Specific Aims: The objective of this research was to evaluate a home-based HIV counseling and testing (HBVCT) pilot implemented in three Ethiopian sites during the first six month of implementation (January 1, 2011 to June 30, 2011). This study sought to document the experiences and challenges from the community voluntary counseling and testing (VCT) counselors providing the HBVCT service as well as specific challenges and barriers faced by ever-married community members. Setting: The pilot HBVCT program was implemented in eight sites in four regions of Ethiopia. The three sites in the Amhara Region were selected for this study. These sites (and rural kebeles) are Bahir Dar (Tis Abay, Andasa), Dessie (Addis Mender, Habru 01), and Gondar (Loza Mariam, Tekele Hymenot). These sites were selected because they are in the Amhara National Regional State. Methods: Secondary counseling and testing reports were collected from each site to analyze the clients' demographic information and testing results. In-depth interviews were conducted with the community VCT counselors and the senior VCT counselors in all three sites. Male and female focus group discussions were held in each community for ever-married men and women age 18 to 59 years old. Counselors were asked about the challenges of providing home-based services and their experience during the first six months of implementation. The focus group participants were asked about the community's perception of the HBVCT program, benefits, and barriers to acceptance. Results: 6,757 clients were tested in the Amhara Region during the first six months of implementation. In all sites, 59.26 percent of clients were female, the age of clients ranged from less than one year to over 99 years of age, 45.37 percent were illiterate, and 79.38 percent reported never before being tested. The qualitative interview and focus group data revealed three major themes: acceptance, challenges and barriers to testing, and benefits of HBVCT. Acceptance included both the general acceptance of the service and the acceptance of the locally selected VCT counselors. Challenges faced by clients were primarily related to understanding and fear of stigma or discrimination. Challenges faced by the counselors were mostly regarding the logistical challenges of providing home-to-home service and the technical challenges of providing counseling service. Benefits of the home-based service included reduction of traditional barriers to counseling and testing and normalization of VCT, making it easier and more socially acceptable to receive testing. Conclusions: HBVCT may provide an important avenue for testing Ethiopia's rural population. In this pilot, 79.38 percent of the Amhara clients had never before been tested for HIV, higher than other reported findings highlighting the need for an alternate testing model (1). Through this study, the HBVCT model was found to be accepted by community members in the three Amhara sites. In addition, community members were comfortable and reported a sense of increased confidentiality when receiving VCT services in their homes, even with a local community VCT counselor. Acceptability and normalization of counseling and testing were strengthened by community-based HIV and VCT education or promotion activities. This occurred by reducing some challenges faced by the HBVCT counselors as well as increasing acceptability among the community. The logistics and discussion of HIV counseling and testing remains a barrier for couples. However, HBVCT can act as a catalyst for couples to discuss and receive testing, especially for couples with low levels of education and for those who reside in rural communities. As the only qualitative and quantitative evaluation of a HBVCT program in Ethiopia, further research is needed to better understand the cost and prevention benefits of home-based service.

Despite recent progress, malnutrition remains a severe problem in Ethiopia. This report provides the findings from an in-depth data-based analysis of malnutrition in Ethiopia and its causes.

As a low-income country, Ethiopia has made impressive progress in improving health outcomes. This report examines how Ethiopia s Health Extension Program (HEP) has contributed to the country s move toward Univeral Health Coverage (UHC), and to shed light on how other countries may learn from Ethiopia s experiences of HEP when designing their own path to UHC. HEP is one of the government s UHC strategies introduced in a context of limited resources and low coverage of essential health services. The key aspects of the program include the capacity building and mobilization of more than 30, 000 Health Extension Workers (HEWs) targeting more than 12 million model families, and the mobilization of health development army ? to support the community-based health system. Using the HEP-UHC conceptual model and data from Demographic and Health Surveys, the study examines how the HEP has contributed to the country s move toward UHC. During the period that the HEP has been implemented, the country has experienced significant improvements in many dimensions: in terms of socioeconomic, psychological, behavioral, and biological dimensions of the beneficiaries; and in terms of the coverage of health care services. The study finds an accelerated rate of improvements among the rural, less-educated, and the poor population, which is leading to an overall reduction in equity gaps and improvements in the equity indicators including the concentration indices - that suggest a more equitable distribution of resources and health outcomes. The HEP in Ethiopia has demonstrated that an institutionalized community approach is effective in helping a country make progress toward UHC. The elements of success in the HEP include the emphasis on community mobilization which identifies community priorities, engages and empowers community members, and supports their ability to solve local problems. The other aspect of HEP is the emphasis on institutionalization of the activities, which addresses the sustainability of community programs through high level of political commitment, and effective coordination of national policies and leveraging of support from partners. These findings may offer useful lessons for other low income countries facing similar challenges in developing and implementing a sustainable UHC strategy.

"Education is often seen as a fundamental means to improve economic prospects for individuals from low income settings. However, even with increased emphasis on basic education for all, many individuals fail to achieve basic skills to succeed in life. The book presents evidence that one core reason is that by the time a child is old enough to attend school, there is already a wide disparity in cognitive skills and in emotional and behavioral development among children from households of different socioeconomic backgrounds. Low levels of cognitive development in early childhood strongly correlate with low socio-economic status (as measured by wealth and parental education) as well as malnutrition. These disadvantages are often exacerbated by economic crises. Fortunately, however, as documented in this volume, there are programs that have proven effective in promoting a child's development through caregiver-child interaction and stimulation, and with well designed preschool programs. While preschool programs currently cover a modest share of low income children, expansion of such services to at risk populations is a cost-effective means of improving overall educational achievement. Thus, focused preschool programs can serve as a key investment in a strategy to reduce the transmission of poverty from poor parents to their children."

This book discusses reforms that should be undertaken in secondary education to support Ethiopia s transition from a low- to middle-income economy. The most critical reform identified is the introduction of a flexible curriculum that serves the needs of all students, including those who may not pursue higher education.

The concept of Comprehensive Primary Health Care focuses on health system efforts to improve equity in health care access, community empowerment, participation of marginalized groups, and actions on the social determinants of health. Despite its existence since the late 1970s very few studies have been able to highlight the outcomes of this concept, until now. Revitalizing Health for All examines thirteen cases of efforts to implement CPHC reforms from around the globe including Australia, Brazil, Democratic Republic of Congo, Iran, South Africa, and more. The findings presented in this volume originate from an international action-research set of studies that utilized triads of senior and junior researchers and knowledge users from each country’s public health system. Primary health care reform is an important policy discourse both at the national level in these countries and in the global conversations, and this volume reveals the similarities among CPHC projects in diverse national contexts. These similarities provide a rich evidence base from which future CPHC reform initiatives can draw, regardless of their country.