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
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 subSaharan African (SSA) Countries
• Improving health and addressing inequities
– Progress in addressing health inequities
• The case of Ethiopia: what’s unique?
2
Summary of main results from EDHS 2011:
Population-based indicators
INDICATOR
EDHS
2005
EDHS
2011
PERFORMANCE
123
88
↑
Infant Mortality Rate (U5MR) (per 1000 live
births)
77
59
↑
Neonatal Mortality Rate (U5MR) (per 1000 live
births)
39
37
↑
Contraceptive Prevalence Rate (CPR) (%)
15
29
↑
Maternal Mortality Ratio (MMR) (per 100,000)
673
676
~=
Total Fertility Rate (TFR) (%)
5.4
4.8
↑
Exclusive breastfeeding under 6 months (%)
49
52
↑
Prevalence of anaemia among women (%)
27
17
↑
Knowledge of HIV/AIDS (women)
90
97
↑
Knowledge of HIV/AIDS (men)
97
99
↑
Under 5 Mortality Rate (U5MR) (per 1000 live
births)
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)
Rate (per 1000 live births)
MDG4: Trend in U5MR, IMR and NMR
180
160
140
120
100
80
60
40
20
0
166
123
97
88
77
49
EDHS 2000
59
39
37
EDHS 2005
EDHS 2011
EDHS Year
Under 5 Mortality Rate (U5MR)
Neonatal Mortality Rate (NNR)
Infant Mortality Rate (IMR)
MDG4: Comparison of trend in U5MR in Ethiopia
and SSA countries
Rate (Per 1000 live births)
250
200
150
100
50
0
1990
1995
2000
2005
2010
2015
Year
SSA trend
SSA MDG by 2015
Ethiopia trend
Ethiopia MDG by 2015
MDG4: Comparison of trend in IMR in Ethiopia
and SSA countries
Rate (Per 1000 live births)
140
120
100
80
60
40
20
0
1990
1995
2000
2005
2010
2015
Year
SSA trend
SSA MDG by 2015
Ethiopia trend
Ethiopia MDG by 2015
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
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.
Ratio
(Per 100000 live births)
MDG5: Comparison of trend in MMR in Ethiopia
and SSA countries
1200
1000
800
600
400
200
0
1990
SSA trend
1995
SSA MDG by 2015
2000
Year
2005
Ethiopia trend
2010
2015
Ethiopia MDG by 2015
Trend in Contraceptive Prevalence Rate (CPR)
29
Rate (per 100)
30
20
15
10
8
0
EDHS 2000
EDHS 2005
EDHS Year
EDHS 2011
Trend in Total Fertility Rate (TFR)
7
5.9
6
5.4
Number
5
4.8
4
3
2
1
0
EDHS 2000
EDHS 2005
EDHS Year
EDHS 2011
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)
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
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)
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
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
MDG6: to combat HIV/AIDS
580,919
600,000
Number of PLWHA
• 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)
700,000
473,772
500,000
376,772
400,000
300,000
100,000
0
268,934
266,507
200,000
164,560
97,299
39,489
24,23618,594
1998
73,124
1999
333,434
208,784
207,733
150,136
152,472
109,930
2000
247,805
2001
2002
2003
Year
Ever enrolled
Ever Started
Currently on ART
2010/11
1990
Developing
regions
Sub-Saharan
Africa
Ethiopia
0
20
40
Percentage
60
80
100
MDG6: to combat HIV/AIDS
(social aspects)
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):
•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
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%).
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.)
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
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)?
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
Thank you