Ethiopia

Ethiopia is a land locked horn of Africa country with estimated area of 1.1 million kilometers square and borders with Eritrea in the north, Djibouti in the east, Somalia in the south east, Kenya in the South and Sudan in the west. Ethiopia is divided into nine regional states and two city administrations. In 2007, UNDP ranked Ethiopia 171 of out of 179 countries in the world in Human Development Index (HDI), a worsening situation from 169 out of 171 in 2006. The HDI for Ethiopia was 0.414 in 2007.The economy is largely dependent on agricultural exports the
main export being coffee.

In November 2001, Ethiopia qualified for debt relief under the Heavily Indebted Poor Countries (HIPC) program and has invested the accrued proceeds widely including physical infrastructure and health sector. The Ethiopian health sector, however, still receives substantial bilateral support which includes Global Funds towards the National Health Plan and discrete donor support from USAID (TBCAP) and PEPFAR. The funds are invested in building and expanding the health infrastructure, rapidly scaling up of health work¬force and revamping the health information systems. The aim is to put in place 3200 health centers by 2010 – including 2500 new ones over half of which are under construction. By December 2008, 11 446 health posts had also been constructed against the target of 15 000 to bring primary health care to all communities. The federal government has also embarked on social mobilization thorough the health extension workers program.

Tuberculosis situation

 
Ethiopia one of 22 high burdened countries in the world reported 141 157 All forms of TB in 2008  corresponding to CNR 175. Twenty nine percent (29%) of the reported cases were new smear positive PTB cases, 35% New smear negative PTB, 35% new extra pulmonary TB and 1% are

re-treatment cases. The CDR is 47% for all cases and 32% for new smear positive PTB cases. By the end of December 2009, Ethiopia had 81(46 non GLC and 35GLC) MDR-TB cases on treatment. Another 300 cases were on register awaiting treatment. No XDR TB cases were reported so far.

TB treatment is provided free of charge in all public health facilities. The treatment success rate for new smear positive PTB cases started on treatment in 2007 was 84%, 6% died while on treatment, 2% failed and 4% were transferred out and 4% defaulted on treatment. The national HIV sera prevalence is 2.5%. A national policy for counseling and testing of TB patients for HIV is in place with universal HIV counseling and testing to all patients seeking care. The uptake is almost unanimous with well over 90% of all notified TB cases tested for HIV in 2008. Thirty one percent (31%) were HIV positive. WHO estimates that in 2007, 40% of TB cases were co-infected with HIV. Although the program prioritizes isoniazid preventive therapy (IPT) for PLWHA, IPT is not provided at the moment because of shortage of isoniazid in the country.

[Core indicators ETHIOPIA: to be obtained from the country data, WHO global report on TB (http://www.who.int/tb/publications/global_report/en/index.html ) and UNDP country statistics ( http://hdr.undp.org/en/statistics ).

Role of KNCV Tuberculosis Foundation

KNCV has had a long standing relationship with NTP Ethiopia since 1990s providing significant technical and financial support during the introduction of DOTS in 1994. All along, the technical support was provided at distance, with specific country missions by consultants based at The Hague. In 2008, however, this changed when KNCV was given the leadership of TB CAP project in Ethiopia, with resultant great achievements in 2009. KNCV thus coordinates partners in TB control implementing the USAID support through the TB CAP APA4 and 5.

Achievements

From 2008 to date KNCV has provided technical support missions starting a situational analysis of the drug resistant problem in Ethiopia by Kitty Lambregts. This was followed by drafting of the treatment guidelines for MDRTB and subsequent application for treatment a cohort of 45 patients every year to the green light committee. Treatment was initiated in 81 MDR-TB patients (46 non GLC and 35 GLC) and plans are underway to expand PMDT countrywide. KNCV also supported Ethiopia to asses the risk of TB transmission in the health facilities through a mission conducted by Hans Mulder and Amos Kutwa in November 2008. This was followed by developing of the TB Infection control guidelines, a national training curriculum and implementation by training in all regions of Ethiopia, providing the TB IC protective equipment and renovations to St Peter’s and ALERT hospitals to allow for admission of MDRTB patients in strict observation of TB Infection control measures.

Next steps

KNCV is in the process of registering as a local NGO in Ethiopia. If it succeeds, KNCV will open country offices, employ technical officers to support TB care in Ethiopia building capacity for PMDT as well as enhancing DOTS countrywide. Meanwhile KNCV shall give technical support for implementation of TB CAP 4 projects funded by USAID. KNCV intends to reestablish relationship with the national TB and leprosy program through a formal MOU for technical support for the expansion of DOTS.