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.
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.
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.
Bringing HOPE to Ethiopia
Our history in Ethiopia
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.
Project HOPE is the prime implementing partner for the PEPFAR/USAID-funded Community HIV Care & Treatment (CHCT) project, a seven-year program aimed to expand access to comprehensive HIV prevention, care, and treatment services. The program works through 28 local implementing partners (LIPs), people living with HIV (PLHIV) networks, and health bureaus with three specific objectives: strengthen community health and support systems for service delivery; improve organizational and technical capacity structures; and increase support for data collection and use for learning and program improvement.
Differentiated Service Delivery Models for Treatment Adherence and Retention
Project HOPE’s adherence and retention programs use Community Adherence Groups to improve adherence and retention among PLHIV. As of May 2022, there were a total of 3,334 groups, comprised of over 17,000 members. Project HOPE provides training to community health workers on HIV treatment, adherence, pharmaceutical care, proper logistics’ management, and other skills.
Local Partner Capacity Building
Project HOPE provides tailored technical assistance and capacity building to LIPs and, since FY21, five LIPs have become prime recipients of PEPFAR support as a result of Project HOPE’s capacity building interventions. A key component of our capacity-strengthening approach is an Organizational and Technical Capacity Assessment Tool (OTCA) that is used to review LIPs’ readiness and increase their ownership of the transition plan. The OTCA tool identifies the LIP’s strengths, gaps, and improvement areas, utilizes progress monitoring tools to ensure prime readiness, and can be adapted for a range of program areas.
Community Health Information Systems
Project HOPE uses CommCare to develop modules tailored to specific programmatic needs and languages. The CommCare application is an open-source system with robust data collection, case management, and bi-directional referral linkage capabilities. It has the ability to track individual-level data longitudinally and it incorporates bi-directional 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 finding, linkage to treatment, and case management and retention among 29 LIPs. CommCare is inter-operable with DHIS2 and is endorsed by the Ethiopian government as an electronic community health information management system
Improving health for mothers, newborns and children
As a partner on the five-year, USAID-funded TRANSFORM Health in Developing Regions (T-HDR) project, Project HOPE is leading the neonatal and child health components. This has included establishing centers for Comprehensive Emergency Obstetric and Newborn Care (CEmONC) and instituting mini blood bank services.
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 is providing a mentorship program for 13 hospital sites.
Project HOPE equipped hospitals and trained health care workers to establish on-site, mini blood banks in order to reduce the barriers to emergency Cesarean delivery services. As part of its work with health centers, the THDR project supported the establishment of 123 newborn resuscitation corners and 500 oral rehydration therapy centers.
Project HOPE has supported immunization services in developing regions through offering health care worker trainings and orientations, revitalizing outreach activities, strengthening defaulter tracing, 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, Project HOPE is also conducting a national evaluation on reaching zero dose children in remote areas and implementing emergency polio and immunization campaigns for internally displaced persons camps.
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 supported 327 outpatient health facilities and 68 inpatient health facilities and trained 653 health care staff on COVID-19 preparedness and response.
Project HOPE also donated personal protective equipment and other supplies to support health care workers as they respond to the COVID-19 pandemic, including 56,000 N95s and 264,000 KN95 respirator masks. Under CHCT, Project HOPE distributed over 500,000 face masks and 37,000 liters of hand sanitizer, reaching over 36,000 beneficiaries.
Emergency Humanitarian Response
As a result of the conflict in the northern part of Ethiopia, millions of people were displaced and required urgent humanitarian assistance. Project HOPE deployed two mobile health and nutrition teams (MHNTs) using its own funds. With sponsorship from the Elsa & Peter Soderberg Charitable Foundation, Project HOPE is currently tripling MHNTs in the region.
Through the CHCT program, HOPE has provided testing services to more than 110,000 people with HIV and helped 120,000 people with HIV better manage and treat the disease. We’ve trained more than 500 health workers, enrolled more than 115,000 people living with HIV in community adherence support services, and distributed over 1.5 million condoms to help prevent the sexual transmission of HIV.
HOPE is also helping thousands of mothers give birth safely, improving the health of thousands of newborns across Ethiopia. Over 39,600 children under fiver years old have been screened for malnutrition. Since fall 2017, we’ve mentored health workers in over 50 health facilities and trained over 5,200 health workers on best practices for newborn care. We’ve also distributed 320,000 N95 respirator masks for health care workers through donatins.