Ethiopia

Ethiopia-map

Ethiopia, a landlocked country in East Africa, is Africa’s oldest independent country and is the continent’s second most populous country, with over 109 million inhabitants as of 2019. With a total area of 1,100,000 square kilometers, Ethiopia’s capital and largest city is Addis Ababa, which lies several kilometers west of the East African Rift that splits the country into the African and Somali tectonic plates.

Over the past decade, Ethiopia has attained high economic growth, averaging 10.7 percent per year. If the country continues its historically impressive growth performance, it could potentially reach middle income status by 2025, according to the latest Ethiopia Economic Update report, which the country aspires to achieve.

Like many developing countries, Ethiopia strives to strengthen its health systems through implementing several initiatives and interventions of WHO’s recommended six building blocks, namely: Service Delivery; Health Workforce; Information; Medical Products, Vaccines, and Technologies; Financing; and Leadership and Governance. 

In the last two decades, the Government of Ethiopia has made significant gains in improving the health status of its citizens. The life expectancy of its citizens improved from 45 years in 1990 to 64 years in 2014; maternal mortality ratio has declined from 1,400 deaths per 100,000 live births to 351 in 2016 and under-five mortality rate has declined by 67%, to 68 deaths per 1000 births. These results were achieved as a result of strong commitment from the Ethiopian government as well as technical and other resource support from development partners. 

The gap between the available supply of health and allied care professionals and the actual demand for their services is one of the most pressing challenges facing Ethiopia’s health system today. This shortage of human resources for health (HRH) undermines the country’s ability to improve and scale-up critical healthcare services, while inadequate and overburdened infrastructure, logistics systems, and supply chains further challenge the Ethiopian health system. In addition, those health workers who are deployed need additional training and capacity building so that the services that they provide are of the quality necessary to achieve the country’s ambitious health agenda.

AIHA’s partners in Ethiopia with the Federal Ministry of Health (FMOH) and its agencies; such as, the Ethiopian Public Health Institute (EPHI), the International Institute for Primary Health Care (IIfPHC),  The Ethiopian Food and Drug Administrations (EFDA), as well as  local and international health and development organizations.

AIHA has had an active presence in Ethiopia since 2006. From 2006 until 2019, AIHA implemented HRH/HSS interventions through twinning partnerships under the  HIV/AIDS Twinning Center Program. Our partnerships in Ethiopia focused largely on national HRH and HSS projects in close collaboration with schools of the health professions and teaching hospitals, and in alignment with the Federal Ministry of Health’s HR2020 strategy to develop health workforce capacity. AIHA managed nine partnerships in Ethiopia, along with a dynamic Volunteer Healthcare Corps.

Click here for a printable overview of our work in Ethiopia under the HIV/AIDS Twinning Center.

Starting in 2016, with support from the Bill & Melinda Gates Foundation (BMGF), AIHA has implemented a series of projects to support the Ethiopian Federal Ministry of Health in a variety of ways, as described below.

Projects

Supply Chain – Strengthening HR Management and Practice (2023 – Present)

In November 2023, AIHA launched a new project supported by the Bill & Melinda Gates Foundation to strengthen human resource management and practices for the supply chain workforce in Ethiopia to improve the availability of pharmaceutical commodities throughout the country.

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The project will build capacity of the Ethiopian Pharmaceutical and Supply Service (EPSS) in areas such as division of labor, workflow management, and collaboration with the private sector. We will build the EPSS institutional and human resource capacity through targeted training and mentorship on financial management, leadership, communication and information management, and other critical competencies. Some of the first activities we plan to implement include: 

  • Conducting stakeholder engagement meetings to achieve buy-in and consensus
  • Developing a project work plan and monitoring and evaluation framework that will provide a roadmap for future activities
  • Developing and launching needs-based training courses to build the capacity of Ethiopia’s pharmaceutical supply chain workforce

Twinning Partnership Program to Strengthen Primary Health Care (PHC) in Ethiopia 

(2020 – Present)

In November 2020, AIHA launched its fourth project in Ethiopia supported by the Bill & Melinda Gates Foundation (BMGF). The goal of this two year project – extended and expanded in 2022 for two more years – is to strengthen the International Institute for Primary Health Care – Ethiopia (IIfPHC-E) to serve as both a national and regional resource for the delivery of quality primary health care service for essential, curative, and preventive services in Ethiopia. 

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The IIfPHC was established by the Federal Ministry of Health (FMOH) to strengthen Ethiopia’s Primary Health Care (PHC) system in the context of achieving Universal Health Coverage (UHC) and meeting the Sustainable Development Goals (SDGs) for health. It does this by serving as a global resource for PHC, building capacity through training and information sharing, carrying out health systems implementation research, and contributing to the global advocacy for UHC through Primary Health Care. It is expected that the Institute will be transformed into a Center of Excellence in PHC Training, Advocacy, and Evidence Generation, and ultimately serve as the first WHO Collaborative Center on the African continent. 

The project, which AIHA is co-implementing with Johns Hopkins University (JHU), supports the IIfPHC-E and strengthens its capacity. This project has developed a strategy and implementation plan for the transformation of the existing PHC system on a national and regional level. It has established a phase-based approach and resources for a comprehensive PHC delivery system that can be achieved in five years – allowing the IIfPHC-E to become a fully functional independent entity. 

AIHA is deploying its hallmark twinning methodology to provide technical assistance to fill the gap in designing standardized training curricula as well as providing TOTs on selected topics such as Maternal Child Health, Behavior Change Communication/Health Education and Communication, etc. The specific areas are informed by an initial assessment that was conducted on existing training gaps, as well as a review of current policies, existing infrastructure, and service delivery, among other areas. AIHA has rolled-out and scaled-up capacity development of the selected core trainers and strengthened the identified six regional centers, also known as PHC hubs.

To read more about this project, click here.

Leadership Incubation Program for Health

(2019 – Present)

The Bill & Melinda Gates Foundation awarded AIHA a second capacity development project in July 2019, which aims to develop a pipeline and provide management and leadership training to the next generation of public health leaders in Ethiopia. This addresses a critical gap identified in a major assessment conducted of the public health system in Ethiopia, calling for leadership, management, and governance capacity-building efforts in order for the Ministry of Health and partners to provide better health services and achieve improved health outcomes in the country. 

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In collaboration with the FMOH and the International Institute for Primary Health Care-Ethiopia, AIHA launched the Leadership Incubation Program (LIP) in late 2019, establishing a health leadership incubation center. The Leadership Incubation Program (LIP) strives to develop future leaders in public health and provide an opportunity for them to make significant contributions to the health sector at all levels of leadership. 

The LIP is a competency-based, six-month in-service training program. Four trainings have taken place so far, a fifth is currently underway, and one additional cohort will be enrolled  before the project is transitioned over to the IPHC-E in 2024. 

The project provides the fellows with leadership experience in areas such as planning, implementation, management, and evaluation through specialized hands-on training and mentorship. LIP fellows are also assigned to a field site where they are provided opportunities to develop competencies as skilled program leaders and provide services that will improve public health. They conclude their program with a capstone project.

The program recruits, develops, and nurtures young professionals who display exceptional commitment and passion for the health of the population and who demonstrate health sector leadership potential. AIHA supports the recruitment of trainees as well as consultants, trainers, and coaches who are engaged in developing training materials and conducting the training and coaching activities. A team of dedicated trainers and coaches are identified from multiple sectors and are deployed to deepen the knowledge of leadership literature, raise self-awareness, and unlock the leadership potential of the trainees. This is being done through a blended learning approach that combines traditional classroom learning with individual mentoring, coaching, and experiential learning opportunities.

More information about the training methodology and accomplishments of the LIP project can be found here, along with testimonials from some of the individuals who have graduated from the program. 

At LIP Graduation Ceremony. Right to left – Dr. Lia Tadesse – Minister of Health, Dinksera Debebe – LIP graduate, and Dr. Frehiowt Negatu – IIfPHC A/ Director

Building Capacity at the Federal Ministry of Health
(2016 – Present)

Based on AIHA’s long established presence in Ethiopia and our close collaboration with the Ethiopian Ministry of Health, in November 2016, AIHA launched its first project with support from the Bill and Melinda Gates Foundation (BMGF), to strengthen the capacity of the Ethiopia’s Federal Ministry of Health to achieve its goals outlined in its Health Sector Transformation Plan (HSTP). The project has been renewed annually and is currently in its sixth and final year, through the end of 2021.  AIHA provides logistical support and grants to assist the Ethiopian Ministry of Health to effectively and efficiently implement its priorities under this Plan, and, more recently, to assist the MOH respond to the COVID-19 pandemic.

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AIHA works in close collaboration with the Ministry of Health representatives, the BMGF, and a third party expert in an advisory committee that reviews the Ministry’s funding requests. This committee approves requests and provides logistical support for the implementation of the proposed projects, or it recommends revisions to the Ministry and provides technical assistance for further development and refinement of requests, including, among other things, different options for vendors or consultants and changes to procurement and solicitation processes.

In addition, the Gates Foundation has requested that AIHA provide consultation and feedback on their Ethiopia Integrated Health Plan (EIHP) based on AIHA’s status as a current BMGF implementing partner and our decade-long experience working in close collaboration with the Ethiopian Ministry of Health to implement successful national and regional HSS/HRH interventions in the country. Our experience, coupled with our close relationship with the Ministry, including a keen understanding of its priorities and processes, positions AIHA well to provide the service required to assist the FMOH in the smooth implementation of its health agenda. 

To read more about the activities facilitated under this project, click here.

Responding to COVID-19
(2020 – 2021)

AIHA launched its third Bill & Melinda Gates Foundation supported project in Ethiopia to assist the Government of Ethiopia address the COVID-19 pandemic.

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AIHA played a key role in coordinating the transactional and logistical elements of the GOE’s response to COVID-19 across a range of requests that were responsive to GoE’s needs around informed decision making among communities, strengthening the emergency response capacity, and strengthening analytical capacity to enhance preparedness.  

The effort was supported through the existing Advisory Committee (AC) to vet funding requests in the above areas coming from the GoE. The AC was comprised of representatives from the Gates Foundation, AIHA, and multi-sectoral experts from the development community. AIHA was directly involved in evaluating identified partners to implement activities, processing all payments and contracts for the production of various communications materials, recruiting consultants, and other related activities and costs to support GoE’s efforts to curb the COVID 19 pandemic.  

To read more about this project, click here.

PEPFAR Civil Society Organization Initiative
(2016 – 2019)

At the request of the Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), the Health Resources Services Administration (HRSA) and its partners, AIHA and the National Alliance of State and Territorial AIDS Directors (NASTAD), created a project with the goal of improving engagement between country teams for the President’s Emergency Plan for AIDS Relief (PEPFAR) and civil society organizations (CSOs).

The CSO Engagement Initiative is a PEPFAR-wide project to support collaboration between in-country/regional PEPFAR teams and CSOs in the PEPFAR planning and implementation process. It enlists the efforts of staff from HRSA and its partners, AIHA and NASTAD. HRSA, AIHA, and NASTAD provide a wealth of expertise in successfully engaging civil society into HIV service planning, prioritization and service delivery, both domestically and globally.

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At the outset of the project, HRSA, AIHA, and NASTAD held multiple calls with PEPFAR country teams to discuss their needs and expected outcomes. The project team then provided a menu of specialized technical assistance options, based on these communications, for PEPFAR country teams and CSOs to choose from, should they be interested in utilizing the project. These options included support for the following: CSO recruitment for participation in COP planning and implementation, meaningful CSO engagement in COP planning, meaningful CSO engagement in PEPFAR implementation, and evaluation of CSO engagement and dissemination of tools.

Ultimately, PEPFAR teams from four countries requested technical assistance (TA) from the CSO Engagement Initiative during the FY 2016-2019 period of performance: Ethiopia, Mozambique, Nigeria, and Uganda. Under AIHA’s HIV/AIDS Twinning Center Program, the project encompassed a series of activities customized to each country’s needs and timed to coincide with COP-related activities as appropriate.

Accomplishments

  • The project team conducted an assessment of the state of civil society and its relationships with PEPFAR country teams prior to additional activities in each country. While every country is unique, common themes included PEPFAR teams finding CSOs lacking in sophistication when it comes to data and unable to provide the type of information that PEPFAR requires from them. In turn, CSOs often described PEPFAR teams as insufficiently engaged with them. Both PEPFAR and CSO respondents agreed on the need for capacity building for CSOs to help them become better partners with PEPFAR in the fight against HIV/AIDS.
  • The project team conducted Data Presentation Workshops. The purpose of these workshops was to help PEPFAR better communicate their highly sophisticated data to an audience who may not be as comfortable with technical terms. In some countries, CSO leadership participated in these workshops as well. There was near unanimous agreement that these workshops were helpful to all.
  • After the Data Presentation Workshops, the project team conducted CSO Orientation Development Workshops and supported PEPFAR country teams as they in turn conducted CSO Orientation Meetings prior to COP 19 activities in Ethiopia. The CSO Orientation Development Workshops provided PEPFAR teams and CSO Leadership with support to design and Orientation Meeting for CSOs to help orient them to COP processes. Once again, PEPFAR team members and CSO leadership reported that the Development Workshops helped them in designing the Orientation Meetings, and Meeting participants reported that they felt more prepared to meaningfully engage with PEPFAR.
  • The project took an explicitly adaptive approach, using data gathered from each activity to improve. This adaptive approach allowed the project team to be as responsive as possible to individual country needs and to change their approach when necessary, contributing to project success.

To read the final closeout report of AIHA’s Twinning Center Program, click here.

Jimma University Institute of Technology, Tegbar-Id Polytechnic College, Addis Ababa University Institute of Technology / Rice University and Texas Children’s Hospital
(2012 – 2019)

Partners worked together to strengthen Ethiopia’s training capacity in the field of biomedical engineering and technology, which represents an important component of health systems strengthening. This was the first PEPFAR-supported project focused on biomedical technology in Africa.

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Clinical laboratory and biomedical equipment is essential for HIV diagnosis, treatment, and care. For example, CD4 machines enable healthcare providers to effectively monitor viral load, provide a baseline reading, and track immune status on an ongoing basis to ensure proper care.

Although limited data on biomedical equipment functionality on a national level exists, PEPFAR estimates that 37-48 percent of CD4, hematology, and microbiology lab equipment in Ethiopia is not working at any given time. This lack of functional biomedical equipment, including autoclaves, centrifuges, microscopes, and other basic diagnostic tools undermines the country’s HIV response, resulting in delays in treatment and increased loss of patients in care.

To address the critical need for well-trained biomedical technicians, AIHA initiated in January 2012 a partnership linking Tegbare-id Polytechnic College and Jimma Institute of Technology (JIT) in Ethiopia with Rice University and Texas Children’s Hospital through our HRSA-supported Twinning Center Program. This partnership was the first PEPFAR- supported project to address biomedical technology in sub-Saharan Africa. Together, partners worked to meet the in- creasing demands of a technology-driven system of care.

In 2015, Rice University and Texas Children’s Hospital graduated from the partnership as AIHA shifted to the second phase of the initiative, which included bringing Addis Ababa Institute of Technology (AAIT) into the program to ensure we were working with the three main pre-service training institutions in the country.

To date, partners have worked with all relevant stakeholders to revise curricula for a bachelor-level biomedical engineering program and diploma-level technician program, supporting pre-service training for 339 biomedical engineers from JIT and 74 from AAIT for a total of 413 graduated to date, along with a total of 332 biomedical technicians.

Partners have focused on a broad range of capacity building activities, starting with targeted faculty development through training and striving to overcome a severe shortage of local teachers by providing long-term international instructors to teach courses under the revised curricula and mentor faculty.

Providing practical hands-on training opportunities for faculty, students, and biomedical professionals working at healthcare facilities has also been a priority. To this end, AIHA and our partners have outfitted skills labs and design workshops with a wide range of equipment, tools, and supplies for improved learning.

Partners also collaborated to develop a free biomedical engineering massive open online course (MOOC) focused on troubleshooting, repair, and routine maintenance of standard biomedical equipment, along with a course on appropriate design for global health. They worked to promote global health technology through a student design competition, developed systems for equipment management at healthcare facilities, and promoted the use of evidence-based resources by establishing Knowledge Management Centers where students and faculty can access the latest information on best practices.

Given the successes of the pre-service component of the biomed partnership, AIHA shifted the main focus of the project to in-service training to build the capacity of biomeds and lab technicians to conduct preventive maintenance and repair on laboratory equipment which directly supports viral load testing in October 2017.

Leveraging the success of this innovative partnership, AIHA launched a public-private partnership with GE Foundation in 2015 to help scale up and complement partnership activities at that time. This public-private partnership enabled AIHA to bring AAIT into the alliance as we worked closely with GE Foundation’s implementing partners to develop and conduct a comprehensive year-long in-service training program for biomedical technicians and engineers across Ethiopia.

To read the final closeout report of our Twinning Center Program, click here.

St. Paul Hospital Millennium Medical College / University of Michigan
(2013 – 2017)

AIHA launched this twinning partnership in March 2013 designed to strengthen Ethiopia’s pre- and in-service training capacity in the field of obstetrics and gynecology. Lack of adequate prenatal and birthing care contributes to the country’s high maternal mortality rate

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In response, AIHA supported an existing alliance between St. Paul Hospital and Millennium Medical College (SPHMMC) in Ethiopia and the University of Michigan’s Department of Obstetrics and Gynecology; the University of Michigan School of Medicine’s Global Research, Education and Collaboration in Health (REACH) Program and the Office of Enabling Technologies also played a vital role in this partnership. These Ethiopian and American institutions had been working together since April 2011, when the Michigan partners began providing technical assistance to improve maternal and child health at St. Paul’s through targeted training and faculty development opportunities.

In this iteration of the partnership, participants developed innovative competency-based educational modules and enabling technologies suitable for delivering obstetrics and gynecology training in low-resource settings. They also focused on improving faculty development opportunities in teaching, research, and leadership that will help ensure the sustainability of local capacity to train new care providers, as well as upgrade the knowledge and skills of current practitioners.

The overall goal of the partnership was to strengthen the capacity of SPHMMC to provide quality pre-service and in-service training programs and prepare OBGYN residents to improve the quality of women’s healthcare, thus more broadly, improving maternal morbidity and mortality and PMTCT of HIV throughout Ethiopia. Specific objectives included to:

  • Developing and teaching and leadership skills among faculty and medical professionals in the ob/gyn field and increasing residents’ competency through connectivity with the global community
  • Strengthen post-graduate Ob/Gyn education by developing a curriculum with subsequent standardized modules, improving teaching materials and resource access, and increasing access to information by introducing open educational resources.
  • Improve clinical services and organizational management through team-based trainings increased provider availability, and enhancing interpersonal skills of healthcare providers, and the procurement of new medical equipment.

To read the final closeout report of our Twinning Center Program, click here.

Addis Ababa University School of Medicine / University of Wisconsin at Madison
(2009 – 2017)

In 2009, AIHA initiated a twinning partnership between Addis Ababa University; the University of Wisconsin School of Medicine and Public Health; and People to People, an organization dedicated to linking the Ethiopian diaspora with Ethiopian institutions to strengthen human resource development, healthcare, and education, to address Adult and Pediatric Emergency Medicine services at Addis Ababa University Tikur Anbessa Specialized Hospital and to improve the clinical care of people infected with and affected by HIV/AIDS. This project, as part of AIHA’s broader Nursing Initiative, established an Emergency Medicine Nursing Masters Degree Program at AAU.

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Before the partnership started, there was not an organized emergency and critical care unit at Addis Ababa University Tikur Anbessa Specialized Hospital, and there were no trained emergency and critical care physicians and nurses who could provide the proper emergency care and service at any hospital in Ethiopia. This partnership helped in initiating and improving the organizational and clinical services of Addis Ababa University Tikur Anbessa Specialized Hospital through the establishment of a well-organized emergency and critical care unit at the hospital and provision of various emergency related training to health professionals who can provide high-quality care for the patients coming to the hospital with emergency conditions. In addition, quality improvement projects were not practiced by healthcare providers at the institution, and this partnership created awareness of quality improvement among the hospital staff.

The overall goal of this partnership was to improve adult emergency care, particularly for people exposed to HIV/AIDS at Addis Ababa University Tikur Anbessa Specialized Hospital, which is a high-HIV burden site. Specific objectives included to:

  • Increase the number and quality of qualified and trained providers, managers, and allied health staff capable of providing adult emergency medical services, care, and treatment to PLHIV
  • Strengthen the human and organizational capacity of Addis Ababa University Tikur Anbessa Specialized Hospital to provide quality adult emergency medical services by implementing quality improvement programs and through the improved organization and resources of the Adult Emergency Medicine Department.
  • Strengthen Ethiopia’s cadre of emergency medical health providers through professional association development, policy reform, accreditation, and licensure support, and support for institutional Continuous Medical Education (CME) focused on Emergency Medicine.

To read the final report on AIHA’s HIV/AIDS Twinning Center Program, click here.

Volunteer Healthcare Corps: Ethiopian Diaspora Volunteer Program (EDVP)
(2006 – 2017)

This innovative initiative helped build institutional capacity to combat HIV/AIDS by recruiting health and allied professionals from the Ethiopian Diaspora for long-term volunteer placements at PEPFAR-supported organizations throughout Ethiopia.

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AIHA launched the Volunteer Healthcare Corps (VHC) program in Ethiopia in September 2006 to identify, recruit, and place Ethiopians in the Diaspora in long-term volunteer assignments designed to build health system capacity in their home country. This program tapped into the highly skilled health and allied professionals in the Ethiopia Diaspora community who have a strong motivation to return to their country of origin and contribute to improving the health system.

In 2012, the Ethiopian Ministry of Health and Ministry of Education launched the Medical Education Initiative (MEI), opening 13 new medical schools and increasing medical student enrollment 10-fold. They also transformed the conventional medical curriculum to a problem-based learning system that promotes alternative and evidence-based teaching and learning strategies. Because the initiative was constrained by a shortage of qualified local medical instructors, AIHA used the VHC to help recruit qualified professionals from outside Ethiopia, placing a total of 14 qualified individuals at new medical schools throughout the country.

Since project inception, AIHA recruited and placed 64 highly skilled health and allied professionals in 74 volunteer assignments at various institutions. Some 57 of these volunteers were Ethiopians in the Diaspora and more than 10 repatriated, which is helping to reverse the country’s brain drain. These volunteers included doctors, nurses, social workers, pharmacists, lab technicians, IT experts, and communications specialists, who were placed at hospitals, clinics, universities, NGOs, and government agencies, including the Ministry of Health.

One of AIHA’s longest projects in the country, the Ethiopian Diaspora Volunteer Program graduated in September 2017.

Addis Ababa University School of Pharmacy / Howard University Pharmacist and Continuing Education Center
(2007 – 2014)

Pharmacists play a key role in HIV/AIDS clinical care, so this university-to-university partnership worked to strengthen AAU’s capacity to provide high quality pre-service and in-service training to support ART scale up throughout Ethiopia.

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Findings from a needs assessments conducted by Howard University in 2007 at the onset of AIHA’s twinning partnership with Addis Ababa University School of Pharmacy underscored the urgent need for the increased and active involvement of the pharmacy profession in the treatment and care of PLHIV in Ethiopia, especially in an environment where there was a shortage of other healthcare professionals, notably doctors and nurses.

At that time, pharmacists in Ethiopia were being trained with a focus on products and traditional drug supply functions, but the demand to play an increasing role in patient-oriented pharmacy services — particularly the provision of ART — required a shift toward clinical pharmacy education, training, and practice. Additionally, the majority of pharmacists in Ethiopia did not have access to accurate and reliable drug information or accredited continuing education opportunities. There was little involvement in clinical practice, but a high demand for clinical training.

AIHA supported this dynamic partnership from 2007 to 2014, during which time Addis Ababa University and their Howard counterparts ushered in many positive changes that spread from the nation’s capital throughout the country.

Working together, partners developed a new five-year bachelor’s degree program in clinical pharmacy, along with clinical rotation guidelines for five hospital and nine community pharmacy rotation sites where students could gain much-needed practical experience. They also trained 40 pharmacists and physicians from 10 institutions to serve as preceptors to support the clinical pharmacy students during their rotations. In addition, six Ethiopian physicians completed a two-week training at US teaching hospitals to gain a better understanding of the role clinical pharmacy plays in the healthcare system.

Addis Ababa University graduated its first cohort of 52 students using the clinical pharmacy curriculum they developed jointly with their Howard partners in 2013. They placed 31 of these graduates at Tikur Anbessa Hospital. The Ministry of Health deployed the other 21 to clinical sites throughout Ethiopia. The new curriculum has been adopted by six other public universities in the country, which graduated 374 students in 2013 with the first cohort, bringing the total number of new clinical pharmacists in the country at that time to 426.

To date, not only have the 11 public schools offering pharmacy training adopted the curriculum, so have the five private schools that train pharmacists in Ethiopia. Together, these schools have graduated a total of 7,080 students from the five-year bachelor’s program in clinical pharmacy, 555 Master’s level (MSc.) students, and three Ph.D students. Looking to provide a career path for the clinical pharmacy graduates, partners launched a

Master’s program in pharmacy practice (MPharm) in 2010, which has to date matriculated 28 students.

Establishing a Drug Information Center (DIC) at Tikur Anbessa Hospital so staff could access evidence-based information resources to respond to queries from healthcare workers was another key accomplishment of this partnership. Partners have trained more than 500 pharmacists and other healthcare workers on drug information services and also collaborated with other universities to establish eight satellite DICs throughout Ethiopia.

In support of the transformations they spearheaded in pharmacy education and practice, partners led several advocacy efforts to help change both the image and the role of pharmacists in the country. They met with senior pharmacists from various sectors and held national consensus building and sensitization workshops with the Ethiopian Pharmaceutical Association (EPA) to discuss the roles, responsibilities, and future of new clinical pharmacy graduates. They also prepared a scope of practice and submitted it to

Ethiopian Food, Medicines and Health Care Administration and Control Authority. These activities were critical for ensuring that the Ministry of Health deployed the new graduates throughout the country. Partners also provided a wide range of continuous professional development (CPD) courses and Addis Ababa University is working with the EPA on national accreditation guidelines and training modules.

Overall, this partnership has transformed the role of pharmacists in Ethiopia from being drug specialists to drug therapy specialists, which is especially relevant for patients on ART. Pharmacists have been able to provide education and sup- port to manage the medication needs of PLHIV, improve ART adherence, address drug therapy problems, and reduce costs. Thanks in large part to the efforts of this partnership, pharmacists in Ethiopia are now considered an integral part of the healthcare team.

To read the final report on AIHA’s Twinnging Center Program, click here.

Debre Berhan Referral Hospital / Elmhurst Hospital Center
(2007 – 2014)

Partners collaborated to improve hospital services — including treatment, care, and psycho-social support — for PLHIV in Debre Berhan’s catchment area. They also worked to increase patient involvement as a means to improve quality of care and better ensure adherence to ARV treatment. As a result of this highly successful partnership, Debre Berhan has emerged as a national benchmark and been named as a top-performing hospital by the Ministry of Health in 2014, 2015, and 2016. Click here to learn about how twinning helped transform Debre Berhan in to model of quality care and effective management.

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Because Ethiopia has been so heavily affected by the HIV/AIDS epidemic, the Federal Government and international donors alike have increased resources to strengthen human and organizational capacity to support the implementation of prevention, care, and treatment programs. Partners at Debre Berhan Referral Hospital and Elmhurst Hospital Center collaborated from 2007 to 2014 to strengthen Debre Berhan’s capacity to provide medical and psychosocial care for PLHIV.

Onsite mentoring and training for Debre Berhan healthcare workers played a crucial role in this highly successful partnership. Key focus areas were strengthening hospital services related to HIV care through improved infection prevention training and policies, increasing patient involvement to improve quality of care, and improving professional knowledge and training opportunities through professional exchanges. Through these, Debre Berhan staff received targeted training on topics ranging from case management and adherence to integrated care and the role of nurses in patient assessment and care.

Through their partnership with Elmhurst, Debre Berhan increased ART uptake from 1,789 patients in 2007 to 5,282 patients in 2014, expanding HIV treatment and care to four rural hospitals and 86 health centers in their catchment area. US partners also helped expand overall medical and psychosocial care for PLHIV, including improving counseling and testing and pain management procedures, and establishing consumer support groups and a Hospital Governance Board, which includes hospital staff, local government representatives, and members of the community at large.

US partners trained their Debre Berhan counterparts on other topics as well, including palliative care, mental health screening, ophthalmological care for PLHIV, post-partum hemorrhage, and hypertension in pregnancy. Experts from Elmhurst also worked with their partners to create the local institution’s

first infection control manual. Elmhurst infection control specialists provided comprehensive training and mentorship for Debre Berhan staff, helped them establish a system of infection control rounds throughout the hospital, and instituted employee interviews to determine knowledge of hospital-associated infections.

Partners also established a pen pal project between patients at both hospitals, who share information about their experiences living with HIV, as well as strategies for coping and staying adherent to treatment; this project has strengthened the patient advisory panels at both hospitals.

As a result of the partnership, Debre Berhan created the position of nursing supervisors to oversee nursing education and act as a liaison between the nurses and the administration and introduced 8-hour shift schedules to improve efficiency and quality of care. Partners also opened a Knowledge Management Center to facilitate the practice of evidence-based medicine.

Prior to graduation in 2014, Debre Berhan Referral Hospital was recognized by Ethiopia’s Ministry of Health as the best performing lead hospital and the best cluster hospital nationwide. Having graduated from the Twinning Center’s technical assistance program, Debre Berhan has maintained their excellence and earned similar awards from the Ministry in 2015 and 2016. Debre Berhan is now considered a national benchmark rural hospital — an accomplishment administration and staff attribute directly to their twinning partnership with Elmhurst Hospital Center.

AIHA also managed a similar partnership linking Ambo Hospital with Jersey Shore Medical Center that graduated in 2011.

To read the final closeout report of AIHA’s Twinning Center Program, click here.

Addis Ababa University School of Social Work / Jane Addams College of Social Work and Midwest AIDS Training and Education Center, University of Illinois – Chicago / Institute of Social Work, Dar es Salaam, Tanzania
(2007 – 2012)

Partners improved care and support for orphans and vulnerable children in Ethiopia by providing in-service social work and case management training to community-based workers, as well as addressing the country’s long-term need for skilled social workers by strengthening pre-service training programs.

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In response to an acute need for qualified social workers at national and local levels to provide care, support, and protection for orphans and vulnerable children (OVC) in Ethiopia, AIHA launched a triangular partnership in 2007, linking Addis Ababa University School of Social Work with the Institute of Social Work in Dar es Salaam and Jane Addams College of Social Work and the Midwest AIDS Training and Education Center at the University of Illinois in Chicago under our HIV/AIDS Twinning Center Program.

At that time, many of the psychosocial care providers working to address the needs of PLHIV or those affected by AIDS epidemic had little or no training on how to handle the complex needs of this and other vulnerable populations.

This partnership worked to change this by strengthening the social welfare workforce on multiple levels and building local capacity for ongoing training that would better support the delivery of care to OVC and their families or caregivers.

Drawing on the Tanzania experience, partners worked to develop a training program and supervision structure for community-based psychosocial care workers providing HIV/AIDS information and linkages to care and support to OVC. In addition to providing skills-based training in key social work and case management, the curriculum also contained lessons on psychosocial support, advocacy, and how to link clients to needed legal, education, medical, mental health, food and nutrition, housing, child rearing, and life skills services, as well as vocational training. Together, they trained more than 742 psychosocial care providers HIV/AIDS issues and OVC support, along with 147 supervisors.

Prior to graduation in 2012, this partnership also focused on improving the quality of pre-service curricula at the bachelor and master levels, conducted a professional symposium on social work education and practice in Ethiopia, and established an alumni association to advocate for the social work profession.

To read the final closeout report of AIHA’s Twinning Center Program, click here.

Ethiopia Ministry of Health, National Counseling and Testing Sites / Liverpool VCT
(2007 – 2012)

This south-south partnership worked to improve access to voluntary counseling and testing, particularly in under-served or disadvantaged segments of the population, as well as increase national capacity to train workers to provide counseling and testing.

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Voluntary counseling and testing services play a critical role in any country’s national HIV/AIDS strategy and in the programming supported by PEPFAR. The rapid development of counseling and testing in Ethiopia has necessitated a review of guidelines for HIV counseling and testing, especially in the area of policy and implementation, while the increased availability of both antiretroviral medications and drugs to treat common opportunistic infections has created greater opportunities for provider-initiated counseling and testing at healthcare facilities. From 2008 to 2012, AIHA supported the Ethiopian Ministry of Health’s efforts to expand HIV counseling and testing services, first tapping into the expansive knowledge and technical expertise of Liverpool VCT, an NGO based in Nairobi, Kenya, and later providing direct technical assistance.

Key areas of collaboration between the Ministry of Health and Liverpool VCT were focused on policy development, quality assurance, and the creation of resource materials for staff and patient education. Under AIHA’s leadership, a core team of in-country partners was established in December 2010 with the objective of further enhancing the quality of HIV counseling and testing services throughout Ethiopia and to help expedite the development and implementation of a new HIV Counseling and Testing National Quality Assurance Manual.

Members were selected by the Ministry of Health and included representatives of Ethiopia’s HIV Counseling and Testing National Technical Working Group, CDC/Ethiopia, the Ethiopian HIV/AIDS Counselors Association, and the Ethiopian Health and Nutrition Research Institute (EHNRI), and other key stakeholders in HIV/AIDS education, prevention, and treatment. In addition, AIHA has provided significant technical contributions toward the development of a broad range of HIV counseling and testing manuals and policy pa- pers, including the Stress and Burnout Management Manual (August 2011); the National VCT Curriculum (August 2011); the VCT Trainers Manual (September 2011); and the HCT Participant Manual (September 2011). AIHA’s technical experts also helped develop other resources, such as guidelines for couple’s counseling; working with MARPs; home- based HTC; mobile VCT; PICT; PMTCT; and comprehensive HIV counseling and testing trainer and participant manual.

AIDS Resource Center / National Clinician’s Consultation Center at the University of California-San Francisco
(2006 – 2012)

This partnership supported clinical, pharmaceutical, and laboratory institutions through the development and expansion of a national telephone consultation service or “warmline” that offers information and advice to healthcare professionals working in HIV/AIDS care.

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Increased access to ARVs in Ethiopia has generated a need for members of the health sector workforce to rapidly increase their knowledge on HIV/AIDS care. In support of the CDC’s implementation of national IT systems, partners at the National AIDS Resource Center (NARC) and the National Clinician’s Consultation Center at the University of California-San Francisco established FITUN Warmline, a call-in service that allows physicians all over the country to record questions on clinical care, which will then be researched and promptly answered by NARC specialists.

The goal of this partnership, which was active from 2006 to 2012, was to improve access to quality HIV care in Ethiopia by providing expert consultation for health workers caring for PLHIV. US partners trained FITUN staff on Warmline methodologies and HIV-related topics.

Partners jointly developed training manuals on a broad range of topics, including ART, perinatal care, PMTCT, post-exposure prophylaxis, clinical pharmacy, pediatric HIV, techniques of effective clinical consultation, opportunistic infections, and TB/HIV, which are used to train FITUN staff. They also developed and implemented a continuous quality improvement program to ensure the Warmline is providing relevant and up to date information to healthcare providers.

By 2012, FITUN Warmline had provided more than 1,800 clinical consultations both via telephone and email.

FITUN Warmline continues to provide critically important consultation to a wide variety of health personnel, including physicians, nurses, health officers, health extension workers, pharmacists, and other HIV care providers, making it a critical tool supporting community health, primary care, and access to HIV/AIDS prevention, care, and treatment.

Ambo Hospital / Jersey Shore University Medical Center
(2007 – 2011)

Members of this hospital-to-hospital partnership worked to improve the quality of HIV/AIDS care by developing both human resource and organizational capacity at Ambo. Key objectives included establishing an infection control program and strengthening coordination of care services to improve patient retention.