Differentiated Service Delivery in Ethiopia



Percent of health facilities providing less-intensive DSD models. All 1,500 ART facilities in the country have enrolled at least 10% of eligible recipients of care into less-intensive models. Source: October 2021 CQUIN DSD Dashboard staging

% In Less-Intensive
DSD Models


Percent of people on ART who are enrolled in less-intensive DSD models. In a sample covering more than 95% of all people on ART, 381,875 of 432,649 recipients of care have been enrolled in less-intensive models. Source: National DHIS2 database, end June 2021

# of Less-Intensive
DSD Models

Number of less-intensive DSD models designed for people doing well on ART. Less-intensive models include: 3-Month Multi-Month Dispensement, Appointment Spacing Model, Fast Track, Peer-Led Community ART Groups, and Health Extension Professional Managed-Community ART Refill Group. Source: October 2021 CQUIN data report

DSD Model

Number of groups for whom less-intensive DSD models have been designed and implemented. Differentiated ART models are available for adults who are doing well on ART and eligible adolescent patients, as well as adults with co-morbidities, patients at high risk of disease progression, pregnant or breastfeeding women, and key and vulnerable populations. Source: October 2021 CQUIN DSD Dashboard staging

Differentiated Service Delivery Implementation in Ethiopia

Ethiopia joined the CQUIN learning network in 2017. Prior to joining, the Federal Ministry of Health (FMOH) had prioritized the scale-up of differentiated service delivery (DSD), launching a national program in October 2016 to focus on a single less-intensive model—the appointment spacing model (ASM) with six-month multi-month ART distribution (6-MMD).

Following an intensive pilot phase, Ethiopia’s ASM initiative was launched in June 2017 and is now available at 1,108 health facilities nationwide, 79 percent of all health facilities providing ART. As of October 2019, more than 194,400 people were enrolled in ASM, representing 87 percent of eligible recipients of care. CQUIN is partnering with ICAP in Ethiopia, FMOH and the Oromia Regional Health Bureau to conduct a qualitative study exploring facilitators and barriers to ASM enrollment.

DSD oversight in Ethiopia is provided by a technical working group of the National HIV Prevention, Care, and Treatment team within the FMOH. Community engagement is also paramount to Ethiopia’s program, with recipients of care engaged in all aspects of DSD planning and support, providing regular feedback through formalized mechanisms, and contributing to the progress of Ethiopia’s DSD program.

These collaborative efforts have contributed towards the planning and rollout of additional less-intensive models launched in 2019, including community-based ART groups (CAGs) and a model tailored for adolescents with HIV. Ethiopia continues to scale up DSD implementation programs and has focused its lens on diversifying models and improving M&E tools to better understand how to reach recipients of care with critical medication.

Given the success of its Appointment Spacing Model – one of the first large-scale models to provide 6-MMD – Ethiopia hosted a south-to-south visit in 2019. CQUIN teams from Eswatini and Mozambique visited to learn more about the initiative and brought important lessons home to their colleagues.

 Visit ICAP’s website for a broader portfolio of work in CQUIN network countries.


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