Ethiopia: Focusing our Program for Impact & Efficiency
Jocelyn Felter Brown Acting Coordinator, PEPFAR Ethiopia AIDS 2014
Stepping Up The Pace
Slide 2
Ethiopia Important Features Population 90 million Predominantly
rural agrarian country Growing economy with large infrastructure
development projects Low/decreasing national HIV/AIDS prevalence:
1.4% Has reached the Tipping Point Significant Urban to Rural
HIV/AIDS disparity: mixed epidemic Government is the primary
service provider Strong political commitment to health & equity
of services Significant Global Fund investment, but expected to
decline with New Funding Model
Slide 3
Ethiopia: Three Ways of Looking at HIV Distribution:
Prevalence, No. Infected, and Density, 2011
Slide 4
PEPFAR Expenditures by Geographic Location & HIV Burden
with Adult Prevalence 4 Source: HIV Related Estimates and
Projections for Ethiopia 2012. Excludes National and Above National
Spending
Slide 5
Focusing the Program: Start with Clinical Care & Treatment
201320142015 Number of Adults in need of ART *
431,761530,835542,632 National Coverage Rate & Goals @69% =
298,33680% 434,106 Adoption of 2013 WHO Guidelines *Source:
Spectrum HIV Related Estimates and Projections for Ethiopia,
2014
Slide 6
Focus on Clinical Care & Treatment HistoricallyUS
University treatment partners led clinical care & treatment
efforts Partners accomplished what they were brought to Ethiopia to
do; time to move more responsibility to Government of Ethiopia
Promising results from transition of University partners to
Regional Health Bureaus in 3 regions demonstrated success and
ability to manage funding Assumption is that we can achieve same
treatment goals, at same level of quality, but more efficiently
across all regions
Slide 7
Achieving Efficiency in Clinical Care & Treatment * 2014
reflects the COP14 submission, new funds only USD, in millions
PEPFAR/HHS-Ethiopia Funding, by Partner Type
Slide 8
Defining Our Core Understand: 1.Current state of epidemicand
how its expected to change 2.National Response: What is USGs
current role -- how might or should it change? 3.What are roles of
other HIV Donors, Global Fund, Government, private sector -- how
might they change? Design: 1.What are the core program
elements/critical enablers required to Save Lives and Prevent New
Infections? 2.What are the core program elements /critical enablers
USG is uniquely qualified to deliver? 3.How and when and to whom
should non-core programs/non- critical enablers transition or end?
4.What is the cost of the core program? 8 We adapted the UNAIDS
Investment Case Framework to further focus and rationalize our
PEPFAR program in Ethiopia
Slide 9
Prioritizing Activities Activities critical to saving lives,
preventing new infections - and/or which USG is uniquely qualified
Core Activities that directly support our goals and cannot yet be
done well by other partners or host govt. Near Core Activities that
do not directly serve our HIV/AIDS goals and/or can be taken on by
other partners or host govt or civil society. Non Core Must Do
Should Do Nice to Do 9
Slide 10
Treatment Prevention (High & Med Risk) Targeted Testing
Supply Chain TA HIV/AIDS Commodities Evidence Base (SI, SS,
M&E) HC Financing/Insurance Training HMIS OVC (incl. ES) Non-
Core Blood Safety TA to Private Sector Health Svcs VMMC In-School
Youth funding to MOE Leadership and Governance (w/ transition plan)
Community/Peer Support Ongoing Construction Commitments Economic
Strengthening ( non-OVC) TA In-school Youth prevention Low-risk
prevention (GPY) PPP TA Infection Prevention Cross-border Cervical
cancer screening Near- Core Core Defining the Core: Results
Slide 11
Using Data to Maximize Program Investment Evidence Base
Analysis Utilized most current ANC surveillance data to ensure
sufficient support in regions and refugee sites with increasing
prevalence Tracked those emerging regions transected by major
transport corridors and targeted funding toward hottest Hot Spots
Assessed areas where HRH capacity is most limited and targeted ToT
support Economic Analysis We utilized national PEPFAR expenditure
data to calculate unit expenditures, which allowed us to cost our
programs core interventions Expenditure data at regional and
partner level prompted refinement to certain activities and
regional interventions Site-Level Analysis Directed spend toward
highest-volume and highest-yield facilities; reduced spend to
facilities with low-volume/low-yield
Slide 12
Geographic Analysis: HIV+ yield distribution across PMTCT sites
80% (14,260) of patients in 22% (371) of 1,668 sites Key: High
Yield = >1 patient/month Low Yield =
Slide 13
Stakeholder Coordination Government Years of successful TA and
strong Govt support ensure readiness to take over Cervical Cancer,
Infection Prevention, VMMC, Blood Safety Extensive Govt led Health
Extension Worker program is able to take on more Community-focused
activities Global Fund Revolving fund for ES allows PEPFAR to focus
on OVC House Holds On-going HSS funding can support health
infrastructure needs Commitment to significant funding of ARVs,
RTKs Civil Society & Private Sector Years of USG and Global
Fund support have capacitated CSOs to take on more Community and
Peer Support activities Years of TA to Private Sector providers
have strengthened their ability to serve clients and support
business With a more focused PEPFAR program, on-going stakeholder
alignment is key to sustain gains and prevent service gaps
Slide 14
ETHIOPIA HAS A REAL CHANCE AT AN AIDS FREE GENERATION Thank
You