The State of Epidemiology in Ethiopia: A Conversation with Dr. Taye Balcha, Director-General of the Armauer Research Institute

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Written by Paul Nash

Dr. Taye Balcha, MD, PhD, MPH, was appointed by Ethiopia’s prime minister, H.E. Hailemariam Desalegn, as Director General of the Armauer Hansen Research Institute in June 2016. The Armauer Hansen Research Institute (AHRI) is a biomedical research facility for infectious disease located in Ethiopia’s capital, Addis Ababa. Prior to this, he served as Special Advisor and Head of Office to the State Minister of Health. He has also worked at various levels of leadership in the Oromia region of Ethiopia, including as Deputy Head of the Regional Health Bureau, researcher and clinician.

Dr. Balcha obtained his PhD degree in Epidemiology from Lund University, Sweden, in 2015. He wrote his dissertation on improved methods of TB diagnosis among HIV-positive individuals. Dr. Balcha received a Master’s Degree in Public Health from the same university and a Doctoral Degree in Medicine from Addis Ababa University. He has led scores of important national initiatives including country ownership and leadership of HIV program and the establishment of Grand Challenges Ethiopia an initiative that aims to stimulate innovation that can catalyze improvement in the health sector and improve people’s daily lives. He has published in several peer-reviewed medical journals. His areas of interest include research in infectious diseases, maternal and child health and health and community systems, as well as health innovation and health biotechnology. Dr. Balcha is a reviewer for a dozen peer-reviewed journals and he is also a member of the Scientific Advisory Board of Grand Challenges Canada, an organization that provides funding support to stimulate innovations that facilitate improvements in global health.

Dr. Balcha, Ethiopia recently became the 42nd country to eliminate maternal and neonatal tetanus since 2000. How do you feel about this achievement, which marks another milestone in Ethiopia’s long battle against epidemic diseases?

Ethiopia has shown accelerated progress in the health sector, particularly since the turn of this century. From the evidence, we can attribute the country’s successes largely to a novel primary healthcare program: Health Extension Program (HEP). HEP was implemented in 2004. The country met the UNDP’s Millennium Development Goals (MDGs) related to the reduction of child mortality, as well as the MDGs related to the burden of, and mortalities due to HIV, tuberculosis and malaria. It also nearly achieved the goal of maternal mortality reduction, cutting maternal deaths by 72 percent (compared to the goal of 75 percent) between 1990 and 2015.  Ethiopia has been polio-free for more than three years and, recently, it joined 41 other countries that have eliminated maternal and neonatal tetanus since 2000.

To what extent do drought and related emergencies play in hindering the country’s efforts to eradicate such epidemic diseases?

Ethiopia has recently experienced back-to-back drought, mainly in the eastern part of the country. Following the droughts, outbreaks of acute watery diarrhea have been reported in some parts of the country. However, the impact of drought on the population’s health as a whole has been minimal for two reasons. First, the government of Ethiopia, in collaboration with its essential partners, has responded to drought aggressively to mitigate its adverse impact by distributing grains, supplying nutritious food to children, and feeding animals. Secondly, Ethiopia has built up a remarkably resilient healthcare system over the years. This system is well-prepared to handle such emergency conditions without detracting from regular health services. As a consequence, drought hasn’t had a major impact on Ethiopia’s progress towards achieving the UNDP’s 2030 Agenda for Sustainable Development in the area of healthcare.

What are your institute’s immediate and long-term strategic priorities?

Our longer-term priority is to contribute to the healthcare sector’s efforts to meet the bold and ambitious health Sustainable Development Goals (SDGs) of the UNDP. In the immediate-term, our priority is to generate high-quality evidence that can drive policy, implementation and further investment in health in Ethiopia. In our research, we focus on priority programmatic areas of the Federal Ministry of Health to deliver potentially useful evidence. Likewise, our long-range priorities mirror those of the Federal Ministry of Health. We stimulate and support local health innovations that that can accelerate progress in regards to maternal and child health, antimicrobial resistance and other priority health programs. We are also currently establishing a platform aiming at the development of vaccines, diagnostics, medicines, and treatment devices for the long-term.

Historically, Ethiopia has been susceptible to epidemic-prone diseases and nutritional emergencies due to recurrent drought and pandemics. Do you feel that Ethiopia is now adequately prepared to respond effectively and efficiently to such threats going forward?

In the past, Ethiopia has been susceptible to disease outbreaks due mainly to recurrent drought. What has changed now is the country’s overall preparedness: the health system’s readiness and the speed and intensity of its response. More than ever, Ethiopia now has the capacity to predict and detect disease outbreaks; its health system is robust and can concurrently respond effectively to outbreaks and regular programs; An Emergency Operating Centre is now in place to facilitate rapid and aggressive response. More importantly, there is strong political commitment starting from the highest levels of the government. I feel that we stand ready to effectively and efficiently respond to any emerging or re-emerging health threats.

In the past, Cholera has been one of the most serious epidemic diseases in Ethiopia. Is it still a major concern?

We recently had an outbreak of acute watery diarrhea in remote villages of Ethiopia but the diagnosis was not clearly established as cholera. Cholera is still is a concern and deserves heightened interventions. What the health sector is now doing is transform the overall hygiene and sanitation in the country. The effort ranges from provision of clean water to ensuring that communities in all geographic areas use latrines. This process is now underway through creating model villages, optimizing health extension programs, and closely working with the water sector. Strengthening our disease surveillance system in Ethiopia has also received great attention.

According to the World Health Organization (WHO), there are over a million people in Ethiopia living with HIV/AIDS. How is the country’s response to this epidemic progressing, and is Ethiopia receiving sufficient international support?

Ethiopia has reduced new HIV infections by more than 90 percent in the past decade. Yet, HIV is a major public health threat in the country with a substantially variable burden in different geographies and population groups. We are currently focusing on prevention—mainly by fighting complacency—and treatment in the spirit of ‘no one should be left behind’. In doing so, Ethiopia receives sizable international support. In the wake of plateauing or declining external support, the Government of Ethiopia is looking inward and is increasing domestic funding towards HIV epidemic control. At any rate, I am optimistic that we will achieve an AIDS-free generation by 2030.

What was Ethiopia able to learn from the 2014 Ebola outbreak in West Africa?

Ethiopia has drawn important lessons from the 2014 Ebola outbreak in West Africa. We have strengthened our healthcare community system through a concept called the “health development army.” They have a mechanism to report any unusual symptoms of diseases in their villages. There is also a community solidarity movement to support each other and prevent stigma and discrimination of any form or kind. The health facilities are on regular alert to provide services in cases of emergencies. The outbreak also helped us establish a biosafety level 4 laboratory, Emergency Operating Centre and surge capacity of emergency workforce at national level.

Photo by Trevor Cole via Unsplash.