[{"bbox": [96, 152, 1134, 257], "category": "Text", "text": "living in conflict affected areas, with a special focus on women and girls, mainly in the northern regions (Tigray, Amhara and Afar) as well as other conflict affected areas. Other population living in the most vulnerable situations such as persons with disabilities, the elderly and Internally Displaced People (IDPs) and refugees will also benefit from this action."}, {"bbox": [96, 270, 1134, 405], "category": "Text", "text": "This Action will be complementary to other ongoing EU funded projects in the health sector, in particular the project 'Social Determinants for Health for Gender Equality' (EUR 24 000 000). It is also complementary to projects funded by EU Member States active in the sector. The Action will also benefit from synergies with the Action on Education under the same Individual Measure, in particular with what relates to sexual and reproductive health and family planning."}, {"bbox": [85, 445, 322, 477], "category": "Section-header", "text": "# 2 RATIONALE"}, {"bbox": [85, 506, 234, 534], "category": "Section-header", "text": "## 2.1 Context"}, {"bbox": [96, 550, 1134, 923], "category": "Text", "text": "Ethiopia is the second most populous country in Africa with around 115 million people (of which 45 million children are 0-14 years old) and the population growth remains high at around 2.5% per year, despite having been decreasing for the past three decades¹. The UN estimates that its population will reach 200 million by 2050, becoming one of the world's ten largest countries². According to the World Bank³, Ethiopia's economy experienced strong, broad-based growth averaging 9.4% a year from 2010/11 to 2019/20, although slowed down to 6.1% in 2019/20 due to the COVID-19 pandemic. Ethiopia has also managed to increase life expectancy from 47.1 in 1990 to 66.6 in 2020⁴. Public investments in basic services provision such as education and health have also contributed to poverty reduction, as did rural safety nets (e.g. the Productive Safety Net Program - PSNP), which contributed to sustain growth and to preferentially increase the welfare of the poor. Education and health access and utilization have increased over the last decade as the number of primary health posts, health centres, and schools increased⁵. Nonetheless, Ethiopia is also one of the poorest ranking 174 out of 189 countries at the Human Development Index (2018); in fact, while inequality has remained low, the very poorest became poorer, posing a challenge to the goal of shared prosperity in Ethiopia. Despite rapid growth, Ethiopia continued to be one of the most equal countries in the world, with a Gini coefficient that remained at 30 percent from 2005 to 2011⁶."}, {"bbox": [96, 934, 1134, 1121], "category": "Text", "text": "Since November 2020, Ethiopia has been engulfed in a civil war. While the conflict is mainly affecting Ethiopia's northern regions (Tigray, Amhara and Afar), spill over effects and smaller pockets of interrelated conflicts (i.e. in Oromia) increase significantly the geographical area with population affected by the conflict. The conflict has caused significant damage to health facilities, translating into thousands of health facilities becoming non-functional. This increased pressure into an already strained health system, which was under difficulties since the start of the pandemic: as of December 2021, there are a total of 377 056 confirmed COVID-19 cases, and over 6,800 deaths have been reported since the beginning of the pandemic⁷."}, {"bbox": [96, 1132, 1134, 1319], "category": "Text", "text": "The conflict has also affected the performance of the health system in most regions. While the regions affected by the conflict, in particular Tigray, Amhara and Oromia, have highly performing health systems (ranking amongst the highest in the country), wide inequalities exist within these regions, having woredas that perform significantly worse than the national average. The trend analysis from the Demographic Health Survey (DHS) results indicate that there are drought prone woredas (poverty areas) within a particular region that perform far below the regional/national average of health status. These low performing woredas have been also affected by the conflict, in particular in Amhara."}, {"bbox": [96, 1330, 1134, 1410], "category": "Text", "text": "Another consequence of the conflict has been delayed improvements in the quality of health care. This has a particular negative effect on women's and girls' access to health services, which is already hampered in the non-conflict areas. Despite Ethiopia's striding change in maternal death over the last decades (decreased from 1 030 in"}, {"bbox": [85, 1450, 836, 1474], "category": "Footnote", "text": "¹ World Bank, World Development Indicators, Ethiopia. Consulted on 21 December 2021."}, {"bbox": [85, 1474, 802, 1498], "category": "Footnote", "text": "² UN Department of Economics and Social Affairs, World Population Prospects 2019."}, {"bbox": [85, 1498, 1017, 1523], "category": "Footnote", "text": "³ World Bank report (2021) - Eighth Ethiopia Economic Update : Ensuring Resilient Recovery from COVID-19"}, {"bbox": [85, 1523, 780, 1547], "category": "Footnote", "text": "⁴ UNDP, Human Development Reports, Ethiopia. Consulted on 21 December 2021."}, {"bbox": [85, 1547, 942, 1572], "category": "Footnote", "text": "⁵ World Bank (2016) Ethiopia: Priorities for Ending Extreme Poverty and Promoting Shared Prosperity"}, {"bbox": [85, 1572, 141, 1593], "category": "Footnote", "text": "⁶ *idem*"}, {"bbox": [85, 1593, 630, 1618], "category": "Footnote", "text": "⁷ WHO COVID-19 Dashboard. Consulted on 21 December 2021."}, {"bbox": [1037, 1680, 1142, 1705], "category": "Page-footer", "text": "Page 4 of 21"}]