These factors have produced in Ethiopia challenging health and social conditions. For example, at the present time Ethiopia ranks highest in the world in malnutrition rates and lowest in primary school enrollment. The health care system is under-financed with poor management capacity restricting access to basic health services. One fifth of Ethiopian children die before age 5, often from preventable diseases such as diarrhea, measles, respiratory infections and malaria. Maternal mortality, at 7-14 deaths per 1,000 live births, is among the highest in the world.

Moreover, Ethiopia is one of the countries hardest hit by the HIV/AIDS epidemic. It is estimated that 2.6 million to 3 million Ethiopians have HIV – with eighteen percent of the urban population HIV positive.

The WHO estimates that malaria causes 1006 deaths per 100,000 Ethiopians ages 0-4, and 198 deaths per 100,000 of all ages. Three-quarters of the territory of Ethiopia is malarious, and the country has approximately 5 million cases of malaria each year. Less than one percent of Ethiopian children sleep under treated bednets. The TB prevalence rate is 370 per 100,000, and the TB death rate is 88 per 100,000 population.

Sources: UNDP/UNICEF; United Nations Statistics Division; AllAfrica.com: Addis Tribune (Addis Ababa), January 23, 2004; Synergy Project; WHO 2004 Global Tuberculosis Report

• Democratization and decentralization of the health service system;
• Development of the preventive and promotive components of health care;
• Development of an equitable and acceptable standard of health service system that will reach all segments of the population within the limits of resources;
• Promoting and strengthening of intersectional activities;
• Promotion of attitudes and practices conducive to the strengthening of national self-reliance in health development by mobilizing and maximally utilizing internal and external resources; and
• Assurance of accessibility of health care for all segments of the population.

In addition, the government is intent on providing health care for the Ethiopian population on a scheme of payment according to ability with special assistance mechanisms for those who cannot afford to pay and the promotion of the participation of the private sector and non-governmental organizations in health care.

Tuberculosis control activities acount for 5 percent of the Ethiopian government's spending on health. Ethiopia has a 2002-6 Strategic Plan for TB Control that utilizes a DOTS strategy. Ethiopia, which has implemented DOTS program for TB in about 95 percent of the country, is identified by the WHO as one of the 22 high-burden countries for that disease. The effectiveness of DOTS is limited by the fact that less that half of Ethiopians live more than 10 kilometers away from any health facilities. As a result, Ethiopia has a low case detection rate of 43 percent. The DOTS treatment success rate in Ethiopia is 81 percent. A recent study by the Ethiopian Ministry of Health (published the International Journal of Tuberculosis and Lung Diseases, July 2002) found a DOTS default rate of about 11 percent in several districts of the country. Researchers attributed the defaults to medication side effects, lack of knowledge about DOTS, and lack of family support. A national TB/HIV coordinating body has just been formed, but activities have not yet begun.

Ethiopia's government announced in April 2006 that it is launching a five-year malaria treatment and prevention plan at a cost of USD 447 million in an effort to lessen the burden of the disease in Ethiopia. The plan will provide early diagnosis and treatment services and implement mosquito control measures, including the provision of insecticide treated nets and indoor residual spraying. The funds will come from the government budget, the donor community and other partners in the health sector. An estimated 68 percent of the country's 73 million people who live in malaria-prone areas will have access to treatment by 2010 when the plan is expected to be fully implemented. It is estimated that 6 million cases of malaria occurred in Ethiopia during the last epidemic between April and December 2003.

Sources: Healthinfo-Ethiopia plc; United Nations Statistics Division; WHO Report 2003: Global Tuberculosis Control; PubMed abstracts; AllAfrica.com: Addis Tribune, 4-25-2003; IRIN, December 23, 2003; WHO 2004 Global Tuberculosis Control Report; IRIN, July 30, 2004 AllAfrica.com;

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

The importance of the private sector in Ethiopia's health infrastructure is growing. For example, Addisa Ababa now has 12 private hospitals and approximately 450 private health clinics.

Ethiopia has three medical schools, located at Addis Ababa University, Jimma University, and Gondar College of Medical Sciences. The country also has some of the basic infrastructure necessary for an indigenous pharmaceutical industry. Two factories in the country, including one owned by Bethlehem Pharmaceuticals, have been licensed to produce ARV drugs. Production has not yet begun due to a lack of investment funds.

Sources: World Bank, IIME Database, WHO Report 2003: Global Tuberculosis Control, IRIN, 10 March 2004

Armauer Hansen Research Institute (AHRI) ( website )

AHRI enjoys EU funding for several research projects, including:

• Development of a new TB vaccine in collaboration with Denmark's Staten Seruminstitute. The PI at AHRI is Joseph Olobo.
• A study of latent TB, a component of which is to improve detection techniques in TB-endemic countries such as Ethiopia.

AHRI is also collaborating in a long-term study of TB genetics with McGill University, and working with other Canadian researchers on TB epidemiological studies.

Dr. Getahun Abate, an AHRI staff member, is the PI for a study of colorimetric assays for the detection of MDR-TB.

Sources: AHRI home page (click on the 'projects' link), WHO MDR-TB Research Database

Ethiopian Health and Nutrition Research Institute, Vaccine Research and Development Task Force

Jimma University, Institute of Health Sciences ( website )

Current research priorities include communicable diseases, maternal and child health, and delivery of health services. The university is home to the Ethiopian Journal of Health Sciences.

Medical School of Gonder

Current research includes:

• the treatment of complicated malaria
• diarhea and AIDS

Source: S. Getahun: History of Gondar Medical College

University of Addis Ababa, Department of Medicine; School of Pharmacy

1. In the 4th round of funding the GFATM approved a grant for $45 over two years to fight HIV/AIDS. The total amount requested was $405 million. The grant agreement is awaiting signature. Source: GFATM