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M&E-The Ethiopian Experience. MERG Meeting Geneva,Switzerland Oct. 25-26,2004 Dr. Wuleta Lemma, CDC/Tulane/WB M&E and Surveillance Advisor, HAPCO/MoH. Outline. Background M&E---Case Study After Bangkok New Development. Status of HIV/AIDS . Background-Ethiopia.

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M&E-The Ethiopian Experience

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M e the ethiopian experience

M&E-The Ethiopian Experience

MERG Meeting


Oct. 25-26,2004

Dr. Wuleta Lemma, CDC/Tulane/WB

M&E and Surveillance Advisor, HAPCO/MoH



  • Background

  • M&E---Case Study

  • After Bangkok

  • New Development

Status of hiv aids

Status of HIV/AIDS

Background ethiopia


  • People living with HIV/AIDS ……..…………….….. 1.5 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 …... 540, 000

  • Number of pregnant women living with HIV …………. 130,000

  • Number of PLWHA needing ART ……………………. 245,000

  • Merg8ethiopia expeienceen

    Weighted urban HIV prevalence: 12.5%

    Merg8ethiopia expeienceen

    : 2.8% (2004)

    2004 prevalence range: 1.0% - 5.2%

    Assumed start of rural HIV epidemic: 1984

    Merg8ethiopia expeienceen

    No. HIV-pos, 2003:



    Total:1.5 million

    M e the ethiopia experience

    M&E-The Ethiopia experience

    Merg8ethiopia expeienceen

    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

    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

    Merg8ethiopia expeienceen

    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 resourcemapping 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

    After bangkok

    After Bangkok

    University students

    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

    Example forms


    Merg8ethiopia expeienceen

    M&E Operational Manual-12 modules-meeting in Nov, 2004

    (>150 people)

    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

    Merg8ethiopia expeienceen

    The Network Model

    Formal Health System Levels Service Components


    Specialty care

    Acute Illness Care

    HIV Counseling and Testing

    Pain Management

    Tertiary Referral Hospitals ( 5)










    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



    Health Posts

    HEP: basic general health care


    Basic care, including pain and symptom relief

    Home based Care

    New development strategies

    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). 2005 M&E training planned

    • Performance based District Block grants



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