1. Ethiopia: Focusing our Program for Impact & Efficiency
Jocelyn Felter Brown
Acting Coordinator, PEPFAR Ethiopia

2. Ethiopia – Important Features
Population 90 million
Predominantly rural agrarian country
Growing economy with large infrastructure development projects
Low/decreasing national HIV/AIDS prevalence: 1.4%
Has reached the “Tipping Point”
Significant Urban to Rural HIV/AIDS disparity: mixed epidemic
Government is the primary service provider
Strong political commitment to health & equity of services
Significant Global Fund investment, but expected to decline with New Funding Model

3. Ethiopia: Three Ways of Looking at HIV Distribution: Prevalence, No
Ethiopia: Three Ways of Looking at HIV Distribution: Prevalence, No. Infected, and Density, 2011

4. PEPFAR Expenditures by Geographic Location & HIV Burden with Adult Prevalence
Source: HIV Related Estimates and Projections for Ethiopia – Excludes National and Above National Spending

5. Focusing the Program: Start with Clinical Care & Treatment
Adoption of 2013 WHO Guidelines
2013
2014
2015
Number of Adults in need of ART*
431,761
530,835
542,632
National Coverage Rate & Goals
@69% = 298,336
80%  434,106
*Source: Spectrum HIV Related Estimates and Projections for Ethiopia, 2014

6. Focus on Clinical Care & Treatment
Historically…US University treatment partners led clinical care & treatment efforts
Partners accomplished what they were brought to Ethiopia to do; time to move more responsibility to Government of Ethiopia
Promising results from transition of University partners to Regional Health Bureaus in 3 regions demonstrated success and ability to manage funding
Assumption is that we can achieve same treatment goals, at same level of quality, but more efficiently – across all regions

7. Achieving Efficiency in Clinical Care & Treatment
USD, in millions
PEPFAR/HHS-Ethiopia Funding, by Partner Type
COP14 local partner funding breakdown (rounded) is as follows: $ 31m RHBs, $ 4m USE (NDFE + Police), $ 5 local universities, $ 3.6m MOH+EHNRI, $ 17m local NGOs (EPHA, FGAE, NEP+, etc)
* 2014 reflects the COP14 submission, new funds only

8. Defining Our Core Understand: Design:
We adapted the UNAIDS Investment Case Framework to further focus and rationalize our PEPFAR program in Ethiopia
Understand:
Current state of epidemic—and how it’s expected to change
National Response: What is USG’s current role -- how might or should it change?
What are roles of other HIV Donors, Global Fund, Government, private sector -- how might they change?
Design:
What are the core program elements/critical enablers required to Save Lives and Prevent New Infections?
What are the core program elements /critical enablers USG is uniquely qualified to deliver?
How and when and to whom should non-core programs/non-critical enablers transition or end?
What is the cost of the core program?
With success and efficiencies shown w/ C&T Transition, in we realized the need to focus the program further, to apply a more focused approach to all program areas, with the goal to maximize public health impact

9. Prioritizing Activities
Activities critical to saving lives, preventing new infections - and/or which USG is uniquely qualified
Core
Activities that directly support our goals and cannot yet be done well by other partners or host gov’t.
Near Core
Activities that do not directly serve our HIV/AIDS goals and/or can be taken on by other partners or host gov’t or civil society.
Non Core
Must Do
Should Do
Nice to Do

10. Defining the Core: Results
Economic Strengthening (non-OVC)
TA In-school Youth prevention
Low-risk prevention (GPY)
PPP TA
Infection Prevention
Cross-border
Cervical cancer screening
Non-Core
Blood Safety
TA to Private Sector Health Svcs
VMMC
In-School Youth funding to MOE
Leadership and Governance (w/ transition plan)
Community/Peer Support
Ongoing Construction Commitments
Near-Core
Treatment
Prevention (High & Med Risk)
Targeted Testing
Supply Chain TA
HIV/AIDS Commodities
Evidence Base (SI, SS, M&E)
HC Financing/Insurance
Training
HMIS
OVC (incl. ES)
Core

11. Using Data to Maximize Program Investment
Evidence Base Analysis
Utilized most current ANC surveillance data to ensure sufficient support in regions and refugee sites with increasing prevalence
Tracked those emerging regions transected by major transport corridors and targeted funding toward hottest Hot Spots
Assessed areas where HRH capacity is most limited and targeted ToT support
Economic Analysis
We utilized national PEPFAR expenditure data to calculate unit expenditures, which allowed us to ‘cost’ our program’s core interventions
Expenditure data at regional and partner level prompted refinement to certain activities and regional interventions
Site-Level Analysis
Directed spend toward highest-volume and highest-yield facilities; reduced spend to facilities with low-volume/low-yield

12. Geographic Analysis: HIV+ yield distribution across PMTCT sites
80% (14,260) of patients in 22% (371) of 1,668 sites
Key:
High Yield = >1 patient/month
Low Yield = <1 patient/month

13. Stakeholder Coordination
With a more focused PEPFAR program, on-going stakeholder alignment is key to sustain gains and
prevent service gaps
Government
Years of successful TA and strong Gov’t support ensure readiness to take over Cervical Cancer, Infection Prevention, VMMC, Blood Safety
Extensive Gov’t led Health Extension Worker program is able to take on more Community-focused activities
Global Fund
Revolving fund for ES allows PEPFAR to focus on OVC House Holds
On-going HSS funding can support health infrastructure needs
Commitment to significant funding of ARVs, RTKs
Civil Society &
Private Sector
Years of USG and Global Fund support have capacitated CSOs to take on more Community and Peer Support activities
Years of TA to Private Sector providers have strengthened their ability to serve clients and support business

14. ETHIOPIA HAS A REAL CHANCE AT AN AIDS FREE GENERATION
Thank You