Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from ECHO. The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

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She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

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The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

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Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

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Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

 

Government of Ethiopia and Humanitarian Partners Release 2017 Humanitarian Response Planning Document

ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.

While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.

In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.

The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.

Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.

UNICEF’s largest global purchase of Therapeutic Food for children in drought-stricken Ethiopia through donor support

Drought in Ethiopia
A mother feeds a her malnourished child a Ready-to-Use Therapeutic Food (RUTF), a high protein and high energy peanut-based paste, in Arsi zone, Oromia, Ethiopia. In Ethiopia, after two years of erratic rainfall and drought, one of the most powerful El Niño weather events for 50 years is wreaking havoc on lives and livelihoods. ©UNICEF Ethiopia/2016/Ayene

ADDIS ABABA, 22 April 2016 – Today, UNICEF thanked donors for their generous contributions and the Government for its strong leadership, which together have enabled a concerted response to the current El Niño driven drought in Ethiopia, particularly in treating children with severe malnutrition.

With support from donors, UNICEF has procured 543,631 cartons of Ready-to-Use Therapeutic Food (RUTF), which represents 22 per cent of the global order for 2015 and is one of the largest single purchases in UNICEF’s history. The donors include the Governments of Canada, Germany, Japan, Sweden, United Kingdom and United States and partners including ECHO and the Bill & Melinda Gates Foundation.

To date in 2016, UNICEF procured in 2015 a further 73,344 cartons of RUTF out of a global procurement estimated at 565,623 cartons, which corresponds to 13 per cent of the global supply. In addition to RUTF, other supplies including therapeutic milk, routine drugs and hygiene and sanitation commodities have been procured as part of the drought response. To accommodate this large volume of supplies and enhance preparedness for the drought response, UNICEF rented a new warehouse in the Gerji area of Addis Ababa, earlier this year.

“On behalf of the Government of Ethiopia and UNICEF, I would like to express my sincere appreciation to the humanitarian donors for their timely and generous financial contributions to purchase Ready-to-Use Therapeutic Food that will save the lives of millions of children diagnosed with severe malnutrition,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “I would also like to especially thank the Ethiopian Customs Authority, the Ethiopian Food Medicine and Health Care Administration and Akakas Logistics, this enormous supply chain operation would not have been possible without their active support. By accelerating our joint nutrition interventions, we can transform the lives of millions of children to become healthy citizens and reach their full potential.”

Ethiopia is experiencing one of the worst droughts in decades due to El Niño weather condition which continues to wreak havoc on the lives of children and their families’ livelihoods. According to the latest Humanitarian Requirement Document issued this year, 6 million children are at risk from hunger, disease and lack of water. Malnutrition rates have greatly increased – 450,000 children are expected to be treated for severe acute malnutrition (SAM) this year.

Inauguration of new UNICEF warehouse
Inauguration of new UNICEF warehouse (L-R) Ms Gillian Mellsop, UNICEF Representative to Ethiopia, Dr Kebede Worku, State Minister of the Federal Ministry of Health, and Ms. Emma William, Deputy Head, DFID Ethiopia ©UNICEf Ethiopia/2016/Tsegaye

As part of the joint drought response coordinated by the Government, UNICEF is leading the Nutrition, Water Sanitation Hygiene, Education (together with Save the Children) clusters and the Child Protection sub-cluster. Together with other partners, UNICEF implements life-saving humanitarian responses including procurement and supply of therapeutic food and milk, drugs, other medical supplies, plus water/sanitation and education and child protection supplies.

UNICEF also supports the treatment of severely malnourished children through the community-based management of acute malnutrition, with training, quality assurance and coordination with other partners. Regular nutrition screening helps ensure that malnutrition in children is diagnosed and treated early, thereby reducing cases of severe acute malnutrition and life-threatening complications.

The supply of RUTF procured by UNICEF to date to respond to the current emergency is worth US$28 million including freight and in-country distribution. With the continued effort of the Government and support from humanitarian actors, 350,451 children were treated for severe acute malnutrition in 2015.

EU gives €3 million to improve the nutritional status of children in Ethiopia

Funds to reach over one million beneficiaries in Ethiopia 

Asmera Bere feeds her son, Amanuel Shibabaw, feeds to her child a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home
Asmera Bere feeds her son, Amanuel Shibabaw, a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home ©UNICEF Ethiopia/2014/Sewunet

ADDIS ABABA, 21 March 2016 – The European Commission today announced a €3 million grant to UNICEF to improve the nutrition for severely malnourished children in the drought affected areas in Ethiopia. 

The EU funding aims to strengthen the current emergency response and reach an estimated 40,000 Severe Acute Malnutrition (SAM) children. It will help provide supplies (40,000 boxes of Ready-to-use Therapeutic Food (RUTF) and 19,700 packs of amoxicillin). The funds will also support one round of Extended Outreach Strategy (EOS) screening which provides biannual vitamin A supplementation and de-worming to children under 5 years of age. Screening for acute malnutrition for children and pregnant and lactating women will also be covered.

“The El Niño phenomenon is impacting entire regions in Africa, notably Ethiopia. The EU support will help UNICEF provide life-saving assistance to the most vulnerable. It will help more than a million children suffering from malnutrition get treatment,” said Jean-Louis De Brouwer, Director of Operations in the European Commission’s Humanitarian and Civil Protection department (ECHO).

“We are grateful to the EU for its continued support for life saving interventions addressing malnutrition in Ethiopia,” said UNICEF Representative to Ethiopia, Ms Gillian Mellsop. “Children are always the most vulnerable group in emergencies but when support is made available, we can change their lives for the better.”

The EU funding targets close to half a million children under the age of five along with nearly 140 000 pregnant and lactating women in the Somali region. UNICEF, at the request of the Government, is responsible for the procurement of supplies for Severe Acute Malnutrition (SAM) management as a key input to the emergency nutrition responses throughout the country. It also provides technical and financial support to ensure programme quality and coverage. 

UNICEF is supporting the Government in responding to the emergency by scaling up and strengthening the treatment of children with severe acute malnutrition, increasing the intensity and frequency of screening of children and pregnant and lactating women, and ensuring key preventative nutrition services are provided to prevent excess morbidity and mortality.

According to the revised Humanitarian Requirement Document (HRD), over 10.2 million people in need of food aid and estimated 435,000 in need of treatment for severe acute malnutrition by the end of 2016. This has significantly devastated livelihoods and greatly compromised the health and wellbeing of children and women, through malnutrition and hygiene-related diseases across Ethiopia with six regions hit particularly hard.

New Analysis Finds Encouraging Results on Nutrition Sector in Ethiopia

Launch of document entitled “Situation Analysis of the Nutrition Sector in Ethiopia” from 2000-2015
Left-Right: H.E Ms. Chantal Hebberecht, Ambassador of the European Union, Mr. Birara Melese, National Nutrition Programme Team Coordinator, Ms. Gillian Mellsop, UNICEF Representative to Ethiopia, at the launch of a document entitled “Situation Analysis of the Nutrition Sector in Ethiopia” from 2000-2015 in Addis Ababa, Ethiopia ©UNICEF Ethiopia/2016/Tesfaye

In recent years, the global momentum on nutrition has been growing rapidly. The Scaling-Up Nutrition Movement has united world leaders and brought the UN, governments, civil society and the private sector together in a collective effort to improve nutrition through shared goals and resources to effectively scale up nutrition policies and programmes.

Ethiopia’s continued reduction of extreme poverty and chronic malnutrition has received international recognition and continues to inspire the international community to remain ambitious in the level of progress it aims to achieve.

Today, 10 March 2016, a document entitled Situation Analysis of the Nutrition Sector in Ethiopia from 2000-2015 was launched which was made possible through funding provided by the European Union to UNICEF, as part of the EU+ Joint Cooperation Strategy for Ethiopia, which aims to ensure a coherent and consistent response to Ethiopia’s development challenges.

Speaking at the launch of the situation analysis, Ms. Chantal Hebberecht, Ambassador of the European Union said, “The study has synthesised the trend and causal analysis of undernutrition, mapping of nutrition specific and sensitive interventions and gap and opportunity analysis. In so doing, it has tried to provide evidence based guidance for future nutrition related policies and interventions in the country.”

As the world embarks on a new sustainable development agenda, the Government of Ethiopia and its development partners can look back on the 15 years of remarkable progress in the Nutrition sector through this Situation Analysis document that we are launching here today. The findings of the Situation Analysis provide evidence of a steady and substantial improvement in stunting over the last 15 years in Ethiopia where the stunting prevalence has dropped from 57 percent to 40 percent. At the same time, food consumption and expenditure have increased on average from about 2,200 calories per household per day in the year 2000 to 2,450 calories per household per day in 2011.

UNICEF applauds the achievements made and the strong commitment of the Government of Ethiopia to improve the nutritional status among children and women, encouraging continued development and expansion of policies and programmes for nutrition interventions. However, there is still a long way to go and the eradication of undernutrition among children and women will require multi-sectoral efforts to ensure a more equitable and sustainable impact.

The report highlights critical gaps in terms of existing policies and programmes which we must address urgently to accelerate nutrition results for women and children.

Some of the key findings of the situation analysis report includes; educating mothers as key factor for improving nutrition, high risk factors for child stunting associated with poor water supply and sanitation and the need to improve production diversity, nutrition knowledge and women’s’ empowerment by making sure that diverse and nutritious foods are available and accessible at all times. In addition, the study highlights the need to expand existing nutrition programmes to improve undernutrition in the Developing Regional States (DRS) with increased resources and improved targeting.

These findings from the situation analysis will be key to inform programming for a wide range of nutrition specific and nutrition-sensitive stakeholders in Ethiopia. The findings will feed into the second National Nutrition Programme (2015-2020), which targets to reduce child stunting prevalence to 26 percent by 2020, as well as the second Agricultural Growth Programme which strives to increase agricultural productivity with a ‘nutrition lens’.

The recommendations in the situation analysis will help support the Government in the realisation of the Growth and Transformation Plan 2 and the achievement of the Seqota Declaration to make undernutrition, in particular child undernutrition, a history in Ethiopia.

Malnutrition is one of the greatest symptoms of injustice and inequality that we are fighting in Ethiopia today. By accelerating our joint nutrition interventions, we can transform the lives of millions of children to become healthy citizens and reach their full potential with their hopes and opportunities restored.

UNICEF and EU save new-born lives in rural Ethiopia

By Efa Workineh, CBNC Project Officer, Save the Children, Ethiopia; Tadesse Bekele, Regional Programme Manager, Save the Children, Ethiopia; Hailemariam Legesse, Health Specialist, UNICEF Ethiopia; Asheber Gaym, Health Specialist, UNICEF Ethiopia  

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Elias with mother Shure after completion of his new-born sepsis treatment provided at the village health post ©SCI/2015/Efa Workineh

Abuna Gindeberet Woreda is one of the eighteen woredas (districts) found in West Shoa Zone, Oromia Regional State, 182 km west of Addis Ababa, Ethiopia’s capital.

Baby Elias Suyum Belacho was born in Guro Furto health centre in Gartoke Kebele (sub district) of Abuna Gindeberet Woreda on September 20 2015.  His mother, Shure Negasa and father, Suyum Belacho took good care of Elias, the fourth born in the family, even prior to his birth.  During her pregnancy, Shure attended three Ante Natal Care (ANC) visits at the Guro Furto health centre. Unfortunately, she had not received the required post-natal visit schedule following her delivery.

When Elias was three weeks old, he attended the routine community based new-born care assessment provided as part of the community based new-born care programme of the national Health Extension Programme (HEP) package. (The HEP is a community health programme covering the whole of Ethiopia provided by two female community health workers (health extension workers) working at rural health posts, at present over 38,000 health extension workers are providing services in over 16,000 health posts across Ethiopia. The community based new-born care programme (CBNC) is one of the key public health interventions provided by HEP through extensive partner support. UNICEF is the major supporter of CBNC scale up in Ethiopia). Emushe Abebe, the health extension worker providing CBNC noted that Elias’ respiration rate was found to be 72 breaths per minutes in two counts; much higher than the upper limit of 60 expected at his age. During the assessment, Emushe asked Shure if she has noted any other symptoms that Elias has been showing recently. Shure explained that Elias had been coughing for the last two days. Thanks to her Community Based New-born Care (CBNC) training, the health extension worker correctly diagnosed Elias’ condition as new-born sepsis; a potentially lethal advanced infection in new-borns. In addition, she found out that Elias was underweight, which was caused by not enough breastfeeding.  As per her CBNC training, she classified Elias’s condition to be very severe. Shure was not aware that she had to breastfeed at least eight times per day and because she did not realise that Elias was seriously sick, she never reached out for medical assistance.

After counselling by the health extension worker, Shure agreed to start the treatment at home immediately and to continue taking Elias to the health post. 48 hours after initiating the standardised (Chart Booklet) treatment with gentamicin and amoxicillin antibiotics, the HEW assessed the status of the child and found that he was rapidly improving. By now he was physically stable:  he showed a lower breathing rate of 48/minute and he was breastfed more than 10 times a day. Following the seven days’ full course treatment, Elias completely recovered from his illness.

Elias’ mother Shure Negasa, who was not aware of her child being in life threatening condition, has promised to seriously take care for her new-born child and other children. From now onwards she will seek health care when ever needed and she will teach her neighbour’s what she experienced.

When Ethiopia along with 196 other countries signed the Millennium Declaration in New York in 2000, maternal and child health situation was bad for the majority of the population. Under five mortality rate – number of children dying before their fifth birthday from 1000 born alive- in 1990 (the beginning of measurements for the MDGs) was 222; one of the highest in the world. Many were sceptical that the country would achieve the targeted reduction of two thirds of the 1990 levels by 2015. Against all odds, the country has achieved child health target of the millennium development goals MDG 4 three years ahead of 2015 by reducing the 1990 child mortality rate to less than 68 child deaths per 1000 live births.

Clear health policy and strong implementation supported by coordinated international partnership; a large scale community health programme targeting rural villages through the health extension programme; sustained investments in health and sustained economic growth are among the reasons for this success story.

Highly appreciable as the improvements in child health are, an under five mortality rate of 68 translates to the unacceptable number of over 200,000 child deaths annually. More than 43 per cent of these child deaths occur during the first 28 days following child birth (the neonatal period) the majority occurring in the few days following birth. Breathing difficulties; premature birth and new-born infections/sepsis are responsible for the majority of neonatal deaths and most are preventable or easily treatable with currently available medical care. Access to health care is nevertheless essential to obtain the benefits of these lifesaving interventions. For the tens of thousands of new-borns born at home and far from health facilities, accessing these lifesaving interventions have been largely impossible.

To overcome this formidable challenge to access key new-born health interventions, Ethiopia in collaboration with its major child health partners including UNICEF has adopted novel public health interventions of ICCM/CBNC (Integrated community case management of childhood illnesses/ community based new-born care). ICCM/CBNC interventions rely on task shifting of key child health interventions responsible for majority of child deaths to community health workers who receive training on detection and treatment of key childhood illnesses at home or at village clinics (health posts). They also timely refer new-borns and older children with severe illnesses to higher level care.

The EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project, allocated Euro 42 million for a three-year support to maternal and new-born health to Ethiopia from 2014-2016. The EU is one of the major partners for the national scale up of ICCM/CBNC programme in Ethiopia. Since its inception in 2013, the ICCM/CBNC programme has rapidly scaled up to increase availability of CBNC services in 75 per cent of the total health posts in the country. Key interventions of the programme include training and mentoring of health extension workers on key skills of detections of new-borns and infants with illness through clear symptoms and signs and provision of essential interventions including provision of antibiotics to sick new-borns.  

Emushe Abebe, the HEW who provided the critical intervention that saved the life of Elias is one of the 2500 health extension workers who received training through EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project support. She is saving lives of many children like Elias, and teaches mothers like Shure the importance of seeking health care.

Joining hands to finish the race for polio eradication

Rotary International advocates, UN advocates and Rotaracts gathered to participate in the National Polio Immunizations campaign at Shinile and Dire Dawa.
Rotary International advocates, UN advocates and Rotaracts gathered to participate in the National Polio Immunization campaign at Shinile and Dire Dawa ©UNICEF Ethiopia/2015/Mersha

World Health Organization, UNICEF and Rotary International, on the occasion of World Polio Day 2015, renew their commitment to finish the race for polio eradication and secure a long-lasting legacy for a healthy Ethiopia

Addis Ababa, 23 October 2015 – Marking the occasion of World Polio Day 2015, the World Health Organization, UNICEF and Rotary International, jointly reaffirm their commitment to ensure Ethiopia joins all countries in a polio-free world by 2018 – the global target for polio eradication world-wide. 

Ethiopia has been free of the wild-polio virus (WPV) for the last 21 months, since the last confirmed case in Ethiopia’s Somali Region. The 2013-2014 Horn of Africa (HOA) polio outbreak resulted in 223 WPV cases across Somalia, Kenya and Ethiopia combined. Out of this number, 10 WPV type-1 (WPV1) cases were reported in Ethiopia, all in the Somali Region. The HOA polio outbreak was a devastating setback for the region, Ethiopia as a country and its people.

Due to the aggressive and innovative response led by the Ethiopian Federal Ministry of Health (FMOH) and polio partners, the outbreak was declared successfully interrupted by national and international experts in June 2015. The last reported wild polio virus WPV on the entire continent of Africa was 14 months ago – with the last WPV1 case confirmed in neighboring Somalia in August 2014. While these successes are cause for celebration; we also underline the importance of sustained commitment at every level. 

In an effort to maintain the momentum, we each play our part as polio partners and bring an important and unique contribution to the polio eradication efforts. “Thirty years ago, we told the world what Rotary believes: that we can achieve the eradication of only the second human disease in history. Our belief is close to becoming reality. For every child, let’s make sure that reality is a bright one. On 23 October, Rotary will host its third annual World Polio Day event,” states   K.R. Ravindran Rotary International President in his friendly call to partners and allies to join World polio Day 2015. 

UNICEF Ethiopia, Rotary International and Somali Regional Health Bureau team members with the signed Pledge of Commitment on the Eradication of Polio
UNICEF Ethiopia, Rotary International and Somali Regional Health Bureau team members with the signed Pledge of Commitment on the Eradication of Polio ©UNICEF Ethiopia/2015/Getachew

WHO and UNICEF continue to prioritise quality polio supplementary immunisation activities (SIA); alongside sustained quality disease surveillance; coordination and technical assistance; social mobilisation; vaccine procurement; cold chain and logistic support. Routine immunisation, the backbone to polio prevention, is the flagship programme for FMOH, WHO, UNICEF and other partners.

The National Routine Immunization Improvement Plan 2014-2016, with the objective to achieve national Penta 3 coverage of 95 per cent by 2016, provides focused support to 51 zones, home to the vast majority of unimmunized children of the country.

“In the spirit of the polio legacy, we as UNICEF and as a global polio eradication partner, are working together towards a country with a strong routine immunization system, to protect all children, everywhere against polio and vaccine preventable diseases, paving the way for a better future for all,” states Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia.

As we commemorate World Polio Day 2015 alongside the 70th anniversary of the United Nations, we reflect upon and celebrate the polio eradication initiative contribution to themes of development and human rights; and we envision further contributions to an even brighter future. Closing out 2015 we celebrate together in recognising Ethiopia’s achievements made towards the Millennium Development Goals particularly the reduction of under-five mortality; and we look towards a polio-free world by 2018.

WHO Representative, Dr Pierre M’pele Kilebou affirms, “WHO is proud of its contribution towards the success attained so far in achieving MDG 4, interruption of WPV transmission and routine immunization improvement; and our efforts would continue to sustain the gain that Ethiopia have realized.”

Even more ambitiously, we all envision the polio eradication legacy contribution to the 2030 Sustainable Development Goals for equitable health and development for all children and families. The possibilities are endless; the successes are at our fingertips. In partnership, we are almost there. We will continue to work together for a polio-free Ethiopia until the job is done. And then we will keep going.