Resilience Amid Disruption: How Ethiopian Health Workers Sustained TB Services During a U.S. Government Pause

In January 2025, the USAID Eliminate TB Project in Ethiopia—led by Management Sciences for Health (MSH)—was temporarily paused due to a U.S. government-issued Suspension of Award. The suspension, part of a broader mandate to re-evaluate and realign foreign assistance priorities, halted direct support to public and private health facilities across the country for six weeks.  

Yet even amidst this uncertainty, one constant remained: the life-saving nature of this work. Across Ethiopia, health workers demonstrated extraordinary resilience—drawing on the skills, systems, and tools introduced by the project to sustain essential services, particularly in high-burden regions like Oromia and South Ethiopia.  These stories illustrate the potential of long-term health systems strengthening—and the risks communities face when that support is interrupted.

Clinical Excellence Sustained in Oromia

At a general hospital in the Bale Zone of Oromia, 20-year-old Mulugeta* returned in late January—just days after completing a six-month regimen for drug-susceptible TB—with persistent symptoms. Although project operations were paused, the previously trained clinical team quickly recognized signs of possible multidrug-resistant TB (MDR-TB).

Using a USAID-donated GeneXpert machine, the hospital team confirmed Mulugeta’s MDR-TB diagnosis and initiated second-line treatment. Within five days, five of his household contacts were evaluated. His 18-year-old brother, Bereket*, also tested positive for rifampicin-resistant TB and began treatment. Both brothers are now receiving monthly clinical follow-up and nutritional support.

When the project resumed in March, contact tracing expanded even further. Four additional household members were screened and, though TB-negative, were started on a six-month preventive therapy regimen for drug-resistant TB, in line with national guidelines.

“The comprehensive knowledge and skills we obtained through the USAID Eliminate TB Activity enabled us to properly evaluate, treat, and follow up with TB patients—even during the suspension,” said Dr. Olyiad Shegene, general practitioner at the hospital.

Community Impact in South Ethiopia

In Boloso Bombe, a district in the South Ethiopia Regional State known for its high TB burden, the impact of the Award Suspension was felt deeply at the community level. Before the pause, the USAID Eliminate TB Activity had strengthened both facility- and community-level TB services. These included advanced clinical screening using AI-assisted chest X-rays, widespread TB preventive treatment (TPT), and robust outreach to reduce stigma and improve awareness.

In December 2024 alone, more than 10,000 adults and children received TPT, 4,469 people were screened, and 2,876 individuals with symptoms were tested using GeneXpert. A total of 614 TB cases were diagnosed—409 of them through AI-supported X-rays—and promptly initiated on treatment.

“We were conducting TB prevention and treatment activities at both community and facility levels, and many families benefited. But during the suspension, we faced serious gaps—no medications, no community awareness, and halted prevention activities,”

Dr. Abiy Letenga, Medical Director at Boloso Bombe Primary Hospital

When the project was suspended, the gains were quickly threatened. “We were conducting TB prevention and treatment activities at both community and facility levels, and many families benefited. But during the suspension, we faced serious gaps—no medications, no community awareness, and halted prevention activities,” said Dr. Abiy Letenga, Medical Director at Boloso Bombe Primary Hospital.

Alemitu Aliye, a nurse and health extension worker at a local health center, recalled one particularly troubling case. A 40-year-old mother, whose two children had previously received preventive treatment through the project, returned to the clinic with TB symptoms. She tested positive, but due to a shortage of TB drugs, she was sent home with only antibiotics and had to wait 12 days before starting treatment.

“In that time, she may have unknowingly exposed many family members and neighbors,” Alemitu said.

Recovery and the Road Ahead

After the cancellation of the Stop Work Order in March 2025, MSH and the project team quickly reactivated key interventions. In Boloso Bombe, community-based screening resumed, facilities were restocked with essential diagnostics and medications, and mentorship visits restarted. In Oromia, clinical teams resumed contact tracing and scaled up support for patients on second-line treatment.

Health workers expressed relief and renewed commitment to their patients.

“It is a big relief that the project has resumed. We are once again able to serve our patients and protect our community,” said Alemitu.

From a referral hospital in Oromia to remote health centers in South Ethiopia, these stories demonstrate what’s possible when TB services are well-integrated and health workers are empowered.  They also serve as a warning: short-term disruptions can have long-term consequences. To eliminate TB in Ethiopia, sustained investments in diagnostics, training, and community-based care are not optional—they are essential.

*Names changed for privacy