on to

lth
Getachew W/Yohannes (Bsc in PH, MPH, PhD)
Learning Objectives
• By the end of the course the student will be able to:
Discuss history of public health
Define public health
Understand that public health is a combination of
scientific disciplines
Describe the essential public health services
Describe the core functions of public health
Public Health: Definition
• The term “public health” came into the general use around
1840.

• It arose from the need to protect “the public" from the spread
of communicable diseases.

• Latter, it appeared in 1848 in the name of a law, the Public

Health Act in England to crystallize the efforts organized by
society to protect, promote, and restore the people’s health
Definition…
• In 1920, C.E.A.(Charles Edward Amory) Winslow, a former
professor of public health at Yale University, gave the off-
quoted definition of public health.
• Public health is “the science and art of preventing disease,
prolonging life and promoting health through the organized
efforts and informed choices of society, organizations, public
and private, communities and individuals(Winslow 1920)

• The WHO Expert Committee on Public Health Administration,

adapting Winslow’s earlier definition, has defined it as
WHO definition…
• “the science and art of preventing disease, prolonging life, and
promoting health and efficiency through organized community
efforts for the sanitation of the environment, the control of
communicable infections, the education of the individual in
personal hygiene, the organization of medical and nursing
services for early diagnosis and preventive treatment of
disease
WHO…..
, and the development of social machinery to ensure for every
individual a standard of living adequate for the maintenance
of health, so organizing these benefits as to enable every
citizen to realize the birthright of health and longevity’’.
What important terms/points can we extract
from this definition? Discuss what each means
• Science
• Art
• Prevention of disease
• Prolonging life
• Promoting health
• Organized community efforts for:
• Education
• Sanitation of the environment
• Control of communicable infections
• Organizing medical and nursing services
• Development of social machinery
• Realize birth right of health
Definition…..
• One of the efforts organized by society protect, promote, and
restore the people’s health (Johon Last)

• It is a combination of sciences, skills, and beliefs that are

directed to the maintenance and improvement of the health
of all the people though collective or social action
Definition…
• Public health professionals focus on optimizing the health of
populations
The field of public health comprises
• evidence- based methods,
• decision- making and
• the application of theories in society.
Definition….
• Effective public health practice is a multidisciplinary effort to
make health a priority for all by understanding the
determinants of health, addressing health disparities,
identifying disease risk factors and implementing preventive
strategies.
Definition..
• The scientific basis for public health rests on the study of risks
to the health of populations (including risks related to the
environment) and
• on the systems designed to deliver required services
Public Health…
• A EURO symposium in 1966 suggested that the definition of
public health should be expanded to include the organization of
medical care services.

• This was endorsed by another Expert Committee of WHO in

1973.

• Thus modern public health also includes organization of medical

care, as a means of protecting and improving the health of
people.

• Since the organization of public health tends to be determined

by cultural, political and administrative patterns of the countries,
there is a wide mosaic of organizational arrangements .
Disciplines….
• Public health, in its present form, is a combination
of scientific disciplines (e.g.,
• epidemiology,
• biostatistics,
• laboratory sciences,
• social sciences,
• demography) and
• skills and strategies (e.g., epidemiological investigations,
planning and management, interventions, surveillance,
evaluation) that are directed to the maintenance and
improvement of the health of the people.
Public Health…
• As a result of improvements in public health during the past
60 or 70 years, public health in the developed countries has
moved from sanitation and control of communicable diseases
(which have been largely controlled) to:

preventive,
therapeutic and rehabilitative aspects of chronic diseases and
behavioral disorders
 Essential public health services

blic health services are as

elow.

h status to identify community health

investigate health problems and health

ommunity.

e and empower people about health issues.

Essential….
4. Mobilize community partnerships to identify and solve
health problems.

5. Develop policies and plans that support individual and

community health efforts.

6. Enforce laws and regulations that protect health and ensure

safety.
Essential….
7. Link people to needed personal health services and assure
the provision of health care when otherwise unavailable.

8. Assure a competent public health and personal health care

workforce.

9. Evaluate effectiveness, accessibility, and quality of

personnel and population-based health services.

10. Research for new insights and innovative solutions to health

problems
Core Functions of Public Health
Assessment

Policy Development

Assurance
Assessment
• Every public health agency should regularly and
systematically collect, assemble, analyze, and
make available information on the health of the
community, including
• statistics on health status,
• community health needs, and
• epidemiological and other studies of health
problems."
Assessment…
• Monitor health status to identify community health problems

• Diagnose and investigate health problems and health hazards

in the community

• Evaluate effectiveness, accessibility, and quality of personal

and population-based health services

• Research for new insights and innovative solutions to health

problems
Policy development
• Every public health agency should exercise its
responsibility to serve the public interest in the
development of comprehensive public health policies by:

• promoting use of the scientific knowledge base in decision-

making about public health and by
• leading in developing public health policy.

• Agencies must take a strategic approach, developed on

the basis of a positive appreciation.
Policy…
• Inform, educate, and empower people about health issues

• Mobilize community partnerships to identify and solve health

problems

• Develop policies and plans that support individual and

community health efforts.
Assurance
• Public health agencies assure their constituents
that services necessary to achieve agreed upon
goals are provided, either by:

• encouraging actions by other entities (private or public

sector),
• by requiring such action through regulation, or by
• providing service directly".
Assurance…
• Assure a competent public health and personal health care
workforce

• Enforce laws and regulations that protect health and ensure

safety

• Link people to needed personal health services and

• assure the provision of health care when otherwise

unavailable
Group Assignment
• Group 1: Implementation of Basic Health Services program in
Ethiopia
• Group 2: The Sector Wide Approach period(1991-2015)
• Group 3: Public Health In the Eighteenth and Nineteenth
Centuries
• Group 4: Leadership in Public Health Practice
• Group 5: Public health evolution
Basic concepts of Public health
• Community
A community is “a collective body of individuals identified by
common characteristics such as geography, interests,
experiences, concerns, or values.”
Communities are characterized by the following elements:
(1) membership—a sense of identity and belonging;
(2) common symbol systems—similar language, rituals, and
ceremonies; (3) shared values and norms;
Community…
• mutual influence—community members have influence and
are influenced by each other;
• shared needs and commitment to meeting them; and
• shared emotional connection—members share common
history, experiences, and mutual support
Community Health
• Community health refers to the health status of a defined
group of people and the actions and conditions to promote,
protect, and preserve their health.
• population health is “the health outcomes of a group of
individuals, including the distribution of such outcomes within
the group.
The public health
• activities undertaken within the formal structure of
government and the associated efforts of private and
voluntary organizations and individuals,” is the organizational
mechanism for providing such conditions.
Global health
A term that describes
“health problems, issues, and concerns that transcend national
boundaries, may be influenced by circumstances or
experiences in other countries, and are best addressed by
cooperative actions and solutions
Public Health and Medicine
• While the broader conceptions of public health required an
understanding of economics and politics, the dominant model
of public health knowledge was based almost exclusively on
the biological sciences.
• With the increasing professionalization of public health,
physicians came to hold a dominant but not exclusive role in
the field
Public health and Medicine….
• The curious relationships between physicians and nonmedical
public health practitioners would shape the subsequent
development of public health practice.

• The practical importance of public health was well

recognized by the early decades of the twentieth century.

• The incidence of tuberculosis, diphtheria, and other

infectious diseases was falling, apparently in response to
energetic public health campaign.
Primary Health Care
• The 1978 Alma-Ata conference reiterated that the health
status of the majority of the world’s population was poor, and
had inadequate and inequitable health care and health
resources.
• The conference also reaffirmed that health is a fundamental
human right and a world wide social goal that required serious
attention.
Primary…..
• The conference stressed the need for an innovative approach
to close the gap between the rich and the poor.
• PHC was generally conceived as an essential care based on
practical, scientifically sound, and socially acceptable method
and technology made universally accessible to individual and
families in the community
PHC…
• Through their full participation and at a cost the countries can
afford to maintain at every stage of their development in the
sprit of self reliance.
• PHC was to be designed as an integral part of both the
country,s health system core function and main focus, as well
as the over all social and economic development of the
community.
PHC
• PHC required political commitment , active community
participation, intra and inter-sectoral collaboration and
appropriate technology for its successful implementation.
• In the implementation of PHC, the Alma-Ata Conference
clearly articulated the specific roles of governments and
international organizations.
PHC….
• In order to enhance the implementation of PHC, effective
mobilization of resources, national commitment and
strategies, technical cooperation, international support and
special/advocacy role by WHO and UNICEF were required.
Challenges of CHS in Ethiopia
• Poor planning process
• Inadequate remuneration
• Absence of continuing education
• Lack of purposeful supervision
• Lack of sustained support by the community
• Inadequate inter-sectoral collaboration
• Weakness in selection and training
Reading Assigments
• Standards of public health practitioners

• Why investing on Public health?

Health and disease determinants
• determinants can be classified under headings such as
physical, biological, behavioral, social, cultural, and spiritual.
• Determinants can be hereditary determinants which means
those that are inborn or constitutional, or
• acquire determinants, which include everything from
infections and trauma to cultural characteristics and spiritual
values.
Age and Sex
• Mortality rates are higher for females than males, although
health care utilization statistics nearly all show higher rates of
utilization for females than males even when reasons related to
pregnancy and childbirth are excluded.
• Females do not live longer on average than males
• because they use more health care services (perhaps in spite
of it) but because of inherent, ill-defined biological
characteristics.
Age
• Age is an obvious determinant of health. Infants, especially if
they are underweight or prematurely born are more
vulnerable to many diseases than are older children.

• The peak of fitness and good health is reached after

adolescence

• Health and physical vitality and efficiency slowly decline until

the seventh or eighth decade.
Race
• A race is defined as a group that is relatively homogeneous
with respect to genetic inheritance.
• African-Americans have higher prevalence and mortality rates
from hypertension and cancer of the prostate than Americans
of European origin.
Physical Determinants
• Too much sunshine is harmful: excess
ultraviolet radiation impairs immune réponses, causes cancer,
and leads to cataracts.
• Iron, iodine, and copper, among many others and those that
may harm health, such as environmental lead, mercury,
cadmium,
and organic compounds
Biological Determinants
• Include the microorganisms that may cause harm, as well as
biologic products such as sera and vaccines that help protect
against disease
• Another class of biologic determinants of health are the
essential dietary nutrients: the carbohydrates, proteins, fats,
minerals, and vitamins that are derived from plant and animal
sources.
Behavioral Determinants
• more difficult to describe, classify, and explain
• Health may be altered by a wide range of emotional states-the
happiness of young lovers, the heartbreak of parents whose
child is unexpectedly struck down by cancer or a fatal traffic
crash,
• the grief of bereavement that sunders a long and happy
marriage, the contentment of a secure and satisfying job, the
anxiety that strikes when that job is lost.
Behav…
• Peptic ulcer and hypertension are identified as stress diseases
• There is abundant evidence for a relationship, which is
probably at least indirectly causal, between these and other
conditions and the occurrence of
persistent emotional stress
Social Determinants
• It was observed that there were striking and consistent
relationships between social class, now usually referred to as
socioeconomic status (SES), and incidence of health and
sickness.
• educational level, occupation, income, and housing conditions
are interrelated and all influence health.
Cultural Determinants
• A nation's collective attitude towards human sexuality is
culturally determined and can profoundly influence several
aspects of reproductive health.
• Particularly notable are the risks of unwanted pregnancy and
sexually transmitted diseases, including HIV infection,
especially among sexually active teen-age children
Spiritual Determinants
• Spiritual determinants of health do not refer to religious
beliefs but to more subtle phenomena, such as the view that
individuals and communities hold of their place in nature

• Reactions of individuals and families to the

occurrence of life-threatening disease, for example, vary in ways
that are best described as spiritual
Economy
• Both national and local economies can affect the health of a
community through reductions in health and social services
• Employers usually find it increasingly difficult to provide health
benefits for their employees as their income drops.
• Those who are unemployed and underemployed face poverty
and deteriorating health. Thus, the cumulative effect of an
economic downturn significantly affects the health of the
community
 Politics
ho happen to be in political office can improve or
ze the health of their community by the decisions (i.e.,
d ordinances) they make.
ost general terms, the argument is over greater or
overnmental participation in health issues
Religion
• A number of religions have taken a position on health care and
health behaviors. For example, some religious communities
limit the type of medical treatment their members may
receive.
• Some do not permit immunizations; others do not permit their
members to be treated by physicians. Still others prohibit
certain foods.
Social norms
• The influence of social norms on community and public health
can be positive or negative and can change over time.
Cigarette smoking is a good example.In US 1965 it was socially
acceptable to be a smoker, especially if you were male .
Overview of Program Planning and Community need
assessment
• Lecture outline
• Program and project?
• Steps in planning (brief account)
• Process of Need assessment (our focus)
• Links: Objective Vs strategies Vs Actions
• We will concentrate on Need Assessment
Objectives
• At the end of this lecture, students are
expected to know:
• Differences Project Vs Program
• Steps in Planning Vs Programming
• Community/public need assessment
• Tools of need assessment
Program Planning
• A process in which an intervention is
planned to help to meet the needs of a
specific group of people.

• It may take a community organizing

efforts to plan such as an intervention
Project and Program
What is the difference:
• Scope
• Finance
• Time: short Vs relatively long
• Programme:
– Relatively long (20-25 yrs and breaking on
2-5yrs
– Has political commitment
– Targets the public service in general
– Requires Budgeting
WHY PLANNING
• Identifying the problems clearly
• Decide what we want to achieve through our action;
• Working systematical;
• Making better use of our limited resources;
• Studying the results of our action
• Planning anticipates future growth and needs;
• Provides direction to long term strategies and programs;
• Reduces uncertainties by predicting the events to follow
• Looks for a change;
• Is a basis for M & E
• Forecasts the need and demand;
Steps in Health Program Planning
• 1. Triggering a planning question or need:
(Understanding and knowing the community)
• Constitution
• Mandates and Responsibilities of Federal/Regional
. Health Bureaus;
• Initiating a new project
Steps in Health Program Planning, cont’d

2. Needs Assessment including priority setting

3. Reviewing Obstacles and Barriers
• Mainly resources
4. Setting Goals, Objectives, Targets
5. Designing Strategies (Core/Specific) and
Activities/interventions
6. Formulating Resource needs
7. Designing Action plan
8. Designing M & E Plan
9. Write up the Plan
10. Implementation;
11. M & E the progress
Step 1: Understanding the Target
Population
• Knowing the population from the earliest stage of planning
the program;
• Finding out information as much as possible about the target
population and its environment
• Forming a “ … Committee” as an entry point for partnership
• Decide if there is a need to go beyond
Needs Assessment
• The process of collecting and analyzing information, to
develop understanding of the issues, resources and
constraints/
• challenges of the target population
• Vs expected the actions/ program being developed.
This could be:
– Professionally identified needs (Expertise, judgments)
– Expressed (felt) needs => Community Demands
• Both types are important and must be identified.
Need ASS..
• Synonymous
• Analysis of the situation
• Situational Analysis
• Identifying Problems
• Community diagnosis (community level)
• Region/Country based diagnosis/Analysis:
– Health Profile (Woreda, Region, etc
Steps in Conducting Needs
Assessment
• Needs planning
• • Determining the purpose and scope of the
needs assessment;
• Preparing TOR
• Designing study Methodology
• Gathering data
• Analyzing the data
• Identifying the factors linked to problem
• Identifying the program focus (Prioritization)
• Validating the prioritized need
• Writing a Report (draft and final)
Need Assess…
Designing the methodology
• What Epi design is appropriate?
– Descriptive (very common)
– Analytical
– Which is best? WHY?
– Which is relevant for Com Dx? How that is
determined?
Needs Assessment
Instruments
• • Primary data
– Those that collected specifically for use in this process:
• Quantitative Methods: Survey (baseline, cross-sectional)
• Qualitative Methods:
– FGD, In-depth interviews, Key Informant Interview, etc
– Observations
– Use participatory approach
• Secondary data
– Those already collected for some other purpose
(Desk top review: reports, journal articles, etc)
• Merits and demerits?
Instruments cont’d
• Analyzing data Vs relating to what “Project
idea” you wanted
• Organizing data (Biostat Knowledge)
• Identifying relevant findings:
– Perceived problems
– Causes of problems
Priority Setting
• A method of defining “essential package”
or “core services” for intervention, among
health problems identified.

• Identifying activities to be performed first in

the order of its importance
Prority Setting
• Selection of most problem that needed an
immediate
intervention
• WHY?– Scarcity Vs Abundance
– Time Vs Depth pf problem
• Limited Resource
– Human
– Financial
– Material
– Time
• Not all problems have equal weight
Priority Setting and Identifying Program
Focus
• Magnitude (impact): what indicators?
• Severity/seriousness: what indicators?
• Feasibility (Operationable ?)
– Enabling factors (Access to resources for executing the
program)
– Predisposing factors (Knowledge and skills gaps within the
• Community that are related to the program to be designed)
– Technical capacity
• Community Concern
– Reinforcing factors (Whether community members/ project
partners give value to the benefits of the program
Procedures Priority setting
1. List the problems one by one
2. Give scores that range 1 – 5 (generally); can be 1 – 10
3. Give equal weight for all the parameters (use same scoring)
4. Use summation or preferably use product
• What is the advantage: summation or product?
5. Order the problems by ascending
6. Select the one you want to intervene (few among many)
1 = very little; 2 = little; 3 = Some what high; 3=
quite high; 4= very high 5 = Extra very high
Challenges when doing priority
setting
• Mismatch between community and expert
based priorities
• How to solve:
– Mobilizing projects that could complement
each other
– Transparency when doing projects in a
community;
– Using participatory approach
Action Plan Development
• Based on the prioritized problems and
selection of objectives
• Resource Planning (human, material, finance);
• Time line
• Implement as per the PoA
• Monitor and Evaluate
Action plan…
• Objective
– To reduce morbidity and mortality from malaria in Zeway
town
• Strategy
– BCC (public awareness creation)
– Elimination of mosquito breeding sites
– Treatment of cases
• Activities
– Education
– Bush clearing
– Provision of anti malaria drugs
– Surveillance
Action plan development
• Target
– Number of people
– Age group
– Gender
– Vulnerability
– Unprivileged
• Time frame
• Responsibility
• Resources required
Take home assignment
• Linking School Health with need
assessment;
• Assume yourself that you are head of
Woreda Health office. You are asked to
make a brief plan to improve the health
condition of school children in the context
of Ethiopia. The time you are given is just
2 days by Woreda Council:
Questions
Q1. What tools would you use to initiate your task?
Which is fairly good enough to assist you in
identifying the problems?
Q2.List possible public health problems seen in
primary schools of Ethiopia. Use a systematic
approach of reviewing existing data;
Q3. Make priorities just using your data. No
hypothetical data is allowed;
Q4 Formulate the conceptual Model to sort out the
school health problem
Globalization and Emerging Infectious Diseases

Key Points:
• Globalization is reintroducing infectious diseases into high-
income regions and introducing chronic diseases into low-
income regions.
• Emerging infections, the development of antimicrobial-
resistant infections, and potential acts of terrorism are
creating new health threats.
THE “EPIDEMIOLOGIC TRANSITION”
AND GLOBALIZATION
• Modern medical technologies and improved nutrition have
in some parts of the world led to a shift from high fertility,
short life expectancy, and deaths from infectious diseases
and under nutrition (the pre-transition profile) to low
fertility, long life expectancy, and deaths from non-
communicable diseases like heart disease, cancers, and
stroke (the post-transition profile).
Epidemiological….
• This “epidemiologic transition” was expected to
predictably follow the “demographic transition” as the
economic status of a population improved
• US, Canada, Japan, and most European countries would
be considered “post-transition” whereas sub-Saharan
Africa and some Asian and Latin American countries
would be considered “pre-transition.”
Epidemio…
• In many low-income countries both pre-and post-
transition population can be found within one city
• Urban professionals may have increasing rates of
cancer while poor urban families continue to
experience high rates of infectious disease.
• globalization is reintroducing infectious diseases into
industrialized nations and introducing new chronic
diseases into developing nations.
Epidemiological…
• “Lifestyle diseases” related to obesity and physical
inactivity are now found even in countries where the
burden of infectious diseases remains high.
• This means that rather than experiencing a health
transition, these countries are facing a dual burden of
infectious and chronic diseases
Globalization..
• Globalization is seen in the increasing number of:
• global governmental and non-governmental organizations,
• the proliferation of multilateral trade agreements,
• increases in foreign direct investment,
• changing production modes,
• increased population mobility (including tourism, urban
migration, and forced displacements), and
• increased cultural diffusion
Globalization and PH
• Globalization is not new to the field of public health.
• Infectious diseases were spread across the globe when sea
and land trade routes like the Silk Road and Spice Route
that linked China, India, and the Mediterranean.
• Massive outbreaks occurred with the Mongol expansion to
Europe in the 13th century.
Globalization vs PH
• The infectious diseases carried by the Europeans who
explored the Americas in the 15th century caused the
decimation of many indigenous American populations.
Globalization vs PH
• The original case of SARS (Severe Acute Respiratory
Syndrome), which emerged in 2003 was probably acquired
in an animal market.
• The infection then was transmitted from person to person
across parts of Asia, and within months cases were found in
Canada, the US, South Africa, Brazil, and many European
nations.
• (This led to the culling of millions of chickens).
EMERGING INFECTIOUS DISEASES
Definition: (Wikipedia, the free encyclopedia)

• “An emerging infectious disease is an infectious

disease whose incidence has increased in the
past 20 years and threatens to increase in the
near future
Emerging…
• This includes diseases caused by a newly
identified microorganism or newly identified
strain of a known microorganism (e.g, SARS,
AIDS), new infections resulting from change or
evolution of an existing organism (e.g,
influenza),
• A known infection which spreads to a new
geographic area or population (e.g, West Nile
virus), newly recognized infection in an area
undergoing ecologic transformation (e.g, Lyme
disease), and
Emerging
• pre-existing and recognized infections reemerging due
to drug resistance of their agent or to a breakdown in
public health (e.g tuberculosis
Mechanisms of emergence & reemergence

• Microbial adaptation; e.g. genetic drift and genetic shift

in influenza A;
• Changing human susceptibility e.g, mass immuno-
compromisation with HIV/AIDS;
• Climate and weather; e.g. diseases with zoonotic
vectors such as West Nile Disease (transmitted by
mosquitoes) are moving further from the tropics as the
climate warms;
Emergence…
• Change in human demographics and trade; e.g, rapid travel
enabled SARS, bird flue and swine flue to rapidly propagate
around the globe;
• Economic development; e.g, use of antibiotics to increase
meat yield of farmed animals leads to antibiotic resistance;
• Breakdown of public health; e.g, negligence to public health
(cholera outbreak in Zimbabwe in 2009);
Emergence..
• Poverty and social inequality; e.g, TB is primarily a problem
in low-income areas;
• War and famine;
• Bioterrorism; e.g, 2001 Anthrax attacks in the U.S.;
• Dam irrigation system construction; e.g, malaria and other
mosquito borne diseases.
Emergence..
• The emergence of new health threats derives from a
complex interaction of:
• Genetic and biological factors,
• Physical environmental factors,
• Ecological factors, and
• Social, political, and
• Economic factors.
Emergence..
• Thirteen specific risk factors have been identified:
1. Microbial adaptation and change,
2. Human susceptibility to infection,
3. Climate and weather,
4. Changing ecosystems,
5. Economic development and land use,
6. Human demographics and behavior,
7. Technology and industry,
8. International travel and commerce,
9. Breakdown of public health measures,
Emergence..
10. Poverty and social inequality,
11. War and famine,
12. Lack of political will, and
13. Intent to harm (Bioterrorism).
Emergence…
• Alternation of the environment, such as deforestation,
reforestation, dam-building, and manipulation of wetlands,
creates new environmental reservoirs for infectious agents.

• And natural disasters like floods and droughts can alter the
landscape and introduce new agents to a region.
Emergence..
• Cultural and behavioral practices , including food
practices, outdoor activities, and risky sexual behavior and
drug use, that become trendy and spread globally may also
facilitate transmission.
• Urbanization facilitates the emergence of new infections as
people with different infections interact with one another
and creates new habitats for vectors (e.g Bubonic
fever/Black Death in the middle ages when cities started to
rise)
Some common elements of global emerging-
disease control plans
• Strengthen international surveillance networks to detect,
control, and reduce emerging diseases;
• Improve the international public health infrastructure (e.g.,
labs., research facilities, technology, and communication
links);
• Develop international standards, guidelines, and
recommendations;
Control…
• Improve international capabilities to respond to disease
outbreaks with adequate medical and scientific
resources and expertise;
• Strengthen international research efforts on emerging
diseases, particularly with regards to antibiotic-resistant
strains of diseases;
• Focus attention and resources on training and
supporting medical and scientific expertise
Control..
• Encourage national governments to improve their public
health care systems, devote resources to eliminating or
controlling causes of emerging diseases and coordinate their
public health activities with WHO and the international
community.
Discussion
• What are your reflections to the global threats of emerging
infectious diseases and the threat to developing countries
like Ethiopia?