Why Pathfinder Works in Ethiopia
Ethiopia faces a tremendous number of challenges to development, compounded by a rapidly growing population and a vast, rugged geographic expanse. Over 83 percent of the population resides in isolated, hard-to-reach villages, presenting major difficulties in health care and service delivery. Harmful traditional practices-like female genital cutting and early marriage-make gender inequality highly visible, limiting educational and employment opportunities for women and girls. Ethiopia has the second largest population in sub-Sahara Africa, with the average woman bearing 4.8 children, placing an insupportable burden on families, communities and a country facing chronic food shortages and environmental degradation. Additionally, the need for increased access to family planning and reproductive health care is demonstrated by Ethiopia's high rate of maternal mortality and low rate of contraceptive use. And while Ethiopia's HIV prevalence rate is lower than many countries in sub-Saharan Africa, HIV and AIDS continue to impact communities and the health systems on which they depend.
In the 1950s, Pathfinder supported the establishment of the first family planning and reproductive health clinic in Ethiopia by providing funds to what is now known as the Family Guidance Association of Ethiopia. By providing technical and financial assistance, Pathfinder helped expand community-based family planning and service delivery through a community distribution network managed by local civil society organizations and the private sector. Today, Pathfinder supports the Ethiopian government's community-based health extension program, providing technical assistance and financial support at federal, regional, zonal, district, facility, and community levels.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Ethiopia, examples of the kinds of evidence we collect range from "total number of marriages for women under age 18 that are postponed or cancelled by marriage conciliation committees " and "couple-years of protection disaggregated by family planning method type, including condoms, oral contraceptives, Depo-Provera, implants (Jadelle and Implanon), intrauterine devices, tubal ligation, and vasectomy " to "the total number of religious and community leaders trained on issues relating to gender, harmful traditional practices, and gender-based violence." Some illustrative data from Ethiopia's Integrated Family Health Program include:
- Pathfinder and its partners provide family planning and maternal, newborn and child health services to an area of Ethiopia containing 34 million people, almost 40 percent of the country's population.
- More than 12,000 early marriages canceled or deferred
- Over 3,600 community and religious leaders sensitized on health and gender issues
- Nearly 8,000 young people trained as peer educators
- Over 11 million new family planning acceptors
- 160 youth-friendly sites established
- Nearly 1.5 million visits to youth-friendly sites
Building Capacity, Strengthening Systems
While the government of Ethiopia should be lauded with having taken the bold and expensive undertaking of expanding health services in the country through a community-based health extension program, the government acknowledges that the quality of services leaves room for improvement. Supplies of contraceptives, drugs, and medical supplies overall is sporadic at best due to lack of resources, weak infrastructure, and an inefficient distribution system. Service quality is poor because of the lack of technical know-how, poor management competencies, poor attitudes to provision of services, weak supportive supervision and follow-up, and lack of accountability and transparency standards.
Pathfinder supports the implementation of the National Health Sector Development Plan by partnering with the Federal Ministry of Health and the decentralized Regional Health Bureaus in four major populated regions of Ethiopia. Pathfinder works to improve both demand for health services by sensitizing and mobilizing rural communities on the importance of preventive health services and the quality of delivery of health services. Pathfinder provides material and financial support as well as training in health services management and improvement of data gathering, reporting tools, and supervision systems. Believing that the development of a nation can only be guaranteed if all sectors of society are given the opportunity to work and consult with each other collaboratively, Pathfinder assists the Ethiopian government, civil society, and private for-profit organizations working throughout the health sector. Pathfinder is committed to documenting experiences, lessons learned, and best practices to inform future project design and policy and procedural guidance.
Young People's Empowerment in Reproductive Health Through Awareness and Service Expansion in Ethiopia (YERASEE)
As a part of the Integrated Family Health Program, YERASEE will build upon Pathfinder’s extensive work in Ethiopia to improve sexual and reproductive health services for young people (ages 10-24) throughout the country.
A USAID-funded program that supports the efforts of the Government of Ethiopia to improve family planning/reproductive health services and maternal and child health in four regions of the country.
With this five-year award from CDC, Pathfinder works with the Ethiopian Ministry of Health to increase access to and use of cervical cancer prevention services among HIV-positive women in Ethiopia.
This technical brief explores Pathfinder's Integrated Family Health Program's approach, implementation experience, and lessons learned when addressing obstetric fistula in four program regions of Ethiopia.
m4Youth: Providing Sexual and Reproductive Health Information to University Students and Peer Educators
Pathfinder is using m4youth, a free SMS service, to impact students’ knowledge of sexual and reproductive health, thereby increasing their utilization of services.
This article retrospectively analyzes the scale up of adolescent-friendly contraceptive services in five countries and draws lessons learned to inform implementation and sustainable scale up of HIV and other services for adolescents.
This brief provides a concise overview of recent activities of the Addis Tesfa cervical cancer prevention project in Ethiopia. Addis Tesfa brings highly effective, yet very simple, cervical cancer prevention methods to women living with HIV.
“Women build the society. They build a nation. And investing in family planning is investing in the future.”-Dr. Tewodros Bekele, Director of Maternal, Child Health & Nutrition Programs, Ethiopian Federal Ministry of Health