International Peacemaking and Human Rights Programs - Ethiopia

Ethiopia

The nation with the highest incidence of blindness in the world, Ethiopia has enlisted the help of The Carter Center to preserve the sight of millions of Ethiopians.

Building Hope

As Africa's oldest independent nation, Ethiopia has had a wide variety of governing institutions, from monarchy to military occupation to Marxist state and finally, a capitalist democracy. The Carter Center's relationship with Ethiopia has been equally diverse, having assisted the nation with disease eradication and control programs, food security development, conflict mediation, and the promotion of human rights. Working together, a brighter future for the Ethiopian people is on the horizon.

Read about the Center's peace work in Ethiopia.

Fighting Disease

Ethiopia Public Health Training Initiative

Preventing many African nations from realizing their full potential, disease is a formidable and often deadly adversary. Because most African countries have little funds to devote to national health care, the majority of villages and towns are without adequate medical services. However, in Ethiopia, a nation where less than half of the population has access to modern medicine, a partnership among The Carter Center, the Ethiopian Ministry of Education, the Ethiopian Ministry of Health, and seven national universities and colleges is changing a desperate situation into a legacy of hope. The goal of the Ethiopia Public Health Training Initiative is to contribute to improving the health of Ethiopians by enhancing the quality of training health staff receive.

In 1991, Prime Minister Meles Zenawi invited President Jimmy Carter to assist with a program that would train health workers for Ethiopia. Six years later, the initiative was launched. Today, The Carter Center works with seven Ethiopian universities to prepare health care workers to serve 90 percent of the Ethiopian population in more than 600 rural health centers. This undertaking is part of the Ethiopian government's plan to open more health centers, expanding modern health care to millions of villagers located in rural communities. Primary goals include strengthening the teaching capacity of health science faculty, development of health-related teaching and learning materials, and improving learning environments.

The Ethiopian Public Health Training Initiative's objectives are accomplished through workshops, seminars, and conferences on the various college campuses. In the workshops, Ethiopian teaching teams analyze the essential tasks necessary to manage each health problem and construct training modules that include the necessary knowledge, attitudes, and skills needed for health teams to carry out their roles in typical settings in rural Ethiopia. The initiative assists the college teams in revising and testing draft materials at the campuses between periodic workshops, prior to final publication for use in the field.

Assisting Ethiopian partners since September 1997, The Carter Center has facilitated 565 workshops and completed more than 60 training modules on topics such as HIV/AIDS, malaria, diarrhea, pneumonia, trachoma, protein-energy malnutrition, and various other endemic health problems. Also, more than 100 sets of lecture notes for use as lesson plans within medical classrooms have been completed, with more in development.

By 2007, the initiative expects to collaborate in production and distribution of the following training and learning materials:

10 core classroom training modules for multidisciplinary teaching of health students on major diseases, proper health processes, and problems faced by rural health service centers and community-based health programs in Ethiopia
10 sets of lecture notes that complement the training modules.

The Ethiopia Public Health Training Initiative is making significant contributions to capacity-building in seven higher education institutions. It is laying a solid foundation, with participating individuals clearly expressing their ownership of the process and products.

Other projects of the initiative include: the reproductive health program, drought assistance program, development of teaching and learning materials for the developing health extension worker program, and administration of the Accelerated Health Officer Training Program.

READ PROFILES:

In 2007, classroom materials were provided to each of the seven partnering universities:

USD $150,000 worth of text and reference books (approximately 2,000 books)
Computers, printers, and a photocopier
10-15 periodical and journal subscriptions for each university
Classroom demonstration materials and basic laboratory equipment, such as anatomical models and microscopes

Learn more about Ethiopia Public Health Training Initiative.

Updated August 2007

Eradicating Guinea Worm Disease

Status: Endemic
Reported indigenous cases in 2006: 1

When The Carter Center began working with Ethiopia's Ministry of Health to eradicate Guinea worm in 1990, there were 2,333 reported cases of the disease, concentrated mostly in the Gambella and Kuraz districts. In 2004, only three indigenous cases were reported; unfortunately, 2005 saw an increase of 26 cases. This increase demonstrates the constant need for vigilance in eradication efforts. The Ethiopia Guinea Worm Eradication Program is part of a larger international effort - spearheaded by The Carter Center - working since 1986 to eradicate this painful and debilitating disease. In 2006 only one indigenous case was reported from the district of Gambella.

Guinea worm disease, also known as dracunculiasis, is a parasitic disease that has affected people since biblical times. Guinea worm is contracted when humans drink water contaminated with the infected larvae of microscopic water-flea-like organisms called copepods. Once ingested, the larvae mature, during which time patients show no symptoms of infection.

By the time a thread-like, whitish Guinea worm burns a hole from inside, breaks through the skin, and forms a sore on the person carrying it, it has lived in the body for about a year. Traditionally, the infected person wraps the Guinea worm around a small stick and extracts it by rolling the 2- to 3-foot worm on it, a slow and painful process that takes many weeks.

The emerging Guinea worm often causes fever, nausea, secondary infection, and burning pain, earning the parasite one of its nicknames, "the fiery serpent."

In collaboration with the Ministry of Health, the strategy for eliminating Guinea worm from Ethiopia consists of several components, primarily driven by health education. The goal of the Guinea worm program is to change behavior and mobilize communities to improve the safety of their local water sources. Approaches introduced to the communities include: health education; distribution of nylon filters to strain out the water fleas that host the infected larvae; safe, monthly ABATE® larvacide treatments of stagnant ponds; direct advocacy with water organizations; and increased efforts to build safer hand-dug wells. Community-elected village volunteers, who are trained, supplied, and supervised by the program, 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 receives 50 birr, about $8 USD, each or an item worth the same amount.

Major constraints on program efforts include: continued difficulty in accessing the last endemic districts of the Gambella region 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 2006, two additional imported 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.

UPDATED July 2007

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

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 was also 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 - its mission: 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 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 2004.

In partnership with the Ministry of Health and APOC, The Carter Center now assists program activities in eight of the ten endemic zones in the country: Bench Maji, Gambella, Illubabor, Jimma, Kaffa, Metekel, North Gondar, and Sheka, By the end of 2006, 93 percent of the annual treatment goal and 100 percent of the geographic coverage was achieved; in other words, 2,554,576 Ethiopians in 13,046 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.

Updated August 2007

Click here to learn more about the Carter Center's River Blindness Program.

Controlling Trachoma

The rate of blindness in Ethiopia is thought to be the highest in the world. It is estimated that 2.7 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. A bacterial conjunctivitis that can persist for years due to frequent re-infection, trachoma causes inflammation and scarring of the inner upper eyelid. It is the leading cause of preventable blindness in the world and is endemic in poorer rural communities.

To promote awareness of trachoma control primary schools in Dera district, Anbessamie, Arb Gebeya, and Humsit celebrated their first annual Trachoma Prevention Day in June and July 2003. Participants included students, teachers, parents, and representatives of The Carter Center as well as local staff of the district administration and health and education offices. Teachers and hygiene experts read poems, and students in the schools' trachoma clubs performed dramas and sang songs about trachoma control, hygiene, and health. Students also completed trachoma question-and-answer contests. More than 200 participants attended each of the events.

Widespread and debilitating, trachoma is a major public health problem in Ethiopia. The Ministry of Health estimates that 1.1 million Ethiopians are in need of immediate surgery to prevent blindness, 15-20 million have active trachoma requiring antibiotic treatment, and the entire population of 71 million is at risk of infection.

In October 2000, The Carter Center, with funding from 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 157 subdistricts 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 to all 40 districts, reaching an at-risk population of 17.45 million people.

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 1-10 years had active trachoma and an estimated 5 percent of people had trichiasis (advanced 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 2001, The Carter Center and the Amhara 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.

In addition to promoting school health education, the program continues ongoing health education promoting personal and environmental hygiene within the community. These activities target especially women and children. In 2007, 654 villages are regularly conducting health education at public gatherings and during household visits.

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 and the construction of model latrines in public gathering places.

Between 2002 and 2006, more than 300,000 household latrines were built 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. Read: Latrine Program a Hit, published in the March 5, 2005, issue of the Atlanta Journal-Constitution.

The Carter Center also supports the Ministry of Health to distribute the Pfizer Inc.-donated antibiotic Zithromax® (azithromycin). As a result, in 2003, the program started mass distribution of azithromycin to all members of trachoma-endemic communities. In 2003, approximately 100,000 doses were distributed. Treatments rose to more than 2.9 million in 2006, and 9.7 million doses are targeted for distribution in 2007. People who are ineligible for azithromycin, due to young age are given tetracycline eye ointment provided by The Carter Center. To date, more than 952,000 doses of tetracycline have been distributed in Ethiopia alone.

The Carter Center also supports the Amhara Regional Health Bureau in corrective eyelid surgery for trichiasis, the stage of trachoma at which individuals may lose their sight. Through the end of 2006, nearly 65,000 people have received trichiasis surgery, relieving them of the dreadful pain associated with the condition and giving them the possibility of restoring their sight. One-hundred-eighty surgeons have been trained by the program to conduct surgery during regular health center visits, surgery camps, and outreach surgical campaigns.

The hard work continues to benefit millions of Ethiopians whose sight is being preserved. The Amhara Regional Health Bureau continues to demonstrate its commitment to controlling trachoma.

UPDATED July 2007

Click here for more information on the Center's Trachoma Control Program.

Increasing Food Production

Ethiopia's government has initiated a process to strengthen the links with its development partners to find a lasting solution to the country's chronic food insecurity. The New Coalition for Food Security has been established, and a technical group has drawn up a detailed program for Ethiopian and donor support.

Food security in Ethiopia is a matter of life and death. More than 5 million people are enlisted for food relief each year, even when weather and market conditions are favorable. With population growth of 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.

Ethiopia requires urgent changes in its approach to rural and agricultural development, which must include improvements in crop yields and production techniques; restoration of the environment, including restoration of depleted soil nutrients; the introduction of an efficient marketing system; and a reduction in population growth.

Led by Nobel Peace Prize winner Dr. Norman Borlaug, 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. Since SG 2000's inception in 1986, more than 4 million African farm families have learned new farming techniques that allow their grain production to be doubled or tripled.

In Ethiopia, The Carter Center has supported regional departments of agriculture in high-potential agricultural areas of the country, assisting farmers in maintaining a high level of food crop production. One intervention involves the establishment of a select number of demonstration plots, known as "standards of excellence" plots, in areas where yield levels have deteriorated on many of the government-sponsored demonstration plots.

During 2001, the program established 372 extension management-training plots, primarily to demonstrate conservation technology. Quality protein maize also was introduced into the farming communities. This new type of fortified maize is expected to reduce infant malnutrition and mortality dramatically. In 2004, the first of a multiyear study has so far indicated positive progress.

Also, a water-harvesting program has included demonstration and development of water- harvesting technologies that will assist farmers in more efficiently irrigating their crops.

During the 2003 crop season, the program, in collaboration with regional bureaus of agriculture and other partners, sponsored the establishment of some 803 on-farm demonstration plots in 34 woredas, or administration districts, in three regions of the country: Oromiya, Amhara, and Southern region. Major activities included demonstrating soil conservation techniques, promoting quality protein maize, developing rice, mounting extension work in water-harvesting technologies, as well as integrating post-harvest technologies and fertilizer studies.

Adopting new technologies to improve crop yields is only half the battle as farmers then must find ways to sell their surplus crops. The program also helps identify local markets for these surpluses, because transporting them can be costly and inefficient. Additionally, projects focus on post-harvest technologies, including methods for processing and storing. Neighboring countries in the program that share crop seasons are encouraged to foster lasting cooperative efforts.

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 where lives are no longer threatened by famine.

Click here to learn more about the Carter Center's Agriculture Program.

Controlling Malaria

The initial focus of the Carter Center's Malaria Control Program, launched in January 2007, is 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 bed nets to cover the entire malaria at-risk population by July 2007.

Using the same community-based networks already established for Ethiopia's river blindness and trachoma control programs, The Carter Center is expanding 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.

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 People's Region), and Oromiya regions, the Center will help protect 18 million people at-risk: 36 percent of the total population at-risk in Ethiopia. In addition to long-lasting insecticidal bed net distribution, the Center will work with other partners to assist with health education and evaluation of the national program

The Center will assist in net distribution and health education to help protect 18 million men, women, and children in more than 100 districts (woredas) and several hundred malarious localities called Kebeles.

In the southwest region of the country, bed net distribution for malaria control is being combined with the country's river blindness program. In the Amhara region, bed net distribution and health education is being coupled with trachoma control initiatives. It is estimated that the national bed net program could save 60,000 to 100,000 lives per year in Ethiopia.

Learn more about the Center's Malaria Control Program.

View Slideshow: Malaria Control in Ethiopia

Waging Peace

Strengthening Civil Society

The Center's Democracy Program currently supports 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 has 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 has provided support to the first phase of the project, which focuses on the facilitation of public discussions based on a model that infuses the discourse with well-researched facts, in a forum that demands respect for opposing viewpoints as the issues are thoroughly discussed. The group also seeks broader dissemination of their model discussions via radio, internet, and print publication. The second phase anticipates partnerships with education and other institutions that will widely replicate discussions according to the model.

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 President 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.

Election Reports

Ethiopia 2005 National Elections: Final Statement on The Carter Center Observations, Sept. 15, 2005 (PDF)
The Carter Center was pleased to accept the invitation of the Ministry of Foreign Affairs of the Federal Democratic Republic of Ethiopia to observe the 2005 parliamentary elections in Ethiopia. The May 15 elections were for 524 of the country's 547 constituency-based seats in the national Parliament. The remaining 23 seats in the Somali region were elected separately in votes held on Aug. 21.

Carter Center Postelection Statement on the Ethiopia Elections, June 9, 2005
The Carter Center joins other members of the international community and Ethiopian citizens in expressing its deep alarm and sorrow at the violence, injuries, deaths, and violations of human rights that have occurred since June 6 in Addis Ababa and elsewhere in Ethiopia in the aftermath of the May 15 national elections.

Postelection Statement on Ethiopia Elections, June 3, 2005
The Carter Center's May 16 postelection statement, based on observations of the polling process in Addis Ababa and selected locations in eight regions, expressed some concerns and noted that for the first time in history, the majority of Ethiopian voters were presented with choices when they went to the polls.

Ethiopia Elections: Jimmy Carter Trip Report, Postelection Statement
The Carter Center thanks the Ministry of Foreign Affairs of the Federal Democratic Republic of Ethiopia for its invitation to observe the May 15, 2005, national elections and all those who welcomed us and took the time to contribute to our understanding of Ethiopian politics and the electoral process.

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