Ethiopia

Pathfinder’s work greatly expanded in 1995, with the opening of our Ethiopia country office. Serving an area that encompasses 85 percent of the population, including many people living in remote, rural areas, our programs are pioneering and effective.

Today, our partnerships with governments, local NGOs, and communities are leading to advances in maternal and child health; postabortion care; services for young people and those affected by HIV and AIDS; and family planning.

Mengistu Asnake, Pathfinder’s Ethiopia Country Representative, knows progress has been made. He remembers the state of reproductive health in 1990, when the country’s contraceptive prevalence rate was a mere 3%.

He recalls visiting a group of women in a rural village. “They had all been married by 15, had an average of 7 or 8 children, and believed pregnancy needed to occur every year—to prove their fertility to their husbands and community.”

“In the last few years, we’ve seen a significant shift,” he says. Preliminary data from the 2011 DHS show that the CPR increased by almost 30%. This makes Ethiopia one of only 3 countries to document a percentage change of this magnitude.

More women can access the services they need, thanks to the government of Ethiopia; mobilization of donor resources; and strong collaboration with civil-society organizations, the private sector, and international nonprofits, like Pathfinder.

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.
• 3,623,818 infants under 1 year of age received a dose of measles vaccine.
• 4,739,931 antenatal care visits were made by skilled providers from US government-assisted facilities.

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.