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Ethiopia’s health care system is among the least developed in sub-Saharan Africa, with fewer than 2,200 physicians and 18,000 nurses working to provide services to 85 million people. Widespread poverty, poor nutrition and limited access to health services have contributed to the high burden of disease and poor health among adults and children. An estimated 80 percent of the health problems in Ethiopia are due to preventable diseases, most notably HIV and malaria.
HIV seroprevalence in Ethiopia ranges from 2.1 percent nationally to 7.7 percent in urban areas. Currently, an estimated 56 percent of those in need of antiretroviral therapy (ART) are receiving it, and 24 percent of HIV infected pregnant women receive ARVs to reduce risk of mother-to-child-transmission.
Comprehensive HIV Prevention, Care and Treatment
ICAP has served as an implementing partner for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in Ethiopia since 2005, working with the Federal Ministry of Health (FMOH) and regional health bureaus (RHBs) to scale up HIV prevention, care and treatment services and to strengthen the broader health system.
ICAP currently supports 276 health facilities across Ethiopia, enabling them to enroll more than 111,000 patients in HIV care and to initiate more than 67,000 patients on HIV treatment—accounting for nearly 20 percent of all Ethiopians on ART.
ICAP supports HIV-related services in four of Ethiopia’s regions: Oromia, Somali, Harari, and Dire Dawa. ICAP support focuses on:
- HIV counseling and testing & early diagnosis.
- Prevention of mother-to-child transmission services (PMTCT).
- ART provision.
- TB/HIV service integration.
- Blood safety and facility-level data and laboratory support.
- Health care worker capacity building.
- Enhanced palliative care.
- The greater involvement of people living with HIV.
ICAP has played a central role in the area of pediatric HIV, supporting the development of guidelines, implementation procedures and training packages for Ethiopia’s first national pediatric HIV care and treatment program. ICAP pediatric advisors have also worked intensively with RHBs and health facility teams to integrate pediatric HIV services with general maternal, infant and child health care. ICAP supported facilities have enrolled close to 10,000 children under the age of four in HIV care and treatment services and initiated more than 5,000 on ART.
Since 2008, ICAP has supported the implementation of the President’s Malaria Initiative in nine regions of Ethiopia: Oromia, Harari, Dire Dawa, Somali, SNNPR, Addis Ababa, Afar, Amhara, and Tigray.
Through this initiative, ICAP provides technical, strategic, managerial, and operational support to the National Malaria Control Program of the FMOH and to RHBs to strengthen the malaria diagnostic capacity of health facility laboratories. ICAP directly supports:
- Baseline assessments of health facility capacity in malaria laboratory diagnosis.
- Policy development for malaria laboratory diagnosis and the revision of training manuals.
- The development of rigorous quality assurance/quality control systems.
- Supervision and mentoring at health centers and hospitals that provide microscopy services.
- The coordination necessary to secure and distribute supplies and reagents for malaria diagnostic services.
Nursing and Midwifery
Through the Global Nursing Capacity Building Program, funded by the Health Resources and Services Administration (HRSA), ICAP works to enhance the capacity of nurses and midwives to address Ethiopia’s national health care needs. Specifically, ICAP is working with Ethiopia’s FMOH, RHBs, and professional nursing associations to strengthen the health system by:
- Expanding the scope of nursing practice to include comprehensive HIV care.
- Strengthening the nursing regulatory framework.
- Supporting continuing professional development for nurses and midwives.
ICAP also leads the Nursing Education Partnership Initiative (NEPI) in Ethiopia, partnering with Addis Ababa University, Arba Minch Health Sciences College, and the University of Gondar to improve the quality of nursing and midwifery education and to increase the number of highly-skilled graduates joining the country’s nursing and midwifery workforce.
Research in Ethiopia
ICAP conducts essential research that informs national and international guidelines on the treatment of HIV, TB and malaria. Research studies currently being conducted in Ethiopia include:
- “Multi-Level Determinants of Late ART Initiation in Sub-Saharan Africa,” a study funded by NIH that aims to achieve the full potential of ART scale-up in the region through more timely ART initiation and looks at factors associated with late ART initiation at the contextual, facility, and individual levels.
- “A Combination Intervention Package for Isoniazid Prevention Therapy in Ethiopia,” funded by NIH and conducted in collaboration with Dire Dawa and Harari Regional Health Bureaus, is examining the effectiveness, impact and tolerability of a combination intervention package versus standard of care for IPT for HIV/TB coinfected patients in Ethiopia.