1. SPECIAL SESSION COUNTDOWN TO 2015 IN ETHIOPIA CHALLENGES AND PERSPECTIVES IN ACHIEVING MILLENNIUM DEVELOPMENT GOALS IN ETHIOPIA Sandro Accorsi Advisor, Policy, Planning and Finance General Directorate Federal Ministry of Health Addis Ababa, 24 April 2012

2. Outline of the presentation Overview of MDG4, MDG5 and MDG6 indicators Trend in MDG indicators – Progress in achieving the health Millennium Development Goals (MDG) – Comparison of performance in Ethiopia and other sub- Saharan African (SSA) Countries Improving health and addressing inequities – Progress in addressing health inequities The case of Ethiopia: what’s unique? 2

3. Summary of main results from EDHS 2011: Population-based indicators INDICATOREDHS 2005 EDHS 2011 PERFORMANCE Under 5 Mortality Rate (U5MR) (per 1000 live births) 12388↑ Infant Mortality Rate (U5MR) (per 1000 live births) 7759↑ Neonatal Mortality Rate (U5MR) (per 1000 live births) 3937↑ Contraceptive Prevalence Rate (CPR) (%)1529↑ Maternal Mortality Ratio (MMR) (per 100,000)673676 ~=~= Total Fertility Rate (TFR) (%)5.44.8↑ Exclusive breastfeeding under 6 months (%)4952↑ Prevalence of anaemia among women (%)2717↑ Knowledge of HIV/AIDS (women)9097↑ Knowledge of HIV/AIDS (men)9799↑

4. Overview of MDG4 Indicators MDG4 to reduce child mortality with a target of reducing under-five mortality rates by two thirds over the period 1990-2015 – Under 5 Mortality Rate (U5MR) – Infant Mortality Rate (IMR) – Neonatal Mortality Rate (NMR)

5. MDG4: Trend in U5MR, IMR and NMR

6. MDG4: Comparison of trend in U5MR in Ethiopia and SSA countries

7. MDG4: Comparison of trend in IMR in Ethiopia and SSA countries

8. MDG4: Conclusions Children under 5 doubled their life expectancy over the past 20 years The lives of over half a million children in Ethiopia have been saved over the past five years Nutritional status has improved Ethiopia on track to achieve MDG4 – But sustained effort is needed for further reduction of Neonatal Mortality Rate

9. Overview of MDG5 Indicators MDG5 to improve maternal health, with a target of reducing maternal mortality ratio by three-quarters over the period 1990-2015 – MMR in EDHS 2000: 871 maternal deaths per 100,000 live births – MMR in EDHS 2005: 673 per 100,000 live births – MMR in EDHS 2011: 676 per 100,000 live births – No improvement in the last 5 years, but large confidence interval (541-810) implying high degree of sampling variability.

10. MDG5: Comparison of trend in MMR in Ethiopia and SSA countries

11. Trend in Contraceptive Prevalence Rate (CPR)

12. Trend in Total Fertility Rate (TFR)

13. MDG5: Conclusions High MMR from EDHS 2011: 676 per 100,000 live births, no improvement in the past 5 years (673 per 100,000 live births in EDHS 2005) – Large confidence interval and uncertainty about estimation Ethiopia needs special effort to achieve MDG5 However Over 5.6 million women of reproductive age are using contraception Women are increasingly empowered to use their preferred contraceptive method Urban areas with lowest fertility as compared to urban areas in Eastern and Southern Africa (ESA) Addis Ababa: only city in ESA with below replacement fertility after the 1990’s (TFR=1.5 from EDHS 2011)

14. Improving health and addressing inequities Dual goals of improving health status and addressing health inequities – MDG achievable without improving health in the lowest quintile (poorest 20%) Measurement of average improvement but also of reduction of inequities (urban/rural, socio-economic status, gender etc.) – Progress in reducing health inequality – Example of inequality in access to health service between urban and rural population (coverage, infrastructure etc.) – Other examples (i.e. on vulnerable groups) in following slides and presentations

15. Overview of MDG6 indicators MDG6 to combat HIV/AIDS, malaria, and other major diseases, with two targets to be achieved by 2015: – (i) to have halted, and begun to reverse, the spread of HIV/AIDS (target 7), and – (ii) to have halted, and begun to reverse, the incidence of malaria and other major diseases (target 8) Indicators on malaria and HIV/AIDS (from administrative reports) and on TB (from TB prevalence survey and administrative report)

16. MDG6: to combat malaria High disease burden, availability of cost-effective interventions, challenge of scale-up for disease control: the example of Insecticide-Treated Nets for malaria prevention - Comparison before and after 2005 showing an increase in ITN coverage in SSA - Ethiopia is among the leading countries in SSA

17. MDG6: to combat malaria WHO assessment of impact of antimalarial interventions in Ethiopia in 2008 : 48% reduction in morbidity 54% reduction in hospital admissions 55% reduction in mortality But malaria control under way to curb recrudescence in malaria cases, as in other SSA countries

18. MDG6: to combat HIV/AIDS Relatively low HIV prevalence : 1.5% in EDHS 2011 High increase in number of facilities providing HCT, ART and PMTCT High increase in number of PLWHA ever enrolled, ever started, and on ART (247,000 on ART in 2010/11) High increase in ART coverage (62% in 2010/11) But Low PMTCT coverage (9% in 2010/11)

19. Ratio of school attendance of orphaned children aged 10-14 to non-orphaned children of the same age in Ethiopia (from UN MDG Report 2011): MDG6: to combat HIV/AIDS (social aspects) Increase in ratio from 0.6 in 2000 to 0.9 in 2008 more children orphaned by AIDS are now in school increasing their chance of receiving education, protection and support

20. MDG6: to combat TB WHO estimates from model: – Ethiopia: 7th high TB burden country in the world and 3rd high TB burden country in Africa 2011 TB Prevalence Survey in Ethiopia with lower estimates – TB prevalence (all forms) = 277/100,000 population vs WHO estimates =572 per 100,000 – Prevalence of sputum smear positive (SS+) TB =108/100000 vs WHO estimate= 284/100000 Ethiopia could achieve MDG targets for TB, but TB cure rate should be improved Treatment success rate=83% (target=85%), treatment cure rate=68% (target=85%).

21. MDG6: Conclusions Low HIV prevalence and high ART coverage Improvement in knowledge of HIV/AIDS and way to prevent it Estimates of TB incidence and prevalence lower than WHO estimates by 50% Three-pronged approach for malaria control (early diagnosis and effective treatment, vector control and epidemic control) with high coverage and use of ITN Ethiopia on track to achieve MDG6 – But further efforts needed to accelerate disease control (increase low PMTCT coverage, control resurgent malaria cases, improve TB cure rate etc.)

22. The case of Ethiopia: what is unique? Health and development relationships are complex, contextual and dynamic Ethiopia implemented pro-poor policies and performed better than other SSA countries despite high poverty and weak infrastructure Ethiopia is unique from other SSA countries because: – Advanced fertility transition in urban areas – Incipient stage in rural areas – Doubling Contraceptive Prevalence Rate in the last five years – Rapid decrease in Infant and Child Mortality – Improvement in service coverage and disease control. – BUT…still high Maternal Mortality Ratio

23. The case of Ethiopia: what is unique? Next presentations will try to answer the questions: – What is the explanation for Ethiopia being on track to achieve health (MDG4 and MDG6) as well as nutrition, water and education MDGs? – Why Ethiopia is NOT on track to achieve MDG5? – Is it possible to achieve good health at low cost? – Can Ethiopia become another case of human development success in spite of poverty (like Bangladesh and Kerala)?

24. The case of Ethiopia: what is unique? It is a long way There are many challenges But We are on the right track towards the achievement of most MDGs in Ethiopia

25. Thank you