ዶክፋን ፋርማ አካዳሚ

1. Vertical, horizontal and diagonal approaches

The debate began in 1978. Alma-Ata argued for comprehensive PHC. Soon after, ‘selective PHC’ proposed a few cost-effective interventions (growth monitoring, oral rehydration, breastfeeding, immunisation, summarised as GOBI). Today most experts advise a diagonal or integrated approach: use priority diseases as an entry point to build general capacity. For example, HIV clinics can offer hypertension and diabetes care; the immunisation platform can also deliver vitamin A, deworming and nutrition screening; one community health worker can handle malaria, pneumonia and diarrhoea (integrated community case management).

2. One Health

One Health is an integrated approach that aims to sustainably balance and optimise the health of people, animals and ecosystems (definition of the One Health High-Level Expert Panel, 2021). It is supported by four international organisations (the Quadripartite): FAO, UNEP, WHO and the World Organisation for Animal Health (WOAH), whose Joint Plan of Action runs 2022 to 2026.

About 60 percent of known infectious diseases, and about 75 percent of emerging infectious diseases, are zoonotic (they pass between animals and people). One Health is used for zoonoses (rabies, brucellosis, anthrax, avian influenza, Marburg and Ebola), food safety, antimicrobial resistance (AMR) and environmental threats. It requires physicians, veterinarians, ecologists, laboratory staff and communities to share surveillance data and plan together.

3. Major disease control programmes: current evidence

HIV/AIDS. HIV infections are prevented by condoms, voluntary male circumcision, prevention of mother-to-child transmission (PMTCT), harm reduction, pre-exposure prophylaxis (PrEP, including long-acting injectables) and treatment as prevention. The UNAIDS targets are 95-95-95 (95 percent of people living with HIV know their status, 95 percent of those are on treatment, 95 percent of those are virally suppressed). New HIV infections fell by 40 percent between 2010 and 2024, to 1.3 million, but this is still far from the 2030 target Health Policy Watch 2026. In Ethiopia, national prevalence is about 0.8 percent, down from about 2 percent two decades ago; new infections among youth remain high. The Ministry is moving to a ‘triple elimination’ framework to end mother-to-child transmission of HIV, syphilis and hepatitis B in routine antenatal care, with a hepatitis B birth-dose coverage target of 90 percent by 2030. In a February 2026 interview, figures of about 4 percent domestic funding for the HIV response and a roughly 40 percent fall in external health aid were put to the Ministry’s HIV lead, who did not dispute them The Reporter 2026.

Tuberculosis (TB). In 2024 about 10.7 million people fell ill with TB and about 1.2 million died. Compared with 2015, incidence is down 12 percent and deaths are down 29 percent, well short of the End TB 2025 milestones (50 percent and 75 percent). Thirty countries account for 87 percent of cases; Ethiopia is among the high-burden countries for TB and TB/HIV. In 2024, US$5.9 billion was available for TB services, just over a quarter of the US$22 billion annual target WHO TB 2025 CIDRAP 2025. Core strategies: find and treat cases early (rapid molecular tests, WHO-recommended shorter regimens), preventive treatment for contacts and people living with HIV, vaccination of infants with BCG, tackling undernutrition, smoking and diabetes, and social protection.

Malaria. In 2024 there were an estimated 282 million cases (up 9 million from 2023) and 610,000 deaths, about 95 percent of them in the WHO African Region. Ethiopia contributed about 2.9 million of the additional cases. Artemisinin partial resistance is confirmed in four African countries; the mosquito Anopheles stephensi, which breeds in urban water containers, has been detected in nine African countries; 17 countries had introduced malaria vaccines by December 2024. Funding was US$3.9 billion against a US$9.3 billion target WHO malaria 2025. Tools: insecticide-treated nets, indoor residual spraying, rapid diagnostic tests and artemisinin combination therapy, seasonal malaria chemoprevention, vaccines (RTS,S and R21), larval source management.

Immunisation. Immunisation prevents an estimated 3 to 5 million deaths each year. Data for 2025 show that 85 percent of infants received three doses of DTP (DTP3) and 90 percent received at least one dose (DTP1). First- and second-dose measles coverage was 84 and 77 percent, below the 95 percent required to prevent outbreaks. About 13.5 million children were ‘zero-dose’ (no vaccine in the first year), and 57 countries reported large or disruptive measles outbreaks WUENIC 2025. Ethiopia has been running catch-up campaigns for zero-dose children and a measles campaign in 2026 that reached 391,832 children against a target of 682,917 in the first half of the year UNICEF SitRep 2026. The Immunisation Agenda 2030 sets the goals.

4. Sources and uses of health information