This is a continuing activity. The Federal Ministry of Health (FMOH) of Ethiopia is the lead Government of Ethiopia (GOE) entity responsible for oversight of the national health care system with the overall goal of improving the health of Ethiopians. The FMOH efforts are guided by a multi-year strategy called a Health Strategy Development Plan (HSDP). Each HSDP is for a five-year period. The FMOH is currently on its fourth HSDP (commonly referred to as the HSDP IV). The HSDP is developed and implemented in collaboration with different development partners and stakeholders, which includes bi-lateral, multi-lateral, international organizations and the private sector. In addition, the FMOH has been a principal recipient of GFTAM funding over the last several years. The USG PEPFAR activities are in line with and support the goals of the FMOH HSDP via the GOE and USG HIV/AIDS Partnership Framework and Global Health Initiative. To strengthen the overall management and coordination of HIV funding coming into Ethiopia, the FMOH also developed a Strategic Plan and Management (SPM) for intensifying the multisectoral HIV/AIDS response. The first SPM was for the period 2005-2010. The FMOH recently developed the second follow-on SPM (or SPM II) for the period 2010-2015. The USG provides direct funding and technical assistance to the FMOH to support building its capacity to specifically lead and manage the national health management information system (HMIS), the national TB/HIV program and the national HIV testing and counseling program.

Diagnosis of TB among smear negative suspects, HIV positive individuals and pediatric clients has been a challenge for the Ethiopian TB Control Program. Among the challenges is the limited access to X-ray equipment for TB diagnosis in most regions. In FY2011, the FMOH has made efforts to identify the X-ray needs and existing capacities within facilities and prioritized facilities to receive technical assistance and support based case load, geographic access and infrastructure capacity. The National TB Program has already procured one digital and 15 conventional X-ray machines and six backup generators for selected facilities. Under COP2012, the FMOH will:

Procure an additional six X-ray machines and backup generators and support minor renovations of X-Ray rooms to meet Ethiopian radiation authority standards.

Provide in-service training for health care workers on X-ray reading and interpretation and will undertake supportive supervision and review meetings to oversee and monitor staff and overall program performance.

Conduct periodic site assessments to oversee the functionality of installed X-ray machines and identify additional facilities are ready to receive technical assistance and support.

Promote transmission of electronic and paper based TB control messages to the public on regular basis using the public media to raise awareness of TB and TB/HIV.

Lead and coordinate TB control advocacy during world TB day commemoration events.

Support capacity building training and experience sharing of the national TB control program to improve technical and leadership capacity at central level.

The effectiveness of a health information system in providing information support for decision-makers depends upon the deployment of well-trained staff. Not only must the mechanics of data collection and reporting be mastered, but high familiarity with case definition, disease classification, service standards, and information use are equally important. In prior years, the FMOH has provided in-service training related information management for over 27,000 health professionals and administrative staff. The FMOH has developed guidelines for integrated supportive supervision to oversee HMIS implementation and management within health facilities and printed and distributed HMIS registers and related material for and formats to health facilities. Under COP2012, the FMOH will:

Provide in-service training to health workers in health facilities that have not yet started HMIS implementation, un-trained workers who have newly joined the health care system as well as refresher training for those who are currently managing the HMIS.

Update and distribute HMIS guidelines and ensure adherence to minimum requirements.

Conduct advocacy at the national-level within the leadership of the health care system to create an enabling environment for HMIS and avoid the development of parallel or duplicative information systems.

Establish an HMIS performance monitoring team within the FMOH.

Print and distribute HMIS registers, tally sheets and cards in a timely manner.

Support Regional Health Bureaus for the planning and conduct of regular HMIS supportive supervisions to health facilities.

Organize regular national HMIS forums to disseminate best practices and collectively address challenges.

The Ethiopian Federal Ministry of Health has made a strong commitment to the process of establishing a national centre of excellence for continuing medical education, combining training, research, and health services. Building the capacity of the Ethiopian health service is essential in order to address the multiple health crises affecting the country. In particular, sustainable human resource development is a priority of the FMOH. Based on this, there are plans to establish a national HIV/AIDS training centre at ALERT hospital, located in the capital (Addis Ababa), to provide training to a wide range of health workers in the field of HIV/AIDS. This would build on ALERTs comparative advantage of being an integrated hospital with long-standing community links, a research center and a training department with solid managerial capacities and technical expertise in various medical arenas.

The FMOHs current in-service training strategy is focused on housing all in-service trainings in one institution like ALERT hospital training center. The institute has already started working with the Addis Ababa City Administration Health Bureau (AACAHB) to conduct HIV related trainings. The proposed national institute would strengthen the in-service training programs of AACAHB and the FMOH.

In addition, the National Training Center will support the AACAHB in establishing facility based in-service training units. In COP 2013, FMOH will :

1. Provide technical assistance to establish in-service training centers at the facility level in Addis Ababa, in collaboration with AACAHB, FMOH, and international stakeholders.

2. Provide training for the health professionals in Addis Ababa.

3. Monitor the progress of the training services provided at ALERT and facilities in Addis Ababa.

The Voluntary Medical Male Circumcision (VMMC) program in Gambella region has been implemented through the prime partner JHU/TSEHAI and its sub partner JHPIEGO since 2009. Since the inception of the program in 2008, the goal was to circumcise 80% of adult men, or approximately 45,000 adult men in Gambella Region, in order for VMMC to have a preventive effect in the community. However because of low demand for male circumcision (MC) due to low awareness about the benefits of circumcision, cultural issues, and inadequate health infrastructure performance, uptake of VMMC was very low in the early phases of the program. Through a concerted effort by JHPIEGO, the RHB, and organizations working in the community like CRS, the awareness about MC and demand gradually increased. JHPIEGO, the main technical implementing partner for MC in the region, circumcised more than 23,000 adult men the by the end of COP 2011 through 11 stationary (1 Hospital & 10 Health Centers) and 8 outreach MC sites. Extensive MC campaigns, involvement of HEW in household level education on MC, and referral and introduction of disposable surgical kits for field level surgery, have also contributed to the improvement of performance. JHPIEGO, in collaboration with the Ethiopian Surgical Society (ESS), has trained 56 mid level professionals (nurses and Health officers) working in the 10 facilities. This training has enabled a successful shift of MC tasks from surgeons mobilized from centers, to those locally trained mid-level professionals.

Since HHS/CDC will be closing out its cooperative agreement with JHU/TSEHAI in COP 2013, there is a need to transition VMMC program activities to the FMOH to ensure local ownership and long-term sustainability. With technical assistance provided by HHS/CDC and its partners, the FMOH will take over the technical and managerial responsibilities of the VMMC program activities in Gambella region starting in COP 2013, and will provide the necessary technical support to the RHB to carry out the following activities:

1) Provide all logistics support, including procurement and timely delivery of MC kits and supplies.

2) Expand VMMC services to the remaining 14 health centers (8 existing 6 new under construction) and circumcise the remaining10-15,000 adult men in the region in COP 2013, in accordance with WHO/UNAIDS/JHPIEGO manuals, which incorporate the MC minimum package of services. (More than 30,000 adult men will be circumcised by the end of COP 2012).

3) Promote introduction of male neonatal and adolescent male circumcision program in all eligible health facilities in the region.

4) Supervise, monitor and technically support facilities in service data documentation, reporting, and utilization of data for services improvement.

Provide technical assistance to and follow up with facilities to establish and implement quality assurance standards for VMMC services. In collaboration with HHS/CDC and its partners, the FMOH will carry out most of these activities, including procurement and distribution of kits and supplies, and also build technical and management capacity for VMMC at the federal and regional levels.

HIV testing and counseling (HTC) is the main entry point to HIV prevention, care, support, and treatment services. During the subsequent five years, there has been a significant increase from 801 HTC sites in 2006/2007 to 2,184 sites in 2009/2010. The number of clients using HTC services significantly increased during the same time period from 564,321 to 9,445,618. To date, the total number of people receiving HTC services in Ethiopia reached 24 million. The accelerated expansion of primary healthcare facilities, the decentralization of HIV/AIDS services, and the innovative millennium AIDS campaign- Ethiopia (MAC-E) launched in November 2006 at the eve of the new Ethiopian Millennium, have been the primary reasons for the significant increase in HTC service uptake. The FMOH has put in place two major national policy initiatives aimed strengthening health care services at the community level in both urban and rural areas. The Urban Health Extension Program (UHEP) will extend primary health care coverage in Ethiopia by using Urban Health Extension Professionals (e.g., clinical nurses) to provide health services at the household-level in urban Kebeles (neighborhoods). These professionals will promote and provide HTC services. The FMOH also is the lead coordinator for the Ethiopian National HIV Counseling & Testing Day, which is observed on the eve of the Ethiopian New Year every year, which is a large-scale national-level promotion of HTC. Under COP2012, the FMOH will continue to provide oversight and leadership in the coordination and supervision of HTC services as well as review and update national policy documents, guidelines and training curriculum as it relates to HTC.

The FMOH is the lead government entity responsible for coordination, implementation and oversight of the national PMTCT program. The FMOH has established and is leading the National Safe Motherhood and the PMTCT TWG to coordinate and direct implementation of the national PMTCT program. The FMOH has recently adopted Option B+ and has developed the National Strategic Plan for the Prevention of Mother-to-Child Transmission of HIV and congenital syphilis: 2013-2015. In collaboration with PEPFAR and its partners, it has also developed the National Guidance for the Implementation of Option B+ in Ethiopia.

The FMOH will support a gradual transition of PMTCT services to the regional health bureaus to ensure local ownership of the PMTCT program.

In COP2013, the FMOH will:

Update guidelines, training packages and job aids to implement option B+; print and dessiminate printed materials

Support rolling out of Option B+ through training and mentoring of health care providers at facilities providing PMTCT services.

Coordinate and support the implementation of PMTCT quality improvement approaches to improve retention of HIV positive mother and HEIs in care services.

Enhance the role of Case Mangers and MSGs to improve retention of HIV+ women and family members in care and treatment services.

Support implementation of the updated PMTCT monitoring system in line with Option B+.

Support training on safe pregnancy and FP counseling, and promote integration of FP and HIV services.

Support integration of TB screening with PMTCT program.

Undertake supportive supervision and review meetings to oversee and monitor overall PMTCT program

Support the national PMTCT program evaluation.

This is a new activity with emphasis on ownership and strengthening the capacity of FMOH(PFSA) for procurement of HIV related laboratory commodities for better diagnosis, capacity building and sustainability in Ethiopia. In addition, FMOH has developed strategy and implementation plan headed by EHNRI for point of care (POC) equipment including PIMA CD4 machines and is going to procure 50 PIMA machines. Thus, the FMOH will require funds to purchase cartridges for PIMA CD4 machines and other lab commodities related with diagnosis and monitoring of HIV.

In COP 2013, the FMOH (PFSA), with technical support and guidance from EHNRI (the federal agency responsible for laboratory related activities), will procure necessary laboratory commodities for POC tests like cartridges for PIMA CD4 machine and other lab commodities and reagents related to the diagnosis of HIV. This will be an opportunity for FMOH and the PFSA to move towards the ultimate goal of country ownership and sustainability in areas related to procurement of commodities for diagnosis and treatment of HIV.