HEALTH CLUSTER- Yemen · The Health Cluster participated in quarterly coordination meetings convened by OCHA with ... The integrated response was introduced and adopted into the CERF

ANNUAL REPORT 2017 HEALTH CLUSTER- Yemen

2 | P a g e ANNUAL REPORT 2017 | Health cluster- Yemen

THE HEALTH CLUSTER: LEADING THE RESPONSE TO RISING HEALTH NEEDS IN YEMEN The Health Cluster maintained a wide range of communication inside and outside Yemen.

Health Cluster used different means of communication to support, improve and promote

health in Yemen. Health Cluster directly communicated with 6 donors, 2 government

entities in Yemen, 28 INGOs, 120 NNGOs, 4 observers, 1 private body, 7 UN agencies and all

other clusters in Yemen.

Out of the 28 INGOs, only 20 were active in the Health Cluster and out of 120 NNGOs, only

34 were active in the Health Cluster in 2017.

When emergencies occur, coordination is paramount. No one organization can respond to a

health crisis alone, which is why the Health Cluster (HC) approach was empl oyed in Yemen

to ensure effective emergency coordination. WHO is the Cluster Lead Agency supporting the

national health authorities in Yemen, by coordinating the efforts of all health response

partners, which include international organizations (IGOs) , nongovernmental organizations

(NGOs), national authorities, affected communities, specialized agencies, academic and

training institutes, donor agencies and UN agencies.

IN 2017, HC PARTNERS HAD SUCCESSFULLY DELIVERED HEALTH SERVICES BENEFITTING 9.5 MILLION PEOPLE


Support a nation’s health system --TOGETHER

The HC exists to relieve suffering and save lives in humanitarian emergencies, while

advancing the well-being and dignity of affected populations. In Yemen, the health

authorities, supported by the HC was proud to coordinate the efforts of 20 International

Non-Governmental (INGOs), 34 National Non-Governmental (NNGOs) and 7 UN agencies,

who were involved in the implementation of critical health activities in-country.

These Health Cluster (HC) partners were represented in 237 districts within 22 governorate s

across Yemen. To ensure close and effective coordination of health activities across Yemen,

the HC established subnational cluster coordination systems in 5 hubs: Aden, Hudaydah,

Ibb, Sa’ada and San’a with dedicated subnational cluster coordinators.

By the end of December 2017, HC partners had successfully delivered health services

benefitting 9.5 million people. WHO in cooperation with national health authorities

reprioritized the HC response in the beginning of 2017, focusing on health systems

strengthening, ensuring the population's access to life-saving health services in the most

vulnerable districts.

In 2017, the number of health facilities operated/supported by HC partners across 22

governorates was 1,618. This included 229 district hospitals, 50 governorate hospitals, 522

health centres, 619 health units, 183 mobile teams and 15 specialized centres--comprising a


large volume of healthcare provision given that year. Health partners also provided the

support services to enable provision of health care in different health facilities, in the form

of medicines which reached 831,133 beneficiaries, fuel provision of 4,356,481 litres and

4,089,168 litres of water were provided.

More help needed to reach those in need

To help HC partners prioritize their interventions, WHO carried out an in-depth analysis to

determine, down to the district level, where needs were greatest. The evidenced-based

assessment looked at many of the different social determinants of health; such as exposure

to the conflict, health systems

capacity, nutrition status and the

availability of clean water and

sanitation services.

In 2017, the Health Cluster aimed

to reach 10.4 million people with

life-saving health services. WHO

is supporting our health partners

in this endeavor providing them

with technical guidance,

epidemiological data and medical

supplies. However, many of the Organization’s partners are constrained by a lack of funding .

The Health Cluster received only 35.3% of total funds requested under the Yemen

Humanitarian Response Plan for 2017.

ster maintained a wide range of communication inside and outside Yemen. Health Cluster

used different means of communication to support, improve and promote health in Yemen.

Health Cluster directly communicated with 6 donors, 2 government entities in Yemen, 28

INGOs, 120 NNGOs, 4 observers, 1 private body, 7 UN agencies and all other clusters in

Yemen.

Out of the 28 INGOs, only 20 were active in the Health Cluster and out of 120 NNGOs, only

34 were active in the Health Cluster in 2017.

IN 2017, THE HEALTH CLUSTER AIMED TO REACH 10.4 MILLION

PEOPLE WITH LIFE-SAVING HEALTH SERVICES


Table (1) Health Cluster members involved in implementation of health activities include:

34 NNGOs 20 INGOs 7 UN agencies

DEC NFDHR ACF UNFPA

ADO NLSD ADRA UNICEF

AGF RDP Direct Aid WHO

BCHR RNHAR EMPHNET UNHCR

BFD RRD HI IOM

CSSW Sajaia foundation IHH WFP

FCDF SAWT Human Appeal OCHA

FMF SDF IMC

HFRD SOUL IRY

HCR TFD INTERSOS

IRD TYF IRC

IYCY YDN Marie Stopes Int

KDH WHNO MdM

KFD YAD Mercy Corps

KRC YRCS PU-AMI

LFD YFCA QRCS

MOZN YWU Relief Int

SCI

VHI

WRG


Meetings

The Health Cluster conducted 24 meetings in total in 2017, and conducted 8 joint Health

and WASH Cluster meetings during the peak weeks of the cholera epidemic. The

subnational cluster coordination system was also established, with fi ve hubs located in-

country: Aden, Hudaydah, Ibb, Sa’ada and Sana’a. Each of the five hubs were assigned

dedicated subnational health cluster coordinators, who conducted monthly subnational

cluster.

meetings with partners and the local health officials, as well as quarterly coordination

meetings in different governorates in Aden, Lahj, Hajjah and Sana’a governorates.

Coordination and strategy are key to successful health response operations, so 11 Strategic

Advisory Group (SAG) Meetings were held to discuss key issues as they related to health

response. For specialized issues, 6 technical working groups, including Information

management, assessment, reproductive health, mental health and psychosocial support and

contingency planning were formed to tackle these key issues.

The Health Cluster participated in quarterly coordination meetings convened by OCHA with

local authorities in various governorates to address several challenges and ensure better

coordination and access for humanitarian partners to reach beneficiaries.

THE HEALTH CLUSTER CONDUCTED 24 MEETINGS IN TOTAL IN 2017, AND CONDUCTED 8 JOINT HEALTH AND WASH

CLUSTER MEETINGS DURING THE PEAK WEEKS OF THE CHOLERA EPIDEMIC


Field Missions/Assessments

Monthly field missions were conducted by sub-national Health Cluster in all 5 Hubs. In Aden

governorate there were 4 field missions conducted to assess health services and health

situation of IDPs through inter-cluster mission. Whiel in Lahj Governorate, there were 2 field

missions conducted in two districts to assess the needs in the districts hospitals. Abyan

Governorate saw 3 field missions to assess health services provided by the districts

hospitals as well as the health situation of IDPs.

In Sana’a Two field missions were conducted to Sana’a Governorate and Amant Al -Asimah

and visited 2 health facilities in two districts. In Al-Hudaydah Governorate, a field mission to

assess the needs of Al Hudaydah renal dialysis center was conducted also with an

interagency mission to identify the health needs and the support needed to health facilities

in northern districts. Three field missions in two districts were also conducted to assess

health services provided and situation of cholera, with a field mission to assess the needs in

the Diphtheria isolation center in AL Thawra.

In Al-Mahweet Governorate, the cholera taskforce held regular meetings. For the Ibb and

Sa’ada hubs, activities have yet to be sent in.

Inter-Cluster: HCT and ICCM

The HC participated in the biweekly HCT and ICCM on regular basis, participated in

development of the integrated response for Famine Risk Reduction among four Clusters of

Health, WASH, Nutrition and food Security clusters. An introductory workshop for partners

from the four Clusters were conducted.

The integrated response was introduced and adopted into the CERF emergency allocation

for Yemen in late 2017. The Health Cluster also actively participated in the development of

the plans and technical guidance for overall health response.

Development of technical documents

The below documents were developed for HC partners for their use and dissemination:

● SOPs for operating health facilities: Developed for NGOs implementing

partners

● Cholera SOPs: Developed for partners setting-up different treatment centers

● SOPs for closing cholera treatment centers

● Health Assessment tools for different purposes such as assessment of different

types of health facilities, health assessment of communities and districts.

● Produced the Health Cluster Indicator Monitoring Tool for 2017.


● Developed and shared the harmonized incentive payment to health workers in

cholera treatment facilities.

Planning

The Health cluster, developed jointly with WASH cluster the Integrated Cholera Response

Plan. Input from protection and Nutrition cluster was incorporated. Two updates were

released of the plan at different phases of the cholera epidemic. Also the Humanitarian

Needs Overview (HNO) using a health severity index as part of the 2018 HRP was conducted

as well as the health section of the Yemeni Humanitarian Response Plan developed.

In terms of contingency planning--the cholera/AWD contingency plan was developed early

in 2017 and a contingency plan developed for possible escalation of conflict in Western

Coastal areas and Sa’ada and Sana’a Governorates in April 2017, which was updated in

October 2017.

Trainings

Below is a list of trainings conducted:

● Conducted TOT on cholera case management, setting up and operating

cholera treatment centers for 83 participants from 41 agencies.

● Conducted two consecutive trainings to qualify 5 SubNational Health Cluster

Coordinators each for 3 days held in San’a.

● Conducted a training needs assessment among health partners and identified

priority training topics. Among the priority training topics were proposal

writing, donor relations, Monitoring and Evaluation and how to conduct

needs assessment

● Communicated with OCHA to jointly conduct the priority trainings in early

2018.

CHOLERA CASE MANAGEMENT IN A DTC OPERATED BY HEALTH CLUSTER PARTNERS.


Response

The Health Cluster led the inter-cluster response to cholera epidemic in Yemen through

working closely not only with WASH but also Logistics, Nutrition and Protection Clusters and

led the response to the escalated conflict in Western Coastal area in late 2017.

In September 2017, a workshop was conducted wherein the implementation of the Yemeni

Minimum Service Package (MSP) in health projects was adopted for implementation by

health partners. Health Cluster partners provided life-saving health services to Yemeni

population in need through operating and supporting 1,618 health facilities of different

categories. The Health Cluster took the lead in coordinating the Diphtheria response with

health partners where training was conducted and health messages were harmonized. Also,

produced were seven weekly joint SitReps with WASH during the course of cholera

epidemic and the HC contributed to 12 issues of the SitRep Emergency Operation Center on

cholera and diphtheria.

Table (2) Distribution of different types of health facilities operated/supported by health

partners by Governorate in 2017

Governorate District

Hospital

Governorate

Hospital

Health

Center

Health

Unit

Mobile

Team

Specialized

centers

Grand

Total

Abyan 16 2 12 3 10 43

Aden 5 5 26 10 4 1 51

Al Bayda 2 1 1 2 6

Al Dhale'e 5 2 30 16 11 64

Al Hudaydah 24 2 86 117 28 1 258

Al Jawf 3 6 16 10 35

Al Maharah 1 1

Al Mahwit 5 4 15 100 2 126

Amanat Al Asimah

13 10 32 2 3 8 68

Amran 8 31 50 9 98


Dhamar 13 6 29 35 8 91

Hadramaut 9 1 4 1 15

Hajjah 8 2 28 69 7 1 115

Ibb 10 2 20 16 4 1 53

Lahj 11 3 30 70 23 137

Marib 5 4 3 1 7 20

Raymah 1 1 1 1 6 1 11

Sa'ada 18 3 25 43 9 98

Sana'a 47 1 99 29 17 193

Shabwah 6 5 11

Socotra 1 1

Taizz 18 2 47 41 14 1 123

Grand Total 229 50 522 619 183 15 1618

Achievements in figures:

Health Cluster partners conducted more than 5 million consultations covering different

needs of beneficiaries.

Table (3) Number of consultations for different medical purposes provided in 2017

General consultation

Communicable diseases

Mental health

Antenatal care

Postnatal care

SAM manage

ment

Total consultati

ons

1,715,873 2,182,402 57,367 611,344 371,644 89,799 5,028,429

In relation to specific health interventions, Health Cluster partners conducted more than 1.9 million

medical interventions as indicated below:


Table (4) Number of beneficiaries received different types of medical interventions in 2017

Hospitalization

admissions

Trauma

case

Penta 3

vaccination Surgeries Physiotherapy

Normal

deliveri

es

CS

Total

interventio

ns

350,967 41,544 1,473,692 583 3,262 46,634 9,099 1,925,781

FIGURE 1 NUMBER OF BENEFICIARIES OF PREVENTIVE AND CURATIVE SERVICES PROVIDED BY HEALTH

CLUSTER PARTNERS DISAGGREGATED BY GENDER, YEMEN 2017

FIGURE 2 NUMBER OF BENEFICIARIES OF PREVENTIVE AND CURATIVE SERVICES PROVIDED BY HEALTH

CLUSTER PARTNERS DISAGGREGATED BY AGE, YEMEN 2017


● Support services to health care provision

Given the fact that health system in Yemen is seriously compromised, health partners

provided the following support services to enable provision of health care in different health

facilities.

Table (5) Support services provided to enable health services provision in different health

facilities in 2017

Medicines (beneficiaries)

Fuel

(liters)

Water

(liters)

1,183,183 4,356,481 4,089,168

Table (6) Training and community awareness provided to enable health services provision in different health facilities in 2017

Trained doctors

Trained nurses

Trained Midwives

Trained

Rapid Response

Teams

Trained

community health

workers

Total health staff trained

Beneficiaries of community

awareness

3,057 892 4,022 3,287 7,265 18,523 1,295,233

FIGURE 3 DISTRIBUTION OF TRAINED HEALTH STAFF BENEFITED FROM DIFFERENT TRAININGS

CONDUCTED BY HEALTH CLUSTER PARTNERS BY CADRE, YEMEN 2017


[PE

RCENTAGE]

[PE

RCENTAGE]

Funding status of Health Cluster in 2017

Funded

Funds

The Health Cluster participated in four Humanitarian Pooled

Funding (HPF) cycles of which 2 were as standard allocations

worth US$120 million in addition to 2 as emergency

allocations.

In 2017, Health Cluster had appealed for US$430,366,785

out of which, the cluster received US$ 153,234,718.

There was an addition fund of US$ 97 million received that

was not reported though the Financial Tracking Sservice.

This would raise the level of funding of health cluster to 58%

in 2017.

Focus for 2018

In 2018, the operationalization and implementation of the Minimum Service Package (MSP)

which is a suite of essential life-saving health services designed specifically to meet all acute

health needs and support the national health system in the middle of this ongoing conflict is

the focus, as part of health systems strengthening in Yemen through the following support

activities:

● Setting up of a functional referral system with SOPs

● Establishment of minimum quality standards of humanitarian health interventi ons,

● Ensuring an Indicators-based Reporting mechanism

● Capacity building for members - implement the trainings as assessed and prioritized

Currently, 16.4 million Yemenis desperately require assistance to access essential

healthcare. The gravity and magnitude of the humanitarian crisis in Yemen requires a

practical and realistic lifeline to save and potentially recalibrate what is left of the country’s

health system. This lifeline, known as the Minimum Service Package (MSP), is a suite of

services or the mechanism with which critical health services can be delivered to people in

need, amidst the backdrop of an ongoing war. The MSP meets acute health needs while

providing a sustainable solution, very much from a developmental perspective, that includes

hospitals and health clinics; community outreach; laboratories; referral; with the right

health workers, supplies and medicines where they are needed and when they are needed.

The unique context in which this crisis is unfolding requires an innovative and transitional

approach that provides accessible, cost-effective and tailored health interventions to people

in need. Staffed by committed and courageous health workers, the remnants of this system

provide a foundation from which to rebuild.


These priority health interventions fall within 8 major areas and are to be implemented

within the country’s District Health System to ensure maximum impact. The crucial

components of these health interventions are:

- General services and trauma care.

- Reproductive, Maternal and Newborn Health.

- Childcare at all levels.

- Mental health and psychosocial support.

- Nutrition.

- Non-communicable diseases.

- Communicable diseases.

This enormous but essential undertaking demands an overarching strategy to sequence

initiatives from over the next two years, partnerships with health facilities in local districts,

as well as with national and international health partners.

This is the “lifeline” needed by the people of Yemen to ensure accessible and targeted

health service delivery amidst the volatile backdrop of civil war.

The roll-out of MSP over the course of 2018, through strategic partnerships with district

health offices (DHOs) and non-governmental organizations (NGOs) is an essential endeavor.

These partnerships allowed for the adaptation and expansion of the hospitals support to

primary levels. With sufficient resources, this work will then be expanded over 2019, with

the goal of stabilizing the national health system.

Challenges

The ever-evolving humanitarian crisis in Yemen will always have its challenges. Currently

these are the critical challenges faced by the Health Cluster:

● Functional health facilities: Limited functional health facilities remains the key

challenges for the Health Cluster and partners,

● Deteriorating security situation: The security deterioration in some Governorates is

considered the most barrier to access most of the health facilities and populations in

need.

● Unpaid HCW salaries: Disruption of health care workers’ (HCWs) salaries means that

health services cannot be made available in all areas of the country whilst health of

the population is threatened by outbreaks of communicable diseases.

● Restriction of movement for humanitarian goods and personnel: There are

impediments to the importation and delivery of medicines and medical supplies, as

well as the restriction of movements applied to humanitarian aid workers. The

country is experiencing a shortage of medicines and medical supplies necessary for

the health services, vaccination and outbreak response.

Documents

HEALTH CLUSTER- Yemen · The Health Cluster participated in quarterly coordination meetings convened by OCHA with ... The integrated response was introduced and adopted into the CERF