Advancing Health in Ethiopia

Over the last decade, the United States’ health partnership with Ethiopia has contributed to significant health gains in a country long known for having some of the poorest health and development indicators in the world. Between 2003 and 2011, the United States made significant health investments in Ethiopia, providing more than $1.4 billion through the President’s Emergency Plan for AIDS Relief (PEPFAR). And in the eight and a half years of the Global Fund’s operations in Ethiopia, over $1.1 billion has been expended toward programs to fight AIDS, tuberculosis, and malaria. This is the single largest Fund commitment worldwide, and it derived one-third of its funds from U.S. contributions.

Today, of course, times have changed. In the midst of tight budgets, in Addis Ababa, Washington, Geneva, and other donor capitals, the steep and remarkable trajectory of U.S. and other external commitments, conspicuous over the past decade and fundamental to advancing Ethiopian public health, will not continue. What then can the United States realistically expect to achieve in its ongoing engagement in health in Ethiopia? What should be the core considerations to guide future U.S. efforts? These are the questions the authors set out to answer through three visits to Ethiopia in 2011, as well as consultations with senior officials in Washington and the Global Fund in Geneva. The findings and conclusions presented here remain preliminary in important respects, owing to the fluid, somewhat clouded, and mixed picture in Ethiopia, with respect to both the U.S. and Global Fund programs.