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Getting
Ethiopia Emergency type: Multiple events Reporting period: 1-30 September 2019
6.0 MILLION IN NEED
1.6 M IDP TARGETED
1.6 M HOST TARGETED
73 WOREDAS
HIGHLIGHTS HEALTH SECTOR
• Flooding was reported in Dolo Ado woreda of Liban zone, affecting 9,374 households in 12 kebeles, leading to displacement, destruction of property, livestock and crops. Humanitarian support is needed in ESNFI, WaSH, food and health.
• 1,683 cases of cholera, with 54 confirmed by culture have been reported since April 2019. There are active outbreaks in Oromia, Somali, SNNP, Amhara and Afar regions.
• A synchronized round two mOPV2 vaccination campaign was implemented in five zones (Dolo, Jarar, Fafan, Nogob and Erar) of Somali region reaching 588,450 children under 5, coordinated between emergency and development programs.
20
HEALTH CLUSTER IMPLEMENTING PARTNERS
MEDICINES DELIVERED TO HEALTH FACILITIES/PARTNERS
117 ASSORTED MEDICAL KITS
HEALTH CLUSTER ACTIVITIES
213,058 OPD CONSULTATIONS
VACCINATION
588,450 VACCINATED AGAINST POLIO
EWARS
4 OUTBREAKS OF CHOLERA, MEASLES, DENGUE, CHIKUNGUNYA
FUNDING $US
95 M REQUESTED
20.8 M 74.2 M
21% FUNDED
GAP
HEALTH CLUSTER BULLETIN #8 September 2019
Water quality testing, Gelana woreda. Photo: WHO.
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Situation update As per the EPHI, 1,683 cases of cholera were reported since April 2019. There are active outbreaks in 11 woredas of Oromia, Somali, SNNP, Amhara and Afar regions. Health Cluster partners are providing support for cholera prevention and control activities in all outbreak affected areas. Coordination, Case management, surveillance and social mobilization are maintained and strengthened. The outbreak response enhanced by the response team deployed from national and regional health bureau with the engagement of community.
The map below shows the locations currently affected by cholera outbreak.
51,361 cases, with no deaths, were reported in Dire Dawa since the Chikungunya outbreak started in August 2019.
Dengue fever outbreak was reported in Gewane woreda of Afar region on September 16. Total cases so far are 536.
Measles outbreaks are ongoing in Amhara (703), Afar (548), Oromia (4,899) and Somali (2,340) regions. 8,490 suspected cases have so far been reported. 50.4% of reported cases are under 5 age group and 25.3% of cases are 15-44 years of age. Notably, 72.6% of the cases have not had a single dose of measles vaccine prior.
Flooding was reported in Dolo Ado woreda of Liban zone, affecting 9,374 households in 12 kebeles. This has led to displacement, destruction of property, livestock and crops. Humanitarian support is needed in ESNFI, WaSH, food and health.
Public Health risks, priorities, needs and gaps
Health risks • Conflict and population displacement leading to increased health demands to the facilities, due to new and pre-
existing conditions and diseases, mental health burden, sexual and gender based violence, and other sexual and reproductive health needs.
• Communicable disease outbreaks due to low literacy levels, poor and congested living conditions, poor WaSH facilities and practices, mass gatherings and activities, and low vaccination coverage for vaccine preventable diseases.
• Food insecurity and malnutrition, resulting from erratic rains and drought and floods in some locations, which contribute to higher vulnerability of children and other people to infectious diseases and other disease conditions.
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Priorities • Delivery of essential life-saving emergency health services to vulnerable populations by ensuring sufficient
quantities of quality medicines and medical supplies, and health workers teams to perform the work.
• Work with and strengthen the capacity of the existing health system by training health workers and establishing humanitarian-development linkages.
• Enhance quality of the response through field level coordination, monitoring and support to partners with the
main focus on IDP/return locations and new incidents. • Improve the collection and collation of data and information from partners, present it in information products
and use it for decision making, resource mobilization and guiding the response.
• Support joint and integrated approaches with other Clusters targeting the same locations and populations with humanitarian response.
Needs and gaps
• Significant shortages of qualified health staff to implement the response in emergency affected locations, in an already strained health system, and partners’ inability to recruit adequately.
• There is need to strengthen the regular supply chain for medicines, and harmonize it with the emergency streams to reduce incidents of stock-outs at health facility level. At subnational levels, areas of support include warehousing capacity, and logistics and distribution mechanisms. Delays in emergency funding and procurement should be addressed.
• Health facilities in many return locations were fully or partially destroyed during the conflict. This means that
for some time the population will rely on MHNT for essential health services. There is need to speedily rehabilitate, re-staff and restock these facilities.
Health Cluster Action
2019 HRP dashboard Indicator Q1 Q2 July Aug Sep Total
1 OPD consultations in IDP locations 132,835 131,632 56,540 114,803 213,058 648,868
2 OPD consultations for CU5 in IDP locations 41,594 47,853 9,703 19,805 52,573 171,528
3 Normal deliveries attended by skilled birth attendants 959 821 174 455 833 3,242
4 WCBA receiving comprehensive RH services (modern contraceptives) 4,678 5,850 2,110 3,828 5,248 21,714
5 Epidemic prone disease alerts verified and responded to in 48 hours 29 24 4 6 11 74
6 Children 6 months to 15 years receiving emergency measles vaccine 650,501 1,230,912 36,120 284 596 1,918,413
7 Health facilities providing CMR services for SGBV survivors 120 196 9 48 25 196
8 Health facilities addressing health needs of persons with disabilities 36 195 5 173 21 195
9 Health facilities providing MHPSS services in IDP locations 33 75 10 192 24 192
10 Referrals to higher level and specialized services completed 409 325 72 153 484 1,443
Strategy and response processes Response to cholera outbreaks continues to be structured around case management, social mobilization and risk communication, logistics and supplies, surveillance and laboratory investigation, and WaSH. The EPHI and RHB lead the interventions, with Health Cluster partners supporting as and when assigned by the authorities. Addis Ababa, Amibara, West Hararge, Hawassa have already benefited from the oral cholera vaccination campaigns, while there are ongoing campaigns in Hudet, Erer and Ewa woredas.
The Health Cluster continued to emphasize to partners that the emergency health services should move with the IDP to the areas of return. Support to health facilities and mobile teams should mostly be directed towards the return locations. This level of flexibility is also expected with partners supporting the cholera and other outbreak response.
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Polio outbreak response in Somali region has presented a very good avenue for collaboration and coordination between the emergency and development programs. Back in June a Polio EOC was established at the EPHI, and at the field level, joint planning and activities have been implemented. Through this campaign, gaps in routine EPI have been identified, and further presents an opportunity for all to work together towards durable solutions.
Health Cluster coordination In September, the Health Cluster held its monthly coordination meeting, focusing on cholera outbreak and IDP/ returnees response. Detailed updates were shared by partners on their operations on the ground. The monthly SAG meeting focused on 2020 HNO. The MHPSS TWG held the monthly meeting on September 24, 2019. EPHI was proposed and endorsed to co-chair the TWG. SCI presented on its child resilience program. The TWG has 6 thematic subgroups. The TWG will hold an orientation workshop for health cluster partners at the end of October. A monthly SRH in humanitarian setting working group meeting was conducted on September 19, 2019 at EPHI office.
At the sub-national level, biweekly coordination meetings continued in West and East Wellega, West and east Hararge, Gedeo, West Guji zones, Amhara and Somali regions. These meetings are conducted by the Health authorities and co-chaired by WHO.
Provision of essential drugs and supplies UNOPS deployed two 5-MT trucks and facilitated dispatch of 78 MT of medical and WaSH supplies in Somali region.
UNICEF dispatched 10 EDK for IDP/returnees in Kamashi zone (7 kits) and Metekel zone (3 kits) to treat over 25,000 people for three months. 8 CTC kits were distributed to SNNPR to support the current cholera outbreak response.
UNFPA with support from the government of Japan imported emergency RH kits to the country and is working with the project’s woreda health offices for distribution to the health facilities.
SCI’s EHF supported supplies project received about 30% of the internationally procured emergency health kits. The rest of the shipment is expected soon.
IRC procured and donated medical equipment and supplies to Oda Biligi woreda health facilities.
WHO distributed 117 IEHK, cholera and SAM kits to partners in Afar, Amhara, Dire Dawa, Oromia and Somali regions.
MSF-Spain donated about 33,000 Euros worth of essential medical supplies and drugs, 2,000 malaria RDT kits and 100 dengue RDT kits to Sabiyan hospital, Dire Dawa, Goro, Gende kore, Legahare and Addis Ketema health centers. After 10 years of support, the Dolo Ado project in Somali region was handed over to health authorities. 3 months’ medical supplies, drugs and commodities, fuel, logistic items, and generators were donated to the health centre.
Training of health workers
UNFPA conducted post abortion care capacity development trainings from September 2 -7, 2019 for 21 health service providers (9 female and 12 male) and Minimum Initial Service Package (MISP) for RH from September 23-26, 2019 for 30 health service providers (15 female and 15 male) invited from Gedeb and Yirgachefe woredas of Gedeo zone and Gelana and Kerecha woredas of West Guji. SCI supported a day’s orientation on surveillance for private health facilities and PHEM focal points, and 3 days training on cholera case management for government health facilities, PHEM focal points and healthcare providers at ORP sites in 10 sub-cities of Addis Ababa. 922 people (411 men and 511 women) were trained. In Hawassa 225 (80 HW and 175 HEW) were trained for 3 days. Orientation on cholera prevention was also conducted for 1 day for 562 participants (242 for town/Sub-city officials and 320 for kebele administrative).
WHO conducted second round national training of trainers for the introduction of the revised SAM management guidelines covering 33 participants from national and regional levels. 70 health staffs were trained in Hawassa on cholera prevention and control and on infection prevention and control. 27 public health workers from Tigray health bureau were trained on data and visualization mapping.
Child health A synchronized round two mOPV2 vaccination campaign was implemented in five zones (Dolo, Jarar, Fafan, Nogob and Erar) of Somali region, reaching 588,450 children under five, from September 23-26, 2019. 100% coverage was reported. This campaign was jointly supported by PEI, FMoH, EPHI, RHB, WHO, UNICEF, CDC and other partners. UNICEF provided operational support for distribution and retrieval of the vaccines.
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UNICEF continued to support the Gambella RHB to provide vaccination for South Sudanese refugee children. 9 children were vaccinated against measles at arrival.
Communicable diseases control and surveillance Table 1: Number of cases reported during WHO Epi week 36-39, 2019, Ethiopia
Region
Mala
ria
MM
SA
M
AF
P
Measl
es
NN
T
Rab
ies
Mate
rnal
Death
Scab
ies
Case
s
Death
s
Case
s
Death
s
Case
s
Death
s
Case
s
Death
s
Case
s
Death
s
Case
s
Death
s
Case
s
Death
s
Death
s
Case
s
Death
s
A. Ababa 211 0 8 0 168 0 10 0 14 0 0 0 120 0 1 2236 0
Afar 6773 1 2 0 910 5 0 0 101 0 0 0 0 0 2
Amhara 40527 1 8 0 2539 4 13 0 188 2 0 2 74 2 10 10021
B. Gumuz 15434 2 8 1 163 1 1 0 4 0 0 0 23 0 0 202 0
Dire Dawa 44 0 0 0 43 0 0 0 0 0 0 0 0 0 3 48 0
Gambella 5299 1 7 0 72 0 0 0 3 0 0 1 0 0 0 15 0
Harari 201 0 15 0 196 0 0 0 91 1 0 1 0 0 3 122
Oromia 18148 2 172 4 9549 8 23 0 735 3 1 0 27 0 42 9263 0
SNNPR 31472 2 28 0 2583 4 15 0 11 0 0 0 10 0 7 3406
Somali 3680 0 24 0 5281 0 5 0 74 0 1 1 0 0 2 3 0
Tigray 14901 0 4 0 594 0 4 0 11 0 1 0 253 0 4 1005
Total 136690 9 276 5 22098 22 71 0 1232 6 3 5 507 2 74 26321 0
EPHI reported that on each epi week from 36 to 39, most regions met the required 80% IDSR reporting completeness and timeliness. EPHI is following up with regions performing below the minimum standards.
OCV campaign was conducted in Hawassa city for 23,356 people. The major target population were industrial park workers, street children. Ongoing OCV campaigns in Hudet woreda target 32,600 people, Erer woreda target 41,600 people, and Ewa woreda 32,600 people.
SCI supported the Oromia health bureau to strengthen cholera outbreak surveillance by facilitating deployment of the government’s 7-member RRT in West Arsi, Shashemene and East Hararghe for 40 days, and 1 vehicle with a driver.
Support to health service delivery MCMDO reached 38,899 beneficiaries with lifesaving health and nutrition services in nine woredas of West Guji zone (20,320), Gedeo (5,374), West wollega (3,081), Kamashi (10,124) zones. The services included OPD consultation and treatment, nutrition, ANC, family planning, delivery, PNC, EPI, Vitamin A and deworming through 11 MHNT/Outreach teams. 15,748 beneficiaries got consultation and treatment service of which 4,775 were under-five children. 1,175 WCBA received comprehensive reproductive health service and 1,184 and 274 pregnant women received ANC1 and 4 services respectively. 18 deliveries were attended by the MHNT midwives and nurses and one obstetric complicated case referred to health facilities.
IMC provided lifesaving emergency health services and cholera response for IDP and returnees in East and West Hararghe zone. This service includes OPD consultations for 4668 adults and 3385 CU5. 67 normal deliveries attended by skilled birth attendants. 903 WCBA received comprehensive RH services. screened 2,849 under 5 year children and 749 PLWs for malnutrition at service delivery sites among those screened <5 year children 68 (boys 31, girls 37) identified for SAM and 322 (boys 140, girls 182) identified for MAM cases and also, among total screened PLWs, 156 PLWs were identified for MAM cases and linked to TFU and TSFP programs at MHNT service delivery sites of E/H zone. MHNT were provided psychosocial supports for mental ill clients, a total of 100 mental ill clients were treated and psychosocially supports and referrers to nearby health facilities.
GOAL’s MHNT is active in 3 woredas of Deratole, Gelatti and BOH. 1,962 adults received consultations, including 180 children. 851 female and 367 male adults received health education messages from the team.
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UNICEF carried out 50,149 medical consultations through mobile health and nutrition teams (MHNT): 19,483 in Afar Region and 30,666 in Somali Region. Of the new cases, 18,939 (38%) were children under 5, 18,961 (38%) were with women, and 12,249 (24%) were other consultations.
UNOPS deployed 61 health workers and 7 SUV in 15 prioritized hard to reach woredas in Somali region, IDP locations and CTC.
IOM provided primary healthcare services for IDPs and host communities in Gedeo, Guji and East Wollega zones. 9,065 people received medical consultations. 3287 children were screened for malnutrition. 1,203 women benefited from SRH services. 9,828 people received health education and promotion services.
Mercy Corps deployed MHNT for Tuliguled, Aware, Dig, Deghamedo, Gungado, East Imi and Berano woredas where they are providing medical consultation, child health and maternal health services, referral service, IYCF-E, OTP, TSFP and community mobilization at IDP sites and hard to reach areas. The mobile teams reached a total of 6,066 individuals (U5 children= 2,682 and adult =3,384), assisted 21 normal deliveries and provide referral service for 21 cases who needed better medical care and follow up. In addition, a total of 99 children were treated in outpatient therapeutic program and 13,702 (U5 children = 7078 and PLWs= 6624) admitted in TSFP and received nutritious food.
IRC reached 47,374 beneficiaries in all 9 woredas of which 12,809 were in East Wollega, 5,727 in West Wollega, 2,716 in Borena (Guchi), 11,143 in Gedeo, and 13,602 in Assosa, Oda Bildig with medical consultation through surge team support. Moreover, the IRC provided technical and logistic support to the HFs and woreda health offices of our operation in the month of September. For Addis Ababa cholera response support was provided to the PHEM office to reach all the sub cities through EOC’S work.
MSF Spain continues support for Gambela hospital in emergency room, maternity, operating theatre, neonatal and surgical wards. The migrants and returnees project at Bole International Airport provided medical consultations for 1,918 arrivals with 21 referrals to advanced medical care. 679 mental health consultations were also performed onsite with 174 admissions to MSF temporary counselling center. 10 patients were referred to a psychiatric hospital for management of severe mental health disorders. MSF deployed the Mission Emergency Response Team (MERT) to Dire Dawa to support the Chikungunya outbreak, including case management, community engagement and environmental control measures.
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Health Cluster 3W map
Plans for future response The Health Cluster through partners will implement essential life-saving health services for IDP, returnees and host communities in emergency locations. Conflict affected Kamashi, Dawa, Wellegas, Hararges, West Guji, Gedeo, and Borena/Moyale, will be prioritized. Response to on-going cholera, measles, chikungunya, and dengue outbreaks, as well as the early warning system will be strengthened. Surge support to the existing network of health facilities and outreach services will be preferred as much as possible, with mobile health and nutrition teams (MHNT) reserved for locations and populations of limited access.
Health Cluster meeting partners National SCI, IMC, MCMDO, IRC, SP, AAH, USAID, ECHO, UNICEF, IOM, UNFPA, UNOPS.
Contacts:
Dr. Wilbert Shihaji, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer,
[email protected], 0953853416. [email protected], 0945184987.
