International Aid to HRH development in Ethiopia: Assessment of Irish Aid investment in the development of human resources for health in Southern Nations, Nationalities and Peoples Region (SNNPR)

Background: Human resources for health (HRH) are considered the linchpin in health development but, until recently, donors were reluctant to support HRH development considered as higher education and not a priority for support. There have been changes in this attitude in the last few years. The evolution in Ethiopia is explored using the experience of Irish Aid (IA) as a case study.Methods: The evolution of HRH in SNNP is explored through study of IA and Regional documents and interviews of key informants, focus group discussions and field visits in the region.Results: Major national initiatives with short and long term impact on HRH are briefly documented including the ‘flooding strategy’, the Accelerated Health Officers Training and the rapid deployment of health extension workers (HEW). Major constraints/uncertainties in improved IA support are noted including absence of specific HRH policy and an outdated health policy; delays in the development of an HRH strategy; impacts of over-drawn BPR process… IA impacts on HRH in the region, including middle level HRH training; training of HEW, in-service training in general…, are commendable. The assessment also documents current weaknesses/gaps in IA support including lack of training needs assessment, weak supportive supervision, lack/delay in upgrading training - for HEW in particular, lag in training to clear the backlog of junior categories and inadequate increase of HRH for Emergency Obstetric Care. Adequate measures have not been taken to improve quality of pre-service training; improve motivation, efficiency and retention of the health workforce (HWF) and strengthen HRH management.Conclusions and Recommendations: Overall, IA had discernable impact on HRH development in the region. Areas for future policy level dialogue and improved impact are recommended

Climate variability affects water-energy-food infrastructure performance in East Africa

The need to assess major infrastructure performance under a changing climate is widely recognized yet rarely practiced, particularly in rapidly growing African economies. Here, we consider high-stakes investments across the water, energy, and food sectors for two major river basins in a climate transition zone in Africa. We integrate detailed interpretation of observed and modeled climate-system behavior with hydrological modeling and decision-relevant performance metrics. For the Rufiji River in Tanzania, projected risks for the mid-21st century are similar to those of the present day, but for the Lake Malawi-Shire River, future risk exceeds that experienced during the 20th century. In both basins a repeat of an early-20th century multi-year drought would challenge the viability of proposed infrastructure. A long view, which emphasizes past and future changes in variability, set within a broader context of climate-information interpretation and decision making, is crucial for screening the risk to infrastructure

Screening multi-reservoir system designs via efficient trade-offs - informing infrastructure investment decisions on the Blue Nile

Multi-reservoir system planners should consider how new dams impact downstream reservoirs and the potential contribution of each component to coordinated management. We propose an optimized multi-criteria screening approach to identify best performing designs, i.e., the selection, size and operating rules of new reservoirs within multi-reservoir systems. Reservoir release operating rules and storage sizes are optimized concurrently for each separate infrastructure design under consideration. Outputs reveal system trade-offs using multi-dimensional scatter plots where each point represents an approximately Pareto-optimal design. The method is applied to proposed Blue Nile River reservoirs in Ethiopia, where trade-offs between total and firm energy output, aggregate storage and downstream irrigation and energy provision for the best performing designs are evaluated. This proof-of concept study shows that recommended Blue Nile system designs would depend on whether monthly firm energy or annual energy is prioritized. 39 TWh/yr of energy potential is available from the proposed Blue Nile reservoirs. The results show that depending on the amount of energy deemed sufficient, the current maximum capacities of the planned reservoirs could be larger than they need to be. The method can also be used to inform which of the proposed reservoir type and their storage sizes would allow for the highest downstream benefits to Sudan in different objectives of upstream operating objectives (i.e., operated to maximize either average annual energy or firm energy). The proposed approach identifies the most promising system designs, reveals how they imply different trade-offs between metrics of system performance, and helps system planners asses the sensitivity of overall performance to the design parameters of component reservoirs