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Promoting High-Quality Health Services in Ethiopia

To improve Ethiopia’s health infrastructure, the Assistance to Health Systems Expansion project built the capacity of local institutions to provide quality assurance and control, as well as services for construction, renovation, and maintenance of health centers and other facilities.

USAID launched the Assistance to Health Systems Expansion (AHSE) project in late 2009 to improve the design, construction, renovation, and maintenance of health centers, and build the capacity of the government, regional health bureaus, and local commercial organizations. AHSE was tasked with assisting the government in its ambitious goal of increasing the number of health centers from 600 in 2008 to more than 3,200 by 2010.

By supporting government-planned health facility expansion and maintenance, AHSE contributed to strengthening Ethiopian health systems, while working toward the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) objective of extending the prevention, treatment, and care of people living with HIV/AIDS in Ethiopia, as well as the Millennium Development Goals of reducing child mortality and increasing access to reproductive healthcare by 2015.

By focusing activities on Addis Ababa, Oromia, Amhara, Tigray, and the Southern Nations, Nationalities, and People’s Region — which make up more than 70 percent of the Ethiopian population — and fostering coordination at all levels of government, AHSE’s impact was regionally targeted and nationally felt. With a diverse team of trainers, health professionals, biomedical engineers, architects, engineers, alternative energy specialists, and water and waste management experts, AHSE was able to lay the groundwork for lasting coordination across relevant stakeholders in the Ethiopian health sector. During three years of implementation, AHSE supported future health systems expansion in Ethiopia, identifying successes, opportunities, and challenges in the country’s complex healthcare environment.

Project Results

  • Assessed structural integrity at more than 150 health centers and hospitals, and medical equipment at 170 health facilities.
  • Provided technical support and systems strengthening for regional health bureaus and the Public Health Infrastructure Directorate. Building flaws at health centers — such as poorly aligned concrete block walls or cracked columns — dropped 61 percent in the second half of 2010, according to the directorate.
  • Developed new designs for primary hospitals — construction is under way for 700 new ones — and multi-story urban health centers.
  • Refined designs for district hospitals and provided on-site adaptation for rural health centers.
  • Conducted regional workshops for more than 630 architects, engineers, and health professionals.
  • More than 800 professionals gained experience in a wide range of topics, including health facility plumbing, electrical equipment maintenance, photovoltaic solar energy systems, housekeeping, and waste management.
  • Assessed 83 health centers for water and electricity needs and developed pilot projects for 10 health centers:
    • Collaborated with the German Agency for International Cooperation to install photovoltaic solar panels and train health center workers.
    • Collaborated with the U.S. Army’s Combined Joint Task Force-Horn of Africa to drill wells at three health centers, providing water for health services as well as the surrounding communities.
    • Installed rooftop rainwater harvesting systems at two health centers and, at one of them, a solar-powered water disinfection unit to purify water for delivery and invasive procedures.
    • Installed solar-powered water heaters at a health center in Addis Ababa to replace electric heaters, reducing costs and interruptions to hot water.

Final Report

Project Duration: 2009 - 2012


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