Ethiopia HIV/AIDS Activities
Ethiopia's national adult HIV/AIDS prevalence for 2003 was estimated from antenatal sites at 4.4 percent, with a 12.6 percent urban prevalence rate and a 2.6 percent rural prevalence rate. A more recent 2005 DHS survey using a population based survey projected a lower infection rate of 1.4% with rates significantly higher among women than men and higher in urban than rural areas. Only 4% of women and 6% of men report having ever been tested for HIV, although knowledge of AIDS and its mode of transmission is high.
Donor and government efforts have focused on building the capacity of public sector provision of counseling and testing, ART and TB DOTS with support coming from PEPFAR and the Global Fund. While these efforts have achieved tangible gains and greatly increased access to quality HIV/AIDS/TB services, there are limits to the absorptive capacity of the public sector. Moreover, the private sector will not wait for donor support to begin providing services. The public sector is not always the best channel to reach high risk groups that may be reluctant to attend public sector clinics and may keep hours that are incompatible with those of public sector clinics. In an epidemic that is more concentrated than previous thought, addressing such factors is increasingly important. For all of these reasons, USAID Ethiopia funded the PC4 project to engage private providers who are providing counselling and testing, TB DOTS and ART and to foster effective public private partnerships to ensure expanded and improved private provision of HIV services.
Unfortunately, knowing that the private sector can play an increased role in HIV/AIDS service provision is easier than facilitating that increased role. Provider training for the private sector is needed, but considerable work needs to be done in adapting training curriculums and strategies from the public sector context to the private sector. Quality assurance and improvement mechanisms need to be put in place for private providers, but through what structures and with whose expertise? Data collection on service provision in the private sector needs to be done, but using what tools and through what reporting mechanisms? Without an oversight mechanism, how does one ensure that providers are motivated to submit accurate data? Donors have funding for needed service commodities (rapid test kits, ART, etc.), but should these commodities be provided to private providers for free? If not, how much should be charged, for how should they be sold, and which private providers should receive them?
USAID/Ethiopia has requested PSP-One to provide policy expertise to work with the government and HIV/AIDS/TB service provision organizations, especially the PC4 project, to address such issues and build consensus for solutions.
PSP-One has been working closely with the newly establish Public Private Partnerships Unit of the Ministry of Health to guide them in their mission to engage the private sector in public health initiatives, specifically those related to HIV/AIDS/TB. The project will help them establish Terms of Reference, detailing the Unit’s purpose and objectives, its role in health initiatives, and guidelines for partnerships; establish a national level PPP working group to facilitate dialogue between government, NGO, and private stakeholders (the working group will eventually be expanded to regional areas); and strengthen the overall capacity of the Unit.
In addition to working with the PPP Unit, PSP-One is also providing technical assistance to provider associations, in particular the Medical Association of Physicians in Private Practice-Ethiopia (MAPPP-E) – the only private sector professional association- to strengthen their capacity to advocate to the government on behalf of the private sector. The project will support the hiring of a full-time technical employee housed in MAPPP-E who will be responsible for representing MAPPP-E at the national PPP working group and other events, liaise with the PPP Unit, and raise the profile of the private sector in Ethiopia, thereby increasing the credibility and visibility of MAPPP-E.
Clearly, there is a need to include the private sector in policy dialogue and development, and just as important is ensuring the quality of the services private providers offer. Trainings for public sector practitioners are often held over multiple days, which is not feasible for private providers who must close their practices and lose revenue to attend. Often times, these trainings are not even open to private providers. Private providers must have trainings available to them in order to maintain and improve the quality of their HIV/AIDS/TB services. PSP-One recognizes quality as a critical issue and will address this by working with training organizations and the government to adapt existing training materials to the private sector context.
Outside of the policy arena, PSP-One is in the last phases of a baseline study examining the provision of HIV/AIDS services in the private sector. There have been few studies examining this aspect of the private sector, so while the study will provide useful information for current and future private sector HIV/AIDS activities in Ethiopia, its results will be valuable to other countries as well. The quantitative study was conducted amongst the practitioners and facility managers in private clinics (lower, medium, and higher levels), pharmacies, and hospitals and examined such topics as facility management procedures, access to and potential uses for credit, availability of HIV/AIDS/TB medical supplies and drugs, training and education, HIV/AIDS/TB services available at the facility, HIV/AIDS testing procedures, referrals and medical records for HIV/AIDS patients, and standards of care. A final report detailing the findings of the study is expected to be produced in mid-2008.
