Ethiopia

Adolescents – young people between the ages of 10 and 19 years – are often thought of as a healthy group. Nevertheless, many adolescents do die prematurely due to accidents, suicide, violence, pregnancy related complications and other illnesses that are either preventable or treatable. Many more suffer chronic ill-health and disability.

In addition, many serious diseases in adulthood have their roots in adolescence. For example, early pregnancy and its complications which contributes to high maternal mortality, tobacco use, sexually transmitted infections including HIV, lack of physical activity can lead to illness or premature death later in life. 

WHO advocates for the prioritization of adolescent health issue as one of Ethiopia’s priority programmes with focus on the provision of adolescent and youth friendly reproductive health services at all levels of the health system. In this regards, WHO has been supporting the Federal Ministry of Health in the development and updating of national strategies, tools and training packages on adolescent and youth related health services.

Blood safety encompasses actions aimed at ensuring that everyone has access to blood and blood products that are as safe as possible, available at reasonable cost, adequate to meet the needs of patients, transfused only when necessary, and provided as part of a sustainable blood programme within the existing health care system.

The World Health Organization Country Office for Ethiopia, with support from the United States Centers for Disease Control and Prevention (CDC), has been supporting the expansion of the blood safety programme in Ethiopia to establish an efficient and sustainable national blood transfusion service. A national blood policy and plan, as well as standards, operating procedures and guidelines for appropriate blood usage have been developed and are being implemented in the country with support from WHO.

Blood services in Ethiopia were provided by the Ethiopian Red Cross Society from 1969 to 2010 through its 12 regional blood banks covering the requirements of 52% of the hospitals in the country. Limited supply of safe blood was restricting access to comprehensive emergency obstetric care and other medical conditions that require blood. Since 2004, with funding from United States President's Emergency Plan for AIDS Relief (PEPFAR) through the CDC, WHO has been supporting Ethiopia to expand and consolidate the blood transfusion service to ensure universal access to safe blood.

In 2010, the Federal Ministry of Health (FMoH) reverted the blood transfusion responsibility to the National Blood Transfusion Service (NBTS) from the Ethiopian Red Cross to the Government led and managed service under the FMoH and the regional health bureaus. The transition strategy was supported by WHO. Through advocacy and support from WHO, the proclamation establishing the NBTS as an autonomous agency was passed by the council of ministers in 2014 and the establishment of the requisite structures to operationalize the agency are is underway. Placing the Blood Transfusion Service (BTS) under the mainstream health care delivery system has improved efficiency of managing the blood banks to ensure the whole population has access to safe blood supply.

Twenty-five blood banks were functional in Ethiopia in 2014; 24 regional blood banks are serving eight to 12 hospitals each in a radius of about 100km increasing the number of hospitals accessing a safe blood supply to about 90%. Thirty mobile blood collection teams are working throughout the country with five fully functional teams in Addis Ababa alone. The proportion of blood collected from voluntary blood donors has increased from 10% in 2012 to 98% in 2014. The Addis Ababa center alone collects over 40,000 units from 100% voluntary blood donations and for a population of 2.5 million, achieves the self-sufficiency target of 10 units/1000 of the population. 

For more information, please contact: Dr. Paul Mainuka, mainukap@who.int 

Ethiopia met the Millennium Development Goal 4 (MDG 4) on child survival in 2012 by reducing under-five mortality by two thirds between 1990 and 2012. In 1990, the under-five mortality rate was one of the highest in the world; by 2013 the number of under-five deaths in Ethiopia had declined from nearly half a million in 1990 to about 196,000. However, the decline in neonatal mortality was not proportional and currently 42% of childhood deaths in Ethiopia occur within the first 28 days of life.

The major causes of under-five mortality in Ethiopia are acute respiratory infection (ARI) (18%), diarrhea (13%), prematurity (12%), newborn infection (10%), asphyxia (9%), meningitis (6%), injury (6%), measles (4%), malaria (2%), TB (3%), congenital anomalies (2%), HIV (2%), pertussis (1%) and others (17%). Malnutrition is a major contributor to child mortality in Ethiopia as underlying cause for nearly 50% of under-five deaths.

Ethiopia had been implementing child survival programmes since the early 1970s as vertical programmes up until 1997 when the integrated management of childhood illnesses (IMCI) was adopted as a service delivery approach. The first comprehensive National Child Survival Strategy (2005-2015) was developed in 2005 prioritizing high impact newborn and child survival interventions. Significant improvements in coverage had been observed primarily in preventive interventions including immunizations, vitamin A, insecticide-treated nets, and water and sanitation. However, care seeking for common illnesses and utilization of clinical services remain low. 

WHO is working closely with the Federal Ministry of Health and partners to improve children’s health in Ethiopia. WHO provides technical and financial support for the development of national strategic documents, guidelines and tools, capacity building of health workers and program officers in various newborn and child health programmes. WHO has supported the introduction of Pediatric Quality of Care (QoC) improvement initiative and the scale-up of integrated management of neonatal and childhood illnesses (IMNCI) and integrated community case management (iCCM) programmes at primary health care units. WHO will continue supporting the long-term goal of ending all preventable child deaths in the next two decades.

Essential medicines satisfy the priority health care needs of a population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines save lives, reduce suffering and improve health; but only when they are of good quality, safe, effective, available and properly used by prescribers and patients. These medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.

The Ethiopian local pharmaceutical market is growing at an annual rate of around 15%; it is currently valued at over USD 400 million from below USD 200,000 in 2000. The share of the domestic pharmaceutical market held by locally produced medicines is around 20% and the rest is filled by importation. The Government of Ethiopia has commitment to improve local production by supplying 50% of the national medicines demand and export of medicines worth USD 20 million by end of 2015. The demand for medicine supply in Ethiopia has increased dramatically as the number of health facilities, including pharmacy establishments, has grown over the last two decades.

The WHO Essential Drugs and Medicines (EDM) programme in Ethiopia contributes towards the achievement of the WHO leadership priorities at country level, through implementation of the WHO Country Cooperation Strategy (CCS), WHO Global and Regional initiatives regarding the pharmaceutical sector. The EDM programme provides technical support for the development and implementation and review of key documents, including national medicines policy, sectoral strategic plans, norms and standards and medicines lists, human and institutional capacity building, generation of strategic information to inform decisions, promotion of local pharmaceuticals manufacturing and partnership geared towards increasing access to safe, effective, quality assured medicines and their rational use.

WHO works in partnership with the Federal Ministry of Health (FMOH) and its agencies, including the Ethiopian Food, Medicines, and Health care Administration and Control Authority (EFMHACA), Pharmaceuticals Fund and Supply Agency (PFSA), Ethiopian Health Insurance Agency (EHIA), Ethiopian Public Health Institute (EPHI) and other government institutions, as well as the civil society to achieve national goals. The government’s commitment to increase access to medicines through development of strategic plan for strengthening local pharmaceuticals manufacturing, supply and regulatory systems is crucial. WHO’s support thus focus on implementation of Ethiopia’s strategic plans and strengthening of the national regulatory system to ensure that the medicines made available in the market are safe, effective and of good quality, as well as rationally used.

Reproductive health is a comprehensive concept which implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. This means that men and women have the right to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.

Knowledge of contraceptive methods is almost universal in Ethiopia. According to recent demographic data, four in every ten currently married women (42%) are using a method of contraception. The use of modern contraceptive methods among currently married women has increased from 6% in 2000 to 40% in 2014 — largely due to the sharp increase in the use of injectables. Unmet need for family planning is progressively decreasing form 25% in 2000 to 18% in 2014. WHO is supporting Ethiopia to reach the target of 10% by the end of the 2015.

Ethiopia is one of the countries that have shown significant reduction in maternal mortality in relation to unsafe abortion. Prior to 2005, the contribution of unsafe abortion to maternal mortality was estimated at 32%. This has dropped to about 8%. Lives were saved as a result of legislation change, a progressive and timely technical and procedural guideline issued by the Federal Ministry of Health in collaboration with health partners, including WHO.

The WHO Constitution was the first international instrument to enshrine the enjoyment of the highest attainable standard of health as a fundamental right of every human being ("the right to health"). The right to health in international human rights law is a claim to a set of social arrangements - norms, institutions, laws, and an enabling environment - that can best secure the enjoyment of this right.

Gender refers to the socially constructed roles, behaviour, activities and attributes that a particular society considers appropriate for men and women. Sex and gender are critical health determinants giving rise to differential health risks and needs, as well as influencing the individual to access to and control over resources. Maternal Health in particular has long been recognized as an area with serious gender gap. Girls, boys and women are more vulnerable to gender-based violence, including intimate partner violence and harmful practices, such as female genital mutilation.

In Ethiopia, malaria is more common among men, but it is particularly serious for pregnant women and often leads to death.  HIV disproportionately affects females and Tuberculosis detection rate is higher in men than women. Unintended pregnancies are common among girls and women in Ethiopia, many lack access to health care services contributing to the country’s high maternal mortality and morbidity rates. Child marriage, a proxy for poor sexual reproductive health, is prevalent in Ethiopia depriving girls of the opportunity for education. Males are more prone to alcohol abuse and injuries, largely due to road traffic accidents and physical fights. Exposure to indoor pollution is associated with a number of illnesses in women and children, who traditionally spend more time inside the home. 

These complex and socio-culturally interwoven gender differences can be minimized through mainstreaming gender across all health programmes and operations. The Ethiopian Health Sector Development Plan (HDSP) provides strategic direction for country’s health system. Before 2011, limited focus was given to mainstreaming gender into health programmes and systems. However, Ethiopia’s fourth HSDP (2011-2015) recognized gender as a critical element for health and development, and is well aligned to the targets of the Millennium Development Goals. 

WHO Country Office supports the Federal Ministry of Health (FMoH) of Ethiopia to mainstream gender into its health programmes and operations. WHO conducted a situational analysis on gender and equitable health services in 2012 with FMoH. The findings of the study and WHO gender mainstreaming tools informed the development of the national gender mainstreaming manual (released in 2013). WHO supported the review of Ethiopia’s gender mainstreaming training package and the building of regional capacity in gender mainstreaming across the health system. WHO country office also initiated discussions with Ethiopian Commission for Human Rights (ECHR) to complement the technical advice to the health sector.   

WHO continues to support FMoH and the national HIV/AIDS secretariat to adopt WHO tools on gender based violence to respond effectively, as well as scale-up interventions across the country as part of the joint UN agencies support (UNAIDS, UNFPA, UNICEF and WHO). The country office is working to ensure that FMoH programmatic policy documents contain gender, equity and human rights principles by including an explicit translation of these policies into practice. WHO is also supporting the development of an implementation manual in collaboration with the ECHR that articulates the health related international human rights instruments for the use of the health sector of the country. 

For more information, please contact: Dr Fikir Melesse, fikirm@who.int

Environmental conditions are a major direct and indirect determinant of human health. Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviors. It encompasses the assessment and control of those environmental factors that can potentially affect health, targeting disease prevention and the creation of health-supportive environments.

Climate change further intensifies the burden of many communicable diseases. The health sector in Ethiopia is greatly affected by climate change, as the country is prone to many diseases, which have transmission cycles that are profoundly shaped by weather conditions. The most common direct impacts on human health are disability and death due to vector-borne infectious diseases like malaria, trypanosomiasis, onchocerciasis, schistosomiasis and leshmaniasis. Waterborne diseases, such as diarrhea and cholera, and malnutrition are also among the major public health problems exacerbated by climate change

WHO’s goal is to achieve safe, sustainable and health enhancing human environments, protected from biological, chemical and physical hazards and secure from the effects of global and local environmental threats. The Organization aims to reduce the risk factors that contribute to the burden of excess mortality and disability that arise from environmental causes, and by promoting environmental considerations within the health sector and interventions for health protection in other socioeconomic sectors.

WHO is currently providing technical assistance to the ‘Building adaptation to climate change in health including least developed countries including Ethiopia. The project on Building adaptation to climate change in health in least developed countries through resilient WASH with support of UK Department for International Development (DFID) is running from 2013 to 2016 in four countries including Ethiopia. 

For more information, please contact: Mr Waltaji Terfa Kutane, email: kutanew@who.int

The human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It can take 10-15 years for an HIV-infected person to develop AIDS; antiretroviral drugs can slow down the process even further. HIV is transmitted through unprotected sexual intercourse (anal or vaginal), transfusion of contaminated blood, sharing of contaminated needles, and between a mother and her infant during pregnancy, childbirth and breastfeeding.

According to the 2014 HIV estimates, the national HIV prevalence in Ethiopia is 1.14%, indicating the country has more than achieved the Millennium Development Goal 6 target of 2.5%. Annual new HIV infections have also declined by 90% and AIDS-related deaths by 53% in the last decade (between 2000 and 2011). Across all the regions, urban areas are more affected than rural ones, and females are more affected than males by the HIV epidemic. The 2014 estimated number of people living with HIV (PLHIV) was 769 600 with 15 700 new HIV infections and 35 600 AIDS-related deaths. Ethiopia has made significant progress to ensure universal access to treatment of HIV/AIDS and HIV testing and counseling (HTC) services have also expanded with about 9.6 million tests done in 2013/14 alone. Almost 2,500 health facilities are providing prevention of mother-to-child transmission of HIV (PMTCT) services with a national level coverage of 61%.

WHO supports the Federal Ministry of Health (FMoH) of Ethiopia in leading and coordinating the national health sector response against the HIV epidemic. WHO is a key player in HIV forums both at national and regional levels in close collaboration with CDC and USAID and their implementing partners. A central area of support to the FMoH is the development, adoption and revision of HIV strategies and guidelines, training manuals and tools. Since 2005, WHO has particularly intensified its technical support to the adaptation and national roll out of IMAI (Integrated Management of Adolescent and Adulthood Illness) guidelines and training tools. Moreover, the Country Office has been a pioneer in promoting the application of task shifting and a public health approach in delivering HIV care and treatment services in Ethiopia. In the post-2015 context, WHO continues to support Ethiopia to strengthen the public health approach to scaling up of HIV/AIDS services through community empowerment. Intensified efforts are targeted at HIV prevention, care and treatment among key and vulnerable populations.

For more information, please contact: Dr Selblewongel Abate, email: seblewongela@who.int

Immunization is estimated to avert between 2 and 3 million deaths globally each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

In Ethiopia, routine immunization was launched in 1980 with the six traditional antigens provided for children below two years of age. The schedule was revised in 1986 to include only infants under one year in line with the global target. The program at its inception aimed to increase the third dose of Diphtheria, Pertussis & Tetanus vaccine (DPT-3) coverage by 10% every year achieving 100% by the year 1990. Between 2003 and 2010, DPT-3 coverage increased from 52% to 80%.

In 2013 and 2014, immunization coverage reached 87% and 83% coverage, respectively, for Penta3. The evolution of vaccination coverage for Penta3 and MCV1 through routine immunization for the last ten years is depicted in the figure below.

Improvements in routine immunization 

With the support of WHO and other partners, the FMOH developed a two-year Routine Immunization Improvement Plan (RIIP) 2014–2015 to address a stagnation in coverage. During 2014, a number of key activities aiming to strengthen the capacity of immunization services delivery were undertaken. These included the training and deployment of technical assistants to high risk zones; the nationwide integration of Reaching Every District  (RED) micro-planning with woreda-based micro-planning;  the training of EPI officers at higher-level and health extension workers at grassroots; and cold chain rehabilitation and expansion.

New vaccine introduction 

In recent years, Ethiopia has successfully introduced additional antigens into the routine schedule, resulting in the protection of millions of children from vaccine-preventable diseases. Haemophilis influenzae type B and Hepatitis B vaccine were introduced in the form of pentavalent combination vaccine in 2007; Pneumococcal conjugate Vaccine (PCV) 10 and Rotavirus vaccine were introduced in 2011 and 2013, respectively.

Over the next five years (2015-2019), the country plans to introduce Inactivated Polio Virus, Measles-Rubella, Meningitis and Yellow Fever vaccines into the routine EPI schedule for children under one year of age. The introduction of Human Papilloma Virus, and Tetanus, Diphtheria (Td) vaccines is planned for girls between 9 and 13 years old.

WHO support to Ethiopia’s Expanded Program on Immunization 

WHO provides technical and financial support to the Federal Ministry of Health’s Expanded Program on Immunization (EPI). WHO supported the FMOH in the development of the national policy guideline and planning documents, capacity strengthening and coordination, implementation and program management, and played a key advocacy role in the formation of the newly established EPI case team within the Federal Ministry of Health and continues to provide ongoing technical support to the team. WHO Ethiopia also supported the set-up of the National and Regional Command Posts, and the National EPI Task Force under the leadership of the FMoH.

Technical assistants were assigned to poorly performing zones in 2014 identified based on the number of unimmunized children and report of measles outbreaks. Additionally, the immunization in-practice guideline was revised and standardized to enhance the capacity of health workers. Trainings were cascaded to respective zones through training of trainers to all WHO field officers in late 2014. A capacity building project jointly supported by WHO and the United States Center for Disease Control and Prevention (CDC) was also implemented in pastoralist communities to enhance routine immunization.

Based on the findings of the national cold chain inventory and effective vaccine management assessment conducted with the technical and financial support of WHO, emphasis is being given to improve the cold chain and vaccine management. The vaccine requisition form has also been standardized to improve proper stock management at all levels.

Significant support has been provided in polio eradication in response to a confirmed wild polio virus (WPV) outbreak in 2013 through heightened advocacy, supplemental immunization activities and new case monitoring and intensified surveillance. 

For more information, please contact: Dr Pamela Mitula, email: mitulap@who.int 

Integrated Disease Surveillance and Response (IDSR) is the process of anticipating, preventing, preparing for, detecting and communicating, responding to, controlling and recovering from consequences of public health threats in order to minimize health and economic impact. The WHO Regional Office for Africa proposed the IDSR approach for improving public health surveillance and response in the African Region linking community, health facility, district and national levels.  IDSR promotes rational use of resources by integrating and streamlining common surveillance activities. Surveillance activities for different diseases involve similar functions (detection, reporting, analysis and interpretation, feedback, action) and often use the same structures, processes and personnel.

The expected outcomes of IDSR are early detection and verification, rapid response and containment of public health emergencies and recovery and rehabilitation of the communities affected. As per the agreement of all African Member States, IDSR is serving as a platform for implementation International Health Regulation 2005 (IHR 2005) to which Ethiopia is a signatory.

Ethiopia has been implementing the Integrated Disease Surveillance and Response (IDSR) strategy for strengthening communicable diseases surveillance in the country since the year 2000. More recently, IDSR has been incorporated as one pillar in the Public Health Emergency Management (PHEM) system under the foresight of the Ethiopian Public Health Institute (EPHI), a specialized agency of the Federal Ministry of Health. The PHEM oversight cascades down to regional level through regional health bureaus, with their zonal health departments and district health offices. Through this system, 21 priority diseases and events have been identified for weekly and immediate reporting from the level of health post upwards.

The Federal Ministry of Health (FMoH) has tasked EPHI/PHEM to be focal point for IHR 2005 in the country. The Ethiopian Food, Medicine and Health Care Administration (FMHACA) is also responsible for the IHR 2005-related regulatory activities at ports of entry (POE).

A total of 2,217 public health emergency rumors were communicated to EPHI in 2013/2014 and confirmed within three hours, with only 31 (1.4%) of the rumors turning out to be public health emergencies. Ninety percent of public health epidemic cases had laboratory confirmation, and 80% of them were confirmed as important emergency and public health cases. Measles, Meningitis Dengue, Polio and Yellow fever are the major outbreaks and epidemics that occurred in the country.

WHO has provided technical and financial support to the Federal Ministry of Health (FMOH), EPHI, FMHACA, regional health bureaus and district offices to strengthen the surveillance, outbreak investigation, risk assessments, management of and response to recorded outbreaks and the implementation of IHR 2005.

Malaria is an acute febrile illness caused by a parasite known as Plasmodium. The disease is transmitted via the bites of infected mosquitoes. Of the four species that infect human beings, Plasmodium falciparum and Plasmodium vivax are the two most dominant malaria parasites in Ethiopia. They are prevalent in all malarious areas in the country (usually below 2000 meters above sea level) with P.falciparum representing about 65-75% of the total reported malaria cases, relative frequency varying in time and space within a given geographical ranges. Symptoms of malaria include fever, headache, backache, joint pains and vomiting, usually appearing between 10 and 15 days after the mosquito bite. If not treated, malaria can quickly become life-threatening by disrupting the blood supply to vital organs. Key interventions to control malaria include: prompt diagnosis and effective treatment with appropriate antimalarial drugs, use of insecticidal bed nets; and indoor residual spraying of houses with insecticides to control the vector population.

About 75% of the land and 60% of the population is exposed to malaria in Ethiopia. Ethiopia is generally considered as a low- to- moderate malaria transmission intensity country. However, the health sector in Ethiopia is greatly affected by climate change which has profound consequences on the transmission cycles of vector-borne infectious diseases like Malaria. Due to the unstable and seasonal transmission of malaria in the country, protective immunity of the population is generally low and all age groups are at risk. Prevalence of malaria is currently estimated to be 1.3% (Ethiopia Malaria Indicator Survey 2011).

Ethiopia has achieved remarkable progress in the fight against malaria during the most recent decade through strong preventive and case management interventions with large engagement of the Health Extension Workers (HEWs) and the Health Development Army (HAD) volunteers providing community based care at the household level. In children under five years of age, malaria admissions and deaths fell by 81% between 2001 and 2011 and 73% respectively. The country is also one of the few sub-Saharan countries that have shown progress in the fight against malaria and in attaining the MDG 6c: halt and begin to reverse the incidence of malaria and other major diseases by 2015.

WHO has been actively supporting the Federal Ministry of Health of Ethiopia (FMoH)in the fight against malaria. Among other contributions, WHO has been providing technical support in building the capacity of health of workers, programme monitoring, review and evidence generation, resource mobilization, supportive supervision at all levels, as well as supporting the revision and updating of strategic documents and guidelines. FMoH and WHO have also jointly developed a new stratification map using health facility based surveillance data.

For more information, please contact: Dr. Worku Bekele, email: workub@who.int 

Maternal health refers to the health of women during pregnancy, childbirth and the postpartum period. Maternal, new born and child health (MNCH) is one of Ethiopia’s priority health programmes. Coverage of health services for most of MNCH areas, including immunization, integrated management of new-born and childhood illnesses (IMNCI), antenatal care and family planning, has consistently increased over the years.  As a result, there has been a remarkable drop in infant mortality in the country, with the country achieving Millennium Development Goal 4 in 2013, two years ahead of target.  However, disparities exist in service coverage among regions, for reasons related to access, security, human resource capacity, health infrastructure and lifestyle, among other factors.

Millennium Development Goal 5, calls for the improvement of maternal health, with a target of reducing the maternal mortality ratio (MMR) by three-quarters over the period 1990-2015 and achievement of universal access to reproductive health by 2015. The Federal Ministry of Health (FMOH) has applied a multi-pronged approach to reduce maternal and newborn morbidity and mortality by improving access to and strengthening facility-based maternal and newborn services. Between 2000 and 2011, national data show that maternal mortality declined in Ethiopia by 22% from 871 to 676 per 100,000 live births. For the period 1990 to 2013, global data show maternal mortality declined by 70%, from 1400 to 420 per 100,000 live births.

WHO supports Ethiopia to strengthen the capacity of the health system to provide adequate care, and to accelerate reduction of maternal and neonatal mortality. The work encompasses supporting the government in setting norms and standards and in adoption of evidence-based strategies including for community engagement, enhancing capacities through supporting in-service and pre-service trainings, providing technical support in monitoring and evaluation of programmes, maternal death surveillance and response. WHO produces guidelines and tools and builds the capacity of health service providers and programme managers through trainings, demand creation and service utilization activities.

Mental health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the WHO's definition of health: "A state of complete physical, mental and social well-being, and not merely the absence of disease". Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.

Mental health is one of the most disadvantaged health programmes in Ethiopia, both in terms of facilities and trained manpower. Ethiopia is a country with about 86 million people and 50 psychiatrists. The only institutions that provide psychiatric services by specialist doctors are found in Addis Ababa. Eleven per cent of the total burden of disease in Ethiopia can be attributed to mental health disorders. People suffering from mental illness are often the most marginalized, and affected by stigma and discrimination.

WHO has been supporting Ethiopia for thirty years to strengthen its mental health and substance abuse services mainly focusing on promoting the integration of mental health into primary health care. More than 450 psychiatrist nurses have been trained and deployed into various health facilities thanks to WHO’s assistance. Ethiopia’s recent Mental Health Strategy aims to develop mental health services that are decentralized and integrated at the primary health care level. WHO, in collaboration and support of the European Union and Foundation d’Harcourt, has been supporting the Federal Ministry of Health to scale-up mental health services and successfully implement the WHO Mental Health Gap Action Programme (mhGAP), which aims to scale up care for people suffering from mental, neurological and substance use (MNS) disorders,  in selected sites since 2011. It is estimated that the programme has helped about 3,500 of Ethiopians suffering from mental, neurological and substance use (MNS) disorders.

Neglected tropical diseases (NTDs) are a group of diseases that cause suffering, blindness, disfigurement, and delays in physical and cognitive growth, perpetuating the poverty of those infected by hindering their productivity. Globally there are 17 diseases identified by the World Health Organization as NTDs. NTDs occur solely or principally in the tropics, and blight the lives of a billion people worldwide and threaten the health of millions more. These ancient companions of poverty weaken impoverished populations, frustrate the achievement of health in the Millennium Development Goals and beyond, and impede global public health outcomes. In recognition of their significance to public health and economies, governments, donors, the pharmaceutical industry and other agencies, including nongovernmental organizations, are investing in preventing and controlling this diverse group of diseases.

Ethiopia is one of the countries that bear a significant burden of NTDs in Africa. The country identified eight diseases as priority NTDs and developed a multi-year national strategic plan for the control, elimination and eradication of these diseases. Millions of Ethiopians are at risk of these diseases – trachoma, onchocerciasis, lymphatic filariasis (LF), soil-transmitted helminthes (STH), schistosomiasis, leishmaniasis, dracunculiasis and podoconiosis – and a number of districts (woredas) are endemic to a few of these.

Following the launching of the Master Plan, the country has completed mapping of NTDs including integrated mapping of soil-transmitted helminthes and LF/Podoconiosis, and the successful conduct of the global trachoma mapping project (GTMP), and has completed onchocerciasis transmission delineation survey. A national onchocerciasis elimination advisory committee to strengthen the national onchocerciasis elimination effort.  Control interventions for the various NTDs, including mass drug administration and case management, have been scaled up. Alongside these interventions, public awareness raising initiatives have been strengthened through the development and dissemination of the NTD pocket manual for health extension workers, and key messages delivered to educate the public on the various NTDs.  The Ministry of Health of Ethiopia is leading these control and elimination activities together with partners such as WHO. 

Non-communicable diseases (NCDs), also known as chronic diseases, are those diseases that are not passed from person to person. They are of long duration and generally slow progression. The four main types of non-communicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. Though communicable diseases continue to pose major challenges for the health care delivery in developing countries, NCDs, including violence and injuries, are also on the rise as a consequence of demographic transition such as urbanization, industrialization and improvement in life expectancy.

The four major NCDs mainly share four common risk factors: tobacco, insufficient physical activity, unhealthy diet and excessive alcohol use. These shared risk factors are usually referred to as Behavioral Risk Factors. By avoiding these common risk factors it is possible to prevent 80% of cardiovascular diseases and diabetes and over a third of cancer-related deaths. With time, the above behavioral risk factors develop into more formidable NCD risk factors usually referred to as biochemical risk factors. These are: raised blood pressure, raised blood sugar, raised blood lipids, overweight and obesity.

In addition to the four common risk factors, NCDs also have other risk factors that include infectious causes such as Hepatitis B & C, Human Papilloma Virus, HIV, Helicobacter pylori, Schistosomiasis, and the Liver Fluke. Infectious causes of non-communicable diseases are more highly prevalent in developing countries than developed countries. Age, genetics, exposure to environmental factors, such as radiation, exposure to some industrial chemicals such as insecticides are cited as additional risk factors for NCDs. 

Non-communicable diseases (NCDs) accounted for 30% of deaths in Ethiopia in 2014. The four major NCDs, namely cardiovascular diseases, cancers, diabetes and chronic respiratory diseases were responsible for more than 80% of NCD-related deaths.  An estimated 3.3% of adults use some form of tobacco, while the prevalence among very young adolescents (aged 13–15 years old) is estimated to be much higher rate of 7.9%; these figures also vary between regional states. Also, an estimated 9% of males and 25% of females, and 11% of rural and 20% of urban populations have insufficient levels of physical activity.

WHO supports the Government of Ethiopia in developing and implementing policies and strategies for the management of the main chronic non-communicable diseases: cardiovascular diseases, diabetes, chronic respiratory diseases and cancer.  Currently, with WHO technical support, strides are being made in the effort to integrate cancer treatment in primary health units.

Nutrition is the intake of food, considered in relation to the body’s dietary needs. Good nutrition – an adequate, well balanced diet combined with regular physical activity – is a cornerstone of good health. Poor nutrition can lead to reduced immunity, increased susceptibility to disease, impaired physical and mental development, and reduced productivity.

Malnutrition, particularly protein-energy and micronutrient deficiency, is a concerning public health issue in Ethiopia. According to the 2014 Ethiopia mini Demographic and Health Survey, the national prevalence of stunting and wasting declined from 58% to 40% and from 12% to 9% respectively, compared to data from the year 2000. However, additional efforts are required to achieve the objectives set out in the national Health Sector Development Programme (HSDP) and National Nutritoin Programme (NNP), as well as the Millennium Development Goals (MDGs) and the 2025 WHO Global Nutrition Targets. WHO Country Office for Ethiopia supports the Federal Ministry of Health’s work to accelerate efforts to achieve the national and global nutrition targets. WHO has supported the development and revision of nutrition-related guidelines, strategies, and capacity-building materials, and in the implementation of evidence-based nutrition actions in line with NNP.

With the Accelerating Nutrition Improvements in Sub-Saharan Africa (ANI) project, the WHO Country Office is working jointly with the Ethiopian central and local governments, as well as an implementing partner, John Snow Incorporated (JSI), to reduce stunting among children under five years of age. The project is supported by the Government of Japan and Department of Foreign Affairs, Trade and Development of Canada (DFATD). Activities include strengthening and scaling up the current efforts of building nutrition capacity among health workers, improving Infant and Young Child Feeding (IYCF) practices, and reducing iron-deficiency anaemia among adolescent girls in 10 woredas (districts) with high presence of undernutrition and anaemia in Amhara, Oromia and Southern Nation Nationalities and People’s regions. 

Polio, or poliomyelitis, is a highly infectious viral disease, which mainly affects children under 5 years of age. The symptoms of polio include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. One in 200 infections leads to irreversible paralysis (acute flaccid paralysis). Among those paralyzed, up to 10% die of breathing complications. There is no cure for polio, but there are safe and effective vaccines.

Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. These symptomless people carry the virus and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges. For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic.

Globally, efforts are underway to eradicate polio. This can only be achieved by immunizing every child with polio vaccine; if a sufficient number of children are fully immunized against polio, the virus is unable to find susceptible children to infect, and dies out.

Response in Ethiopia

Polio eradication is high on the agenda in Ethiopia. Effective coordination at national, regional and outbreak zone level, intensified surveillance and strengthened routine immunization with weekly monitoring of progress of planned activities is taking Ethiopia step by step closer to polio eradication. Working closely with national and regional authorities, WHO and UNICEF established an Operations Base in Wardher, Doollo Zone, Somali region – the epicenter of the latest Ethiopian polio outbreak – to bring together the needed technical expertise to provide ongoing support for polio interventions in the zone and kick polio permanently out of Ethiopia.

No new cases of wild polio virus have been reported from the Somali region of Ethiopia since 5 January 2014, but the risk of polio cases in Horn of Africa prevails. Many children, especially those from nomadic communities and hard to reach areas are at risk. Since June 2013, numerous rounds of polio immunization campaigns have been conducted in addition to on-going vaccination along the border with Somalia. Vaccinators are going house to house, settlement to settlement, in all the communities across the country to ensure that all children are protected.

Global Polio Eradication Initiative
The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and prevention (CDC), UNICEF, and supported by key partners including the Bill and Melinda Gates Foundation. Since the GPEI was launched in 1988, the number of cases has fallen by over 99%. GPEI’s strategies for interruption of wild poliovirus are routine immunization, high quality surveillance for acute flaccid paralysis, supplementary  immunization activities with polio vaccine, and targeted “mop-up” campaigns.

Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease. In healthy people, infection with Mycobacterium tuberculosis often causes no symptoms, since the person's immune system acts to “wall off” the bacteria. The symptoms of active TB of the lung are coughing, sometimes with sputum or blood, chest pains, weakness, weight loss, fever and night sweats. Tuberculosis is treatable with a six-month course of antibiotics.

Ethiopia is one of the 22 high burden countries (HBCs) and TB remains one of the leading causes of mortality.According to the 2014 WHO report, the prevalence and incidence of all forms of TB are 211 and 224 per 100,000 of the population, respectively. Excluding HIV related deaths, in 2013 TB mortality was estimated to be 32 per 100,000 of the population. About 13% of all new TB cases are also HIV coinfected.Moreover, Ethiopia is one of the high TB/HIV and multidrug resistant TB (MDR TB) burden countries. Among TB patients with known HIV status, about 11% were HIV co-infected. According to the recent national TB drug resistance surveillance report, 2.3% of new TB cases and 17.8% of previously treated TB cases were estimated to have MDR.

The Millennium Development Goal 6 target on reducing the TB incidence rate has already been achieved in Ethiopia. Nationally, the TB incidence rate has fallen to 224 per 100,000 of the population in 2013 compared 369 in 1990. The target of halving TB prevalence rate by 2015 has also been met; TB prevalence rate has fallen by 50.5%. Ethiopia has also achieved the target of 50% reduction of TB mortality rate: by 2013, the national TB mortality rate had decreased by 64%.

The WHO plays key role in leading and coordinating the health partners’ on TB/HIV and MDR TB, including Centers for Disease Control, USAID's TB CARE I and Bristol-Myers Squibb Foundation. WHO has been supporting the Federal Ministry of Health (FMoH) through the national TB Research Advisory Committee (TRAC) in setting TB and TB/HIV research priorities, in conducting operational research, dissemination of research findings and use of research results for policy guidance. The country office also supports the documentation and sharing of best practices, surveillance, as well as the adaption of global guidelines to the Ethiopian context. WHO continues to provide technical assistance to FMoH to ensure that all aspects of the new End TB Strategy are integrated and implemented nationally.

Inadequate sanitation is a major cause of disease world-wide and improving sanitation is known to have a significant beneficial impact on health both in households and across communities. Provision of water and sanitation also plays an essential role in protecting human health during crisis and disease outbreaks. 

Ethiopia has made remarkable progress in water and sanitation over the last two decades. According to WHO/UNICEF Joint Monitoring Programme 2014 report, the country has improved water supply by 57% (97% in urban areas and 42% in rural areas), thus achieving the Millennium Development Goal (MDG) 7 target 7C. Although the sanitation target has not yet been achieved, there has been tremendous progress during the past decade in improving sanitation and ending open defecation. The progress has been largely due to the establishment of a Government-led WASH coordination mechanism (ONE WASH programme) involving Ministry of Water, Health, Education and Finance and Economic Development, as well as development partners.

Despite the progress seen in Ethiopia, 43% of the population does not have access to an improved water source and 28% practice open defecation. The National WASH Inventory (NWI) report of 2012 also indicates that the majority of health facilities in Ethiopia lack access to clean water and only about 32% have access to safe water. Moreover, 17% of childhood deaths are associated with diarrhea (EDHS 2011) which remains the third leading cause of under-five mortality attributed to poor water, sanitation and hygiene.

In the area of water and sanitation (WASH), WHO support has focused on capacity building activities. The WHO initiative Water Safety Plan was introduced through capacity building training in collaboration with the Ethiopian Government and partners including German Agro Action, Drop of Water, Relief Society of Tigray, JICA, Norwegian Church Aid and Finland’s COWASH Program. More than 500 professionals and students attended various trainings organized in 2013, 2014 and 2015. WHO is currently providing technical assistance to the ‘Building adaptation to climate change in health in least developed countries through resilient WASH’ project with support from the UK Department for International Development (DFID), as well as to the Ministry of Water, Irrigation and Energy (MoWIE) to implement the ‘Climate resilient Water Safety Plans’ through development of a national strategic framework. 

For more information please contact: Mr Waltaji Terfa Kutane, email: kutanew@who.int