“We wish to remain steadfast in our support to the government’s grand vision”
Haddis Tadesse is the country representative of the Bill & Melinda Gates Foundation. He has been at the helm of one of Ethiopia's biggest development partners since 2012 since he moved from Seattle. Here he reflects with Samuel Getachew of The Reporter on the work of the foundation, on working on gender empowerment, on the challenges of the COVID-19 pandemic and the wisdom of vaccinations. Excerpts:
The Reporter: The Bill & Melinda Foundation has become an important organization within Ethiopia, involved in areas of health among others. Share with me the highlights of the work of the foundation within the nation?
Since making our first grant in Ethiopia in 2000 and opening our office in Addis Ababa in 2012, we have partnered with the government, the private sector, donors and civil society to help Ethiopians live healthy and productive lives. We are guided by the strong conviction that every life has equal value and this grand mission informs all our engagement.
Our priorities in Ethiopia are in the areas of health, nutrition, agriculture and women’s empowerment. To do this, we work with more than 135 partners including government agencies and affiliates at the federal and regional-level.
For agriculture, our focus is on ensuring smallholder farmers have access to products and services they need to grow productive crops. Ethiopia has shown that a country can accelerate inclusive agricultural transformation when a government provides a clear vision for the sector and aligns public and development partner funds around a set of priorities. We will continue supporting Ethiopia to succeed and be an exemplar for others to follow.
For health, we support sustained, universal coverage of family health, expanding access to immunizations, and strengthening existing health systems. We are supporting the government’s goal of strengthening Ethiopia’s capacity to achieve Primary Health Care (PHC), by focusing on the delivery of evidence-based, high impact health and nutrition interventions at national and regional levels.
And in all our focus areas we seek to address gender barriers and to that end integrate gender across all our workstreams.
The foundation, as well as the Gates continue to be engaged within the continent and both have become an important and noted partners with increasing spending investment in Ethiopia. What is the long-term vision of the foundation in the country?
Our mission is to support Ethiopia in its efforts to reduce poverty and increase the coverage of life-saving development and health delivery interventions.
We are proud to be a strong partner for Ethiopia as we have witnessed tremendous developmental strides, shepherded by a strong central government which has pursued an ambitious development agenda. We wish to remain steadfast in our support to the government’s grand vision of building a prosperous Ethiopia.
Since 2000, the poverty rate has dropped from 63 percent to 23.5 percent, life expectancy has increased from 50 to 67 years and is now higher than the average for Sub-Saharan Africa, which is 61. We have also seen both maternal mortality and under five mortality rates drop by nearly 70 percent. Ethiopia has made great strides in education too, with almost all children enrolled in primary school.
As always, more can be done and we need to focus our resources to improve quality and address critical bottlenecks.
One area that is noted to receive much support in Ethiopia is areas of gender equality and girls’ empowerment, including in access to education from the foundation. Tell me about that?
We believe everyone should have an equal opportunity to lead a healthy, productive life. And we know that no matter where you’re born your life is harder if you’re a girl and this is even more pronounced in countries like Ethiopia.
In Ethiopia our work on improving gender equality mostly focuses on supporting programs that give women and girls better access to health services and overcoming the persistent challenges they face in the agricultural sector.
Ethiopia has made progress advancing gender equality over the last few years: more girls are finishing primary school and women across the country have better access to healthcare. In 2000, less than 20 percent of girls completed primary school, and today just over half do. One area where Ethiopia has had significant success in addressing gender equality is the delivery of health services. In the last 20 years, the maternal mortality rate in this country has decreased from a ratio of about 1,000 deaths per 100,000 births to 401 deaths per 100,000. This is a significant achievement and the result of strong leadership from the government and the ongoing support of key partners, including the foundation.
The ongoing coronavirus pandemic provides us an opportunity to rebuild a more prepared and equal society. As Melinda wrote recently, COVID-19 might be gender blind, but it isn’t gender neutral. Economically the crisis exploits existing disparities women face when it comes to jobs and accessing credit. There is a health implication too. We’ve seen from previous pandemics that when health systems are strained, maternal mortality rises. This is no coincidence. The parts of health systems devoted to caring for women are the most fragile and underfunded, so they tend to collase first and fastest.
But the COVID-19 pandemic provides policymakers with a chance to do things differently—improve health systems, design more inclusive economic policies, gather better data, and prioritize women’s leadership—countries can build back better, more prepared, and more equal.
How do you see the current development of COVID-19 within Ethiopia and perhaps reflect on the work of the foundation on that front?
Ethiopia, like many African countries, needs to be congratulated for its swift and effective response to COVID-19. We commend the government for taking bold and decisive measures to mitigate the immediate health-related impact of COVID-19 and protect venerable communities from the damage that may be inflicted on them by the COVID-19-shock. In January, even as many Western nations hesitated, Ethiopia began passenger screening at Bole International Airport and put in place other preventive measures. Of course, the pandemic isn’t over and things could change quickly, but today the continent is the least impacted region in the world according to the World Health Organization (WHO), with less than five percent of reported cases and less than one percent of all deaths, despite being home to 17 percent of the global population.
In Ethiopia, we have been helping the government in coordinating its response. This includes providing technical assistance to forecast supply needs, helping strengthen disease surveillance, and helping prepare for and mitigate the economic costs of the pandemic. We are also working with other donors and regional agencies to help the government secure protective equipment and other treatment supplies.
Ethiopia has also benefited from our work at the regional level, particularly with partners such as the Africa CDC, and WHO’s regional office for Africa. One of the best examples of this has been our partnership with the Africa CDC to train lab teams, including in Ethiopia, on how to test for and detect COVID-19. In February, only two countries on the continent had the capacity to test for COVID-19. Today, almost 50 countries do.
There is growing interest for potential vaccines for the virus and the Gates are one of the most visible funders of it. What are the prospects of a vital vaccine being discovered for the virus that has devastated countless people and killed thousands in the world?
We have been informed by the experts that safe and effective vaccines could be developed as early as the end of the year - pending the results of large-scale clinical trials - with scale up and delivery happening well into 2021 and beyond.
What is equally important is that once safe and effective vaccines are available, that they can be delivered to countries and people who need them most, not just to those who can pay the most.
The role of vaccinations and its acceptance in Ethiopia is growing. Share with me the work of the foundation on that front and how far, as a society, we have become to make it accessible and vital to those who need it most?
I remember reading one of your recent articles on how mothers are beginning to witness first-hand the lifesaving power of vaccines in Ethiopia. Such stories of progress are backed up by data. Almost three-quarters of Ethiopian children received their full course of routine immunizations in 2017 compared to only 50 percent in 2007. That is amazing progress to see in a single decade.
However, despite extraordinary progress, there are still logistical and cultural challenges to delivering vaccines in certain regions. For example, in Addis Ababa nearly 85 percent of children received all basic vaccinations but in Afar and Somali regions, the rate is below 20 percent. More than 870,000 children in Ethiopia missed out on lifesaving measles, diphtheria and tetanus vaccines in 2018. We must continue to work together, governments and global partners alike, to help protect and save children from deadly, preventable diseases. We also need to exert maximum effort to ensuring that women and girls are not disproportionately affected by these challenges.
I believe the same set of constraints that impede the implementation of general health services in Ethiopia (such as inadequate follow-up and supervision) are the same challenges for immunization programs.
Vaccination coverage in Ethiopia often varies according to household wealth and maternal education.
Thankfully, targeted programs to reach under-immunized children in these subpopulations have helped improve vaccination coverage and equity outcomes in Ethiopia. Over the years, various innovative measures, such as training 40,000 health extension workers, have been critical to improving health outcomes across the country.
The most visible warriors of the pandemic, as well as those who implement the vision of your foundation are the health practitioners in the world and Ethiopia is no exception. Any parting message you have for them?
COVID-19 has changed our lives beyond recognition. We have seen how diseases can spread rapidly with no respect to national borders. COVID-19 anywhere is a threat to people everywhere.
We owe a profound debt of gratitude to our heroic frontline healthcare workers who day-in-day-out are putting themselves at risk to help control and manage the disease. Much of our success to-date has been the result of their hard work and dedication and the exemplary leadership that is being given across all levels should continue unabated.