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UNFPA’s Achievements and Impact

UNFPA’s Reproductive Health Programme has implemented successful interventions in three core areas to improve the health of mothers, slow the spread of HIV/AIDS, and mitigate the virus’ impact:

Skilled attendance at birth: UNFPA is intensifying support to midwifery and anesthesia-training schools through its Midwifery Programme. The Midwifery Programme in Ethiopia started in October 2008 in five locations: Mekelle, Hawassa, Gonder, Haramya, and Jimma. A Regional Midwife Association has been formed in Tigray, which facilitated additional EmOC trainings. Capacity building is focusing on 3 topics: strengthening regulatory mechanisms, developing and strengthening education and accreditation mechanisms, and at last, promoting the development and role of midwives associations. As gaps are identified, selected midwifery schools will be equipped with the necessary textbooks, training models, and mannequins.

Emergency Obstetric Care: A new Masters of Science Programme to train midlevel health care providers (“non-physician clinicians”) in integrated emergency obstetric care and surgery has been initiated at 4 universities; a Baseline EmONC Assessment that will guide policy and programming has been conducted.

Reproductive Health Commodity Security: Health Management Information System (HMIS) tools (registers, forms, etc.) have been distributed to all health facilities in the country to enhance commodity delivery and tracking. Gaps at health facilities – such as low knowledge or insertion skills among health facility workers – that have resulted in poor uptake of long-term family-planning methods were identified. As a result, UNFPA has offered training to health-facility workers in IUCD insertion. Contraceptive procurement has also been going on for large quantities. The first trench of 4 million Depo has arrived in Addis, and other commodities, including Implanon (450,000 pcs) will be arriving by the end of February 2009. A woreda mapping exercise designed to decrease overlapping efforts among partners, to ensure equitable distribution of commodities, and to maximize utilization of resources was conducted, especially taking into account the underserviced and remotest areas. Public-Private partnerships have resulted in much-enhanced coordination, including the standardization of training on Comprehensive Family Planning Programs, and the development and adoption of the guideline for use by health care providers and Health Extension Workers.

The HIV/AIDS component

Prevention of mother-to-child transmission (PMTCT) of HIV: A PMTCT advisor has recently been recruited to provide support to both HAPCO and the Family Health Department (FHD) in the Ministry of Health on the implementation of the PMTCT programme. Content to strengthen prongs 1 and 2 of the PMTCT strategy has been developed and added to the PMTCT training manual. Input has also been provided on other key documents being developed for the PMTCT programme. UNFPA also facilitated improved communication between HAPCO and FHD, which was non-existent prior to UNFPA involvement with the programme, and supported workshops on integration within the Federal Ministries.

UNFPA also produced six in-depth analysis research papers on the 2005 Ethiopia Demographic and Health Survey (EDHS), which distilled and interpreted statistics collected on issues of RH, HIV, PD and gender. These analyses have been, and will continue to be, used to design programming that strengthens not only HIV prevention, treatment, care, and support services, but also maternal health interventions. Among the Ethiopia-specific documents, subjects included factors fueling the prevalence of HIV and contributing to regional variations, a review of the national response and strategic directions for increasing HIV prevention, the drivers of HIV epidemic, and a policy and legal framework analysis aimed at identifying gaps in protecting women and girls from HIV.

Integrated Interventions: Gender and Maternal Health

UNFPA conducted a year-long campaign to stop early marriage, an HTP that significantly increases a young woman’s risk of death or injury in childbirth. Girls ages l0-14 are five times more likely to die in pregnancy or childbirth than women aged 20-24. Girls ages 15-19 are twice as likely to die. The vast majority of these deaths take place within marriage.

“The Fight Against Early Marriage,” short film including descriptions of Berhane Hewan (“Light for Eve”), an early marriage intervention, and the 2008 “Stop Early Marriage” campaign.

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The “Stop Early Marriage” campaign was designed to raise awareness in Ethiopia’s regions and to increase support from donor countries for interventions to address early marriage. To build public support for the “Stop Early Marriage” Campaign, UNFPA commissioned 30 well-known Ethiopian artists to create the largest painting in the country – 100 metres long – inspired by the campaign’s message. At the launch event, His Holiness Abuna Paulos, Patriarch of the Ethiopian Orthodox Church, publicly stated that the Church would not condone early marriages.

Over the course of 2008, the canvas toured three regions of Ethiopia where early marriage is highly prevalent. It was exhibited in community centers to schoolchildren, parents and caretakers, community leaders, and government ministers, all of whom were invited to sign a blank section to pledge their support.  Most recently, UNFPA, the Embassy of Spain in Ethiopia and the Spanish International Development Cooperation held an exhibition in Madrid at the School of Fine Arts at the Universidad Complutense.

Each of these exhibitions has helped strengthen partnerships among key governmental bodies, other UN agencies, local communities, and leading public figures (including the First Lady of Ethiopia, H.E. Woizero Azeb Mesfin) to end early marriage. The hundreds of signatures on the canvas to date—mostly from communities in the regions of Ethiopia—signal growing support for the campaign’s message.

The Madrid exhibition was particularly designed to illuminate the relevance of the “Stop Early Marriage” campaign beyond Ethiopia’s borders. That event, itself, celebrated Ethiopian and Spanish cultures; facilitated inter-cultural dialogue about human rights and their universality; demonstrated how culturally sensitive approaches can still advance the principle of universal human rights; and strengthened our partners’ support for UNFPA Ethiopia’s Gender Programme activities.

Integrated Interventions: Humanitarian Assistance, HIV and Maternal Health.

UNFPA supported the local production of clean delivery kits, in collaboration with ISAPSO, to assist women giving birth in crisis-affected areas with little health system support. The project generated income for women in the Addis Ababa region and eliminated the need to obtain the kits from UNFPA’s global procurement center in Copenhagen. UNFPA additionally purchased and distributed various emergency reproductive health supplies to enhance maternal health of the affected populations of Somali, SNNPR, Gambella, and Oromia Regions. The Fund also held various capacity building trainings on RH, HIV, and GB for health workers in these same disaster-affected areas.