The Carter Center has had a long relationship working with Ethiopians to advance peace and health. Activities include assisting the nation with disease eradication and control programs, increasing food production, mediating conflict, observing elections, and promoting human rights.
The Center's peace programs have worked with all factions of Ethiopian civil society and government to increase dialogue between disputing groups, mediate conflict, observe elections, prevent human rights violations, and build institutional protections for human rights in the nation.
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. These mediations marked the first time the parties agreed to negotiate without preconditions in the presence of a third-party mediator.
The 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 Ethiopia's 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 Prime Minister Meles Zenawi. 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 1994 for a dialogue.
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 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 of 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.
The Carter Center observed the country's third national elections on May 15, 2005. While the Center's assessment determined that the majority of the constituency results were credible and reflected competitive conditions, a considerable number of constituency results were problematic. After the election, Carter Center observers were witness to and received reports of human rights violations occurring in and outside Addis Ababa, and on June 9, 2005, the Center issued a statement condemning the postelection violence.
After the 2005 elections, the Center's Democracy Program supported the efforts of civic leaders in Ethiopia to convene 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. The Carter Center helped facilitate public discussions based on well-researched facts, in a forum with respect for opposing viewpoints.
A partnership between The Carter Center, the Ethiopia Federal Ministry of Education, the Ethiopia Federal Ministry of Health, and seven universities and colleges, known as the Ethiopia Public Health Training Initiative, improved the health of Ethiopians by enhancing the quality of training and education that health workers receive. That initiative has ended, but The Carter Center remains deeply involved in building health and hope in Ethiopia through work to combat Guinea worm disease, river blindness, trachoma, lymphatic filariasis, and malaria, which cause tremendous suffering in the nation.
Current status: Endemic
Indigenous cases reported in 2015: 3
With assistance from The Carter Center, the Ethiopia Ministry of Health established its National Dracunculiasis Eradication Program in 1991, launching a village-by-village nationwide search, which found 1,120 cases in 99 villages in two regions of the southwest part of the country. Transmission of Guinea worm disease (dracunculiasis) in the Southern Nationalities, Nations, and Peoples Region (SNNPR) was interrupted in 2001, but continued in the Gambella Region. In 2007, Gambella Region reported zero indigenous cases for 12 consecutive months.
In 2008, Gambella reported 41 indigenous cases, and by 2014, only three cases of dracunculiasis were reported. The strategy for interrupting transmission of Guinea worm disease in Ethiopia relies on active surveillance systems in high-risk areas to detect all cases and contain them by preventing patients from contaminating water sources. Approaches for changing behavior and mobilizing communities to protect their drinking water 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 (donated by BASF Corporation); voluntary isolation of patients in case containment centers; 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.
As part of the effort to provide safe water to communities with Guinea worm disease, the Carter Center-supported program and a partnering nongovernmental organization, Norwegian Church Aid, have constructed hand-dug wells in the Gambella Region. The Ethiopian Federal 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.
Committees were formed to stimulate community participation and to reach villagers displaced from Akobo by tribal conflicts to the relatively inaccessible woredas (hamlets) of Jikawo and Itang. Some 20 resettled Akobo volunteers were trained on surveillance, health education, and the use of nylon filters, and a UNICEF-donated motorboat assisted with reaching some of the most difficult areas.
A reward system provided by Health and Development International was established in all endemic areas to improve the detection and reporting of cases. A monetary reward induces people with cases to report early and, for the duration of their illness, to remain at a health facility, where they receive three meals a day, a place to sleep, and free medical care until all worms are removed.
Major constraints on program efforts include: maintaining surveillance throughout Guinea worm-free districts in the Gambella Region, where health extension workers are not engaged in support of the national Guinea worm program, and where districts are periodically inaccessible due to insecurity and heavy rains during the peak transmission season; and migration of people from South Sudan to Ethiopia.
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. In 2000, The Carter Center was invited to help implement Ethiopia's national River Blindness Program. The Center continues to assist the national program, in partnership with Lions Clubs International Foundation, Lions of Ethiopia, and other international, nongovernmental, and private organizations. In 2012, the Ethiopia Federal Ministry of Health, with encouragement from The Carter Center, established a goal of interrupting transmission of the disease nationwide by 2020 by increasing the frequency of Mectizan® treatment from annual to twice per year (semi-annual) treatment though a staggered approach. As part of this plan, in 2012, The Carter Center and Lions Clubs International Foundation assisted the Ethiopian government in providing almost 4.9 million treatments, a 50 percent expansion of treatments from the previous year.
The Ethiopian Onchocerciasis Elimination Expert Advisory Committee was inaugurated in October 2014 with the support of The Carter Center and the Lions Clubs International Foundation. Representatives from Ethiopia’s Federal and Regional Ministries of Health, the World Health Organization, the U.S. Centers for Disease Control and Prevention, and Merck also attended the first annual meeting. Establishing this advisory committee was a monumental step toward nationwide elimination of river blindness in Ethiopia
The Carter Center's activities in Ethiopia have expanded to address multiple diseases simultaneously. For example, with support from GlaxoSmithKline, The Carter Center helped the Ethiopia Ministry of Health launch a lymphatic filariasis elimination program in the Gambella Region. The first of its kind in Ethiopia, the program has administered more than 235,000 combined Mectizan and albendazole (a drug donated by GlaxoSmithKline used to treat lymphatic filariasis) treatments for lymphatic filariasis elimination in onchocerciasis-endemic areas. .
In 2015, The Carter Center assisted the Ethiopian government in providing over 15 million treatments in one year, most of which were semi-annual, overtaking the Center’s Nigeria office as the largest Mectizan program of The Carter Center. Treatments are provided in Amhara, Oromia, SNNPR, Metekel and Gambella. The same year, The Carter Center helped to establish an onchocerciasis molecular diagnostic laboratory at the Ethiopia Public Health Institute, the technical arm of the Federal Ministry of Health. The University of South Florida provides reference laboratory oversight for the state of the art laboratory.
The Carter Center's Lymphatic Filariasis Elimination Program in Ethiopia emerged from the Center's more than 20-year history promoting health in partnership with local communities.
Since 2009, with support from GlaxoSmithKline (GSK), The Carter Center has helped Ethiopia's Federal of Ministry of Health to fight lymphatic filariasis through integration of activities with malaria and river blindness, helping to save time and limited resources.
Lymphatic filariasis is a mosquito-borne illness and a leading cause of permanent and long-term disability worldwide. The disease can be prevented through health education, the adoption of, long-lasting insecticidal bed nets, and community distribution of the medicines Mectizan® (donated by Merck) and albendazole (donated by GSK).
In Ethiopia, efforts established in 2007 supported the nationwide distribution of free bed nets to fight malaria, and have created an important layer of protection for lymphatic filariasis, since the same mosquito spreads both diseases in Africa.
Because Mectizan also treats river blindness, lymphatic filariasis mass drug administration campaigns help combat both diseases simultaneously. The albendazole given for LF provides the ancillary benefits of treating intestinal worms.
The Ministry of Health of Ethiopia, in partnership with the Center, started a pilot project in Gambella region in 2012 to demonstrate that elimination of lymphatic filariasis is possible in Ethiopia. Today, the pilot project has evolved into a full-fledged, national campaign that is part of the global campaign targeting lymphatic filariasis elimination for 2020.
Treatment for LF has expanded dramatically from 77,442 treatments in 2012 to 1,114,753 treatments in 2015. Health education encourages communities to adopt and reinforce other behaviors that help prevent these diseases.
The preventable bacterial infection trachoma afflicts 1.2 million people in Ethiopia. In 1999, with funding from the Lions-Carter Center SightFirst Initiative, The Carter Center accepted the Ethiopian government's invitation to work on controlling the disease in the Amhara region, the most endemic of the 10 regions in Ethiopia. Carter Center-supported surveys found trachoma affected 39 percent of children, and the advanced stage of the disease, trichiasis, which requires surgery to prevent blindness, affected an estimated 5 percent of people.
Since 2007, the Carter Center-assisted program has reached the entire at-risk population in the Amhara region, through a partnership with the local Ethiopian Lions Clubs, which plays a key role in the implementation and advocacy for trachoma control in the country. The Carter Center-assisted program is "at scale" providing the SAFE strategy, a multipronged approach to trachoma prevention (Surgery, Antibiotics, Facial cleanliness and hygiene education, and Environmental improvement) to all persons at risk in the Amhara region.
To reduce the number of people living with trichiasis, The Carter Center works with the Amhara Regional Health Bureau to provide corrective eyelid surgery. In 2015, The Carter Center-assisted program performed 71,460 trichiasis surgeries. From 2001 to 2015, The Carter Center assisted the Amhara Regional Health Bureau in performing 455,881 corrective eyelid surgeries.
The Carter Center also helps the Federal Ministry of Health to distribute antibiotics for trachoma control. Adults and children older than six months are treated with Zithromax® (azithromycin), donated by Pfizer Inc, while infants and self-reporting pregnant women receive tetracycline eye ointment. From 2003 to 2015, The Carter Center supported the distribution of more than 124 million doses of azithromycin in Ethiopia.
The Carter Center and the Amhara Regional Health Bureau work closely to deliver health and hygiene education to communities and schools in an effort to raise awareness in improving facial cleanliness and the construction and use of latrines. The curriculum covers the SAFE strategy with an emphasis on "facial cleanliness" and "environmental sanitation," to encourage students to identify and find solutions for hygiene problems in their own communities. In 2015, the curriculum was evaluated and updated and printed with support from local Lions Clubs. As of 2015, a total of 3,459 communities had been targeted for health and hygiene education activities against trachoma.
To improve environmental sanitation and control the flies that can transmit trachoma, the program promotes household latrine construction and use. Since 2002, more than 3.2 million household latrines have been constructed in the Amhara region with help from The Carter Center.
From 1997-2010, at the invitation of the late Prime Minister Meles Zenawi, the Carter Center-supported Ethiopian Public Health Training Initiative (EPHTI) worked successfully in partnership 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 and one of the highest infant mortality rates. This critical situation was compounded by the emigration of Ethiopia's skilled health professionals to other countries.
Today, more than 31,000 trained health service professionals serve 90 percent of the Ethiopian population.
International experts worked side by side with Ethiopian teaching staff at the University of Gondar, Defense College of Health Sciences, Haramaya University, Hawassa University, Mekelle University, Jimma University, and Addis Ababa University.
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.
In 2007, the Ethiopia Public Health Training Initiative Replication Conference provided the opportunity for ministries of health, education, and science and technology from 10 African governments to learn how EPHTI's model could help address the severe shortages of health care professionals in their own nations. Following the conference, several countries expressed interest in establishing similar programs. Read the press release: U.S. President Jimmy Carter, Delegation To Tour Africa.
In late 2010, as part of the original agreement between the Ethiopian government and The Carter Center, the Carter Center-assisted EPHTI was officially transferred to Ethiopia's Federal Ministries of Health and Education. Read the press release: The Carter Center Celebrates Transfer of Ethiopia Public Health Training Initiative to Ethiopia Ministry of Health and Federal Ministry of Education.
At the request of the Federal Ministry of Health, The Carter Center expanded its health assistance in Ethiopia to include a malaria control initiative in 2007. The initial focus was supporting the Federal Ministry of Health in its goal of protecting the entire population at risk for malaria through free distribution of long-lasting insecticidal mosquito nets.
From December 2006 to July 2007, The Carter Center 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 and represent an essential step toward malaria elimination within Ethiopia.
The Center has focused its malaria activities in Amhara region, where malaria and trachoma efforts are combined into semiannual weeklong MalTra (malaria-trachoma) campaigns that treat millions for trachoma and test and treat for malaria. Between 2008 and 2012, 236,672 people were treated for malaria.
In addition, the Center has managed two large representative household surveys, which show 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. Between 2007 and 2012, the program supported the distribution of nearly 6 million long-lasting insecticidal bed nets.
The Center also has been a strategic partner for Ethiopia's nationwide Malaria Indicator Surveys (MIS) that assess the progress made in prevention and control. The 2011 MIS surveyed nearly 50,000 people, making it the largest MIS carried out in any African country. The results indicated that gains in key malaria interventions following the scale-up of activities in 2006-2007 have been sustained: in Amhara, 70 percent of households have at least one mosquito net, and around half of children under age 5 and pregnant women reported sleeping under a net the previous night. This has resulted in a significant decline in malaria prevalence throughout Amhara, from 4.6 percent in 2006 to 0.8 percent in 2011.
Finally, the Center works with the Federal Ministry of Health and regional health bureaus to teach health workers to diagnose and treat cases and to detect and respond to outbreaks and epidemics of malaria. The Center has helped develop new guidelines for malaria surveillance and epidemic detection to ensure that outbreaks are dealt with quickly and provides health education to encourage appropriate use and care of bed nets. As a result of these activities, the proportion of eligible health facilities submitting weekly data increased from 51 percent to more than 90 percent in 2012.
Insecticide-Treated Nets (ITNs)/Long-Lasting Insecticidal Nets (LLINs) Distributed in Ethiopia and Nigeria with Assistance from The Carter Center, 2004–2012
In 1993, a joint venture between the Carter Center's 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 percent higher yields. Participating farmers went on to teach others, creating a ripple effect to stimulate self-sufficiency.
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.
The Carter Center ended its agricultural activities in Ethiopia in 2011.
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Size: 1,104,300 square kilometers
Population below poverty line: 39 percent
Life expectancy: 62 years
Ethnic groups: Oromo, Amhara Somalie, Tigray, Sidama, Gurage, Welaita, Hadiya, Affar, Gamo, Gedeo, Silte, Kefficho, other
Religions: Ethiopian Orthodox, Muslim, Protestant, traditional, Catholic, other
Languages: Oromo, Amharic, Somali, Tigrigna (Tigrinya), Sidamo, Wolaytta, Gurage, Afar, Hadiyya, Gamo, Gedeo, Opuuo, Kafa, other, English, Arabic
Source: U.S. Central Intelligence Agency World Factbook 2016