A World Bank Emergency Rehabilitation Programme (ERP) follow-up mission travelled to Addis Ababa and Tigray from 22 January to 2 February in order to assist the Government of Ethiopia in finalizing a detailed Programme Implementation Plan (PIP) prepared as part of the World Bank’s assistance to the Government in post-war recovery. The PIP, which outlines the sectoral activities, projects, contributing partners and delivery mechanisms of the ERP, has enabled the World Bank to declare credit effectiveness.

The mission, whose primary focus was on the US$30 million humanitarian demining component of the PIP, acted as a point of convergence for several key stakeholders in humanitarian mine action. Participants included Ethiopian demining and UNDP mine action specialists, MEDaC and World Bank representatives and Tigrayan authorities.

The Government of Ethiopia has expressed their desire that loan funds target support for operating costs for national demining and the provision of equipment. The strategy will be to combine these funds with bilateral/multilateral grant funds to cover international technical assistance and additional equipment. The USA has already pledged US$1.6 million to begin training/retraining of deminers.

The timing of the mission coincided with the Council of Ministers decision to initiate a series of legal regulations including the establishment of a civilian humanitarian demining capacity. This capacity will culminate in the establishment of The Ethiopian Mine Action Office (EMAO) as an autonomous legal entity taking over the mandate from the former Ethiopian demining project.

The third meeting of the Military Coordination Commission (MCC) of the United Nations Mission in Ethiopia and Eritrea (UNMEE) was held in Nairobi, Kenya on Tuesday, 6 February 2001. An agreement was reached between the Ethiopian and Eritrean delegations to move forward with the establishment of the Temporary Security Zone (TSZ), a 25-km-deep buffer zone separating the two armies. Accordingly, Ethiopia began to redeploy its force from high ground positions starting from 12 February to 26 February. Eritrea began to redeploy its force to the northern boundary on 17 February and will finish on 3 March.

Meanwhile, some 3,700 UNMEE peace keeping troops and military observers have been deployed in the mission area as of February 2001.

Reports reaching WHO Ethiopia confirmed that another cycle of sporadic meningococcal meningitis outbreaks in the country began in late January. At least five regions (Tigray, Amhara, SNNP, Gambella, Benshagul Gumuz) are reported affected. The majority of the reports are from Amhara Region in the northern part of the country along the main highway. Kobo wereda in North Wollo Zone, Amhara region was hardest hit with 104 cases and nine deaths over a period of eight weeks followed by Alamata wereda in South Tigray Zone with 81 cases and seven deaths over a similar period. The outbreak is reported to have complicated the life of refugees in Sherkolie refugee camp in Benshangul Gumuz Region. Meningococcal meningitis is also reported in the western part of the country (Gambella), along the Sudan border and also from the eastern part of the country close to Somalia.

Immunizations were carried out in Kemissie, Quarit, and Shinile districts and Dessie town. The Ministry of Health with WHO and other partners have taken measures to revitalize and strengthen regional and national epidemic committees. A preparedness plan has been compiled and urgent requests have been sent to all partners to assist in the implementation of the plan.

It is hoped that a minimal stock of drugs will not jeopardize the effort. In response, UNICEF procured 10,000 vials of meningitis vaccines and AD syringes which are expected in country this week.

Dr. Yves Guinand and Dechassa Lemessa from the UN Emergencies Unit for Ethiopia (UN-EUE) undertook an intensive study on famine and wild foods in Ethiopia throughout the year 2000. Their study was designed to document indigenous knowledge on wild-foods and, more particularly, on ‘famine-foods’, to identify and better understand the importance of wild-food plants in the survival strategies adopted by rural people in food insecure areas of the country.

WFP monitors have reported unseasonal rainfall in parts of the South and Southwest of Ethiopia, which bodes well for livestock dependant populations, with mixed impact on crop dependant populations as currently, crops are being harvested. WFP monitors will continue to follow the situation closely on the ground and their feedback, combined with forecasts from the Drought Monitoring Centre Nairobi, satellite imagery and other sources, will be regularly compiled and analyzed by WFP’s VAM Unit.

The Addis Ababa office of the International Organization for Migration (IOM) has ongoing activities for medical screening, HIV/AIDS testing with pre- and post-counseling services in refugee camps. This program provides care for refugees intending to resettle in host countries. By the end of 2000 participants in this program reached some 550 and for 2001 it is expected to go beyond 3,000. IOM is also implementing two projects on prevention through voluntary testing and counseling (VCT), the first focusing on the mobile, migrants and the population living around the main trucking routes in Ethiopia, the second dealing with HIV/AIDS prevention and reintegration of demobilized soldiers in different settings.

Substantial progress has been in made in Gulomehda woreda in Eastern Tigray, where UNICEF, supported by the US State Department’s Office for Population, Refugees and Migration, is engaged in a multi-sectoral programme aimed at the construction of shelter, the rehabilitation of water points and support to basic health services. In Gulomehda, UNICEF has initiated the shift from emergency assistance to rehabilitation activities. As of today, over 400 most vulnerable households have been provided with wood poles, corrugated iron sheets, nails and wire to assist in rehabilitation of damaged or destroyed houses. 10 sites for the construction of wells have been selected and four wells are being drilled. Drugs from a previous stock are being distributed to mobile health services and will be replenished as soon as new drug kits are available.

Pockets of severe needs continue among drought displaced and security-affected IDPs even in areas of declining overall food aid needs, such as Afder and Liben zones. . Destitute IDPs, as a result of recent tensions between Somalis and Oromos have gathered in various areas of Filtu in Liben zone especially need attention along with those in Hi-Suftu and Hudet. Significant numbers of drought displaced are still present in Denan town in Gode zone, and elsewhere in the Region.

WFP and World Bank Discussions
Discussions took place last month between WFP and the World Bank to explore areas of complementarity between WFP’s IDP programme and the US$ 230 million Emergency Recovery Project of the World Bank.

Following a relatively quiet period of port activity, the situation changed in the latter half of January, with a record discharge/dispatch on a direct delivery basis of over 9,200 mt on 22 January. Between 18-31 January, some 68,000 mt food aid was transported under FATS from Djibouti Port to primary hubs in Ethiopia. WFP discharged/dispatched some 64,660 mt of food from Djibouti Port in the first two weeks of February against a total of over 85,000 mt scheduled to arrive at the Port in the month. At present, 1,500 FATS long-haul trucks are involved in this operation. Permission for the use of the WFP helicopter until end March 2001 for logistic purposes has been received from the relevant government authorities. WFP logistics has been given an allocation plan by DPPC for the short-haul truck fleet, covering deliveries for food distributions in seven zones of Somali Region, using the new DPPC appeal figures

Relief Food Assistance
The DPPC states that the overall food situation in 2001 will be characterized by self-sufficiency with a possible surplus in the western half of the country, but continuing reliance on relief in many areas of the rest of the country. Where they occur, surpluses will make the local purchase of food for relief possible. The total number of people expected to need relief assistance in 2001 due to natural disasters is estimated at 6.24 million, while the food situation of an additional 3.1 million people still needs close monitoring. Food will be distributed to a minimum of 3.2 million beneficiaries in February. Relief food requirements for 2001 are estimated at 639,246 MT. Taking into account carry over stocks and undelivered pledges of some 168,588 MT, the total net relief food requirements for 2001 are 470,658 MT.

The Government appeal stresses that the emergency response should go beyond the provision of food, covering the technical, material and financial needs for the key non-food sectors. The health and water infrastructure in drought-affected pastoral areas is weak. Fast-onset disasters such as floods need to be addressed in a timely manner. Emergency stocks of food and non-food supplies need setting-up, strengthening and managing.

In order to monitor the extent of malnutrition and identify appropriate targeting, funding is needed to make the central ENCU fully operational and to establish others at regional and zonal levels.

Capacity building is vital for undertaking effective emergency operations and prevention measures. To ensure that capacity constraints both at Federal and Regional levels do not hamper relief operations, the Government is requesting:

Drought-affected
Although there is currently a more favourable crop production outlook, the purchasing power of many impoverished rural communities remains very weak, limiting their access to food even when markets are reasonable well supplied. Moreover, recovery in drought-affected pastoral areas will take a number of years, necessitating the continuation of a basic humanitarian safety net.

Of the 2001 net relief food aid requirements of 476,658 to support 6.24 million drought-affected persons indicated by the Government, WFP is requesting 206,200 MT of food to assist an estimated 2.5 million of these beneficiaries and funding to strengthen logistics. Other priorities will include communicable disease prevention and provision of basic health services by UNICEF and WHO. UNICEF also plans the provision of safe drinking water and sanitation, shelter and education assistance. FAO activities will stress the revitalization of agricultural and livestock production. Funding requirements are as follows:

The estimated 395,366 IDPs, returnees and deportees in Tigray and Afar will be given priority especially in terms of continuing relief assistance where needed, facilitating a safe return home and restoring a minimum level of self-sufficiency. Special attention will paid to providing a bridge to the World Bank Emergency Recovery Programme, humanitarian mine action (UNDP/UNICEF/WHO), preventing HIV/AIDS transmission (UNAIDS), re-establishment of basic health, water and education services (UNICEF/WHO) and continued food assistance (WFP). Funding requirements are as follows:

Ethiopia is currently hosting a caseload of 206,879 refugees. UNHCR’s priorities will include the provision of essential services to camp-based populations and the voluntary repatriation of those who wish to go home. WFP’s Protracted Relief and Recovery Operation has planned for a caseload of 238,000 persons, translating to 42,711 mts for the year 2001.

As part of their Beyond Relief Programme, Guardian-SERRO has started a school-feeding project for Kelafo and Mustahil district primary schools for a ten-month period. The project is benefiting 1,320 school children with the aim of improving their nutritional status. Pending funding, Guardian-SERRO plans to extend their school-feeding programme to Ferfer and Shilaabo district schools.

Other Guardian-SERRO planned projects linking relief to development are the rehabilitation of wells and water reservoir, health education for the prevention of sexually transmitted diseases and HIV/AIDS, reforestation, and small-scale irrigation.

The HIV/AIDS epidemic has added to the poverty burden of the country. Scarce human resources, limited access to basic services and a high dependency rate are further eroded by worsening trends on most demographic, health and socio-economic indicators. All signs indicate that the epidemic is escalating very fast.

Over 80% of the cases of HIV/AIDS are found in persons between the ages of 20 and 49 -- the most economically productive age group of the population. HIV has now spread throughout the country, and cases are reported from every region in Ethiopia with a greater concentration in urban centers.The current adult prevalence in urban Ethiopia is estimated to be much higher at 13.4% (16.8% in Addis Ababa) than in rural areas, where current adult prevalence is estimated to be 5%. (15) Today the number of adults and children infected with HIV is estimated to be about 2.6 million, out of which 250,000 HIV infections are among children under the age of five years.

One of the worst impacts of the death of adults from AIDS is the dramatic increase in the number of orphaned children. It is estimated that 1,200,000 children have lost their mother or both parents to AIDS in Ethiopia since the beginning of the epidemic. (source: UNICEF)

With the HIV/AIDS crisis worsening, the Government established a comprehensive policy for national mobilization in 1998 and formed the National HIV/AIDS Council (NAC) in early 2000 with the primary objective of providing an enabling environment for the prevention and mitigation of HIV/AIDS. The Council is composed of members from the government, sector ministries, religious organizations, non-governmental organizations, community based organizations, the private sector, individuals and people living with HIV/AIDS (PLWHA). The President of the Federal Democratic Republic of Ethiopia chairs the Council, which meets once every four months. HIV/AIDS councils are also formulated at all levels in every region. The third session of the NAC is scheduled for 3 March with an agenda focusing on the evaluation of what has been accomplished thus far and the strategic plan for the country. The government’s strategy is to take the lead in confronting HIV/AIDS and to expand a multi-sectoral response to the epidemic in a sustainable manner. Additionally, on 19 February, the head of the NAC Secretariat updated Parliament on the current status of operations.

Recognizing that caring for patients is not enough, OSSA is intensively involved in teaching and informing the population about the disease with the goal to create awareness and change sexual behavior, especially of the younger population. The backbone of OSSA’s awareness strategy is hundreds of volunteer counselors, trained by OSSA, who not only care for all of the physical needs of patients, but also provide a connection to the community. One of OSSA’s main approaches for information, education and communication (IEC) programmes in the field with the assistance of these volunteer counselors, is through "Anti-AIDS Clubs" that motivate interested people to get involved in protecting themselves and the community, particularly youth. These clubs use innovative avenues of music, drama, the circus and videos to educate members on HIV/AIDS. OSSA supports 664 clubs with 48,000 members throughout Ethiopia with the objective of eventually ensuring that these clubs are self-sustaining.

Orphans are of special concern to OSSA. Thus far, OSSA has supported over 3,200 orphans who lost their parents due to AIDS. Psychosocial support is provided to grown up orphans, remaining families and caregivers. OSSA promotes alternatives to orphanages like extended families, foster families, child sponsorship and family houses. They provide skills training like sewing and carpentry and focus on keeping AIDS orphans in school.

Medecins Sans Frontieres (MSF) is a private, non-profit, international humanitarian organization whose objective is to provide medical aid to populations in crisis.

MSF Belgium started its operation in Ethiopia in 1992 in order to assist with medical crises in the country. In 1996 MSF Belgium launched STD and HIV prevention programs in four health centres of Addis Ababa. This project engaged in the dissemination of information communication and education materials, the provision of medicine for STDs with minimum amounts of funds and trainings on syndromic case management (also known as the sign and symptom method), which refers to investigating STD problems through interviews. From 1998 onwards the project expanded its program to all health centres of Addis Ababa.

As part of this project, MSF is now also working on a self-help and empowerment program for women in prostitution (WIP). The project mainly works on creating awareness, disseminating information and giving counseling HIV, STD and family planning. It also has an income generating mechanism that provides different kinds of trainings for peer educators and members including savings and credit schemes for the WIP. The project addresses 1,500 WIP in the target areas of Addis Ababa (Arat Kilo, Kasanchis, Merkato and Cherkos).

Dhendra K. Tyagi (DKT) International is a Washington based NGO that has over 20 years of experience in more than 30 countries. It uses commercial marketing techniques to make primary health care products accessible and affordable to people uncovered by the public health system and the commercial sector.

DKT Ethiopia started its operations in Ethiopia with a tripartite agreement with the Ministry of Health and the Disaster Prevention and Preparedness Commission (DPPC). It is committed to assisting the people and the Government of Ethiopia in the fight against HIV/AIDS. Accordingly, DKT’s main objective is reducing sexual transmission of HIV/AIDS and other STDs by making good quality condoms accessible at an affordable price and by increasing contraceptive prevalence through continuous supply of contraceptives. Its major areas of activities include a Social Marketing Program (SMP), an awareness campaign using mass media, health education and training, information education and communication (IEC) and distribution of promotional material and product sales and distribution.

DKT started to implement SMP throughout the country in February 1990. The main components of SMP include training of health care providers of the public and private health sectors, ensuring media communication in order to create and increase awareness in family planning and HIV/AIDS prevention, designing, developing, producing and distributing IEC materials, creating familiarity with DKT’s health products and distributing sales products (condoms, pills etc). Sales of condoms increased from 699,506 in 1990 to 49,919,649 in 2000 adding up to a total of 236,239,603 in ten years.

SYGA has branch offices in Nazreth and Debrezait. In addition it provides technical and financial support to ten self-help initiative clubs in these areas. Currently different clubs are also working under the network of SYGA in different parts of the country: Agaro, Asela, Ambo, Dila, Shashemene, Sebeta, Debrebrhan and Ziway.

Mekdim HIV positive Persons and AIDS Orphans National Association is an organization comprised of HIV positive persons and orphans whose parents have died as a result of the HIV/AIDS. It was established in 1997 to contribute its share to fight against HIV/AIDS, with the objective of promoting public awareness, providing support and protecting the rights of HIV positive people and orphans, and providing counseling service. The main targets of its project are high school students, university students, military camps and factory workers.

Mekdim currently has an active project with four components. The first includes information education and communication (IEC) services, personal testimony by HIV positive people, different drama and musical shows and door-to-door education which is to be implemented in the coming two months. The second program provides home based care for critically sick bed ridden AIDS patients. Care is given by well trained HIV positive people and health professionals as necessary. Treatment includes massage, reflexology and dressing wounds. Mekdim also provides basic medicine and covers hospital expenses for patients if needed. This program benefits thirty patients on average monthly. The third program provides counseling service to fifty people per month by giving pretests and ongoing and/or post test counseling services. Mekdim is also planning to initiate pre-testing counseling services in test centers and hospitals as these services are non-existent in Ethiopia. The ongoing counseling on how to live with the virus, will also continue for those who test positive. Counseling will also be provided to those who are negative. The Social Support Project is the forth program in which critically sick patients, needy families and AIDS orphans are given financial and medical support. This project supported by Save the Children Sweden covers house rent, school fees and other expenses of the patients and the family. Mekdim in collaboration with Concern Ethiopia has designed a new program to strengthen the care and support project for the year 2001. This program will focus on provision of medicine, clothes, blankets and other home based care materials and on building the over all capacity of the association.

UNAIDS brings together the efforts and resources of UN system organizations to help prevent new HIV infections, care for those already infected and to mitigate the impact of the epidemic. Its aim is to help mount and support an expanded response--- one that engages the efforts of many sectors and partners from government and civil society.

Currently, a primary emphasis for UNAIDS is on providing support to the National AIDS Council and the Secretariat. Additionally, due to the number of players with HIV/AIDS programmes in Ethiopia, UNAIDS is focusing on researching stakeholders and compiling an extensive matrix to identify gaps and overlaps in activities. This matrix will allow the government to develop linkages between organizations working in similar areas. The UN theme group on HIV/AIDS supported by UNAIDS is also reviewing modalities of coordination between the Secretariat and the UN, focusing on how they can best complement each other.

The WHO Country Office in Ethiopia has been providing technical backstopping services in the formulation of national health policy and guidelines in addition to actively participating in the development of a framework of multi-sectoral response and plans in priority interventions.

WHO has joined hands with government partners to undertake regular epidemiological surveillance on the spread of the pandemic. With the establishment in April 2000 of the National AIDS Council (NAC), WHO Ethiopia has been working to help make this crucial step in the creation of strong national coordination a reality.

The country office has supported the MOH in revising and elaborating the 2001 Plan of Action on HIV/AIDS/STI prevention and control, and is now in the process of mobilizing resources for its implementation. In collaboration with the MOH and other partners, it has played an active role in facilitating the establishment and running of the majority of the existing 75 HIV testing laboratories in the country. Together with the ministry, it has organized a national workshop on the clinical management of AIDS, which is now compiled and ready for implementation. The recent national workshop on Voluntary Counseling and Testing (VCT) was jointly supported by WHO, UNICEF, USAID and other stakeholders. The latter culminated in the development of a National VCT Guideline under the National AIDS Council Secretariat (NACS).

WHO Ethiopia is facilitating activities including the conduct of antenatal sentinel surveillance at 21 sites along with behavioral surveys at selected sites for monitoring trends, providing technical guidelines, training and orientation of staff in HIV/AIDS/STD prevention, care and support. Currently, the Country Office is promoting blood safety, vaccine development and home care with a strong team of experts to handle the epidemiology, care and support (including home based care) and demographic aspects of the HIV/AIDS pandemic. The Country Office has also seconded a public health specialist to the Ministry of Health to strengthen the HIV/AIDS/STD Team.

WHO/AFRO recently launched an initiative that provided 50 home based care kits and allocated USD 20,000 for purchase of basic drugs for the treatment of persons living with HIV/AIDS on a pilot scale in collaboration with Christian Relief and Development Association (CRDA), an umbrella for almost all NGOs in Ethiopia. Experience gained from such an initiative together with that of OSSA is expected to help improve care and support.

WHO is closely working with CDC, Atlanta for the effective implementation of the LIFE Initiative to fight the HIV/AIDS epidemic in Africa, in which Ethiopia has been identified as one of the beneficiaries.

The World Food Programme Ethiopia Country Office, in co-operation with other UN agencies and NGOs has been very active in the prevention of HIV/AIDS through training and education programmes in all WFP assisted emergency and development projects. WFP programmes target women attending MCH clinics and through family planning clinics to cover both men and women clients. There are several HIV/AIDS awareness generation volunteers and peer volunteers who conduct awareness generation programmes in communities. Some NGO partners also conduct street plays for awareness generation. UNICEF is also using WFP food distributions for internally displaced people as fora for HIV/AIDS information/awareness sessions. In 2000, WFP, UNHCR and DKT jointly sponsored a training undertaken by DKT for 50 HIV/AIDS activists to cover a population of over 70,000 refugees. Thousands of HIV/AIDS prevention pamphlets were distributed.

As a member of the UN Thematic Working Group (UNTWG) on HIV/AIDS, WFP has played a co-leadership role (WFP, UNAIDS and UNICEF) in having recruited a team of consultants and closely monitoring their activity on the preparation of a joint UN Country Team working document on "HIV/AIDS and Development" in Ethiopia. As per the UNTWG activities for the year 2000, WFP would contribute US$ 20,000 to carry out: 1) Reproduction and distribution of HIV/AIDS Information, Education and Communication (IEC) materials, as well as adaptation of the materials where appropriate, to suit internally displaced people needs. 2) Establishing a foundation for the provision of HIV/AIDS peer voluntary counselling.

WFP is encouraging other UN partners and NGOs to use its food distribution sites in all food assistance projects for HIV/AIDS awareness and other HIV/AIDS training venues.

WFP conducted a training course entitled "HIV/AIDS in the work place" for staff members in the Country office and as well as separate sessions for family members in January 2001.