SUB NATIONAL HEALTH CLUSTER ONLINE MEETING MINUTES Yemen, Al Hudaydah Hub 30 September 2020

Venue: Virtual Online Sub National Health Cluster Meetings, Using Zoom application.

Date: 30, September 2020.

Facilitator: Dr. Abdullah Zohairy; The Sub-National Health Cluster Coordinator of Al Hudaydah Hub, (SNHCC). Meeting Agenda: 1. Welcome & Introduction & Review and Follow Up the Previous Action Points. 2. Health Cluster Matters. 3. Outbreaks Status; Response & Needs & Gaps. 4. GHOs Health Needs 5. Partner’s Updates & Challenges. 6. RH Working Group Updates. Previous Meeting Action Points

No Action Points Status 1 Prioritization of Health activities: Health Cluster to share a file with the cluster objectives with partners for Done their inputs.

2 UNICEF or WHO to give their feedback for the possibility to cover the gap of the 3 DTCs that were supported Pending by SCI.

3 UNCIFE to give their feedback for the payment of incentive for health workers which hasn’t paid since the Pending beginning of 2020.

4 Partners to continue their support to the primary healthcare services through MSP and other activities. Pending

5 Health partners are requested to report any impact continuously to the Health Cluster. Pending Meeting Minutes: Meeting Agenda Discussion Action Points

Introduction of • Sub-National Health Cluster Coordinator (SNHCC), Dr. Abdullah Zohairy • Virtual Online Sub-National Health Partners & Review of welcomed all partners to this first virtual online meeting using teleconference the previous action Cluster Meetings will be held on Points: technology (Zoom). biweekly basis. • An introduction was done with partners introducing them self’s as well as their

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position within their organization though SMS in the chat Box of Zoom. • The previous action points of the Last SNHC Meeting have been reviewed and endorsed. The Modality of the Due to COVID-19 current situation and not allowing • SNHCC to share Zoom guide with HC Upcoming Online any gathering and in light of the increased need for Partners who need to install Zoom SNHC Meetings: online collaboration; application in their laptops and • The Health Cluster will organize and conduct a virtual online meetings using activate a Zoom account to Zoom. participate in the upcoming online

SNHC Meetings.

• SNHC Partners have to activate a

Zoom account allowing SNHCC to

invite HC Partners to online meetings

and schedule one on a desired date

and time, and share the link in

advance.

Health Cluster  Registration: Information Management: - Active Health Cluster Members: To join the Yemen Health Cluster list: https://forms.gle/cjBRNhjTgGRHusgy6

- Non Health Cluster Members!!: To meet with Yemen Health Cluster Membership Criteria.

 Regular Reporting – DHIS (District Health Information System):

- Monitoring & Updating:

- Matrix prepared.

- Non-reporting partners after 60 days will be withdrawn from Health Cluster.

 IM Products:

- Availability through dedicated websites: Health Cluster & OCHA website: http://yemenhc.org/ https://www.humanitarianresponse.info/

Health Cluster  The Health Cluster team emphasized on the health cluster membership Membership requirements and criteria that should be met by all new NGOs who are requesting to join the cluster.

 Noting that joining the cluster meeting doesn’t mean by any way that the NGO has been granted the membership. This is because we need to make sure that partners have good capacity and capable to save people lives.

 Encouraging all Local NGOs who are attending the SNHC Meetings to focus their efforts to establish partnerships with UN agencies and international NGOs to start implementing health projects and activities, and that this partnership is the best way through which they can build and develop their capabilities in the way of obtaining the Health Cluster Membership or the OCHA Eligibility. Health Cluster • Health Cluster will share the drafted Matters 1: Prioritization of Health Activities: Cluster Objectives and programs  With many thanks to those partners who have shared their inputs and feedback sequencing with partners for final

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on the cluster objectives and programs, Health Cluster will collate all those comments.

feedbacks received. The Health Cluster:  The Health Cluster continue to consult the Health Cluster SAG, health partners and cluster team to finalize the requested steps from the cluster side on prioritizing the health activities and program.

 As per the Consultation with the SAG, the Health Cluster team has been working on twofold directions: 1) Revise the PIN and severity analysis Cluster will focus on priority districts fall under 4, 5 and 6 severity scores taking into account the deadline. This will be done by IM.

2) Once PIN and priority is finalized, the capacity analysis will be done that will include access, partner presence and 4W -Drafting the cluster objectives and programs sequencing.

 As a result of those consultations, the Health Cluster team presented the drafted cluster objective that align with the HRP SO 1 under the outbreak and infectious diseases. Also, the cluster team suggested to add one cluster objective under the SO 3 for the protection and specialized care that should cover the need for specialized care of chronic diseases.

 The programs sequencing was also drafted for final check with SAG, CLA and partners. There was a suggestion by WHO to add the utilization data to the severity analysis.

 The paper of draft cluster objectives and programs grouping will be shared with all partners along with the minute for any final comments. Health Cluster • Health Cluster will send an email to

Matters 2: Data & Information Sharing: all partners to indicate the MoPHP  Impact of MoPHP directives to stop sharing information and data with partners at health facilities: request and share the feedback with

 Regarding the last MoPHP (North) circular that instructing GHOs and facilities the MoPHP. not to share the data, information and statistics with INGOs and NNGOs;

1) Health Cluster Team at the national level highlighted and discussed this • Health Cluster will share the list of

issue during the last Health Cluster Meeting. indicators that all partners are 2) The Health Cluster has initiated an immediate discussion with MoPHP collecting data to meet those seniors to understand the reason behind this and how to work together on indicators, for this it is recommended this. to have a consultative meeting with 3) Where the Health Cluster focal point mentioned that this should be centralized and MoPHP should have all information and data and then to partners and SAG to agree on the share with partners. indicators. 4) Health Cluster Team mentioned that during the discussion with deputy • All the information products that IM minister, it was highlighted the importance of having this regular updates from partners to the cluster and also the donors. team of Health Cluster are prepared 5) As partners are using all relevant MoPHP approved forms and registries in will be shared with MoPHP. the health facilities and they only extract summaries from those registries

for the reporting purposes while all forms and registries are kept at health

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facility.

6) This is also will be addressed by the CLA representative in the coming

meetings with the Minister of MoPHP.

The SNHCC as follow up with the last circular that shared by

MoPHP instructing all GHOs and HFs not to share any data with health partners, clarified the following;

 Many series of meetings and discussions that has been initiated by the CLA with the Minister of health.

 The Health partners were briefed on the latest updates on this issue based on

the fruitful meeting conducted last Tuesday 29th September 2020 with DG of IM and Research department at MoPHP and DG of technical cooperation

department at MoPHP.

 With this, the DG of IM and Research has kindly joined the meeting and highlighted on the importance of coordination with the MoPHP in terms of

collecting data from HFs and show support of MoPHP.

 As the aim of this circular was to ensure all collected data by partners are unified and collected to serve the humanitarian purposes. Therefore, for this

the MOH is requesting health partners to indicate the following;

1) What type of tools that are being used for the data collection at HFS level?

2) When those tools started to be used, and description of the collected data?

3) Ensure that all partners apply the same information tools to avoid multiple parallel systems and fragmentation of information, and allow aggregation and joint analysis of data across different areas of operations, ensuring that the process is coordinated under the Ministry of Health, or by the Health Cluster.

4) Agree on and use the same sets of geographical and administrative denominators and demographic estimations, leading towards harmonized information that is easier to integrate.

5) Include the use of national or common standardized data collection and management systems in a memorandum of understanding between agencies, donors and health authorities.

6) Agree on health facility reporting tools, information technology platforms for uploading data, their interoperability, and processes for reporting. The SNHCC opened the floor for the discussion on this important challenge: Several participants offered reflections, insights and advice and many different ideas have been suggested and put forward in this regard, below is a short overview of the speaker’s statements as the following:

Dr Baleigh Comment:  Dr Baleigh has supported the idea of sharing the data centrally through the Ministry of Health, but on the other hand, he indicated that, at the present time, they are facing many difficulties when compiling monthly reports at the

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health facility level.

 From his own experience, he stated that they were intending to conduct a training session for health workers on the collection, analysis and use of relevant public health data.

 He expressed concern that the process of obtaining data centrally through the Ministry of Health may take more than two or three weeks, which may negatively affect the flow of the information sharing with donors who require partners to submit monthly reports. Hajjah GHO DG Dr Ibrahim Al-Ashwal Comments:  Dr Ibrahim supports the idea of sharing the data centrally through the Ministry of Health to avoid sharing contradictory or incorrect information, especially if we take into account the insufficient knowledge and skills of health personnel to manage data and deal with it in a correct technical manner, as many health workers did not receive sufficient training sessions on how to collect, manage and deal with data in a correct approach before sharing it, which may lead to sharing incorrect information that may result in making wrong decisions and disproportionate humanitarian interventions that do not correspond to health needs. Therefore, MoPHP and GHOs want to unify one platform and a unified channel for sharing health information and data.

 Health Cluster Coordinator Abdullah raised a question regarding the partners they have concerns about the data delays and what are the alternative proposals to prevent this delay.

 Dr Ibrahim emphasized that the data is currently shared smoothly on monthly basis through GHOs with the partners and partners aren’t receiving the data through the health facilities, most of them receiving the data through GHOs at the governorate level.

 Hajjah GHO DG suggested that Health Cluster Partners should support to build and strengthen the Health management information systems & data systems at the health facilities in all the governorates on key quality of care indicators, leading towards harmonized information and ensure that it is then submitted in a correct and unified manner to the Ministry and then partners could get it from the Ministry on monthly basis.

 Hajjah GHO DG stressed that Hajjah GHO has IM officers who review, check and examine the data and information. Al Mahweet GHO DG Dr Ameen Hubiash Comments:  Dr Amin reported that the data was shared smoothly with partners at the health facility level, but because of the he last circular that shared by MoPHP instructing all GHOs and HFs not to share any data with health partners, we followed the instructions.

 Dr. Amin suggested a number of ideas as alternative solutions;

 Adopting three persons in each health project as information officers and supporting them with monthly incentives, one at the level of the health facility, one at the level of GHO, and one at the level of the Ministry of Health, Therefore, the Ministry will be aware of the data that is uploaded from the HFS and GHOs, and data is reviewed and analyzed by passing from the Health Office, then the Ministry, then submitted to the Organizations who can share it

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with donors.

 Allocating a budget in each health project for the information sharing aspect, in this way, the information system will be strengthened at all levels after three or four health projects.

- The SNHCC commented on him that the CLA WHO is already supporting the eDEWS system at the different levels.

- Dr Ameen replied “These support is ongoing by WHO on monthly basis and they have already supported by tools and phones also these phones have software system or report directly and immediately and these ONLY for surveillance system.

- The SNHCC commented on him “can’t we use them for other health activities, otherwise surveillance”.

- Dr. Ameen replied “ we can’t because each health project has its separate health activities and 3 person will be good idea for any health project to ensure that all the health information are shared on regular basis on focal point . Fuel Shortage • Health partners are requested to Impact: Follow Up with Fuel Shortage Impact report any impact continuously to  As this has been a serious challenges and taking the attention of HCT and ICCM, The Health Cluster Team emphasize on the importance of capturing the the Health Cluster. impact of fuel crisis on provision of health services in health facilities that partners are supporting. • GHOs are requested to share with

the Health Cluster a list with the

 Based on the partners’ reports, as of 30th August 2020, responses were amount of fuel quantities that are received from 10 health partners supporting total of 367 health facilities in 69 needed per each Hospital. districts of 15 governorates;

- Of those HFs, impacts were reported from 197 health facilities (162 Primary • Health offices should promptly share Health Care Facilities and 35 Secondary Care Facilities). the Health Cluster with a list of the

most important health needs and  Health Cluster Team urged all partners to continue informing the Health gaps so that the Health Cluster and Cluster on any impact on health services provision resulting from the fuel crisis Health Cluster partners can try to as this should be a continuous process as long as the crisis remains. search for financial resources to Al Hudaydah GHOs Deputy Director Mr. Haitham commented on this issue as the following: respond and meet these needs  Many health facilities in Al Hudaydah governorate that are receiving fuel support from WHO on monthly basis are in a dire need for additional quantities of fuel, as the quantities that are distributed do not cover all the needs of these health facilities, and the Health Office receives continuous requests for additional quantities of fuel.

Hajjah GHO DG Dr Ibrahim Al-Ashwal commented in

this regard that the Hajjah GHO had launched a distress call regarding the

suspension of Al-Shaheed Yasser Wathab Hospital from providing its health services due to the severe shortage of fuel, as the hospital receives an amount of 4,000 liters of fuel as a monthly support from WHO while The actual fuel needs of the hospital is estimated at about 11,000 liters of fuel per month. Outbreaks Status & Given that we have not shared any data regarding the epidemiological situation of Gaps & Health Needs:

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the various epidemics, we will open the discussion to the GHOs DGs who are participating with us in the meeting to give us a brief overview of the most important epidemiological updates & Needs & challenges; Hajjah Epidemiological Updates - Dr Ibrahim (Hajjah GHO DG) reported that the epidemiological situation of Malaria and Dengue fever in Al Hudaydah Governorate and Hajjah is very critical.

- In August 2020, the case reached more than 133,000 cases. These numbers were taken from eDEWS system, and about 40 – 45 health facilities are not included in eDEWS system for that maybe the number cases are more than 133,000 cases.

- There is an acute shortage of malaria drugs and the amount of malaria drugs that arrived from Sana'a from the National Malaria Control Program does not cover the needs in the field, as the quantity that was agreed upon with the National Malaria Control Program to cover the need for a period of two months, unfortunately, did not cover at least one month.

- Many calls for help were directed due to these poor health conditions in the governorate and we presented and delivered our plans that summarize all our health needs to all organizations, chiefly the World Health Organization and UNICEF, whose representatives visited us more than once and handed them over the plans to combat this epidemic, including the most important needs such as providing medicines, awareness, and ways to remove the sources that cause the epidemic By getting rid of hotbeds, swamps, breeding sources, spray campaigns and mosquito nets.

- Many meetings were held with many organizations regarding malaria and dengue fever at the end of 2019, including the visit of Dr. Ahmed Al-Soofi (the representative of the World Health Organization in the Hodeidah office) to Hajjah, from whom we requested additional quantities of diesel, and unfortunately the quantities remained the same and the necessary rations were not raised according to the needs of each hospital.

- A list of medicneeds was presented to all organizations last year, but unfortunately we did not receive any response from any organization, and we are very concerned about the exacerbation of the epidemiological situation, especially with the start of the epidemic season of malaria and dengue fever in the absence of an effective response like last year.

- A decline in basic health service utilization was observed during the first quarter of 2020 particularly impacting the primary health care, despite the wide range of partners’ contributions and the long-standing efforts of the Yemen Health Cluster, some major programming gaps remain as many programs providing essential health services in health facilities have already ended by December 2020.

- On our part, we tried to find some solutions, as we formed local committees at the governorate level, at the district level and at the village level, but these committees cannot cover the needs, especially with regard to medicines, and we hope that organizations and partners will provide at least the minimum necessary Health Needs.

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- We do not underestimate the support provided by the organizations and health cluster partners, and we thank them all for what they have provided, but the support is much less than it was in 2019, and we hope that they will strengthen the health support provided, especially in these epidemic seasons.

- There are a number of health gaps in Hajjah governorate, the most important of which is that about 94 health facilities do not have any intervention either at the primary or secondary health care level or through the minimum health services package.

- Reproductive Health Services: Hajjah Governorate needs urgent support with basic and comprehensive obstetric emergency services, noting that the support provided by UNFPA in 2019 has significantly decreased during 2020, and there are more than 7 hospitals in urgent need of BEmONC OR CEmONC and more than 45 health centers that do not have BEmONC. UNICEF's interventions in Hajjah:

- UNICEF has supported 10 HFs in Hajjah governorate with emergency obstetric services,

- We would like to thank UNICEF for their kind significant support that facilitated access to health services in HFs that were difficult to reach through Mobile team and outreach.

- On the other hand, most of the activities that were supported by WHO and UNICEF have been stopped since April 2020 till now, such as; 1) The suspension of cholera incentives and Rapid Response Teams a month ago, 2) The suspension of incentives for health workers since the fourth quarter of 2019 and until now, certainly this will negatively impact the provision of health service. Hajjah Health Needs: For Cholera Outbreak: 1) Provision of cholera medicines and supplies according to the cholera standards. 2) Provision of Cholera Rapid Tests. 3) Providing cholera awareness posters, broachers for treatment policy.

For Malaria & Dengue Outbreaks: 1) Provision of intravenous fluids, supplies and IV Paracetamol, according to the dengue treatment guidelines. 2) Provision of DF Rapid Tests (NS1). 3) Provision of sufficient amount of malaria drugs according to the approved treatment protocols. 4) Provision of Malaria Rapid Tests. 5) Conducting the routine major indoor residual spraying campaigns. 6) Supporting the awareness activity. 7) Supporting the activity of eliminating mosquito breeding sources and filling swamps. Primary Health Care: 1) 94 Health Units require intervention with primary health care services.

2) MSP support in Rural Hospitals and Health Centers, Al Shahil Hospital, Al

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Shaghadirah Hospital, Mabyan Hospital, and Al-Shaheed Yasser Wathab Hospital in Khayran Al Muharraq district.

3) The suspension of some UNICEF-supported activities due to non-disbursement of employee incentives (such as outreaches, health points for IDPs, mobile clinics, and other activities).

4) Request from UNFPA to start the restoration of the mother and child hospital building in the Abs district, especially after awarding the tender to one of the contracting companies that submitted to the tender.

5) Increase the monthly amount of fuel provided to hospitals by WHO as needed; (Al-Shaheed Yasser Wathab Hospital in Khayran Al Muharraq, Mabyian Hospital and Abs General Hospital).

6) Request WHO to approval to support the two main COVID-19 Isolation Centers in Hajjah governorate with fuel (Abs center of Abs Hospital and Al Rahdi Center of the Republican Hospital Authority).

7) Supporting the ambulances with an amount of 3000 liters of diesel per month.

8) Begin to assess the needs of the general emergency departments in all hospitals in Hajjah Governorate to determine the needs of incentives, medicines, supplies and equipment to improve public emergency services in all hospitals and respond accordingly. Al Hudaydah GHO Health Needs: Al Hudaydah GHOs Deputy Director Mr. Haitham emphasized on the importance to respond to cover the following Health Needs & Gaps: 1) Increase the monthly amount of fuel provided to hospitals by WHO as needed. 2) Begin to assess the needs of the general emergency departments in all hospitals in Al Hudaydah Governorate to determine the needs of incentives, medicines, supplies and equipment to improve public emergency services in all hospitals and respond accordingly. 3) Strengthening the operating room in Al Hudaydah Health Office. For Cholera Outbreak: 1) Provision of cholera medicines and supplies according to the cholera standards. 2) Provision of Cholera Rapid Tests. 3) Providing cholera awareness posters, broachers for treatment policy. For Malaria & Dengue Outbreaks: 1) Provision of intravenous fluids, supplies and IV Paracetamol, according to the dengue treatment guidelines. 2) Provision of DF Rapid Tests (NS1). 3) Provision of sufficient amount of malaria drugs according to the approved treatment protocols. 4) Provision of Malaria Rapid Tests. 5) Conducting the routine major indoor residual spraying campaigns. 6) Supporting the awareness activity. 7) Supporting the activity of eliminating mosquito breeding sources and filling swamps.

Al Hudaydah GHO DG Statement & Comments

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During the meeting, the Director General of the Public Health and Population Office in Al Hudaydah Governorate, Dr. Khaled Al-Madani, raised many pressing health concerns and several important issues, which are summarized as follows: 1) Many health projects and activities that were supported by the Health Cluster Partners have been ended by the end of 2019, which led to the deterioration of health services in most health facilities, especially rural ones.

2) The deterioration of the infrastructure of many Rural Health Facilities due to the poor performance and the ineffective response of some Health Cluster Partners that do not focus on developing the infrastructure of the Health Facilities, as I was surprised during my visit to some health units in Zabid district that they lack the simplest operational means, such as electricity and fans, and despite this, I found health workers present in them eager to provide health services to patients who set the most wonderful examples of commitment dedication to work despite all the circumstances, challenges and lack of capabilities.

3) He asked Save the Children to speed up the delivery of the medicines that it promised to provide to the health facilities agreed upon with them.

4) He would like to take the opportunity to call on all humanitarian organizations working in the health sector to play their role and respond to all health needs in an efficient and urgent manner in order to preserve the lives of patients, given the specificity of the extra-ordinary situation of Al Hudaydah Governorate in terms of supporting the general emergency departments in inter-district, rural and central hospitals, as well as in terms of controlling epidemics. especially prevalent malaria and dengue fever. Health Needs in the Front Line Districts in Al

Hudaydah Governorate

At Tuhaytah District:

 Support Al-Suwaiq HC and Al-Maghras HC with the following: 1) Support the general emergency services. 2) Provide X-ray machine / general blood analysis device / chemistry apparatus / laboratory Reagents incentive for staff and medicines. 3) Support theses 2 HCs with BEmONC package services as there is no delivery room in the center, noting that the nearest hospital is Zabid Inter-District Hospital which in turn suffers from severe shortage. Zabid District:

1) Comprehensive support for Zabid Rural Hospital. 2) Comprehensive support for Zabid Rural Hospital with CEmONC the emergency obstetric services package. 3) Supporting the general emergency department in Zabid Rural Hospital with furniture and other operational medical supplies. 4) Comprehensive support for Zabid HC that located in the mid center of Zabid city. Al Garrahi District:

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1) Comprehensive support for Al Garrahi New Rural Hospital. Hays District: (Knowing that Hays district does not have any support)

1) Al-Jamadi HC needs restoration and furnishing, laboratories and delivery room and operational support. 2) Quarantine HC needs restoration and full support. 3) Al Qolma HU needs restoration, rehabilitation, expansion and operational support. Al Thawrah Public Hospital Health Needs:

1) Supporting the ONLY Public Hospital with the provision of sufficient quantities of Medicines, Medical Supplies, Laboratory Reagents and Hygiene Materials on irregular basis. 2) Provision of X – Ray Machine to the COVID-19 Isolation Center in Al Thawrah Hospital. SCHMCHA & IDPs Health Needs:  Mr. Nashwan, representative of SCHMCHA in Al Hudaydah, indicated the importance and necessity of providing the free health services for the displaced, as they are the most vulnerable group, as there are no health facilities that provide health services for free to the IDPs.

 The Health Cluster Coordinator commented that IOM Organization was supporting a clinic that was providing health services to the IDPs in Al Hudaydah City but unfortunately due to funding shortage this clinic has been stopped at the beginning of 2020.

 The Sub National Health Cluster Coordinator called on IOM Organization if they could reactivate the IDPs Clinic in Al Hudaydah City to cover this gap. Partner’s Updates: Dr Agron (UNICEF Representative): • The Sub National Health Cluster

1) He emphasized that the payment of the health worker is on process. Coordinator suggested a bilateral

2) He Suggested a bilateral Meeting with WHO to coordinate for the response of meeting between the two the 3 DTC that were supported by SCI. organizations UNFPA & PU-AMI to Dr Abdullah Al-Nozaily (BFD Representative): coordinate and avoid the duplication. 1) He affirmed the continuity of the BFD's support to Zabid Hospital on the side of

the comprehensive obstetric emergency, where there is a specialized • Health Cluster to share the gynecologist and a pediatrician in addition to a new furnished building. 2) He requested further clarification from the General Director of the Public Guidelines of the Triage in Non- Health and Population Office in Al Hudaydah Governorate regarding COVID HFs. deficiencies in the obstetric emergency at Zabid Hospital, which he referred to during his speech, and identify gaps so that the BFD organization can correct the deficiencies if any or respond to the gaps by addressing the donors. 3) He also mentioned that the BFD has supported Zabid Hospital with an amount of 8,000 liters of diesel during the last three months. Dr Hassan Al Khadir (ADO Representative): 1) After what Dr. Khaled Al-Madani said regarding the shortage of medicines and the reason for their delay were to obtain the permits for Medical devices and health Kits in the Ministry, and within a week the medicines will be delivered and will be inside the health facilities. 2) Regarding solar energy, it will be delivered this week and it is under

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examination by the company. 3) We are suffering from shortage medicines because the budget for medicines at the beginning of the project was canceled by the donor because WHO said that they will support partners with Health Kits and because of the lack of medicines, we have allocated a small budget that is not enough for even 30 patients a day. Dr Iman Nasher (The Reproductive Health Coordinator): 1) With the arrival of the COVID-19 pandemic in Yemen and due to the lack of funding, many of UNFPA’s life-saving reproductive health programs in Yemen have been suspended. 2) She stressed that UNFPA priority is to ensure that access to reproductive health care for women is not disrupted and that they are protected from violence and abuse during these difficult times. 3) Currently, with the availability of a little funding, through which UNFPA will re- support a number of health facilities in Hajjah and Al Mahweet governorates, and once approval is obtained, we will share the list of these Health Facilities. 4) Dr. Iman indicated that there is duplication in reproductive health services in Al-Sukhnah district with PU-AM organization, and she requested further clarification from Dr. Yazid, the representative of the PU-AMI organization in Al Hudaydah about the nature of the services they are providing in Al-Sukhnah district. Action Point: The Sub National Health Cluster Coordinator suggested to conduct a bilateral meeting between the two organizations UNFPA & PU-AMI to coordinate and avoid any duplication. Dr Elham Al-Absi (SCI Representative): 1) She stressed that the medications shipment that which Al Hudaydah GHO DG referred to during his speech, will be delivered to the HFs during the day or the day after tomorrow as they promised. 2) She requested Health Cluster to share the Guidelines of the Triage in Non- COVID HFs. Dr Abdullah Salem (WHO Representative): 1) He mentioned that a decline in basic health service utilization was observed during the first quarter of but several factors were put into account which include, defunding, movement restriction of population, and because some health facilities have been repurposed for COVID-19.

2) He stated that despite the long efforts of WHO, Yemen Health Cluster and its partners in coordination with health authorities, significant gaps remain due to funding shortages to the humanitarian response in Yemen, due in large part to the insufficient health funding in Yemen, according to the Health Cluster mapping activities, many programs providing essential health services in health facilities have already ended by December 2020 due to funding shortages.

3) Challenges also include; Security Constraints, Expanded Frontlines, COVID-19 Pandemic, Fuel Shortage that impacted some health facilities. 4) WHO is supporting the HFs in Al Hudaydah Hub with the following monthly support:

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 Supplying 32 HFs in Al Hudaydah Hub with 256,600 liters of fuel on monthly basis;

- 22000 liters for 5 HFs in Al-Mahweet (Al Jomhori hospital, Altaweelah HC, Alrujm HC, Shibam hospital, Bani Saad District Hospital).

- 183000 liters for 20 HFs in Al Hudaydah (AL Monerah Hospital, Allohaiha hospital, Aljarahi hospital, Aldehi hospital, Almansoriah hospital, Alamal Cancer Center, Alsalkhana hospital, Althawra hospital, Dar Al Salam mental Health Hospital, Bayt al fageh dist Hospital, Hoieidah dialysis Center, Zabid dialysis Center, Bajel dialysis Center, Al Knaws dialysis Center, Alsalam HC, Zabid hospital, Alzaidiah hospital, Alolofi hospital, National Publice Health Laboratory, Bajel hospital).

- 41100 liters for 5 HFs in Hajjah (Aljumhori hospital, Al-Mahabishah hospital, Mabyan hospital, Qafl Shammar District Hospital, Khairan Almoharak hospital),

- 10500 liters for 2 HFs in Raymah (Al-Mithaq District Hospital, Altholaya hospital).

 Supplying 53 HFs with 5688500 liters of Water on monthly basis;

- 2105000 liters for 3 HFs in Al Hudaydah,

- 2422000 liters for 42 HFs in Hajjah,

- 932000 liters for 6 HFs in Al-Mahweet,

- 240000 liters for 2 HFs in Raymah.

 Ongoing support for 421 of eDEWS sites in the four governorates (155 in Hodeida, 60 in Mahweet, 135 in Hajjah, and 71 in Raymah). Also 72 Rapid response teams are supported (26 in Al Hudaydah, 9 in Mahweet, 31 in Hajjah, and 6 in Raymah).

5) We know very well that this support may not cover all the health needs, but it must be noted that this support greatly contributes to maintaining the continuity of health services in health facilities that are receiving this type of support on monthly basis.

6) With regard to WHO Response to malaria / Dengue Fever, there is already ongoing central coordination and communication between the WHO head office in Sana'a with the Ministry of Health and the National Malaria Control Program to receive the support from WHO and other organizations supporting the implementation of activities in coordination with the malaria units and malaria coordinators in the governorates.

7) For Anti-Malaria Medicines: the NMCP has distributed ACT, artesunate injections …etc., to all health facilities in Al Hudaydah Hub last March 2020.

8) IV Fluids: WHO has delivered IV fluids to Hajjah and Al Hudaydah GHOs. 9) ELISA kits for Central Public Health Laboratories (CPHL): 600 ELISA kits arrived to Sana’a airport in May 2020 and have been distributed to the CPHLs (the kits for detection of dengue, Chikungunya, West Nile Virus, Yellow Fever, Rift Valley, etc.).

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10) Indoor Residual Spray Campaign (IRS): The plan is to conduct the routine major indoor residual spraying campaign in November 2020 for more than 230,000 houses in Tehama.

11) For Dengue RDTs: WHO delivered 70,000 cassettes of RDTs on 18 May 2020, but it delivered directly from airport to MoPHP stores. NMCP Manager has coordinated with GHOs office and dispatch dengue RDTs accordingly. If there is any urgent need now, GHOs are kindly requested to contact with NMCP.

12) Bed Nets: 540,000 LLINs already arrived to Hodeida sea port last month. It is on clearance process and 1.1 million LLINs will be delivered from Djibouti to Hodeida.

Dr Mohammed Abkar (WHO Epidemiologists): 1) WHO is in a continuous contact with all GHOs in all governorates and has a direct relationship with office managers, Coordinators and RRTs.

2) During the past two weeks, WHO has supported a group of medical personnel to conduct a supervision field visits to more than 12 districts in Al Hudaydah, 13 districts in Hajjah, 6 districts in Al Mahweet, and 4-5 districts in Raymah.

3) This medical team has been established to investigate and follow up the epidemiological situation on the ground and to monitor the commitment of HWs with the application of Case Definition & Case Management standards.

4) We are looking for more cooperation by health offices for an effective response to control spreading epidemics to overcome all obstacles and challenges, as happened last year during Dengue Fever and chikungunya outbreaks in November 2019. AOB

For more information, please visit the Health Cluster Website: http://yemenhc.org/