health in ethiopia health in ethiopia health in ethiopia has improved markedly since the early 2000s, with government leadership playing a key role in mobilizing resources and ensuring that they are used effectively. a central feature of the sector is the priority given to the health extension programme, which delivers cost-effective basic services that enhance equity and provide care to millions of women, men and children. the development and delivery of the health extension program, and its lasting success, is an example of how a low-income country can still improve access to health services with creativity and dedication. preparing a measles vaccine in ethiopia life expectancy at birth in ethiopia the human rights measurement initiative finds that ethiopia is fulfilling 83.3% of what it should be fulfilling for the right to health based on its level of income. when looking at the right to health with respect to children, ethiopia achieves 94.5% of what is expected based on its current income. in regards to the right to health amongst the adult population, the country achieves only 90.6% of what is expected based on the nation's level of income. ethiopia falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 64.8% of what the nation is expected to achieve based on the resources (income) it has available. overview ethiopia is the second most populous country in sub-saharan africa, with a population of over 94.1 million people. as of the end of 2003, the united nations (un) reported that 4.4% of adults were infected with human immunodeficiency virus/acquired immune deficiency syndrome (hiv/aids); other estimates of the rate of infection ranged from a low of 7% to a high of 18%. whatever the actual rate, the prevalence of hiv/aids contributed to falling life expectancy since the early 1990s. according to the ministry of health ethiopia, one-third of current young adult deaths are aids-related. malnutrition is widespread, especially among children, as is food insecurity. because of growing population pressure on agricultural and pastoral land, soil degradation, and severe droughts that have occurred each decade since the 1970s, per capita food production is declining. according to the un and the world bank, ethiopia in 2005 suffered from a structural food deficit such that even in the most productive years, at least 5 million ethiopians require food relief. line graph showing the trend of mortality from hiv and tb in ethiopia, africa and the globe the fact that the country achieved mdg 4, reducing the child mortality and the decline of hiv mortality has helped life expectancy to increase to 65.2 years in 2015 from 46.6 years in 1990. the under 5 mortality rate and infant mortality rate dropped from 203 and 122 in 1990 to 61.3 and 41.4 in 2015. the ministry of health has achieved this through the health extension program by using a special implementation platform called women development army. table 1: ethiopia's health status trend from 1980 to 2015 health indicator 1950 1960 1970 1980 1990 2000 2015 u5mr32927524324020314461.3 imr-16214314312289.541.4 life expectancy (yr)33.83943.744.646.651/165.2 ethiopia experiences a triple burden of disease mainly attributed to communicable infectious diseases and nutritional deficiencies, ncd and traffic accident. shortage and high turnover of human resource and inadequacy of essential drugs and supplies have also contributed to the burden. however, there has been encouraging improvements in the coverage and utilization of the health service over the periods of implementation of health sector development plan, the health chapter of the national poverty reduction strategy, which aims to increase immunization coverage and decrease under-five mortality at large. the health service currently reaches about 72% of the population and the federal ministry of health aims to reach 85% of the population by 2009 through the health extension program (hep) . the hep is designed to deliver health promotion, immunization and other disease prevention measures along with a limited number of high-impact curative interventions. a new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by the lancet in september 2018. ethiopia had the lowest level of expected human capital among the 20 largest countries with less than 5 health, education, and learning-adjusted expected years lived between age 20 and 64 years. this put it in 175th place, an improvement over its position in 1990 when it was 189th. tb and leprosy control program tuberculosis has been identified as one of the major public health problems in ethiopia for the past five decades. the effort to control tuberculosis began in the early 60s with the establishment of tb centers and sanatoria in three major urban areas in the country. the central office (co) of the national tuberculosis control program (ntcp) was established in 1976. from the very beginning the co had serious problems in securing sufficient budget and skilled human resource. in 1992, a well-organized tb program incorporating standardized directly observed short course treatment (dots) was implemented in a few pilot areas of the country. an organized leprosy control program was established within the ministry of health in 1956, with a detailed policy in 1969. in the following decades, leprosy control was strongly supported by the all african leprosy and rehabilitation training institute (alert) and the german leprosy relief association (glra). this vertical program was well funded and has scored notable achievements in reducing the prevalence of leprosy, especially after the introduction of multiple drug therapy (mdt) in 1983. this has encouraged ethiopia to consider integration of the vertical leprosy control program with in the general health services. the two programs were merged to being the national tuberculosis and leprosy control program (ntlcp), and coordinated under the technical leadership of the co from 1994. the most recent who global report classifies ethiopia as one of the top 30 high burden countries for tb, tb/hiv and mdr-tb. the tb prevalence estimates in ethiopia shows a steady decline since 1995 with an average rate of 4% per year, which is accentuated in the last five years (annual decline of 5.4%). likewise, the estimates for tb incidence reached a peak value of 431/100,000 population in 1997, and has been declining at an average rate of 3.9% per year since 1998, with annual decline of 6% within the last five years. the incidence estimate for all forms of tb in 2015 is 192/100,000 population. tb mortality rate has also been declining steadily since 1990 and reached 26/100,000 population in 2015. the decline in prevalence rate for all forms of tb has declined from 426/100,100 in 1990 to 200/100,000 population in 2014 (53% reduction). similarly, the tb incidence rate has dropped from 369 in 1990 to 192/100,000 population in 2015 (48% reduction), after a peak of 421/100,000 in 2000. furthermore, tb related mortality rate has been declining steadily over the last decade from 89/100,000 in 1990 to 26/100,000 in 2015 (70% reduction from 1990 level). in 2011, the first population based national survey shows a prevalence rate of 108/100,000 population smear positive tb among adults, and 277/100,000 population bacteriologically confirmed tb cases. the prevalence of tb for all groups in ethiopia was 240/100,000 populations in the same year. this finding indicates that the actual tb prevalence and incidence rates in ethiopia are lower than the who estimates. additionally, the survey showed a higher prevalence rates for smear positive and bacteriologically confirmed tb in pastoralist communities. however, pertaining to its methodology, the survey did not produce further disaggregated sub-national estimates. malaria though its prevalence in ethiopia is relatively low compared to other african nations, malaria remains the leading cause of outpatient morbidity and is among the leading causes of inpatient morbidity. nearly 60 percent of the population lives in areas at risk of malaria, generally at elevations below 2,000 meters above sea level. recently, many densely populated highland areas, including the city of addis ababa, were classified as malaria-free. because peak transmission coincides with the planting and harvesting season, malaria places a heavy economic burden on the country. sixty percent of malaria infections are due to the plasmodium falciparum parasite, though the plasmodium vivax parasite is also present. insecticide resistance among vectors and antimalarial drug resistance have been documented in the country. usaid using anti-malarial spray to prevent mosquitoes from entering a home in oromia, ethiopia. the carter center conducted research in ethiopia in the mid-2000s where they analyzed how malaria affects the ethiopian population among various factors. the factors considered included living situations and housing conditions, as well as ethiopian age and gender demographics. this study found that ones socio-economic position directly corelates to their chance of contracting malaria. researchers concluded that a key method of reducing the prevalence of malaria in ethiopia is by improving the quality of housing and living conditions. they found an effective disease countermeasure to be the use of anti-malarial spray, as households that had been sprayed had lower rates of infection. this research also concluded that while the poorest households are more likely to face these poor conditions, they are also the ones less likely to take steps towards malaria prevention, thus continuing transmission of the disease. the carter center chose three specific areas in ethiopia to assess the impact of the use of insecticide treated mosquito nets on malaria prevalence. during the course of the study, malaria prevalence fell to 0.4% from a starting 4.1%. this study concluded sleeping under these mosquito nets is an effective tactic for mitigating malaria in regions of concern. this study has revealed the importance and effectiveness of malaria prevention in ethiopia, and thus has led to health workers promoting the use of these long lasting insecticidal nets in areas where use is still limited and disease prevalence is highest. a research study done by the ethiopian public health institute revealed flaws with ethiopia's laboratories and their workers as it pertains to malaria diagnosis. the study found 26.7% of the 106 ethiopian laboratories assessed lacked adequate supplies needed for proper diagnosis. researchers attributed this to multiple factors, such as insufficient lab funding and supporting third parties not providing supplies in a timely manner. the study also noted a lack of job competency in the microscopists who look for malaria in blood cells in these labs. the ethiopian public health institute found that, in conjunction with the ministry of health and local health providers, they should be working to better educate, supply and monitor these labs and their workers in order to prevent further obstacles in malaria mitigation in ethiopia. although much of ethiopia remains at risk of malaria, routine surveillance data from the last decade have noted declines in malaria outpatient morbidity and inpatient mortality trends. prompt access to malaria case management, including laboratory-based diagnosis in remote rural areas, has improved dramatically over the last decade together with surveillance systems that capture malaria morbidity and mortality. maternal and child health main article: maternal health in ethiopia development of child mortality rate in ethiopia since 1966 maternal and child health program is a priority agenda of the government of ethiopia and this has been clearly indicated on the currently being implemented strategic plan of the fdre ministry of health. though maternal and child health program is still one of the target area which needs much organized, systematic and focused effort, clear progress has been witnessed over years as per the demographic health survey report of the country. the recent dhs in the country shows these steady changes. other recent studies show notable variation across the country as well as progress at both the national and subnational level. ethiopia has seen a 67% decrease in child mortality and a 71% decrease in maternal mortality over the last two and a half decades. maternal health status could be assessed with many indicators of which modern contraceptive use, skilled delivery and maternal mortality are some of the majors. modern contraceptive use by currently married ethiopian women has increased over 15 years prior to the 2016 dhs. jumping from 6% in 2000 to 27% and 35% in 2011 and 2016 respectively. the skilled delivery has increased from 10% in 2011 to 27.7% in 2016. the total fertility is declining but the changes are