The Ethiopian Public Health Institute (EPHI) is the result of the merger in April 1995 of the former National Research Institute of Health (NRIH), the Ethiopian Nutrition Institute (ENI) and the Department of Traditional medicine (DTM) of the Ministry of Health.
The merger was affirmed by the council of ministers regulation No 4/1996, which recognized the Institute as an autonomous public authority having its own legal personality.
The following is the unique landmarks of the merged institutions in terms of historical development:
1. National Research Institute of Health (NRIH)
Before the end of the 19th century, Ethiopia did have little knowledge of exercising the modern type of health care practices. People were dependent on natural resources and the various techniques that they had developed to enhance health care facilities. Traditional techniques and herbal remedies were widely used by traditional health care system throughout the country. The delivery of the basics of health care services in Ethiopia was started to wards the end of the 19th century.
“The first health unit to be established on a permanent basis was a Russian hospital. After the battle of Adwa in 1896, Emperor Menilek II had over 3000 wounded soldiers, and he had invited for help from the Russian Red Cross. The first medical mission, consisting of three physicians, four nurses, and several orderlies, arrived and treated wounded soldiers in Harar area (Ministry of Health,1980:13).”
Members of the Russian Red Cross Missionary, after the accomplishment of their mission, they did not return to their country. Instead, they move to Addis Ababa to provide their health services.
“After the completion of the task , the medical mission arrived in Addis Ababa and established a hospital with 50 beds near the area which is now known as “ Russian street”. It is interesting to note that the mission produced a small booklet of 22 pages in Amharic, which was to serve as a textbook for Ethiopian staff in the Hospital. The Russian missionaries stayed in the country for ten years, and in 1906 the Hospital was closed (Ibid).”
Consequently, the delivery of modern health care services by the Russian medical missionaries initiated Emperor Menilek II and led him to think about the establishment of a hospital in the country.
“In that year, 1906, Menilek II established the first Ethiopian Hospital on the site of the Russian Hospital. At the beginning it had 30 beds. The Hospital has been in operation ever since then on the same site, and even today it is called by the original name “ Menilek II Hospital (Ibid).”
Following the establishment of the first hospital, different missionaries were attracted to come to Ethiopia to provide medical assistance to the society. One of such missionaries was the American missionary, which came in the late 1920s, with different health professionals.
“At that time there were several Christian missions operating in the country, and in addition to their religious and some time educational activities, they often provided health services.
In 1922 another hospital was established in Addis Ababa. An American missionary named Dr. Thomas Lambie collected money and erected a building in the Geullele area…. The hospital had four medical doctors and five nurses as its staff. The hospital was operational until the Italian occupation; however, after the liberation it was converted to a “Medical Research Institute (Ibid).”
When the Italian army invades Ethiopia in 1928 EC, the hospital was also confiscated by the Italian fascist Regime and the name was called “MINSTRO DELA SANITA”. During that period the location of the institution was moved to the place called Arat Killo to the recent premises of Pension Agency.
When the Italian occupation came to an end in 1933 EC, the Ethiopian government took over the Ministry Dela Sanita with all its Ethiopian and foreign staff and named it the “IMPERIAL MEDICAL RESARH INSTITUTE.”
After having the new brand and legal status, the Institute moved to a new place to the Princess Zenebework Haile Slassie School around the recent area of Urael Church. Again in 1936 the Imperial medical Research Institute moved to another place to the “casa popular”, currently houses the branch of the Ethiopian Road Authority.
Finally, in 1943 E.C. the Institute was once again moved to its present premises to Gullele, Addis Ababa. At that time the premises was serving as Teferi Mekonnen Hospital.
In 1944 E.C, the Imperial Ethiopian Government made an agreement with the Institute Pasteur of Paris. That bilateral agreement leads to the creation of an Institute of microbiology which took the name of “Institute Pasteur d’Ethiopie.”
To this effect, a contract was signed by both parties in July 1944 EC. In the contract document there were different articles that can show the roles and responsibilities of the institute.
According to Article I, the new Institute have several departments called, Departments of bacteriological, parasitological and serological analysis, Departments of chemical analyses, Department of preparation of antivariolic vaccine, Department of preparation of antityphus and antitypho-paratyphoidal vaccines, Department of preparation of B.C.G vaccine, Department of antirabic analyses and preparation of antirabic vaccine and Department of preparation of other microbial vaccines.
During that time each year the Institute was providing Anti-viriolic vaccine 3,000,000 doses, Anti tyhus vaccine 400, 000 doses, Anti rabic vaccine 50, 000 doses, BCG vaccine 30,000 doses, Anti typhoparatyphoidal vaccine 10, 000 doses and Yellow fever vaccine 6, 000 doses for free of charge.
In addition to that, the Institute was also engage in research and special studies in bacteriology, parasitological, entomology and chemistry.
In early 1957 EC the bilateral agreement with the Institute Pasteur d’ Paris was terminated and the institution was hand over to the ministry of public health and its name was changed to the Imperial Central Laboratory and Research Institute. At that time the Institute was delivering its former service only by Ethiopian professionals.
In 1977 EC the Institute was again reestablished as “The National Research Institute of Health” by the proclamation No. 271/1985.
Major objectives & Responsibilities of the Institute were; conduct research on major public health problems of the country, provide referral laboratory diagnostic services, provide training in laboratory technology, produce biological substances for prophylactic as well as diagnostic, administer quality control of foods and beverages as well as biological and chemical preparations and supervise regional public health laboratories.
2. The Ethiopian Nutrition Institute (ENI)
Some historical documents stated that, previous to 1950’s, only little was known about Nutrition in Ethiopia. However, in the early 1960’s there been some discussion on malnutrition by some concerned health professionals and health related agencies. It was clearly understood that malnutrition in the form of under nutrition was one of the contributor causes to underdevelopment in Ethiopia like in any other third world country.
To overcome this problem of malnutrition, many discussion and conferences were carried out, the result of which was a recommendation for a national nutrition survey. Since Ethiopia had neither the finance and logistics, nor the experience and expertise in this matter, an external agency known as the Interdepartmental committee on Nutrition for National Defense (ICNND) from the USA, was given the task to execute this survey. ICNND carried out surveys from September- December 1959 and produced figures and facts of malnutrition for the 1959 confrence. Following this conference there was a recommendation for establishment of a “Nutrition unit” under the Ministry of Health.
In 1962, an agreement was signed between the Ethiopian and Sweden Governments for the establishing the children’s Nutrition unit (CNU) in Ethiopia in the former prince Tsehay Hospital (now Armed Forces Hospital), in 1968. CNU was renamed as the Ethiopian Nutrition Institute (ENI). As the same time it was agreed that the Ethiopian government would successfully take over the institute from foreign experts. The change in the name of the Institute indicated also a wider scope of activities in the work of improving nutrition in the country, with the inclusion of groups other than children, e.g. pregnant and lactating women, school children, other adult groups etc.
In the years 1962-68, the plan of agreement envisaged several tasks among which the following were the main ones:-
a. Conducting nutritional status surveys based on age, sex and socio-economic relationships;
b. Conducting dietary surveys of different communities and families;
c. Enrichment of food items that were already known by the community;
d. Dissemination of nutrition education and training.
Following this, the unit expanded its scope of activity and responsibility and at the same time an Ethio-Swedish agreement was reached for a second five term, lasting up to 1973.
In 1973 famine in the country totally altered the aims and objectives of the Institute and the scope of its activities as well.
Faced with this unexpected disaster, the Institute started to reorganize itself and execute its function. Of course, priority was given to the drought and famine. It deployed “flying – squads” to perform survey/surveillance activities in the drought affected areas of the then wollo , Tigrai, Hararghie, Bale, Sidamo, Keffa, and laid the foundation for an emergency relief program. Feeding shelters were simultaneously set up and run by these ENI squads, who at the same time conducted quick “tailor – made” training of contract employees for the feeding programs in the different shelters.
The drought triggered the need for more supplementary food and the ENI started to develop new products under the brand name Dubie and Edget. These two types of supplementary foods together with the other products diversified and increased the whole supplementary food production to an industrial scale and by 1976; the production sector was transferred to the Ministry of Industry.
As the drought expanded, the survey/surveillance program continued, on all aspects of nutrition such as agriculture, water health, climate, migration, etc. The data so obtained served not only for action Programs but also created what was known as the Early Warning System (EWS.) The ENI was the Relief Agency of the time. To strengthen this EWS, the ENI contacted concerned agencies and expanded the activity of EWS. In the later stages efforts ware made strengthening the ENI’s capacity.
This phase of transition occurred between 1974 and 1978 which was the third phase of the Institute’s development. Field studies were conducted on the epidemic of Lathyrism in Denbia and Fogera Awrajas of Gondar region and appropriate recommendation on intervention was given. Extensive studies were conducted in the fields of Vitamin A and Iodine deficiency, Sorghum utilization, fermented foods etc.
In the last phase 1979-1983, Swedish assistance took the form of project funding and gradually phased out. All running costs were started being covered by the Ethiopian Government.
This period marked the continuation of planning and consolidation on training aspect, much emphasis was given to manpower development of the Institute. A lot of research activities were carried out and tangible intervention programmed were executed on the basis of priority needs of the country. Contacts with internal agencies like the Addis Ababa University and external institution like the University of Manitoba on research and manpower development were conducted. In the latter stages efforts were made in strengthening the ENI’s capability that includes library up grade, computer facilitation for data processing, incorporation of a food technology centre and development of printing unit was. To this end, there appeared a major transformation in the over all structure and functional state of the Institute.
Generally the ENI has played a major role in nutrition intervention in Ethiopia. However, the bulk of its energies having been devoted to intervention programs, it has failed to make significant studies in research activities, so the issue of remodeling its objectives and redefine its structure based on the existing nutritional problems of the country was mandatory.
3. The Department of Traditional Medicine (DTM)
The term traditional medicine implies the ancient and culture bound medical practices which existed before the application of science to health matters. Guided by taste and experience, early societies developed a means of healing by using plants, animal products and minerals that were not mostly among their usual diet.
In Ethiopia the long history of the use of medicinal plants is reflected in the various medico- religious manuscripts produced on parchments and believed to have originated several centuries ago. The practice persists to date for a number of reasons including socio-cultural and economic factors. Its continued popularity, however, seems to be largely due to its biomedical benefits in dealing with many of the local health problems.
The widespread use of traditional medicine among both rural and urban population in Ethiopia could be attributed to cultural acceptability, its attributed efficacy against certain types of diseases, physical accessibility and economic affordability as compared to modern medicine. In view of this the development and its ultimate integration of traditional medicine with the modern system is believed to have significant impact in the expansion of the health care coverage. In recognition of its importance as an alternative health resource readily available to both urban and rural communities, a co-ordinating office for Tradition Medicine was established in the Ministry of Health (MOH) in 1979. The office was mandated to co-ordinate nation wide activities such as phytochemical Screening, clinical evaluation of traditional health practices and surgical procedures, etc.
Recently, health, research ventures in Ethiopia have stated to be viewed as essential component of better health delivery system for improving the prevailing dismal health status and ensure general well being of the population. National research policies have been formulated, institutions with due power and capacity have been created to realize and implement those policy objectives, attempts are made to encourage and stimulate research experts by creating favorable carrier structure and incentives. Establishment of Ethiopian Health and Nutrition Research Institute (EHNRI) with its respective goals and objectives reflected in proclamation of the Council of Ministers No. 4/1996 is one of the major advances in this line.
There is very little epidemiological information available concerning, vital statistics, the distribution and determinants of major health problems, e.g, disease, disability and death in the population. Even existing data on these aspects is scare and largely unreliable, and it enables to make no more than an impression to be formed about its magnitude and influencing factors. Valid health information is crucial as the basis for effective decisions to improve health and general well being of the population. Therefore, it is justified for the government to show commitment to improve and develop health related research activities in the country.
Based on the existed appropriate health policies, research output from the institution contributes to wards the health sector development. Some of the policy terms, which guide research priorities and health intervention programs and strategies, are put as follows:
The control of communicable diseases, epidemics and disease related to malnutrition and poor living conditions;
The development of beneficial aspect of traditional medicine, including related research and its gradual integration into modern medicine;
Applied health research addressing the major health problems;
Strengthen research capacities of national institutions and scientist in collaboration with responsible agencies.
The emphasis given to research and commitment to wards its development is reflected in the Science and Technology policies, which outlined the government’s vision to:-
Establish system to support and encourage applied and basic science and research. Formulate mechanisms for speedy dissemination and application of research and development results.
Establish conducive working environment and appropriate career and promotion structure for scientists and researchers.
Encourage and support participation of Ethiopian scientists and researchers in national, regional and international conferences, seminars, symposium and workshops.
Since its inception about 70 years ago, the present Institute has contributed a lot for the improvement of public health and nutrition problems of the country in different names and organizational structures.
Based on the prevalence of health and nutrition problems and by taking public needs into considerations, the Institute had been setting different priority strategies at different times to address the public demands, Currently the Institute is focusing on priority disease research and strengthening the national public health laboratory services in the country. It is also the technical hand of the federal Ministry of Health.
In 1996 EC the Institute has been re-established by an act of Ministers Regulation No.4/1996 of the Federal Democratic Republic of Ethiopia. The regulation recognizes the institute as an autonomous public authority having its own legal personality and it is accountable to the Federal Ministry of Health.
The Institute conducts research on the caused and spread of diseases, nutrition, traditional medicine and medical practices and modern drugs and there by support the activities for the improvement of Health in the country;
It also contribute to the development of health science and technology, more over it has been given the mandate to serve as a referral medical laboratory services relating to the occurrence, causes prevent and diagnosis of major diseases of public health importance and to establish and support National Laboratory Quality Assurance programs and systems.
The state of art of laboratories equipped with hi-tech laboratory equipments.
The Institute secures average annual revenue of 25 million Birr and more than 20 million USD (in cash and in kind) from different donors.
Research outputs of the Institute as of 1995 E.C.
1. Infectious and other diseases Research more than 100 publications were published by different researchers
2. In the areas of Nutrition and Food science research more than 70 publications were published.
3. In the areas of drug Research more than 16 publications were published’
4. Currently there are about six grand projects which are on going and there are other projects which are on going.