Ethiopia

Our Work and Methods

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, Prime Minister Meles Zenawi requested former U.S. President Jimmy 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, we worked with various Ethiopian government ministries in 1992 and 1993 to prevent human rights violations.

Lasting Impacts

• Increased awareness and understanding of human rights issues within the judicial system.
• Provided targeted training and assistance in Ethiopia to conduct fair trials of officials from the former regime and design a comprehensive human rights training program for law enforcement personnel.

Our Work and Methods

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 27-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. The negotiations were reconvened in Nairobi, Kenya, in November 1989.

These mediations marked the first time the parties agreed to negotiate without preconditions in the presence of a third-party mediator.

Lasting Impacts

• Created groundwork for future peace processes in the region.
• Helped establish important dialogue channels between previously warring factions.
• Contributed to the peaceful transition of power following the fall of the Mengistu regime.

We observed Ethiopia’s third national election on May 15, 2005.
Our assessment determined:

• The majority of the constituency results were credible and reflected competitive conditions.
• A considerable number of constituency results were problematic.

Our Work and Methods

After the 2005 election, we supported the efforts of civic leaders in Ethiopia to organize discussions about the most pressing and contentious political and social issues facing the country.

The agenda included constructive dialogue on issues such as media policy, ethnicity, and economic development.

L

Current status: Endemic
Indigenous human cases reported in 2024: 0*
Animal infections reported in 2024: 2*

How It Started

With Carter Center support, Ethiopia’s Ministry of Health launched its National Dracunculiasis Eradication Program in 1991, conducting a nationwide village-by-village search that identified just over 1,100 cases in 99 villages. Intensive surveillance, community engagement, and water safety interventions have since brought transmission to the brink of elimination.

Our Methods

Community-elected village volunteers are trained by the program to carry out surveillance and interventions. The strategy for interrupting transmission of Guinea worm disease in Ethiopia relies on:

• Active surveillance in high-risk areas to detect every case
• Case containment to prevent individuals and animals from contaminating water sources
• Community mobilization to change behavior and protect drinking water by:
  • Distribution of nylon filters to strain out water fleas that host Guinea worm larvae
  • Treatment of stagnant water sources with ABATE®, a safe larvicide
  • Advocacy with water organizations to expand access to safe drinking water
  • Construction of hand-dug wells in the Gambella Region and training of local teams, through Ethiopia’s Federal Water Resources Development offices, to build hand-drilled wells.

Challenges

Major constraints on program efforts include: maintaining surveillance throughout Guinea worm-free districts that are periodically inaccessible because of insecurity and heavy rains during the peak transmission season, and migration of people from South Sudan — where the disease is endemic — to Ethiopia.

Lasting Impacts

Thanks to these sustained efforts — and the dedication of community volunteers, health workers, and partners — Ethiopia reported zero human cases in 2024, a historic milestone on the path to elimination.

How It Started

Onchocerciasis, or river blindness, was first reported in southwestern regions of Ethiopia in 1939, while the northwestern part of the country was recognized to be endemic in the 1970s.

Our Work and Methods

In 2000, The Carter Center was invited to help implement Ethiopia’s national River Blindness Program.

In 2014, with support from The Carter Center and the Lions Clubs International Foundation, the Ethiopian Onchocerciasis Elimination Expert Advisory Committee was inaugurated.

This committee determined in October 2022 that transmission of the disease had been interrupted in 17 districts in the South West Ethiopia Peoples’ and Oromia regions and that treatments could be stopped for more than 1.3 million residents. Transmission was interrupted in Metema subfocus (Amhara region) in 2017.

Lasting Impacts

Ethiopia and its neighbor Sudan achieved the first coordinated cessation of mass drug administration after both countries broke transmission of river blindness in an area along Ethiopia’s northwestern border.

The program continues to grow and now reaches more than 14 million people.

Trachoma affects an estimated 61.3 million people in Ethiopia, making Ethiopia the most severely affected country worldwide. According to the World Health Organization (WHO):

• Ethiopia accounts for 59% of the total global population at risk for trachoma
• The Amhara region of Ethiopia is the most trachoma-affected region in the world
• Of the 61.3 million people at risk in Ethiopia, more than 22 million (36%) live in the Amhara region

Our Work and Methods

Since 2001, our Trachoma Control Program has assisted the Amhara region in implementing the WHO-endorsed SAFE strategy.

The strategy comprises:

• Surgery to reverse in-turned lashes caused by advanced trachoma, known as trachomatous trichiasis, or TT
• Antibiotics to treat infection and reduce transmission
• Facial cleanliness to prevent bacteria from spreading
• Environmental improvement to improve access to clean water and basic sanitation to reduce the fly population

This work is performed in collaboration with the Amhara Regional Health Bureau, the Ethiopia Ministry of Health, and the Amhara Public Health Institute.

By the Numbers

Surgeries

• Between 2016 and 2024, a total of 353,460 TT surgeries were completed in Amhara, making up 44% of the total TT surgeries that took place in the entire country.
• In 2023, 75% of the total TT surgeries completed worldwide were performed in Ethiopia. In collaboration with Amhara’s health bureau, we supported 45% of those surgeries.

Antibiotics Distribution

The Carter Center works with the national and regional health entities to distribute antibiotics for trachoma control.

Adults and children older than six months are treated with Zithromax® (azithromycin, donated by Pfizer Inc). Those ineligible for Zithromax receive tetracycline eye ointment (TEO).

Between 2001 and 2024, we supported the distribution of more than:

• 213 million doses of Zithromax
• 5.6 million doses of TEO

In 2023 alone, 11% of the total trachoma antibiotics given out worldwide were distributed with our assistance in the Amhara region.

Lasting Impacts

As of December 2024, 58 districts — or 37% of all health districts in the region — have reached a key elimination threshold, meaning an estimated 6.6 million people no longer require mass antibiotic distribution to combat trachoma.

We work closely with the Amhara health bureau to deliver health and hygiene education to communities and schools, raising awareness about:

• Improving facial cleanliness
• Constructing and using latrines
• The SAFE strategy
  

An estimated 20,000 teachers are trained on the School Trachoma Program curriculum every two to three years to cover the needs of the more than 8,900 primary schools. Teachers and school principals also work with students to establish trachoma clubs, which present skits about prevention and educate students and community members about the disease.

The trachoma curriculum has now been incorporated into the standard regional curriculum for all schools, and a new curriculum for preschool children has been developed to reach the youngest students, who carry the greatest burden of trachoma.

Following recommendations from the 2021 WHO Informal Consultation encouraging alternative approaches for persistent trachoma, the Ministry of Health proposed an enhanced mass drug administration (MDA) strategy focused on children in six districts.

This “child MDA” approach combines the standard communitywide MDA with a follow-up treatment four weeks later for children ages six months to nine years. In 2023, The Carter Center and the Amhara Regional Health Bureau piloted child MDA in Lasta and Wadilla districts, distributing 337,423 doses. In 2024, the strategy expanded to seven districts, providing 236,739 doses to children to help combat persistent trachoma.

How It Started
Lymphatic filariasis (LF) is a mosquito-borne illness and a leading cause of permanent and long-term disability worldwide.

The disease can be prevented through:

• Health education
• Adoption of long-lasting insecticidal bed nets
• Community distribution of the medicines Mectizan® (donated by Merck & Co., Inc.) and albendazole

Our activities in Ethiopia often address multiple diseases simultaneously.

For example, we helped the Ethiopia Ministry of Health launch a lymphatic filariasis elimination program in the Gambella region in 2009. This program helped Ethiopia fight lymphatic filariasis through integration of activities with malaria and river blindness, saving time and limited resources.

Our Work and Methods

This initial effort grew into our Lymphatic Filariasis Elimination Program in Ethiopia, emerging from a more than 20-year history of promoting health in partnership with local communities.

This program supports treatment and health education for nearly 2 million people in these regions:

• Amhara
• Gambella
• Beneshangul Gumuz
• Central Ethiopia
• South Ethiopia

Lasting Impacts

Treatment for LF expanded dramatically, from 77,442 treatments in 2012 to a peak of more than 2.3 million in 2016.

The number of treatments has declined since then as districts achieve the impact needed to stop treatment. Communities — whether still seeing new LF infections or not — continue to receive health education and guidance on preventing mosquito bites.

How It Started

At the request of the Federal Ministry of Health, we expanded our health assistance in Ethiopia to include a malaria control initiative in 2007. The initial focus was supporting the ministry in its goal of protecting the entire at-risk population through free distribution of long-lasting insecticidal mosquito nets.

Our Work and Methods

We focused our malaria activities in the Amhara region, where malaria and trachoma efforts were combined into semiannual weeklong MalTra (malaria-trachoma) campaigns that treated millions for trachoma and tested and treated them for malaria. Between 2008 and 2012, 236,672 people were treated for malaria.

Insect Bed Nets

In 2006 and 2007, we purchased 3 million nets — the balance of nets needed by the national program — and helped to coordinate their delivery and distribution in more than 100 districts. These Center-assisted efforts help protect 36 percent of the at-risk population.

Between 2007 and 2012, we supported the distribution of nearly 6 million long-lasting insecticidal bed nets.

Household and Nationwide Surveys

In addition, we managed two large representative household surveys, which showed a threefold increase in the proportion of households owning at least one net in malaria endemic areas and a fourfold increase in the average number of nets per household. 

We also were a strategic partner for Ethiopia’s nationwide Malaria Indicator Surveys (MIS) that assess the progress made in prevention and control, surveying nearly 50,000 people.

Education and Training

Finally, we worked with the Federal Ministry of Health and regional health bureaus to teach health workers to:

• Diagnose and treat cases
• Detect and respond to outbreaks and epidemics of malaria

We helped develop new guidelines for malaria surveillance and epidemic detection to ensure that outbreaks are dealt with quickly and to provide health education to encourage appropriate use and care of bed nets.

How It Started

1997-2010

At the invitation of the late Prime Minister Meles Zenawi, we supported the Ethiopian Public Health Training Initiative, which worked with seven Ethiopian universities and the Ethiopia Ministries of Health and Education to address the dangerous void in rural health services for 75 million Ethiopians.

When the program began, Ethiopia had:

• One of the lowest life expectancies in the world
• One of the highest infant mortality rates

This critical situation was compounded by the emigration of Ethiopia’s skilled health professionals to other countries.

Our Work and Methods

International experts worked side by side with Ethiopian teaching staff at colleges and universities.

By the Numbers

More than 2,500 faculty were trained through 565 workshops and seminars. In addition, 228 learning materials were developed, addressing life-threatening diseases and longer-term health needs, such as HIV/AIDS, infectious diseases, nutrition, maternal and child health, mental health, reproductive health, and water and sanitation.

EPHTI enhanced classroom and learning environments for health sciences students by providing more than 7,000 textbooks, subscriptions to professional journals, computers, anatomical models, and supplies such as stethoscopes and gloves. A second component of the program trained health center staff and community health workers, including traditional birth attendants and community health agents.

Lasting Impacts

In late 2010, as part of the original agreement with the Ethiopian government, the Carter Center-assisted EPHTI was officially transferred to Ethiopia’s Federal Ministries of Health and Education.

Today, more than 31,000 trained health service professionals serve 90% of the Ethiopian population.

Our Work and Methods

In 1993, a joint venture between our Agriculture Program and the Sasakawa Africa Association helped Ethiopian farmers improve agricultural production.

The program supported regional departments of agriculture in high-potential agricultural areas of the country, helping them more effectively assist farmers in maintaining high levels of food crop production. The program provided farmers with credit for fertilizers and enhanced seeds to grow test plots, which often had 200% to 400% higher yields.

Participating farmers went on to teach others, creating a ripple effect to stimulate self-sufficiency.

Lasting Impacts

Part of a larger partnership led by Nobel Peace Prize laureate Dr. Norman Borlaug, the initiative helped more than 8 million small-scale sub-Saharan African farmers in countries where malnutrition is a constant threat.

We ended our agricultural activities in Ethiopia in 2011.