Ethiopia - Country Progress Report - unaids

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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. 42
Report on Progress towards Implementation of the UN Declaration of Commitment on HIV/AIDS Selected Bibliography 1. CSA/ ORC Macro: Ethiopia Demographic and Health Survey (2005), August 2006 2. EPHA: Determinants of Behavioral Change in HIV/AIDS and IEC – BCC Approach for Rural Ethiopia, Addis Ababa, December 2005 3. FHAPCO, M&E Department: “Millennium AIDS Campaign Ethiopia”, Addis Ababa, September 2007. 4. Federal Ministry of Health/National HAPCO: AIDS in Ethiopia, Sixth Report, September 2006 5. Federal Ministry of Health, Planning and Programming Department: Health and Health Related Indicators, 2005/06 6. HSDP – III CORE PLAN EFY 2000 (2007/08) 7. Federal Ministry of Health: Annual Performance Report of HSDP – III, EFY 1999 (2006/2007), October 2007 8. Federal Ministry of Health: HSDP III, Health Sector Strategic Plan (2005/06 – 2009/10), September 2005 (EFY 1997) 9. Federal Ministry of Health: Single Point HIV Prevalence Estimate, June 2007 10. Federal Ministry of Health: Ethiopia’s Third National Health Accounts, 2004/2005, Addis Ababa, March 2007 11. Federal Ministry of Health, Disease Prevention and Control Department: Accelerating Access to HIV/AIDS Treatment in Ethiopia, ROAD MAP For 2004 – 2006 12. Federal Ministry of Health/HAPCO, AAU, CSA, EPHA: HIV/AIDS Behavioral Surveillance Survey (BSS) Ethiopia 2006 Round Two 13. Federal Ministry of Health/HAPCO; Department of Community Health, Faculty of Medicine, A.A.U; CDC- Ethiopia; WHO, and Engender Health: Ethiopian National Health Facility Survey, 2005 14. FHAPCO: Annual HIV/AIDS Monitoring & Evaluation Report, Ethiopia, 2006/07 15. FHAPCO: Annual HIV/AIDS Monitoring & Evaluation Report, Ethiopia, 2005/06 16. FHAPCO: National Monitoring and Evaluation Framework for the Multi-Sectoral Response to HIV/AIDS in Ethiopia, December 2003 17. FHAPCO: Comprehensive Community-Based Care & Support Guideline for PLHIVs, OVCs and Affected Families, Addis Ababa, January 2006 18. FHAPCO/Federal Ministry of Health: Ethiopian Strategic Plan for Intensifying Multi Sectoral HIV/AIDS Response, December 2004 19. MOFED/UNCT: Millennium Development Goals Report: Challenges and Prospects for Ethiopia, Addis Ababa, March 2004 20. MOFED- “Ethiopia: Building on Progress- A Plan for Accelerated and Sustained Development to End Poverty (PASDEP), 2005/06 – 2009/10, Addis Ababa, September 2006 21. National AIDS Council: Strategic Framework for the National Response to HIV/AIDS in Ethiopia (2001-2005), June 2001 22. UNAIDS, Action Guide for United Nations Country Teams: Implementing the Declaration of Commitment on HIV/AIDS- adopted at the UNGASS on HIV/AIDS, 25-27 June 2001, Geneva, October 2002 23. UNAIDS: Mapping Study of Internally Displaced Persons (IDPs) and HIV/AIDS in Ethiopia, Undertaken under the Auspices of the UN Country Team and with the Support of the Netherlands Government, March 2002 24. UNAIDS: In-depth Study of the Knowledge, Attitude, Behavior and Practice (KABP) of Internally Displaced Persons (IDPs) in Ethiopia towards HIV/AIDS and their Health Status and Medical Care Assessment, undertaken under the auspices of the UN Country Team and with the support of the Netherlands Government, Addis Ababa, December 16, 2002 25. UNAIDS: UNGASS- Monitoring the Declaration of Commitment on HIV/AIDS, Guidelines on Construction of Core Indicators, 2008 Reporting, April 2007 26. Yemane Birhane, Yared M et.al.- “HIV/AIDS in Ethiopia- An Epidemiological Synthesis”, Study commissioned by HAPCO & the World Bank, Draft Document, November, 2007. 27. Ministry of Health/HAPCO, AAU, CSA, EPHA; “HIV/AIDS Behavioral Surveillance Survey (BSS) Ethiopia – Round two”; 43
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