1. M&E-The Ethiopian Experience
MERG Meeting
Geneva,Switzerland
Oct ,2004
Dr. Wuleta Lemma, CDC/Tulane/WB
M&E and Surveillance Advisor, HAPCO/MoH

2. Outline
Background
M&E---Case Study
After Bangkok
New Development

3. Status of HIV/AIDS

4. Background-Ethiopia
People living with HIV/AIDS ……..…………….… million
Estimated percent of adults (15–49) infected with HIV ….. 4.4%
Rural = 2.6%; Urban = 12.6%
Cumulative deaths due to AIDS ………………..…... > 1 million
Children infected and living with HIV ………………... 96,000
Cumulative number of children orphaned by AIDS … , 000
Number of pregnant women living with HIV …………. 130,000
Number of PLWHA needing ART ……………………. 245,000
UNAIDS estimated, by the end of 1999, about 3 million people to be living with HIV/AIDS in Ethiopia.
Though Ethiopia constitutes only 1% of the world’s population, it contributes about 9% of the world’s HIV/AIDS case burden.
Estimated percent of adults aged 15 to 49 infected with HIV was 10.7%.
There have been over a million cumulative deaths due to AIDS with 280,000 occurring in 1999 alone.
UNAIDS estimated 150,000 children to be currently living with HIV and an astounding 1.2 million children to have been orphaned by AIDS.

5. Weighted urban HIV prevalence: 12.5%

6. : 2.8% (2004)
2004 prevalence range: 1.0% - 5.2%
Assumed start of rural HIV epidemic: 1984

8. No. HIV-pos, 2003:
Female: 810,000
Male: 650,000
Total: 1.5 million

9. M&E-The Ethiopia experience

10. Challenges to “One M&E System”
No M&E unit at the national level
Indicators not harmonized- Everybody have their own – Ministries, Donors, CSO etc
No unified data collection formats- Organizations have their own different formats for similar indicators- “Same person ” at lower fills it all !!!!
Different report-Information Flow
Limited not unified capacity building plan -- including training and human capacity at all levels to role out a national M&E system
Non existence of an integrated data base (including HMIS)
Surveillance more developed than Program Monitoring
Limited Budget for M&E
Non-existent and disjointed Evaluation plan
Infrastructure (road, telecommunication, networking, etc) varies from region to region

11. M&E-2003-present
M&E Department at national ( 5 Staff ), Regional HAPCOs and district focal persons. M&E team includes MoH
Secured budget (MAP,GF, PEPFAR and Others)
Comprehensive training plan for all regions developed – ToT manual to follow
Equipment (Computers & accessories) for all regional M&E Departments and all new ART sites- Take advantage of Woreda net
National M&E Framework (with indicators, methods of data collection, Information flow, who collects what etc) after extensive consultation published in December 2003 and distributed to all Regions, NGOs, FBOs & Donors

12. M&E 2003-present
National M&E Operational Plan with detail M&E Formats for all program activities
Assessment of National Financial Monitoring System of NHAPCO
Harmonization of GF requirement with national Indicators
Consolidated Surveillance and M&E resource mapping for MoH completed
Expanded Surveillance : 66 sites for 2003, almost twice the number sampled in 2001 (34 sentinel surveillance sites in 2001)
first BSS done/report distributed nationwide (>27,000 sample)
BBS-2 starting

13. After Bangkok

14. University Students 2003/4 (1996 ET) M&E data collected
2 University Students/ Region plus
~2 per District (606 district)
Most regions completed
Information includes at Federal level --Sector Ministries, Bilateral, Multilateral and NGOs

15. Example-Forms

16. M&E Operational Manual-12 modules-meeting in Nov, 2004
(>150 people)
Module 01
Education
Module 02
Drug Administration and Control Authority (DACA)
Module 03
Ethiopian Red Cross Society (ERCS)
Module 04
FMoH, RHBS, WHOs and Facilities (Health)
Module 05
Other Government Offices
Module 06
Bilateral and Multilateral Organizations
Module 07
Civil Societies (NGOs, FBOs, CBOs, POs, etc.)
Module 08
Kebele HIV/AIDS Committee??
Module 09
Woreda HIV/AIDS Committee??
Module 10
Zonal HIV/AIDS Committee??
Module 11
Regional HAPCO
Module 12
National HAPCO

17. Other-Opportunity/Challenge
Ethiopia approved for the largest GF (GF2+GF4 > $600M, PEPFAR around 50M/year)
~10-12% for M&E(inc. HMIS) and Surveillance/year
FMoH- HMIS (HMIS and M&E Advisory Committee formed-Work stared)
LMIS
Lab Information system
Patient monitoring system
M&E National/Regional ToT training
Training on Medical Record

18. The Network Model Formal Health System Levels Service Components ART
Specialty care
Acute Illness Care
HIV Counseling and Testing
Pain Management
Tertiary Referral Hospitals ( 5) C O M U N I T Y
Regional / Zonal Hospital
Uniformed Services
District Hospital
District Hospital
District Hospital
Health Center
HIV counseling and testing, PMTCT, OI treatment and prophylaxis, TB dx , ART follow up, nutrition counseling and support, psychosocial support [ pain management]
Health Center
Health Center
Health Center
Transporters
CSW
Health Posts
HEP: basic general health care
CHWs
Basic care, including pain and symptom relief
Home based Care

19. New Development/Strategies
HAPCO to Report to MoH
Implication on M&E not clear (assumed not much as the National M&E Framework was accepted in SPM)
Implication on structure not clear
Health Extension Workers (23,000 to be deployed in 5 years) M&E training planned
Performance based District Block grants

20. Thanks!!!
A small section of Mosi-oa-tunya (also called Victoria Falls) in June at high water, from the Zambian Perspective.
A mile along the precipice, a 100 meter cascade, 1.5 million gallons per second, awe-inspiring.