Expanding PMTCT Services in Private Health Sectors in Ethiopia

In FY08, the Ethiopian Public Health Association (EPHA) will continue prior-year activity by serving as the

prime PEPFAR partner implement expansion of PMTCT services in private health institutions in the city of

Addis Ababa. EPHA will subcontract with the Ethiopian Society of Obstetricians & Gynecologists (ESOG). In

FY08, ESOG will continue supporting expansion of PMTCT services in hospitals and special clinics with

maternal-child health (MCH) services in Addis Ababa.

ESOG is a nonprofit professional organization that claims nearly all obstetricians and gynecologists in the

country as its members. Previously, the society has effectively implemented several safe-motherhood and

reproductive health projects, in collaboration with both national and international organizations, including the

Federal Ministry of Health (MOH), the International Federation of Gynecology and Obstetrics (FIGO),

IntraHealth/USAID, and the David and Lucille Packard Foundation. Currently, the society is also engaged in

several nationwide efforts to reduce maternal and newborn morbidity and mortality. Because several ESOG

members are providing MCH services in the private sector, ESOG has a comparative advantage to

implement and expand PMTCT services in private health facilities, particularly in urban settings where the

HIV seroprevalence among pregnant women is very high. Furthermore, as a professional organization,

ESOG can play an advocacy and leadership role to scale up PMTCT in Ethiopia.

Expanding PMTCT Services in Private Health Sectors in Ethiopia

In order to facilitate implementation of PMTCT, in FY07, ESOG identified training needs by assessing

existing knowledge, attitudes, and practices on

PMTCT among health professionals working in private health facilities. The findings will also be

disseminated using the Society's publication, The Ethiopian Journal of Reproductive Health. Based on the

needs revealed in the assessment, 150 health professionals will be trained, and 25 health institutions

strengthened to enroll 7,875 pregnant women in voluntary counseling and testing (VCT) and provide a

complete course of ARV prophylaxis in a PMTCT setting to 900 pregnant women. ESOG will provide

continuing supervision support to these health professionals, as well as technical support to MOH and the

Addis Ababa Administrative City Health Bureau.

In FY08, the number of service outlets providing the minimum package of PMTCT according to national and

international standards will be increased from 25 to 30, and 180 health professionals in these institutions will

be trained to provide VCT service to 9,450 pregnant women and provide a complete course of ARV

prophylaxis to 1,080 HIV-positive pregnant women. Referral linkages among health facilities will be

established and supportive supervision will be provided for the effective implementation of PMTCT. ESOG

will continue a strong collaboration with the Addis Ababa Health Bureau, associations of private health

workers, ABT Associates (a private-sector partner) and PEPFAR-supported PMTCT implementing partners

in order to harmonize and avoid duplication of efforts in implementing PMTCT services in the private and

nongovernmental sectors.

EPHA will support institutional capacity building of ESOG so that it can be more responsive to the high

demand for PMTCT services in the country.

Infection Prevention Advocacy

Infections acquired in health facilities (nosocomial infections) are a serious problem throughout the world,

but particularly in developing countries like Ethiopia, where infectious diseases are prevalent and there are

severe constraints on health resources.

Healthcare providers are a critically important resource in Ethiopia. Like the patients for whom they care,

they are at risk for nosocomial infections, including HIV, but they are often overlooked in HIV prevention

programs.

The Ethiopian Public Health Association (EPHA) believes that professional associations, such as the

Ethiopian Medical Association (ENA), the Ethiopian Nurse Midwives Association (ENMA), the Ethiopian

Nurses Association (ENA), and Lab Associations, have moral mandates and professional responsibility to

advocate for standard safety procedures and to protect their members from HIV infection. In FY06, EPHA

laid the groundwork for this project, bringing together the associations with members at high risk for

nosocomial HIV infection with specialized institutions like JHPIEGO, Making Medical Injections Safer/John

Snow International (MMIS/JSI), and the Ethiopian Federal HIV/AIDS Prevention & Control Office/Ministry of

Health.

In FY06 and FY07, EPHA continued working with associations for health professionals on infection

prevention (IP)—addressing medical doctors, nurses, nurse midwives and laboratory technicians with the

objective of preventing healthcare workers and beneficiaries from acquiring nosocomial infections (including

HIV) on the job.

Major activities included in this project are: basic IP trainings & training-of-trainers (TOT) for members of

associations for health professional (ENA, ENMA, EMA & EPHA); panel discussions; continuing medical

education and continuing nursing education (CME/CNE); and advocacy campaigns to bring the attention of

policy makers & stakeholders to the need for infection prevention. The main strategies of the project include

involving sister associations (ENA, EMA, ENMA) and creating linkages between major stakeholders

(JHPIEGO-Ethiopia and MMIS/JSI).

Building on FY07 activities, during FY08, EPHA will continue its advocacy expansion work through

professional associations and with partners at regional and district levels. Activities will include: advocacy

through panel discussions, workshops, and CME/CNE; in-service trainings; TOT; experience-sharing

schemes; dissemination of educational and informational brochures, posters, and pamphlets; supporting

regional health bureaus and district health offices to conduct supportive supervision and monitoring;

conducting review meetings; establishing Infection Prevention/Universal Precaution (IP/UP) committee; and

situational assessment/data generation and dissemination. Building the capacity of sister associations and

strengthening the Technical Working Group are among activities given priority during FY08.

This is a continuation activity following on from a formative assessment completed by the Ethiopian Public

Health Association (EPHA) in FY07 on men who have sex with men (MSM) and HIV.

Sex between men occurs all over the world. In Europe, the Americas, and Asia, the lifetime prevalence of

MSM ranges between 3% and 20%. Recent evidence highlights increasing risk levels and vulnerability in

this group in developing countries. Due to stigma and discrimination, male-to-male sex is frequently denied,

forcing the HIV epidemic underground and threatening the health of MSM, and their male and female

partners. Studies in certain developing countries indicate prevalence of HIV and sexually transmitted

infections (STI) among MSM as high as 14.4% and 25% respectively. Few epidemiological studies exist on

HIV and vulnerability to sexually transmitted infections among MSM in sub-Saharan Africa. In Ethiopia,

before this recent assessment on MSM, there had been very little information about MSM and their HIV risk

behavior. As in most developing countries, MSM tend to congregate in cities, in places frequented by

expatriates, and along major tourist travel corridors and destinations. A recent pilot study of MSM in Addis

Ababa confirms that this population has long existed covertly. The assessment showed that MSM have an

early age of sexual debut, and male-to-male sex appears to be on the increase. MSM were found to have

misconceptions about HIV risk; some believe sex with men carries a lower risk of infection than

heterosexual sex.

In FY08, EPHA will conduct the following activities:

1) Dissemination workshop on the result of the assessment of MSM conducted in FY07, where all regional

HAPCO representatives and responsible persons will be in attendance

2) Technical assistance support on HIV interventions among MSM in a hidden population

3) Strengthen interventions reaching the MSM network with promotion of condoms and counseling and HIV

testing

4) Studies of STI and HIV prevalence among MSM.

5) Developing training manuals on MSM behaviors and MSM/HIV prevention for counselors and health

workers

6) Training of 40 health workers on counseling and working with MSM in a hidden population (in the

Ethiopian context)

7) Participatory community assessment on identification of MSM-network meeting places

8) Experience-sharing visit to Kenya and Ghana to look at successful program interventions on MSM and

HIV

9) Development and distribution of educational materials adapted to the needs and contexts of MSM

10) Procurement and provision of condoms and lubricants

11) Creation of a referral system for STI and linkages to HIV counseling and testing

This funding will be used by the Ethiopian Public Health Association (EPHA) to provide technical assistance

to Health Extension and Education Center (HEEC) of the Federal Ministry of Health, one of the departments

in the HEEC is Health Communication which deals about Health Education and promotion.

This program is designed to build the capacity of HEEC so that HEEC will play a leading role in leading and

standardizing the national health communication programs particularly HIV/AIDS communication

interventions in a sustainable manner. The activity will also include capacity building for the HEEC through

trainings, personnel secondment, technical assistance, and also equipment.

In this regard, HEEC will collaborate with the JHU/CCP/ARC to strengthen its technical capacity and to

undertake different activities through this program. The activities includes organizing national symposiums

to enhance leadership in strategic health communication; standardize national IEC/BCC materials to make

sure HIV/AIDS communication is incorporated in the heath sector system (wraparound). The activity will

also help to establish HIV/AIDS communication national taskforce and carry out some activities in the sow

of the taskforce.

EPHA is also required to implement a twinning between HEEC, JHU/CCP/ARC, Behavioral Science

Department of JHSPH, HAPCO and Jimma University. Part of this funding will also be used to support and

provide technical assistance to Federal HIV/AIDS Prevention and Control Office (HAPCO) to scale up the

National HIV Prevention Advisory Group, Lead TWG, Advocacy, Social mobilization and behavior change

communication activities.

No narrative 10/8/08

Laboratory Capacity Development

This is a continuing expanding activity implanted by the Ethiopian Public Health Laboratory Association

(EPHLA), established and supported by PEPFAR Ethiopia to achieve its objectives with an efficient

laboratory system and professional diagnostic skills, as well as quality assurances in enhancing capacity of

laboratory professionals needed for high laboratory standards. These will contribute to optimal provision of

laboratory services and influence a high quality of ART services in Ethiopia.

Starting in FY08, EPHLA will contribute to national laboratory services by providing technical support to

National Technical Working Groups on drafting national laboratory policy and assist with developing

qualitative assessments, drafting, and finalizing the national laboratory policy and its guidelines.

With PEPFAR/Ethiopia support, EPHLA will continue supporting local organizational capacity development

through laboratory education, workplace HIV/AIDS interventions, publications, dissemination of research

findings, and strengthening of public health laboratory systems in Ethiopia. In partnership with the Ethiopian

Public Health Association and the Associations of Public Health Laboratories/USA, EPHLA will continue its

activities to: strengthen the capacity of public health laboratory facilities to support the HIV/AIDS program;

provide in-service trainings to 60 lab professionals in private health institutions (the public sector is covered

by the government); and support five Masters theses in Laboratory Science. The Ethiopian Health and

Nutrition Research Institute will assist trainings with the national standard guidelines. Continuing education

to upgrade and accredit laboratory professionals will be provided to 100 members.

Capacity Building for Evidence-informed Decision Making, Generation and Dissemination of Strategic

Information

I. AIDS Mortality Surveillance ($910,000)

In FY06, with PEPFAR support, the Ethiopian Public Health Association (EPHA) began to support the Addis

Ababa Mortality Surveillance Project (AAMSP) to monitor the population impact of ART via analyses of age-

and sex-specific trends in AIDS mortality. In FY07, PEPFAR Ethiopia supported the expansion of EPHA's

AIDS Mortality Surveillance to four rural project sites, namely, Butajira, Gilgel Gibe, Dabat and Kersa, which

sites are run by Addis Ababa, Jimma, Gondar and Haramaya Universities, respectively. In addition, the

AAMSP continues. These five project sites have established a network for strengthening the generation of

usable information on the impact of AIDS and ART intervention for national level policy- and decision-

makers.

In FY08, EPHA will support two more new AIDS Mortality Surveillance sites, which will be run by Mekelle

and Arbaminch Universities. This will be a step toward ensuring that the data generated by AIDS Mortality

Surveillance projects is nationally representative so that it can be used by the Federal Government of

Ethiopia and other partners engaged in ART intervention efforts and reducing the impact of AIDS. EPHA will

also strengthen the networking of the project sites and training of university staff members and project-site

coordinators, critical supports required to ensure quality of the data generated. Since the surveillance sites

are linked to governmental universities, PEPFAR support will ensure continuous and sustainable generation

of information for decision-makers even after the phasing out of the fund.

II. Capacity Building for Evidence-Informed Decision making ($920,000)

In FY07, EPHA, in close collaboration with the Federal Ministry of Heath (MOH), regional health bureaus

(RHB), CDC Ethiopia, and CDC Atlanta, conducted a one-year Leadership in Strategic Information (LSI)

training program for leaders from five regions. Sixteen trainees from these regions completed the course,

including one staff member from the AAMSP. The need for this type of training had become evident, as it

enabled program managers to critically evaluate and use data for decision-making and designing and

implementing evidence-informed programs. Certificates were awarded for those who completed the course.

To meet the increasing need for the course, the LSI training program is to be expanded to Jimma University

in FY08 so that HIV/AIDS program managers at zonal and district levels can also be trained. The current

course capacity can accommodate only those from the regional level who are capable of serving as field-

site supervisors to the trainees of the Field Epidemiology Training Program.

To contribute to the sustainability of trained, human-resource capacity and continuity in the use of evidence-

informed data for decision-making in HIV/AIDS programs, EPHA, in collaboration with MOH and with the

support of CDC, has developed a two-year, field-based, service-oriented master's degree program in

advanced analytic epidemiology, public-health program management, laboratory management, and

communications. The program enrolled ten leader trainees at the end of 2007 for the two-year training,

which is based at Addis Ababa University and which enjoys the full support of MOH. This activity will

continue in FY08, during which the students will be attached to regions and health facilities to gain field-

level experiences.

III. Generation of Strategic Information and Institutional Capacity Building ($600,000)

EPHA is uniquely positioned in Ethiopia to assist in strategic-information generation and dissemination

activities because of its ongoing involvement in HIV/AIDS and related programs, supported particularly by

PEPFAR Ethiopia. In FY07, EPHA supported the generation and dissemination of strategic information by

supporting targeted evaluations and postgraduate theses in the areas of HIV/AIDS, sexually transmitted

infections, and tuberculosis to enhance the monitoring and evaluation capacity of the public health sector.

EPHA also disseminated surveillance data, best practices, and research findings through its annual

conference and sisterly professional associations, its website, and both regular and special publications

throughout the year.

During FY08, EPHA will continue supporting generation and dissemination of vital strategic information

through the EPHA annual conference, master's theses extracts, and publications for scientific communities,

policy-makers, health-service providers, and the general public. EPHA and its members will also engage in

operational studies and targeted EPHA-CDC project-evaluation activities. Another component of this activity

will be strengthening the leadership, technical, and managerial capacity of EPHA itself, so that it can

adequately respond to the increasing needs for evidence-based information for policy- and decision-making

on HIV/AIDS in particular, and public health in general.