Malaria prevention and control are major foreign assistance objectives of the U.S. Government (USG). The purpose of this Malaria Operational Plan (MOP) is to provide a framework and a rationale for nominating and supporting malaria prevention and control projects in Ethiopia with FY 2014 funding to accomplish the USG's foreign assistance objectives through the President's Malaria Initiative (PMI) in the context of the Global Health Initiative (GHI). Through the GHI, the USG will help partner countries improve health outcomes, with a particular focus on improving the health of women, newborns, and children. The MOP process for PMI Year 7 (FY 2014) considers information from the Ethiopian Federal Ministry of Health (FMOH), Regional Health Bureaus including the Oromia Regional Health Bureau (ORHB), international malaria program donors including the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), malaria subject matter experts, and other malaria program stakeholders about the malaria situation, and the malaria control program capacities and gaps in Ethiopia. The President's Malaria Initiative is a core component of the GHI, along with health programs for HIV/AIDS and Tuberculosis; PMI was launched in June 2005 to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in selected high-burden countries in sub-Saharan Africa. Other PMI goals include removing malaria as a major public health problem, promoting development in the Africa region, strengthening malaria control activities, and containing the spread of antimalarial drug resistance. The programming of PMI activities follows the core principles of GHI: encouraging country ownership and investing in country-led plans and health systems; increasing impact and efficiency through strategic coordination and programmatic integration; strengthening and leveraging key partnerships, multilateral organizations, and private contributions; implementing a woman- and girl-centered approach; improving monitoring and evaluation; and promoting research and innovation. Malaria is ranked as the leading communicable disease in Ethiopia, accounting for about 30% of the overall Disability Adjusted Life Years lost. Approximately 68% of the total population of 84.3 million lives in areas at significant risk of malaria. According to the FMOH, in 2010/2011, malaria was the leading cause of outpatient visits, accounting for 15% of all visits, and health facility admissions, with 15% of all admissions. Malaria is one of the top ten causes of in-patient deaths among children less than five years of age and adults. President's Malaria Initiative support to malaria prevention and control in Ethiopia began in FY 2008 with an initial focus on Oromia Regional State, the largest of Ethiopia's nine regional states, covering a third of the country. Ethiopia has received four malaria grants from the Global Fund in recent years. PMI has contributed between $20 and $43 million annually to malaria control efforts in Ethiopia during the last five years.