Ethiopia - Country Progress Report - unaids

Report on Progress towards Implementation of the UN Declaration of Commitment on HIV/AIDS
Weak health infrastructure, transportation and general systems: Addressing this challenge requires huge
investment to improve services and scale up towards universal access all over the country.
Quality: The high number of patients lost to follow up in 2007 emphasizes the need to improve the quality of care
in parallel with scaling up of services. Improving adherence among those on ART and instituting ARV resistance
surveillance require prioritization.
Harmonization and alignment: Harmonization and coordination are still weak. Although developments have been
made towards the coordinated and integrated efforts of all partners from national to the facility level, additional
alignment to national plans, priorities and systems, as called for in the “Three Ones”, is required.
Prioritizing scale-up towards universal access: In general all preventive and treatment services need to be expanded
and made available to a broader population in both the urban and rural areas. But to maximize the effectiveness of
available resources, prevention efforts should focus on high-risk groups, particularly in urban areas, and regions with
comparatively high prevalence, and rural hot prevalence spots. Prevention efforts should also focus on interrupting
urban-to-rural transmission and containing the rural epidemic at its current low levels through social mobilization.
Services for couple counseling, combined with education on appropriate prevention measures, mainly in urban areas,
need to be established as a high priority.
PMTCT: Service uptake of PMTCT remains exceptionally low at 6.48%. The country’s target for 2010 is 80%. In order
to have any hope of reaching that target, the following major gaps and challenges must be urgently addressed:
Low rates of skilled attendant deliveries, limited number of skilled and motivated human resources and a weak M&E
system.
Mainstreaming and leadership: The efforts made by various organizations in HIV/AIDS mainstreaming are indeed
significant, but the process is still at a nascent stage. HAPCO’s 2007 study on mainstreaming found that resource
limitations as well as inadequate commitment and support from leadership and top management are among the
critical bottlenecks in the implementation of HIV/AIDS mainstreaming in Ethiopia. An HIV/AIDS mainstreaming
stocktaking also needs to be carried out in all regional states to assess status of implementation and benchmarking
for future measurement of achievement.
Ownership and empowerment: A number of advocacy works, community dialogues and workplace interventions
have been undertaken, but the translation of these discussions into doable actions at grassroots level is still low. More
effort is needed in the future until all communities have developed and are implementing concrete action plans.
Surveillance and research: Surveillance in rural areas needs to be increased, not only to monitor the spread of the
epidemic, but also to continue to provide better estimates of the true prevalence of the epidemic in the country
whose population remains overwhelmingly rural. Such efforts also need to target urban hinterlands that potentially
have a role in the transmission of HIV to the nearby rural areas. Additionally, information on particular risk groups
is often based on studies that were undertaken in the early 1990s. There are gaps in knowledge of recent trends,
and some programming decisions have been based on out-of-date assumptions about risk groups and patterns of
transmission.
Other Challenges: In addition to the main challenges cited above, there are other challenges that are seriously
hampering the multisectoral response to the epidemic. Poverty, conflict and famine exacerbate the vulnerability
of society towards the impact of the epidemic. The gap between orphans and PLHIVs who need care and support
and those who receive services is quite wide. The two national behavioral surveillance surveys have shown some
indications of behavior change, but the high rates of unprotected sex and low comprehensive knowledge of HIV/AIDS
that more must be done to stimulate safer sexual behavior and reduce of misconceptions, stigma and discrimination.
The expansion of the epidemic to remote rural areas is a big challenge in terms of reaching those in need and in
providing care, support and treatment services. The financial gap between the total resources needed to reach
universal access and the funds already secured is enormous.
Overcoming these challenges will require the engagement of the government, civil society and every citizen, as well
as the continuation for many years to come of all-round assistance from development partners.
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