems, local capacity building, and water, sanitation, and hygiene.
HIV/AIDS
Project HOPE is the prime implementing partner for the Community HIV Care & Treatment (CHCT) project funded by PEPFAR/USAID, a seven-year program to expand access to comprehensive community-based HIV prevention, care, and treatment services in Ethiopia. The program works with 28 local implementing partners (LIPs), networks of people living with HIV (PLHIV), and regional health bureaus on three specific objectives: strengthening community health and support systems for service delivery; improving organizational and technical capacity structures; and increasing support for data collection and use in learning and program improvement.
Community-based ART Refill Group Models
Project HOPE pioneers the piloting and scale up of the first community-based differentiated service delivery model in Ethiopia. As of June 2023, there were a total of 4,500 community health workers led and peer-led ART refill groups, with a total of over 27,015 members. Project HOPE also provides training, mentoring, and technical assistance to hundreds of community health workers and more than 3,000 volunteers on targeted community-based HIV testing, case management, HIV treatment, adherence support, pharmaceutical care, proper logistics management, and other skills.
Local Partner Capacity Strengthening
Project HOPE provides tailored technical assistance and capacity strengthening services to LIPs and, since FY21, five LIPs have become the prime recipients of PEPFAR support as a result of Project HOPE’s capacity strengthening interventions. A key component of our approach is an Organizational and Technical Capacity Assessment Tool (OTCA) that is used to review readiness and give LIPs ownership of the transition plan. The OTCA tool identifies the strengths, gaps, and improvement areas of LIPs; utilizes progress monitoring tools to ensure prime readiness; and can be adapted to a range of program areas.
Community Health Information Systems
Project HOPE uses CommCare, an open-source health information management system, to develop modules tailored to specific programmatic needs and languages. With CommCare, program partners are capable of robust digital data collection, case management, and bi-directional referral linkages with other service providers. CommCare also provides partners with the ability to track individual level data longitudinally and incorporate referral linking across sites, which is a critical feature for confirming referrals and capturing feedback. Under the CHCT program, Project HOPE uses CommCare to track case identification, treatment, and case management and retention among 29 LIPs. CommCare is inter-operable within DHIS2 and is endorsed by the Ethiopian government as an electronic community health information management system (eCHIS).
Maternal, Newborn, and Child Health
As a partner on the five-year, USAID-funded TRANSFORM Health in Developing Regions (T-HDR) project, Project HOPE is leading program activities related to neonatal and child health. As partners, we have helped establish centers for Comprehensive Emergency Obstetric and Newborn Care (CEmONC), helped hospitals set up mini blood bank services, and supported immunization efforts.
CEmONC Centers
Project HOPE is working with the National Obstetric Society to develop a comprehensive mentorship and improvement program for CEmONC services, following extensive assessments of the intervention sites. The program currently has provided CEmoNC clinical mentorship for 15 hospitals.
Project HOPE equipped hospitals and trained health care providers to establish on-site, mini blood banks to reduce barriers to providing emergency Cesarean delivery services. As part of its work with health centers, the T-HDR project supported the establishment of 123 newborn resuscitation corners and 500 oral rehydration therapy centers.
Immunization Support
Project HOPE has supported immunization services in under-resourced regions by providing trainings for health care providers, revitalizing outreach activities, strengthening tracing efforts, and reengaging children with interrupted immunization schedules, increasing vaccine management, supporting cross-border activities, bolstering mid-level management, and strengthening post-polio free certification activities. With funding from the Bill & Melinda Gates Foundation (BMGF), Project HOPE is also conducting a national evaluation on reaching zero-dose children in remote areas and implementing emergency polio and immunization campaigns for IDP camps. This evaluation provided evidence for the national strategic planning of Ethiopia.
Under the THDR activity, nearly 3,500 health care workers were trained on different immunization areas. More than 3,349 integrated outreach immunization sessions were conducted to improve access to immunization in the four regions. With this effort, 30,398 children under the age of two received the pentavalent vaccine to protect them from five different life-threatening diseases.
Additionally, Project HOPE has supported immunization services in IDP camps in the six regions of Ethiopia with the support of BMGF. As of June 30th, 2023, the project reached nearly 3,958,213 children through static outreach and campaign service delivery approaches in all targeted regions. Among those, 136,973 were zero-dose children and 163,367 of them were under-immunized.
Global Health Security
Pandemic Preparedness and Response
With support from USAID, Project HOPE implemented a six-month project to strengthen COVID-19 prevention, preparedness, and case management for the health systems in Somali Regional State. The program trained 653 health care providers on COVID-19 preparedness and response and supported 327 outpatient health facilities and 68 inpatient facilities with critical trainings, reaching 788 additional health care workers. Our team also provided mentoring, WASH equipment, and supplies. A total of 113,234 IDPs were reached with risk communication and community engagement, 72,068 were tested for COVID-19, and 81,877 were provided with WASH supplies.
Project HOPE donated personal protective equipment and other supplies, including 56,000 N95s and 264,000 KN95 respirator masks to support health care providers as they responded to the COVID-19 pandemic. Project HOPE also distributed over 500,000 face masks and 37,000 liters of hand sanitizer, reaching over 36,000 PLHIV and community health workers.
Emergency Humanitarian Response
As a result of the conflict in northern Ethiopia, millions of people were displaced since November 2020 and required urgent humanitarian assistance. In response, Project HOPE deployed mobile health and nutrition teams (MHNTs) to Amhara and Afar regions to provide life-saving health and nutrition services, deliver essential medical, pharmaceutical, and infection prevention kits, and conduct health facility rehabilitation services. Additionally, in the Tigray region, Project HOPE was among the first responders to deliver water truck services to IDP sites and deploy MHNTs to accessible areas near the Afar region.
As of June 2023, Project HOPE provided treatment to 3,435 severely malnourished children and 6,747 moderately malnourished children and pregnant and lactating women, provided antenatal care services to 2,773 pregnant women, served 59,238 IDPs and host communities with outpatient clinical consultations, and screened 24,553 children for malnutrition and 7,188 for mental health illnesses. A total of 1,152 conflict-a ected and internally-displace people with mental health disorders were managed, of whom 20% were referred to a higherlevel facility by Project HOPE-deployed mental health professionals. Moreover, Project HOPE reached 1,111,538 people with risk communication and community engagement, of whom, 32,568 were engaged on psychoeducation. To support this response, Project HOPE mobilized funds from the Elsa & Peter Soderberg Charitable Foundations, other donors, and its internal sources and secured more than $250,000 USD worth of emergency health packs and standard medical emergency and reproductive health kits from IHP, WHO and UNFPA.
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