ARV scale up in Ethiopia

On April 30, 2009, in aid effectiveness, Ethiopia, HIV/AIDS, by Karen Grepin

In the past, I have blogged about some country-specific case studies that have been launched to evaluate the system wide effects of rapid ART scale up in developing countries. In this month’s PLoS of Medicine, a case study of the Ethiopian experience based on secondary document analysis, was published by Yibeltal Assefa, Degu Jerene, Sileshi Lulseged, Gorik Ooms, and Wim Van Damme.

In their paper, they document the rapid expansion of ART treatment in Ethiopia since about 2003. As of today, over 100,000 patients are receiving ART treatment in Ethiopia up from nearly nothing just half a decade ago. About 25% of those who have started ART in the public sector have been loss to follow-up or presumably have died.

Their work highlights some successes and some potential areas for concern. They find find no major declines in measures of health system performance and actually find that indicators such as infant and child mortality immunization coverage have improved in recent years. However, they also find that there has been a rather dramatic decline in physicians in the public health service and attribute this to internal migration of health professionals towards mainly AIDS NGOs who have “poached” these workers. However, it appears that simultaneously there have been other efforts to rapidly scale up human resource availability in the country, so that the number of other health professionals has increased over this time period offsetting these losses.

This work points to an overall positive picture in Ethiopia, perhaps because it was able to so rapidly scale up human resource availability over this time period. Ethiopia is usually considered an outlier on how it is handling its health workforce needs, so it would be interesting to think about how realistic it would be to assume similar effects in other countries. But, I am happy to see yet another case study that is adding to our knowledge of the impact of global health initiatives on health systems. I’m off to Ethiopia in a few weeks and am looking forward to seeing some of this myself first hand.

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1 Response » to “ARV scale up in Ethiopia”

  1. johnwilpers says:

    Dear Karen,

    First of all, I apologize for using your Comments area to reach out to you but I couldn’t find an e-mail address on your blog.

    Secondly, I want to tell you what you probably already know (but it’s always nice to hear it from someone else): “Karen Grepin’s Blog” is excellent. I have been having a very hard time finding terrific world health blogs and so I was delighted to find yours (in Christine Gorman’s Global Health Report blog roll!). All your posts are well-written, well-informed, intelligent, provocative, and yet still accessible for the layman who’s not up on the healthcare lingo.

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    My job is to build a list of blogs that will appear on GlobalPost where we have approximately 65 correspondents in some 46 countries plus high-profile correspondents writing about nine major themes.

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    The way it would work if you accept our invitation is that we would use your RSS full-text feed to place your most recent post on your personal page on We would point back to your actual blog for comments and for archives, hopefully driving lots of traffic to your site. Each time you write a new post, it would replace the older one so only one post would appear on at any one time.

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    I look forward getting your permission to put your full-text RSS feed on our site. Thank you!


    John Wilpers

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