At Work Around the World

In collaboration with the Ministry of Health, the strategy for interrupting transmission of Guinea worm disease from Ethiopia relies on an active surveillance system in high-risk areas to detect all cases and prevent each patient from contaminating additional water sources (case containment). One of the goals of the Guinea worm program is to change behavior and mobilize communities to prevent contamination of sources of drinking water. Approaches include: distribution of nylon filters to strain out the water fleas that host the Guinea worm larvae; monthly treatment of stagnant sources of drinking water with ABATE® larvicide; and advocacy with water organizations for provision of safe sources of drinking water. Community-elected village volunteers are trained by the program to carry out monthly surveillance and interventions.

In 1995, as part of the effort to provide safe water to communities with Guinea worm disease, 15 hand-dug wells were completed in South Omo, with an additional 40 wells constructed by a partnering nongovernmental organization, Norwegian Church Aid. Later, additional wells were dug in Itang and Gog woredas of the Gambella region. The Ethiopian Water Resources Development offices also have provided training on the use of Vonder drilling rigs to develop a village-level capacity to construct hand-drilled wells.

During the mid-1990s, committees were formed to work with communities to identify factors affecting community participation as well as coordinate efforts to reach people displaced by tribal conflicts from Akobo village. Approximately two-thirds of Akobo's total population were said to have abandoned their homes and resettled in relatively inaccessible woredas (hamlets) of Jikawo and Itang. Following this shift, some 20 volunteers from Akobo were trained on surveillance, health education, and the use of nylon filters. A UNICEF-donated motorboat assisted with reaching some of the most difficult areas.

Since 1996, a reward system has been established in all endemic areas using resources provided by Health and Development International to improve the detection and reporting of cases. If a case is reported before the worm emerges, both the patient and the person who brings the case to the attention of the health worker receive 100 birr, about $10 USD. The reward system further strengthens eradication efforts by encouraging people with cases to report early and remain at a health facility during the duration of their illness to prevent contamination of water sources. Patients who stay at the health facility receive three meals a day, a place to sleep, and free quality medical care until all worms are removed.

Major constraints on program efforts include: maintaining surveillance throughout the Gambella region, including districts that periodically become inaccessible due to insecurities and heavy rains during the peak transmission season. Because Sudan remains the most endemic country in the world, migration of people between Sudan and Ethiopia remains a risk for continued transmission of Guinea worm disease in Ethiopia. In 2007 and 2008 , additional cases were imported from Southern Sudan to Ethiopia. Ethiopia must monitor migration across its borders and strengthen surveillance and cross-border collaboration with Sudan in the final push to eradicate the disease from the world.

Learn more about the Carter Center's Guinea Worm Eradication Program.

Updated July 2009

Controlling River Blindness
Onchocerciasis, commonly known as river blindness, was first reported in southwestern Ethiopia in 1939 by Italian investigators. However, Ethiopia was not alone in its burden of this parasitic disease. River blindness is endemic to 37 countries in Africa, Latin America, and Yemen. Transmitted by the bites of black flies found near fast-flowing rivers, onchocerciasis causes severe itching, eye damage, and sometimes blindness.

After being approached by the Ethiopia Ministry of Health to be a partner, The Carter Center started fighting onchocerciasis in Ethiopia in 2000. Today, the Center's River Blindness Program continues to work in partnership with Ethiopia's Ministry of Health as well as a consortium of international agencies, nongovernmental organizations, and private companies.

After being approached by the Ethiopia Ministry of Health to be a partner, The Carter Center started fighting onchocerciasis in Ethiopia in 2000. Today, the Center's River Blindness Program continues to work in partnership with Ethiopia's Ministry of Health as well as a consortium of international agencies, nongovernmental organizations, and private companies.

Studies conducted in the 1970s reported that, in addition to southeastern Ethiopia, the northwestern part of the nation also was endemic. A complete national survey begun in 1997 and finished during 2004 determined that onchocerciasis was much more widespread than originally believed. Nine regions surveyed for river blindness were shown to be endemic, with 7.3 million people at risk and more than 3 million already infected.

After the government of Ethiopia created a national plan to fight onchocerciasis in 1999, The Carter Center was invited by the Ministry of Health to join the effort to fight the disease in 2000. That same year, the National Onchocerciasis Task Force was established by Ethiopia's Ministry of Health with a mission to: mobilize and educate onchocerciasis-endemic communities; coordinate Mectizan® tablet procurement and distribution, and coordinate all partners in the program. Mobilization efforts began in 2000 in the Kaffa and Sheka zones of the Southern Nations, Nationalities and Peoples region. The Carter Center and the African Programme for Onchocerciasis Control (APOC) play a critical role in supporting the Mectizan distribution program in these areas. The program went on to expand into other areas, doubling treatments each year until reaching scale in 2004.

In partnership with the Ministry of Health and APOC, The Carter Center now assists program activities in eight of the 10 endemic zones in the country: Bench Maji, Gambella, Illubabor, Jimma, Kaffa, Metekel, North Gondar, and Sheka. By the end of 2008, 95 percent of the ultimate treatment goal (the eligible population) was reached and 100 percent geographic coverage was achieved. In other words, 2,983,055 Ethiopians in all 14,268 targeted villages received Mectizan treatment and health education for control of river blindness.

The onchocerciasis program in Ethiopia is completely dependent on external financial support, as there is no specific item in the government's budget dedicated to river blindness control. Thus, more funding will be needed to continue to provide treatment and prevention education.

Learn more about the Carter Center's River Blindness Program.

Updated May 2009

Controlling Trachoma
The rate of blindness in Ethiopia is thought to be the highest in the world. It is estimated that 2.8 million Ethiopians suffer from low vision, while 1.2 million people are blind. One of the major causes of loss of sight is trachoma - accounting for approximately one-third of all cases of blindness and visual impairment in Ethiopia.

Widespread and debilitating, trachoma is a major public health problem in Ethiopia. The Ministry of Health estimates that 1.3 million Ethiopians are in need of immediate surgery to prevent blindness and the entire population of 71 million is at risk of infection.

In October 2000, The Carter Center, with funding from the Lions-Carter Center SightFirst Initiative, accepted the Ethiopian government's invitation to work on controlling trachoma in the Amhara region in the north. The initial intervention area included four districts with a total population of more than 1 million. In 2006, the Trachoma Control Program reached almost 4 million people, 22 percent of the Amhara region. In 2007, the program expanded and now covers all 153 districts, reaching the entire at-risk population. The program is able to implement at scale through a deep partnership with the local Ethiopian Lions Clubs. The Ethiopian Lions Clubs play a key role in the implementation and advocacy of trachoma control in Ethiopia.

When the program began in the Amhara region in 2000, prevalence surveys were conducted to gauge the extent of the disease. They found approximately 88 percent of all children aged one to 10 years had active trachoma and an estimated five percent of people had trichiasis (blinding trachoma requiring corrective surgery). These numbers far exceed the intervention criteria set by the World Health Organization: 10 percent of children with active trachoma and a trichiasis rate of 0.1 percent in the general population.

To reduce the number of people currently living with trichiasis, The Carter Center works with the Amhara Regional Health Bureau to provide corrective eyelid surgery. Since 2001, 626 surgeons have been trained and more than 146,000 people have received trichiasis surgery to relieve them of the dreadful pain associated with this condition. In 2008, 185 new surgeons were trained by the program to conduct surgery during regular health center visits, surgery camps, and outreach surgical campaigns.

The Carter Center also supports the Ministry of Health to conduct mass distribution of antibiotic for trachoma control. Zithromax® (azithromycin), donated by Pfizer Inc., and tetracycline eye ointment, purchased by The Carter Center, are distributed through outreach campaigns to prevent and stop the transmission of trachoma infection. Adults and children older than six months of age are treated with azithromycin while infants and self-reporting pregnant women receive tetracycline eye ointment.

In 2003, The Carter Center began coordinating mass distribution of antibiotics to trachoma-endemic communities in one pilot district, reaching approximately 100,000 people. Since the first district, the geographic coverage of antibiotic distribution has expanded, with more than 12.6 million people receiving azithromycin in 2008. To date, more than 27.6 million doses of azithromycin and 1.5 million doses of tetracycline have been distributed in Ethiopia alone.

To strengthen community health education, The Carter Center and the regional health and education bureaus developed a trachoma prevention curriculum and corresponding health education materials to cover all components of the SAFE strategy with an emphasis on "facial cleanliness" and "environmental sanitation." Each lesson encouraged students to identify other problems related to hygiene in their own communities and come up with their own solutions. In 2004, the curriculum was translated into Amharic and printed with support from local Lions Clubs. Learn more about the SAFE strategy.

To improve environmental sanitation and control the flies that can transmit trachoma, the program promotes household latrine construction and use. This is accomplished through several channels: routine latrine promotion during health education led by Health Extension Workers and the construction of model latrines in public gathering places.

Since 2002, more than 1 million household latrines have been constructed in the Amhara region with Carter Center assistance. This incredible achievement has been possible due to the leaders' vision and the commitment of the entire community.

This hard work continues to benefit millions of Ethiopians at risk of trachoma. The Amhara Regional Health Bureau, the Federal Ministry of Health and the Ethiopian Lions Clubs continue to work together to control trachoma.

Read the Atlanta Journal-Constitution News Story: Latrine Program a Hit, published on
March 5, 2005 >

Read the Transactions of the Royal Society of Tropical Medicine and Hygiene Expert Article: Risk Factors for Active Trachoma in Children and Trichiasis in Adults: A Household survey in Amhara Regional State, Ethiopia (PDF) >

Read the Transactions of the Royal Society of Tropical Medicine and Hygiene Expert Article: Evaluation of Three Years of the SAFE Strategy for Trachoma Control in Five Districts of Ethiopia Hyperendemic for Trachoma (PDF) >

Watch the CNN Impact Your World Feature on the Carter Center's Trachoma Control Program >

Learn more about the Center's Trachoma Control Program.

Updated September 2009

Increasing Food Production
Ethiopia's government is strongly vested in finding lasting solutions to the country's chronic food insecurity. Food security in Ethiopia is a matter of life and death. More than 5 million people depend on food relief each year, even when weather and market conditions are favorable. With population growth of about 1.8 million each year, an additional 340,000 metric tons of food grain are needed annually just to maintain per capita food grain consumption at its present level.

Sasakawa-Global 2000, a joint venture between the Carter Center's Agriculture Program and the Sasakawa Africa Association, has been helping Ethiopian farmers since 1993 to improve agricultural production. SG 2000 has supported regional departments of agriculture in high-potential agricultural areas of the country, helping them to more effectively assist farmers in maintaining high levels of food crop production. The government has been very active in promoting agricultural modernization, and as a result, Ethiopia today has one of the strongest agricultural production records in Africa. 

Over the last few years, SG 2000's Ethiopia program has been promoting and demonstrating the use of the broad bed and furrow maker, as well as conservation and minimum tillage technologies. In 2007, the government targeted areas where adoption had looked promising and scaled up the process to involve thousands of farmers. Meanwhile, the program continued to emphasize the promotion of quality protein maize (QPM), rice, line planting of wheat, water harvesting, and new post-harvest and agro-processing technologies.

Although improved production technologies have led to marked increases in crop yields in recent years, the payoff after harvest has been less significant. "This is largely due to post-harvest losses resulting from poor handling systems, both in the field and in storage, higher labor requirements, use of primitive tools and techniques, and poor quality agricultural products," says Dr. Aberra Debelo, project coordinator of SG 2000's Ethiopia program. "The price of most raw materials also fluctuates according to supply and demand, which is beyond the control of the farmer. This can mean that marketing middlemen intrude, and the farmer loses out."

Now, however, the introduction of post-harvest and agro-processing technologies, in collaboration with SAA's agro-processing program, means that farmers get a better deal. The new technology increases efficiency, minimizes crop wastage, and reduces the drudgery of traditional processing. Thanks to these approaches, production is increased, farmers can realize the gains brought about by improved production techniques, and they can process and market the quality produce that consumers demand.

Ethiopia must continue to be diligent when monitoring food security programming to improve quality of life and prevent famine. The nation is not alone in this struggle: The Carter Center and its international partners are dedicated to building hope in Ethiopia – hope for a future in which lives are no longer threatened by famine
 
Learn more about the Carter Center's Agriculture Program.

Updated May 2009

Controlling Malaria
Using the same community-based networks already established for Ethiopia's river blindness and trachoma control programs, The Carter Center has expanded its support for health work in the country to include malaria control initiatives. Malaria is the single largest cause of death in Ethiopia, the largest and most populous country in the Horn of Africa.

The initial focus of the Carter Center's Malaria Control Program, launched in January 2007, was to assist Ethiopia's Ministry of Health in its goal to protect all 50 million Ethiopians at risk for malaria through free distribution of long-lasting insecticidal mosquito nets to cover the entire malaria at-risk population by July 2007.

By purchasing the balance of nets needed by the national program — 3 million of Ethiopia's estimated total 20 million nets — and by coordinating net distribution and health education on malaria in the Amhara, SNNPR (Southern Nations, Nationalities, and Peoples region), and Oromiya regions, the Center is helping to protect 18 million people at risk (36 percent of the total population at risk in Ethiopia) in more than 100 districts (woredas) and several hundred malarious localities called kebeles. In addition to long-lasting insecticidal bed net distribution, the Center is working with other partners to assist with health education and evaluation of the national program. The Center managed two large representative household surveys in 2006 and 2007, which showed that the proportion of households in malarious areas owning at least one net increased threefold, and the average number of nets per household increased fourfold. The massive scaled-up insecticidal net campaign will assist Ethiopia in moving toward its ambitious goal of eliminating malaria.

In the southwest region of the country, bed net distribution and net replacement for malaria control are being combined with the country's river blindness program. In the Amhara region, bed net distribution and health education are being coupled with trachoma control initiatives, which now include biannual "MALTRA weeks" at which malaria diagnosis and treatment are offered during azithromycin distribution.

Evidence now shows that the large scaling-up of malaria prevention, testing, and treatment across the entire country in 2006 and 2007 may have reduced the number of cases of the disease. However, without constant attention to malaria prevention activities, the disease's resurgence in endemic areas remains a threat. The Carter Center has been working with the Ethiopia government to improve and sustain the targeting of control efforts.  In addition, the Center has assisted with new guidelines for malaria surveillance and epidemic detection to ensure that outbreaks are dealt with quickly, and the impact on public health minimized. 

View Slideshow: Malaria Control in Ethiopia >

Read the article: Individual, household, and environmental risk factors for malaria infection in Amhara, Oromia, and SNNP regions of Ethiopia (PDF).

Learn more about the Center's Malaria Control Program.

 
 

Waging Peace


Strengthening Civil Society
The Center's Democracy Program has supported the efforts of civic leaders in Addis Ababa to convene discussions about the most pressing and contentious political and social issues facing the country.  The group set an ambitious agenda of modeling constructive dialogue on issues such as media policy, ethnicity, and the future of the country's economic development. The Carter Center provided support to the first phase of the project, which focused on facilitating public discussions based on well-researched facts, in a forum that demands respect for opposing viewpoints.  The group sought broader dissemination of their model discussions via radio, Internet, and print publication. They also anticipated partnerships with educational and other institutions to widely replicate this model of discussions.

Mediating Conflict
In 1988, former U.S. President Jimmy Carter visited Addis Ababa to consult with Ethiopian dictator Mengistu Haile Mariam. On a subsequent visit to the region, President Carter met with Eritrean and Tigrayan revolutionary leaders who had been engaged in a 30-year war with the Ethiopian government. At the invitation of both sides, President Carter presided over peace negotiations between the Ethiopian government and the Eritrean People's Liberation Front at The Carter Center for 12 days in September 1989. These mediations marked the first time the parties agreed to negotiate without preconditions in the presence of a third-party mediator.

These negotiations were reconvened in Nairobi, Kenya, in November 1989. Despite having made some progress, the parties continued to fight. In May 1991, Tigrayan forces reached the capital city of Addis Ababa, forcing Mengistu to flee the country. Eritrea became an independent nation in May 1993.

A 1991 conference of the leading forces in Ethiopia set the course toward full democracy under President Meles. Subsequently, all but President Meles' Tigrayan groups withdrew from the transition government. Although Ethiopia was well on its way to achieving democratic practices, elections in 1992 were flawed. Eager to help the country deepen its democratic practices, President Carter invited all sides to The Carter Center in February of 1994 for a dialogue.

Read more about the Carter Center's Conflict Resolution Program.

Intervening for Human Rights
President Carter and The Carter Center have a long history of interaction with the current and past governments of Ethiopia. In August 1988, President Carter interceded on behalf of 30 Ethiopian Jews and 220 Somali prisoners of war in his first meeting with Ethiopian dictator Mengistu Haile Mariam. They were released a month later.

In 1992, President Meles Zenawi, who assumed office in May 1991, requested President Carter's help to incorporate strong mechanisms for the protection of human rights into the structure of the Ethiopian state. With these goals in mind, the Center worked with various Ethiopian government ministries in 1992 and 1993 to prevent human rights violations. Training and assistance were provided to: conduct fair trials against officials of the former regime, design a human rights training program for law enforcement personnel, and increase awareness within the judicial system of human rights issues.