General Statement of Purpose of the Contract 

Launched in 2013 by President's George W. Bush, and reauthorized in 2008 , PEPFAR holds a place in history as the largest effort by any nation to combat a single disease. Since its inception, PEPFAR has succesfully demonstarted worldwide success in addressing the HIV/AIDS epidemic with gains particularly evident in Africa. It achieved success in expanding access to HIV prevention, care and treatment in low resource settings.
With a projected population of over 100 million people, Ethiopia is the second most populous country in Sub-Saharan Africa. Despite impressive economic growth, Ethiopia remains a low-income country with a real per capita income of US $550 and 33.5% of the population living below the international poverty line of $1.90/day. According to the 2015 UN Human Development Index, Ethiopia ranks 174 out of 188 countries on both the overall index and the per capita Gross National Income, with a gross domestic product of $1,428. It is also one of the least urbanized countries, with 80% of the population living in rural areas. The HIV/AIDS epidemic in Ethiopia continues to be characterized by a low-intensity, mixed epidemic with significant heterogeneity across geographic areas and population groups. There is significant prevalence variation by region; from 4.8% in Addis Ababa, 4.4% in Gambella, to 0.6% in Southern Nations, Nationalities and Peoples’ (SNNPR) region.  Key and Priority Populations (KP and PP) are key drivers of the epidemic. For KP, PEPFAR-E only targets Female Sex Workers (FSW); and for PP, PEPFAR-E includes divorced and widowed persons, Orphans and Vulnerable Children, HIV negative partners in discordant couples, clients of FSWs, uniformed personnel, and vulnerable adolescent girls and young women.

Since 2005 trends in ANC prevalence in Ethiopia show steady and steep declines by as much as 60% according to latest UN models of HIV incidence, and suggest general success of combined prevention efforts by PEPFAR, GOE and other partners.  With the right strategies, an AIDS-free generation may be truly achievable in this setting. A high circumcision rate (92%), among other factors such as significant gains in prevention of mother-to-child transmission (PMTCT), continue to favor primary prevention among the general population. Among the general population, sources of new infection can be divided into sexual transmission from high-risk behavior before or outside marriage and sexual and vertical transmission occurring within marriage. The aging demographic profile of the epidemic combined with high rates of sero-discordant married couples (65%) imply that more HIV transmission occurs within marriage compared to other African epidemics; remarriage rates, however, exceed 40% regardless of gender or residence. Widowed and divorced men and women show substantially higher infection rates than other groups. Early arranged marriage, partner violence, and gender inequality are cited as causes of high divorce rates and significantly elevated rates of HIV prevalence associated with divorce and remarriage. Beginning in 2005, implementation of PEPFAR is through 5 USG agencies: U.S. Centers for Disease Control and Prevention (CDC), U.S. Department of Defense (DOD), U.S. State Department (Population and Refugee Migration Office, and the Community Grants Office), Peace Corps, and the U.S. Agency for International Development (USAID); however Peace Corps is in the process of transitioning out of PEPFAR. To date bilateral USG investment is $2.6 billion. In addition Ethiopia has been a recipient of over $2 billion from the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund).  Given the nature of Ethiopia’s epidemic, PEPFAR-E’s strategic goals are primarily to (i) support the Government of Ethiopia to achieve the UNAIDS Fast Track Strategy toward sustained epidemic control; and (ii) support the national HIV/AIDS response to strengthen case detection, treatment, care and support interventions toward key and priority populations, and in high HIV burden geographic areas. PEPFAR funds prevention, care and treatment activities implemented at facility and community sites; as well as cross-cutting activities in laboratory, strategic information, and supply chain management. Historically, support for health systems strengthening (HSS) have included efforts to expand the health workforce through support to pre-service training, implementation of Ethiopia’s Pharmaceutical Logistics Master Plan, the Laboratory Master Plan, the Health Management Information System Scale-up, Health Sector Financing Reform and Health Insurance, Hospital Reform Implementation Guidelines, and the Human Resources for Health (HRH) strategy. The private healthcare sector is nascent but growing and could be an important complement to the public arena, particularly as the public sector engages private practice as a workforce retention strategy. PEPFAR supports activities through 44 partners including government, civil society, international and local NGOs, and the World Health Organization. In 2014, PEPFAR began transitioning the full care and treatment portfolio to the Ethiopian government, providing funding to eight of 11 Regional Health Bureaus (RHBs) and one international NGO to provide technical assistance.

The PEPFAR Deputy Country Coordinator, reporting to the PEPFAR Country Coordinator (PCC) in Ethiopia, will support the full mandate of the PEPFAR Ethiopia Coordination Office (PECO). The Deputy Country Coordinator will work closely with the PCC to ensure full communications between and among the various USG agencies involved in the President's Emergency Plan for AIDS Relief (PEPFAR) in Ethiopia as well as communicating with the Office of the U.S. Global AIDS Coordinator (OGAC), particularly the Ethiopia Country Lead. The Deputy Coordinator manages critical and time-sensitive communications and work products between and among the various US Government (USG) agencies involved in the PEPFAR Ethiopia Program. The Deputy Coordinator liaises routinely with OGAC. In the absence of the Country Coordinator, the Deputy Coordinator serves as the Acting Country Coordinator.