HEALTH CLUSTER BULLETIN #21 February 2021 EPI outreach activity in Lare woreda, Nuer zone, Gambela region. Photo: FIDO. Emergency type: Multiple Events Reporting period: 1-28 February

8.7 M PEOPLE 2.9 M IDP 1.6 M HOST 166 WOREDAS IN NEED TARGETED TARGETED HIGHLIGHTS HEALTH SECTOR

• It is estimated that 4.5million people are HEALTH CLUSTER 30 affected in Tigray, of whom morethan IMPLEMENTING PARTNERS 560,000 are internally displaced, and MEDICINES DELIVERED TO HEALTH 62,000 displaced to Sudan. FACILITIES/PARTNERS

• The current estimated people in need for 160 ASSORTED MEDICAL KITS Health assistance in Tigray Region is 2.8m and target population for support is 1.25M. HEALTH CLUSTER ACTIVITIES

• The number of people in need of 136,471 OPD CONSULTATIONS emergency health services in 2021 is estimated at 8.7M. VACCINATION • As of 26 Feb 2021, a total of 157,047 VACCINATED AGAINST 3,508 MEASLES confirmed COVID 19 cases, 2,340 deaths and 134,561 recoveries have been EWARS reported in Ethiopia. CONFIRMED COVID-19, POLIO, 5 YELLOW FEVER, CHOLERA, • 15 suspected Polio cases were reported MEASLES OUTBREAKS during week 7. FUNDING $US 140 M REQUESTED % FUNDED M M GAP

Situation update The humanitarian crisis in Northern Ethiopia resulting from November 2020 conflict led to total disruption of essential life-saving health services for the affected population. It is estimated that 4.5million people are affected in Tigray, of whom morethan 560,000 are internally displaced, and 62,000 displaced to Sudan. The current estimated people in need for Health assistance in Tigray Region is 2.8m and target population for support is 1.25M. The health cluster joins other humanitarian responders to support Federal Ministry of Health and Regional Bureau of health to revitalize health services throughout the Region. Despite access improvement inside the Tigray region, insecurity continues to prevent the delivery of much needed health and humanitarian assistance. The Government of Ethiopia has provided blanket clearance for humanitarian operations, but access to rural areas outside of main transportation corridors continues to be limited due to insecurity. Interruptions in electricity and communication continue to be reported. These, combined with limited disease surveillance/ early detection and clinical management capacities, will potentially result in high fatality rates. Violence, including SGBV, continues to be reported, which will also contribute to higher morbidity and mortality. OHCHR reported 136 cases of rape from Mekelle, Ayder, Adigrat and Wukro between December 2020 and January 2021.

Figure 1: Number of people targeted for Humaniterian assistance by Zone in Tigray, Source: OCHA The number of people in need of emergency health services in 2021 is estimated at 8.7M. This was analysed at woreda level based on selected indicators for health humanitarian needs overview. The selected indicators are number of cholera cases, cholera incidence rate, displaced population, measles vaccination coverage and covid-19 attack rate at woreda level, the indicators were also used to analyse the level of severity of needs. The 2021 humnaiterian needs overview is published. https://reliefweb.int/report/ethiopia/ethiopia-humanitarian-needs-overview-2021-february- 2021. Suspected Cholera outbreak is ongoing in SNNP region. A total of 40 suspected Cholera cases were reported from SNNP region during week 7. 15 suspected Polio cases were reported during week 7. Highest 3 suspected polio cases were reported from , SNNP, Amhara and B. Gumuz region. Confirmed outbreak of measles is ongoing in different woredas of the country. A total 112 suspected measles cases without death were reported during week 7 . Highest 49 suspected measles cases were reported from SNNP region, 34 were from Oromia region and 19 were from Amhara region. . One associated death was reported from Gura Damole woreda, Bale zone of Oromia region. As of 26 Feb 2021, a total of 157,047 confirmed COVID 19 cases, 2,340 deaths and 134,561 recoveries have been reported in Ethiopia. Response continues through the national and subnational PHEOC, with partners supporting various pillars at all levels. Public Health risks, priorities, needs and gaps Health risks • With ongoing community transmission of COVID-19, Ethiopia remains at high risk of increasing caseloads and mortalities, thereby straining the health system. • 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. • Revitalization of the healthcare delivery system in Tgray. • 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 by conflict, floods and other causes. There is need to speedily rehabilitate, re-staff and restock these facilities.

Health Cluster Action Strategy and response processes The cluster finalized preparation of the 2021 HNO/HRP through wide ranging participation of partners. The final document is waiting endorsement. The Anticipatory Action plan (AAP) intiated late last year was finalized. Through this action, we will strengthen RRTs so as to shorten response time and thus reduce morbidity and mortality. AAP will be implemented in drought affected woredas of Oromia, Somali and Afar regions and and some food insecure woredas of Tgrai region. Health Cluster coordination For Tigray response, The Health cluster continues to play a key role in providing the necessary leadership for Health response, partner coordination, technical assistance and operation support in response to both Regional Health Bureau and partner efforts. In March, WHO activated a second sub national Health cluster coordination forum in Shire in addition to the existing one in Mekelle with participation of 09 (nine) partners. The cluster continues to advocate for more partners’ presence in the whole of the Region –to-date, there are 20 operational partners with presence in 65% (57/88) woredas in Tigray (11 partners are providing MHNT services as of week 13) compared 09 (nine) partners way back in January 2021. The health cluster continued its weekly virtual meetings to regularly update and guide on the ongoing partners’ contribution to essential health services and the emergency response in Tgray. Efforts are underway to reactivate the monthly meeting of the national MHPSS TWG which was interrupted because of the pressure created by the COVID 19 outbreak. Field Monitoring and support The Health Cluster Sub national Coordination closely worked on the Cholera outbreak response in Oromia region, closely monitored with the regional surveillance team, also presented the situation in the weekly National Health Cluster team to aware the partners implementing in the outbreak area so that to support the response. Partners were made aware of different Cholera response activities including WASH, OCV and Risc communication activate.

2021 HRP dashboard Indicators January Feburary Total 1. Number of health facilities including COVID-19 isolation facilities and mobile 273 1,093 1,093 teams supported in crises affected locations 2. Number of OPD consultations 119,767 136,471 256,238 3. Number of normal deliveries attended by skilled birth attendants 1,201 1,451 2,652 4. Number of women in child bearing age receiving modern contraceptives 4,468 8,468 12,936 5. Number of community members receiving health IEC messages including COVID- 125,654 218,224 343,878 19 6. Number of assorted emergency medical kits and COVID-19 PPE kits distributed in 10 28 38 crises affected locations 7. Number of cases with injuries and disabilities treated and referred for further care 85 348 433 8. Number of cases receiving mental health and psychosocial support services 15,669 24,907 40,576 including COVID-19 9. Number of survivors of SGBV receiving clinical care for rape 61 37 98 10. Number of epidemic prone disease alerts including COVID-19 verified and 49 390 439 responded to within 48 hours 11. Number of children 6 months to 15 years receiving emergency measles 1,165 3,508 4,673 vaccination

Communicable diseases control and surveillance Table 1: Number of cases reported during WHO Epi week 9-12, 2021, Ethiopia

SAM

Malaria Malaria

(Confirmed (Confirmed & clinical) Suspected Meningitis Suspected AFP Suspected Measles Suspected NNT Suspected Rabbies Maternal Scabies

Region

Cases Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Deaths Cases Deaths Addis 179 0 8 0 200 0 2 0 14 0 0 0 5 0 5 1032 0 Ababa Afar 7968 0 20 0 1351 1 1 0 0 0 0 0 0 0 4 1 0 Amhara 15912 0 60 0 2273 3 29 0 226 3 2 4 501 5 15 10176 0 Benishangu 4483 0 5 0 116 0 0 0 10 0 0 0 33 0 3 130 0 l-Gumuz Dire Dawa 84 0 0 0 83 0 0 0 0 0 0 0 0 0 1 71 0 Gambella 3860 0 5 0 120 0 0 0 0 0 0 0 0 0 0 13 0 Harari 56 0 20 2 96 0 0 0 0 0 0 1 0 0 4 57 0 Oromia 8035 0 186 0 10541 7 46 0 105 0 7 1 22 0 47 4344 0 Sidama 1951 0 31 1 888 6 7 0 15 0 2 0 0 0 0 297 0 SNNPR 20772 0 37 0 2743 8 6 0 58 0 2 0 39 0 5 1328 0 Somali 4549 0 66 0 6884 0 7 0 11 0 0 0 0 0 1 92 0 Tigray 510 0 0 0 834 0 0 0 1 0 0 0 49 0 14 480 0 Grand 68359 0 438 3 26129 25 98 0 440 3 13 6 649 5 99 18021 0 Total EPHI reported that on each epi week from 9 to 12, most regions met the required 80% IDSR reporting completeness and timeliness. Cluster partners provided assistance in OCV campaigns conducted in Gambella and SNNPR. Training of health workers IMC provided on the job training for 22 HWs on mental health psychosocial support activities in East and West Hararghe zones. AAH Provided IPC on the job training for frontline health care workers in the context of COVID-19 adaptive health and nutrition programming in Gambella, Borena, East Hararghe and Somali operational areas. IOM conducted Mental health gap action program (mhGAP) and Psychosocial Support Mainstreaming Training in Gondar. targeting Government Focal points, Volunteers, and Implementing Partners in collaboration with Ministry of Women, Children and Youth Affairs and University of Gondar. OWDA conducted zonal cascade training on FGM for 187 health workers (F:75 and M:112) in four zone of Somali region, 49 from Jarar, 61 from shabelle, 33 from Doolo and 44 from Korehe zone. Provision of essential drugs and supplies WHO donated 160 IEHK module, 2 different nutrition medicine equipment and 1130 PPE materials to partners and zonal health offices in all regions in Feburary. Support to health service delivery

AAH continued supporting MCMDO providing MHNT CRS in , government in awareness raising response project in Tigray, B. and Medigatola, reached 4,211 activities on COVID-19 using Gumuz and SNNPR regions. households with health education locally translated IEC materials in Reached 27,324 beneficiaries with on prevention of outbreak prone all its operational areas. Field lifesaving health and nutrition diseases at community level. 2,432 teams supported the polio services. Accordingly, 10,106 people were reached with key vaccination campaign in its beneficiary in Kamashi and Covid-19 messages in Kumbi, operational areas through Metekel zones, 12,030 Siraro and Medigatola. CRS MHNT logistics and technical support. beneficiaries in Tigray region and in Medigatola, Chinaksen Kumbi Supported Zonal and Woreda 5,188 Benificiaries in Gedeo zone and Babile reached 4,246 patients health offices and RRT by were addressed through with essential health services. assigning vehicles for community Consultation and treatment, and facility-based surveillance nutrition screening, ANC, FP, MSF S conducted mental health and mobilization Efforts. delivery, PNC, EPI, Vit A and consultation for 171 individuals, Continued supporting remote deworming. 195 group with 2,261 participants area that has no Health Facilities and 1,269 patients seen by to implement Covid-19 WVI under SWAN project outpatient consultation,156 Community awareness through distributed Medical kits of patients referred for secondary MHNTs in Somali &Hararghe. different types including drugs care through Migrants and and medical supplies to five returnees response project. MSF S GOAL MHNT conducted medical hospitals (Shire Hopital , Wukro in Tigray, provided primary and consultations for 1,369 clients in Hospital , Adigrat Hospital, secondary health care activities in Yirgachefe, Medawolabu, S.Samre Hospital and Mekelle Axum university Hospital, Axume Dolomena, and Abaya woredas. Town) and six health centers HC, Adigrat hospital, Adwa HC and Health education was conducted centers (Enderta HC, H/Selam HC, Abi Adi HC. MSF S Metekel for 7,525 individuals. In Somali Adigrat HC, Wukero HC, Shire HC, Emergency project, provided 116 region (Galadi, Daratole, Bokh Segede HC) in Tigray region. The mental health Individual woredas), medical consultation total price of medical kits worth consultation and treated 18 was conducted for 1,918 clients, of $123,559. The medical kits psychiatric patients, reached out and health education conducted meant to address the primary and to 1936 people through 36 group for 7,267 individuals. advanced health demands of up sessions. to 340,000 people.

UNICEF MHNT in Afar and Somali IMC provided lifesaving emergency FIDO vaccinated 223 children as regions conducted 43,321 new health services and outbreak per the EPI schedule in February. medical consultations of which 41% response for IDP and returnees in Provided MHPSS service in of them were CU5 and 35.8% were East and West Hararghe zones. for Kuergeng health center of Lare women. continue to support the 4,932 adults and 2,602 CU5 among woreda in Nuer zone. FIDO has Gambella RHB to provide vaccination those 8 clients were disabled. been conducting active case for South Sudanese refugee children 2,243 children`s were surveillance on vaccine- at entry points and refugee camps. supplemented with Vit-A & preventable diseases in three 469 children received polio deworming’s and 199 pregnant woredas of Nuer zone. vaccination and 674 children women attended by skilled birth Distributed basic IEHK kits to received measles vaccination at attendants. 2,586 WCBA received Itang woreda health office. FIDO entry points in Gambella. In 2021 comprehensive RH services. 80 installed four handwashing UNICEF reached 62,830 people with clients were received MHPSS. 83 stations per health facility for primary health care services. provide referral services to higher COVID- 19 prevention measures Distributed 29 EDKs to Amhara for HFs. 3,474 CU5 & 984 PLWs were for seven prioritized health Metekel IDPs, another 10 EDKs for screened for malnutrition. Out of facilities. Furthermore, surgical B/Gumuz region to provide essential which 79 were identified for SAM masks were distributed to health health service for Metekel IDPs. and 325 CU5 and 116 PLW workers in the prioritized health provided 10 EDKs for Oromia for identified for MAM. MHNT facilities. response to IDPs and returnees. provided Health education, and Through OFDA support, UNICEF health promotion sessions for Plan Int`l has continued procure and distribute, 53,970 hand 6,021 clients and caretakers. enhancing the local health system sanitizers and 50,000 masks, N95, to in three districts of Waghamera 6 health facilities in Oromia and OWDA MHNTs provided free Zone Amhara region and two Somali regions for continuation of medical health care services in districts in Zone one and two of primary health care service in Deka, Gashamo, and Moyale Afar Region through its mobile IDP/returnees hosting districts in Woredas of Somali region and health and nutrition COVID-19 context. treated a total of 6,284 patients implementation modalities. 40 through consultation and case health facilities including COVID- IOM continued essential health management. OWDA provided 167 19 isolation facilities and mobile services in East Wollega, West Guji, cases for MHPSS during the MHNTS teams supported with Logistic Gedeo zone, Dire Dawa (millennium site consultations. OWDA has and technical support, reached site) and East Hararge (Kersa, Goro provided comprehensive social 15,385 with OPD consultation; Gutu) IDP camps. In response to the mobilization integrated with 424 pregnant women deliveries Northern Ethiopia crisis, IOM COVID-19 key message and attended by skilled birth supported 2 IDP camps in North and reached t2,632 individuals of attendants; 3,580 women in child central Gondar and scaled up its which 1,723 were female and 909 bearing age have received response to 5 sites in Mekelle. were male participant. modern contraceptives; 204 cases Cumulatively 13,611 medical with injuries and disabilities consultations were conducted, and treated and referred for further 3,337 children were screened for care; 8,393 cases have received malnutrition. 25,998 individuals MHPSS; 866 children received were reached with key health measles vaccination and 9,996 messages and 3,080 women received community members have basic Sexual and reproductive health received key healthy life and services. COVID-19 prevention measures messages.

Health Cluster partners presence map

Plans for future response The health cluster will continue working with the government departments to deliver essential life-saving healthcare services to the most in need populations. Partners will contribute to and participate in readiness and response efforts at subnational level. The cluster’s priority target populations will include IDP, returnees and host communities in emergency locations. New conflict and floods induced IDP and returnees will be prioritized, while the needs of chronic IDP will be assessed from time to time. Response to ongoing cholera 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 GOAL, WVE, ECHO, MCMDO, UNICEF, ACF, OWDA, SCI, IRC, IMC, PIN, CARE, CRS, CCM, CWW, USAID Transform PHC, UNAIDS, FIDO, UNESCO, FHI360 IDDS, GHSC-PSM, MSF-E, MSF-H, CUAMM, PIN, UNDP, UN Women, Mercy Corps, Child Fund, Plan International, UNFPA, IOM, WHO, UNHCR, OCHA.

Contacts: Dr. Patrick Abok, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer, [email protected], +251 967897964 [email protected], 0945184987