Ethiopia

ETHIOPIA

Dr. Filimona Bisrat, Secretariat Director and Senior Regional Technical Advisor

Secretariat Host Organization/ Consortium of Christian Relief and Development Associations (CCRDA)

Programmatic Focus

CGPP Ethiopia reaches underserved rural, pastoralist, and semi-pastoralist border areas to facilitate opportunities to vaccinate and conduct case search to maintain AFP surveillance quality. The CGPP focuses on preventing polio through assistance to large-scale vaccination campaigns (SIAs), strengthening immunization systems, and community-based surveillance. Community Volunteers, Health Development Army Leaders (HDALs), and Health Extension Workers (HEWs) actively search and report cases of AFP, measles, and neonatal tetanus and track mothers from early pregnancy. They regularly conduct house-to-house health education sessions and social mobilization activities during routine and supplementary immunization campaigns. The project integrates COVID-19 awareness (at no cost) and community-based surveillance for three priority zoonotic diseases – rabies, anthrax, and brucellosis – to strengthen Global Health Security.

Implementation Focal Sites

CGPP Ethiopia operates in 85 rural, pastoralist, and semi-pastoralist border woredas (districts) across the five regions of Gambella (13 woredas), SNNP (13 woredas), Oromia (11 woredas), Somali (28 woredas) and Benshangul-Gumuz (20 woredas).

Implementing Partners

Five international PVOs – Catholic Relief Services*, Save the Children, World Vision, International Rescue Committee and Amref Health Africa – and four local NGOs – Pastoralist Concern, Ethiopian Orthodox Church, Ethiopian Evangelical Church Mekane Yesus and Organization for Welfare and Development in Action. *Additionally, local partners Bahir Dar-Dessie Catholic Secretariat and Harerghe Catholic Secretariat work with Implementing Partner CRS.

Overview

In November 2001, CGPP Ethiopia began operations in hard-to-reach communities with vaccination services and surveillance activities. Ethiopia is a country at high-risk for importation from neighboring conflict-affected Somalia and South Sudan. The government reported its last case of wild poliovirus in January 2014.  Due to COVID-19, low routine immunization coverage, and weak surveillance, parts of the country in 2021 continue to see climbing numbers of circulating Type 2 vaccine-derived cases (cVDPV2); the government reported 35 cases by the end of 2020.

Rugged terrain, scattered population settlements, weak health service systems, limited participation of key community members in the planning vaccination activities, and porous borders with polio-endemic areas pose the most significant challenges to control polio transmission in Ethiopia.  These barriers result in low community awareness about polio vaccination and AFP surveillance; resistance to the polio vaccine is minimal.

Ongoing ethnic and tribal conflict in Somali, Benshangul-Gumuz, Gambella and Oromia regions contributes to population displacement and impedes project staff movement, challenging project implementation. Another major concern has been the poor access to and the quality of health care, particularly for pastoralist populations and refugees crossing borders to escape conflict. There are significant disparities found across project regions. Still, all share several features: difficult geographies, weak health infrastructures (with low technical and managerial capacities), bureaucratic systems with little accountability, low routine immunization coverage, poor surveillance systems, unrestricted population movement, and vulnerable populations scattered along the hard-to-reach borders. Increasing the involvement of traditional and religious leaders is among several strategies employed by CGPP Ethiopia to improve community acceptance of the polio vaccine rather than seek traditional healers to treat vaccine-preventable diseases.

The CGPP in Ethiopia has been a pioneer in using community volunteers for immunization promotion and community-based surveillance activities. In FY 2020, an active network of 10,506 Community Volunteers and Health Development Army Leaders (CVs/HDALs) provided crucial support to increase the coverage of polio and other routine immunizations as well as surveillance of polio, measles and tetanus in hard-to-reach, high-risk, pastoralist and semi-pastoralist regions, which are sparsely populated. CVs, HDALs and Health Extension Workers (HEWs) actively search and report cases of AFP, measles and neonatal tetanus and tracked newborns from early pregnancy. In 2020, the NPAFP rate in project areas was 3.58 per 100,000 children under 15 years, an improvement from FY19 and significantly higher than the national rate of 2.1 per 100,000 children. Project areas reported 45 NPAFP cases, with CGPP CVs/HDALs reporting 75.5%; 29 cases were from nomadic populations.

CGPP Ethiopia volunteers regularly conduct house-to-house health education sessions and social mobilization activities during routine and supplementary immunization campaigns. In FY 2020, the CGPP reached 3.2 million persons with routine and supplementary immunization campaigns, community-based disease surveillance, and house-to-house health education activities to track and register pregnant mothers, newborns, and defaulter children. CVs/HDALs referred 128,026 pregnant women (NNT and ANC care), newborns, and defaulters to health centers during the 2020 project year. They also referred 16,357 defaulters to vaccination posts.