Ethiopia

Ethiopia made significant progress in reducing chronic and acute malnutrition in recent decades, but progress stalled and even reversed over the past four years due to shocks related to climate (drought), conflict, COVID-19, and rising inflation. Our work in Ethiopia aims to improve the quality of nutrition services in the health system that treat and prevent malnutrition among children and pregnant women.

Innovations such as simplified screening approaches and new wasting treatment services are being piloted to ensure that children are identified early and can recover sooner. We also support the Ministry of Health in introducing multiple micronutrient supplements during pregnancy, to help prevent stillbirth and low birth weight while improving maternal nutritional status.

Prevention of micronutrient deficiencies is a priority that cuts across the health and food systems, with wheat flour and edible oil fortification being rolled out across Ethiopia and research underway to deliver folic acid plus iodine through salt, given the high level of folate deficiency, which can cause spina bifida.

We work closely with the Ministry of Agriculture to ensure the adoption of nutrition-sensitive agri-food systems policies, which has led to significant ministry investments in human resources and data information systems. We also work to strengthen nutritional resilience in the lowest-income communities by piloting the delivery of a package of nutrition services and commodities through key country safety net programs, to meet critical nutrition and health needs.

More than 2 million Ethiopian women with an expressed intention to use a family planning method have unmet family planning needs. We support Ethiopia’s goals for modern contraceptive prevalence and reaching women with a full suite of method choices to meet their unique and changing needs during the course of life.

This work includes expanding the method mix through the introduction of the self-injectable DMPA-SC contraceptive and improving commodity availability; scaling up postpartum family planning services through training of health care providers; improving health care integration to reduce missed opportunities for service provision; equipping the Health Extension Program to deliver all methods as appropriate, including intrauterine devices; and deploying mobile health and nutrition teams to bring integrated services to hard-to-reach populations.

Our work also aims to reach historically underserved populations, including adolescent girls through the Adolescents 360 Smart Start program, which supports life planning and family planning counseling to girls and young women ages 15 to 24. We also seek to improve awareness of and access to family planning services and information to address demand-side challenges.

Over the past two decades, Ethiopia has made significant strides in improving maternal and child health, as evidenced by substantial reductions in maternal, neonatal, and under-5 mortality rates. Despite these achievements, considerable efforts are still needed to reach the 2030 targets in Sustainable Development Goal 3. The way to do this is by adapting and scaling up innovative and effective service delivery solutions.

Through our focused efforts on improving primary health care (PHC) systems, we aim to make health care services more accessible, efficient, and effective for mothers and children. We support Ethiopia in achieving its goals by focusing on innovations that address the primary drivers of maternal and neonatal mortality.

One key example is our support for the introduction and implementation of the postpartum hemorrhage (PPH) bundle, an innovative approach that aims to improve early diagnosis and management of PPH, one of the leading causes of maternal mortality.

To reduce the neonatal mortality rate and achieve the targets set by the global Every Newborn Action Plan, we support efforts to increase access to level 2 neonatal intensive care units and enhance the quality of small and sick newborn care (SSNC) across the country. Providing critical care to newborns with severe health conditions, with an emphasis on quality SSNC, can ensure that more newborns receive the care they need for a healthy start in life. Integrating such targeted solutions into the health care system can enhance the quality of maternal and neonatal care and ultimately reduce mortality rates and improve overall health outcomes for mothers and newborns across Ethiopia.

Ethiopia faces significant challenges with high numbers of zero-dose children. A 2022 evaluation funded by our foundation revealed that the country had 1,240,625 unvaccinated children. To address this, we are supporting efforts to understand and analyze the factors behind zero-dose status. We are also collaborating with Gavi, the Vaccine Alliance, on immunization investments and the use of health service delivery platforms, such as mobile health and nutrition teams, for immunization.

Measles vaccination coverage in Ethiopia remains inadequate, prompting a nationwide campaign in December 2022 that targeted more than 15.5 million children. Despite these efforts, measles outbreaks have surged, leading to policy changes such as supporting a five-dose measles vial and enhancing routine immunization through outreach and periodic intensified routine immunization. We plan to support efforts to understand and address vaccine dropouts before the nine-month touch point.

Ethiopia has adopted single-dose human papillomavirus (HPV) vaccination amid a global HPV vaccine shortage and is working to reconcile coverage discrepancies between PMA and administrative data to accelerate cervical cancer elimination. We provide preparatory and costing support for multiage cohort HPV vaccination and efforts to reach out-of-school girls. We also provide support for new vaccine introductions, the rotavirus vaccine switch, and strengthening routine immunization in conflict-affected regions.

To achieve its goal of universal health coverage by ensuring access to quality PHC, Ethiopia launched the Health Extension Program (HEP) in 2003. The HEP has since expanded its geographic coverage and enhanced the health care packages it provides to communities. This has significantly increased use of PHC services, which has been instrumental in reducing maternal, child, and neonatal mortality.

In 2019, we supported the Ministry of Health in conducting a national assessment of the HEP. Based on the findings, a 2020–2025 roadmap for improvement was developed. To remain effective, the program must continue evolving to meet the changing needs of the communities it serves. Our support aligns with the country’s vision of revitalizing its community-based PHC delivery system through the HEP, expanding access to essential PHC services for rural populations, and ensuring responsiveness to the evolving needs of communities.

In addition to establishing health posts and delivering health care packages through health extension workers, the HEP mobilizes volunteer community health workers, such as village health leaders, to enhance community engagement.