Ethiopia Emergency type: Multiple Events Reporting period: 1-30 April 2020

5.9 MILLION IN NEED

1.6 M IDP TARGETED

1.6 M HOST TARGETED

158 WOREDAS

HIGHLIGHTS HEALTH SECTOR

• As of 22 May, 398 confirmed cases and 5 deaths of COVID-19 have been reported in Ethiopia, 84,183 cases and 2,739 deaths reported in 45 African countries.

• Cholera outbreaks continue in three regions of Somali, SNNP and Oromia. The woredas reporting most cases in the last three weeks include Dolo Ado, Desenach, North Ari, and Wonago.

• The NDRMC has reported heavy rains and flooding in Somali, Afar, Oromia, SNNP, Harari, Dire Dawa. Already 470,164 people are affected, and 301,284 diplaced.

18

HEALTH CLUSTER IMPLEMENTING PARTNERS

MEDICINES DELIVERED TO HEALTH FACILITIES/PARTNERS

449

ASSORTED MEDICAL AND PPE KITS

HEALTH CLUSTER ACTIVITIES

132,219 OPD CONSULTATIONS

VACCINATION

931 VACCINATED AGAINST MEASLES

EWARS

5 CONFIRMED COVID-19, POLIO, YELLOW FEVER, CHOLERA, MEASLES OUTBREAKS

FUNDING $US

95 M REQUESTED

1.3 M 93.7 M

1.4% FUNDED

GAP

Health Education on COVID-19 and other diseases, Warder woreda. Photo: OWDA.

HEALTH CLUSTER BULLETIN #15 April 2020

Situation update

Cholera outbreaks continue in three regions of Somali, SNNP and Oromia. The woreda reporting cases in the last three weeks include Dolo Ado, Desenach, North Ari, Wonago, Abaya, Alle, Shashemene, Uba Debretsehay, and others. The epidemiological curve for total caseloads is comparable to last year. Some of the partners supporting government response include SCI, IRC, MCMDO, IOM, WHO and UNICEF.

Transmission of Guinea worm is ongoing in Duli Village, Gog woreda, Gambela region. Ethiopia reported 7 human cases of the disease in April. Active surveillance, cleaning of ponds, distribution of water filters, health education and case management are ongoing.

Measles outbreaks continued across the country with Oromia region affected most. Some of the woredas with active transmission include Ancaar, Gumbi Bordode, Tullo, Chiro kuria, Mieso, Koricha, Abay Chomen, Lemu Bilbilo, Odo Shakiso, Shashemene town, Sokoru. Partners supporting response include IMC, ACF, GOAL, MCMDO, USAID Transform project.

As of 22 May, the country has reported 398 confirmed cases of COVID-19. Response continues through the national and subnational PHEOC, with support from partners in different forms. At the time of writing, there were 2.5M confirmed cases and 311, 847 deaths globally, including 84,183 cases and 2,739 deaths in 54 African countries.

Useful sites for information include: Health Cluster on Humanitarian Reponse: https://www.humanitarianresponse.info/en/operations/ethiopia/health EPHI: https://www.ephi.gov.et/index.php/public-health-emergency/novel-corona-virus-update WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 WHO: https://www.afro.who.int/health-topics/coronavirus-covid-19 JHU: https://coronavirus.jhu.edu/map.html

The NDRMC has reported heavy rains and flooding in Somali, Afar, Oromia, SNNP, Harari, Dire Dawa. Already 470,164 people are affected, and 301,284 diplaced. Ongoing multisectoral response includes health interventions by partners like SCI, IOM and GOAL, guided by the recently completed response plan of $30.7M.

Public Health risks, priorities, needs and gaps

Health risks • Following WHO’s declaration of COVID-19 outbreak as a pandemic, Ethiopia was categorized as very high risk

due to its position as an air travel hub, and the country now has community transmission.

• 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.

• 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.

• Food insecurity and malnutrition, resulting from erratic rains and drought in some locations, which contribute

to higher vulnerability of children and other people to infectious diseases and other disease conditions.

Priorities • COVID-19 outbreak readiness and response.

• 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 facilities, and address delays in emergency funding.

• Health facilities in many return locations were fully or partially destroyed during the conflict. There is need to

speedily rehabilitate, re-staff and restock these facilities.

Health Cluster Action

Strategy and response processes The country activated the Health sector’s scenario 3 COVID-19 EPRP once the outbreak spread beyond two regions. Objectives of the response include minimizing caseloads, deaths and the impact of the outbreak on the health system. In line with this plan, a multisectoral national plan was compiled by the ECC. The Health Cluster contributed to the monthly updated version of the COVID-19 GHRP, making considerations of the scenario 3 EPRP. Revision of Ethiopia 2020 HRP is near completion, incorporating COVID-19 response.

Response to cholera and measles outbreaks continues to be structured around case management, social mobilization and risk communication, logistics and supplies, surveillance and laboratory investigation, WaSH and the use of OCV. The EPHI and RHB lead the interventions, with Health Cluster partners supporting as and when assigned by the authorities. Surge support to functional health facilities remained the main modality of response for Health Cluster partners, with some also able to offer technical support to the local health authorities. Mobile teams remain an option whenever necessary.

2020 HRP dashboard

Indicators Jan Feb Mar Apr Total

1 Number of health facilities including COVID-19 isolation facilities and mobile teams supported

35 88 62 305 305

2 Number of OPD consultations 43,721 185,290 112,982 132,219 474,212

3 Number of normal deliveries attended by skilled birth attendants

46 1,403 834 840 3,123

4 Number of women in child bearing age receiving modern contraceptives

1,779 8,033 17,709 3,037 30,558

5 Number of community members receiving health IEC messages including COVID-19

50,442 99,428 93,042 195,325 438,237

6 Number of assorted emergency medical kits and COVID-19 PPE kits distributed in crises affected locations

217 90 244 449 1,000

7 Number of cases with injuries and disabilities treated and referred for further care

63 216 298 54 631

8 Number of cases receiving mental health and psychosocial support services including COVID-19

- 56 97 2,098 2,251

9 Number of survivors of SGBV receiving clinical care for rape - 4 9 8 21

10 Number of epidemic prone disease alerts including COVID-19 verified and responded to within 48 hours

15 41 612 571 1,239

11 Number of children 6 months to 15 years receiving emergency measles vaccination

700 400,469 5,874 931 407,974

Health Cluster coordination

In April, the Health Cluster held weekly virtual meetings to regularly review partners’ contribution to the national COVID-19 response. It was noted that all partners were involved in the response in all their project locations. The monthly partners meeting was combined with the weekly meeting on April 15, 2020. Several partners have joined the cluster since the COVID-19 outbreak was declared. The cluster SAG met virtually on April 10 and 16, 2020 to discuss EHF first standard allocation. It agreed to invite partners to present proposals based on the guidance provided by EHF and the cluster’s priorities identified through the HWN TWG advocacy paper.

The MHPSS TWG held meetings and discussed on coordination of service provision for people in COVID-19 quarantine centers and isolation/treatment centers. It is finalizing a project proposal to establish a hotline that would provide services to the general population, patients, health workers and people in quarantine facilities.

The SRH TWG held two meetings to discuss MCH services in COVID-19 quarantine and treatment centers and ensuring continuity of essential services in all health facilities. In the context of the pandemic, its focus will mainly be on continuity of essential SRH services.

Communicable diseases control and surveillance Number of cases reported during WHO Epi week 14-18, 2020, Ethiopia

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A Ababa 180 2 21 0 106 0 1 0 27 0 0 0 83 0 11 1623 0

Afar 8,144 1 13 0 975 5 0 0 156 2 1 0 0 0 1 0 0

Amhara 19,956 0 19 0 2,065 5 7 0 885 6 0 0 70 3 29 6,946 0

B Gumuz 6,849 0 6 0 65 0 1 0 11 0 0 0 28 0 2 166 0

Dire Dawa 181 0 0 0 83 0 0 0 5 0 0 0 0 0 0 62 0

Gambella 7,665 0 5 0 155 0 0 0 0 0 0 0 1 0 0 4 0

Harari 70 0 14 0 48 0 0 0 19 0 0 0 0 0 4 51 0

Oromia 9,073 3 224 0 8,403 8 0 0 2,073 14 11 1 12 1 52 3,833 0

SNNPR 18,721 0 20 0 2,112 8 0 0 19 0 0 1 10 0 4 1,512 0

Somali 5,020 8 56 0 7,009 3 5 0 6 0 0 6 0 0 15 10 0

Tigray 7,489 2 24 1 694 0 0 0 70 1 0 0 246 1 10 1,651 0

Total 83,348 16 402 1 21,715 29 14 0 3,271 23 12 8 450 5 128 15,858 0

EPHI reported that on each epi week from 14 to 18, most regions met the required 80% IDSR reporting completeness and timeliness.

Training of health workers

MCMDO provided trained 115 health extension worker on the job.

IOM supported the West Guji ZHO to conduct COVID-19 case management training for 54 health workers.

Provision of essential drugs and supplies

WHO donated 324 emergency health kits to partners and ZHO in all regions.

UNOPS distributed 26 Mt of humanitarian supplies in Somali Region. These included PPE and hygiene supplies.

Support to health service delivery

IMC provided lifesaving emergency health services and outbreak response for IDP and returnees in East and West Hararghe zones. The services included OPD consultations for adults (2,410) and CU5 (1,487) . 382 pregnant women attended normal deliveries by skilled birth attendants. Also 1,890 WCBA received comprehensive RH services including modern contraceptives. 131 cases were referred to higher level services and 187 clients received mental health and psychosocial supports. 2,490 under five children and 1,356 PLWs were screened for malnutrition. health education health promotion sessions were conducted for a total of 2,508 clients and caretakers.

IOM continued providing essential services in East Wollega, West Guji and Gedeo. IOM conducted 4,489 medical consultations, screened 1,451 children below 5 years for malnutrition and reached 6,802 individuals with key health messages at HPs. 736 women received basic SRH services. 220,325 individuals were reached with COVID 19 key messaging in the 3 zones using a van. IOM donated 250 blankets and 1 infrared thermometer to Bule Hora university QC. In East Wollega, IOM distributed 1,850 posters with COVID 19 key messages and demonstrated handwashing to 600 individuals. IOM seconded 19 staff in Addis Ababa to support the 5 quarantine centers.

MSF-Spain continues to support Gambela hospital to strengthen the quality of secondary health care for refugees and host community. 1,406 patients received emergency care; 170 patients were admitted to surgical ward; 105 life-saving surgical interventions were performed. 249 individuals received mental health consultations. 176 units of blood were collected, screened and availed for transfusion. 5 group sessions of psycho-education with 211 participants were conducted in April. COVID-19 RCCE activities were started including messages on hand washing and explanations on mandatory quarantine; 329 persons were reached withthese interventions.

GOAL in Yirgachefe, Medawolabu, Dolomena, reached a total medical consultation of 567; from the total cases 425 are adults and 142 are under five children. Health education is provided for 14,841 individuals on a key health messages out which 7,066 are male and 7,775 are females. In Somali (Galadi, Daratole, Bokh woredas), a total medical consultation of 2,271 clients got service; from the total cases 1,649 are adults and 622 under five children. Health education is provided for 7,614 individuals on a key health messages out which 3,204 are male and 4,410 are females.

IRC established hand washing facilities at woreda offices, HCs, marketplaces, shops and restaurants in Haro limmu district, East Wollega zone. Health education with hand washing demonstration were conducted at health facility and community level reaching a total of 1,093 individulas in the woreda. In Oda Bildgilu district, Assosa zone, hand washing materials (soap and water tank) were donated to all health facilities (1 HC and 6 HP) and public hand washing points. A total of 3,274 residents of the woreda were reached with awareness creation messages.

Mercy Corps had three MHNT in three woredas of Somali namely; Tuliguled, East Imey and Bercano which will continue until July 31, 2020. MHNTs provided medical consultation for total of 1,822 beneficiaries of whom 153 were under five years and 570 were between 5 to 18 years while 967 were adults above the age of 18 years and 129 were elderly people and 3 disabled people. A total of 159 children were given measles vaccination. In addition, MC’s MHNT identified and treated 56 SAM children without medical complications at outreach sites.

OWDA’s MHNTs provided free medical health services to venerable communities, reached a total of 4,814 beneficiaries in Danod and Daratole district of Doolo zone. OWDA conducted social mobilization and awareness raising to the communities for the prevention and control of COVID19 Pandemic. OWDA surveillance teams conducted case search in house to house visit in the target of disease surveillance like COVID-19, AFP, Measles, NNT, Rabies, Anthrax and Brucellosis, and detected 10 measles, one AFP cases .

SCI health humanitarian projects are located in Somali, Oromia, and SNNP regions. The health responses are for IDPs, returnees and drought affected communities. through mobile health and nutrition teams, reached 24,203 beneficiaries through compressive curative, preventive and promotive primary health care services and saved many lives of victimized population groups. In the month there were outbreaks of cholera and flooding in Somali where our MHNTs have engaged in response with other partners in communicating the risk, managing cases and providing NFIs.

UNICEF conducted a total of 38,495 new medical consultations in Afar (19,855) and in Somali (18,640) regions through UNICEF supported mobile health and nutrition(MHNT) teams. Of which 44% of them were under five children and 31% were women.

WHO leads the one-UN incident management team meeting held three times a week. WHO co-led the development of the national COVID-19 response plan, the UN contingency plan and business continuity plan. WHO has developed a regional support strategy to work within regional EOCs to provide much-needed support in case investigation, contact tracing, active case search and epi-surveillance data management and capacity building across all pillars. Over 10,000 health workers and staff from other sectors such as airline crew, military, media were trained. WHO is providing technical guidance on setting up isolation/treatment centres, and has donated 2000 sets of PPEs and 200 handwashing stations.

USAID Transform’s Primary Health Care in SNNPR, Multiple woredas, HWs are deployed to CTCs, sanitary materials are purchased, and support is ongoing. Yellow Fever vaccination campaign was also supported. In Amhara, Waghimra zone, integrated case-management orientation given to 93 HWs and 420 key actors are sensitized. Routine program strengthened with periodic outreach service for hard-to-reach areas. In Tigray, Asgede Tsimbla woreda; Case-management training, mop-up campaign& active surveillances supported and routine EPI is being strengthened. COVID-19- in addition to technical supports, a total of 941,694 USD is mobilized is filling critical response gaps in the four agrarian regions.

MCMDO reached a total of 35,036 beneficiaries through lifesaving primary health care and nutritional service. A total of 12,318 beneficiaries got consultation and treatment service of which 2284 under-five children. In total 1,346 WCBA received modern contraceptive of which 485 long acting and 766 and 368 pregnant women received ANC1 & 4 services respectively also 18 deliveries were attended by the MHNTs Midwiferies Nurses. Health education service provided to 13,080 beneficiaries that targets COVID-19 and other communicable diseases. Logistic support was provided for zonal and woreda health offices (nutrition and other medical supplies) and screening campaign.

AAH provided logistic support to Gimbi and Mana Sibu woredas of West Wollega and Sedal and Agalometi Woredas of Kamashi Zones for transportation of essential materials and supportive supervision for COVID-19. AAH procured and donated different materials (mainly WASH NFI) for 60 TFP sites as part of COVID19 prevention to Itang Woreda Health office of Gamabella Region. It distributed more than 30,000 bars of soap and sanitizers to beneficiaries who cannot afford to buy soap and hand sanitizer in all ACF operational areas in coordination with woreda and zonal EOC.

Health Cluster 3W map

Plans for future response The Health Cluster is working with the PHEOC to support response to COVID-19 nationally and in all regions. Through its partners the cluster will continue implementing essential life-saving health services for IDP, returnees and host communities in emergency locations. Conflict affected zones with new IDP and returnees will be prioritized, while the needs of chronic IDP will be assessed from time to time. Response to on-going cholera and measles outbreaks, flooding, 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 UNFPA, IOM, DFID, WHO, UNHCR, GOAL, UNAIDS, FIDO, UNESCO, UNRCO, WVE, ECHO, MCMDO, UNICEF, ACF, USAID, GHSC-PSM, MSF-E; OCHA, CUAMM, GNE, UNDP, UN Women, Mercy Corps, Child Fund, Plan International,

Nutrition International.

Contacts:

Dr. Wilbert Shihaji, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer,

Shihajiw@who.int, 0953853416. bbayou@immap.org, 0945184987.