Ethiopia Stakeholder Engagement and Advocacy Plan for TB Domestic Resource Mobilization and Sustainability

As a result, nearly two million cases of TB have been identified and treated in the last two decades. All major TB indicators—incidence, prevalence, and mortality—have decreased by more than half since 1990. Despite this progress, Ethiopia remains among 30 countries with the highest burden of TB and multidrug-resistant TB, with an estimated TB incidence of 119 per 100,000 population in 2021. It is also one of the countries with the highest burden of TB and TB/HIV co-infection globally. TB is the fifth overall leading cause of death and the fourth leading cause of death among communicable, maternal, neonatal, and nutritional diseases in Ethiopia. The country has ambitious plans to eliminate TB as a public health problem. In 2015, Ethiopia adopted the global END TB Strategy, with the aim of reducing deaths attributed to TB by 95 percent and reducing the number of people who develop TB every year by 90 percent by 2035. This translates to less than 10 cases per 100,000 population by 2035. While Ethiopia is on track to meet the END TB targets of reducing TB incidence, the country is still a long way from meeting the 2025 milestone of reducing TB-related mortality. The most recent Tuberculosis, Leprosy, and other Lung Diseases National Strategic Plan (TBLLD-NSP) outlines the country's priority strategies and required budget for meeting the targets defined by the World Health Organization's END TB Strategy and ending the TB epidemic. Under the TBLLD-NSP, the country has developed a plan to reduce TB incidence and mortality to 73 and 4 per 100,000 population, respectively, by 2030. The total anticipated financial need for implementing the national TBLLD-NSP strategies and plans requires an investment of US$ 805 million over seven years. Despite the high burden of TB in Ethiopia, it only receives 1.8 percent of the total health expenditure, which amounts to US$ 66 million annually. This means that half of the interventions included in the TBLLD-NSP are not being implemented. Not only does this financing deficit threaten the country's ability to meet its commitment to end TB by 2035, but it also has implications for Ethiopia's most vulnerable households and communities. The TIME analysis in the TBLLD National Strategic Plan reveals insights on the impact of the implementation of key TB interventions on mortality and disability. The implementation of full interventions, which includes scaling up molecular test utilization, active TB case finding among Key and Vulnerable Population, and active TB case finding (ACF) plus treatment of latent TB infection, would lead to a substantial reduction in both incidence and mortality rates. If full intervention is not implemented, an estimated 110,000 lives will be unnecessarily lost due to TB over the seven-year period between 2023 and 2030. Similarly, full intervention implementation can prevent an additional 182,421 Disability Adjusted Life Years (DALYs) from being lost during the period. The Ministry of Health-Ethiopia has developed a Stakeholder Engagement and Advocacy Plan (SEAP) for TB Domestic Resource Mobilization and Sustainability. The plan aims to engage stakeholders and advocate for increased domestic resource mobilization and sustainability to support the implementation of the TBLLD-NSP. The plan identifies key stakeholders, including the National TB Program, Regional Health Bureaus, and Civil Society Organizations, and outlines engagement messages and strategies to influence decision-makers and secure increased funding for TB control and elimination. The plan also outlines a stakeholder engagement timeline, which includes activities such as stakeholder identification, engagement message development, and advocacy activities. The plan is expected to contribute to the achievement of the END TB targets and the elimination of TB as a public health problem in Ethiopia.