HEALTH CLUSTER BULLETIN #20 October 2020 Global hand washing day, Kombolcha Industrial Park. Photo: CWW.

Ethiopia Emergency type: Multiple Events Reporting period: 1-31 October 2020

10.6 MILLION 2.0 M IDP 4.5 M HOST 231 WOREDAS IN NEED TARGETED TARGETED HIGHLIGHTS HEALTH SECTOR

• In early November 2020, a war broke out HEALTH CLUSTER 30 in the Tigray region of between IMPLEMENTING PARTNERS national government and regional forces. MEDICINES DELIVERED TO HEALTH FACILITIES/PARTNERS • The crisis has been characterized by an information blackout, blockade to free 626 ASSORTED MEDICAL KITS communication and lack of movement into or out of the region. HEALTH CLUSTER ACTIVITIES

• An ICCG response preparedness plan 157,313 OPD CONSULTATIONS targeting 2M people in three regions requires $76M for 3 months’ implementation, including $8.7M for VACCINATION emergency healthcare services. VACCINATED AGAINST 9,669 MEASLES

• Cholera outbreaks are active in 15 EWARS woredas of SNNP, Sidama and CONFIRMED COVID-19, POLIO, regions in mid-November. 5 YELLOW FEVER, CHOLERA, MEASLES OUTBREAKS • As of 24 November, 106,591 confirmed FUNDING $US cases and 1,661 deaths of COVID-19 have 195 M REQUESTED 14% FUNDED been reported in Ethiopia. 27.4 M 167.6 M GAP

Situation update In early November 2020, a war broke out in the Tigray region of Ethiopia between national government and regional forces. According to UNOCHA’s situation reports, the crisis has been characterized by an information blackout, blockade to free communication and lack of movement into or out of the region. Reports from across the border in neighboring Sudan indicate an increasing number of Ethiopian refugees in thousands, and internally displaced people spilling into northern Amhara and likely in western Afar region. Basic services like banking are not currently available in the region. High level advocacy in the humanitarian community has continued, asking government to ensure unconditional access to all affected locations and populations in order to commence urgent life-saving interventions. The ICCG is strengthening subnational coordination mechanisms in Mekelle, Shire, Amhara and Semera, asking all clusters to assign focal persons or coordinators in these locations. An ICCG response preparedness plan targeting close to 2M people in the three regions requires $76M for 3 months’ implementation, including $8.7M for emergency healthcare services. About 12 health cluster partners have been mobilized in readiness for rapid response once access to Tigray is granted. Cluster partners are already supporting trauma care for casualties in northern Amhara and western Tigray. The cluster had prepositioned some kits in Mekelle before the conflict, and these have been used to support trauma care and essential health services around the city. Based on UNOCHA’s situation report in mid-November, the security situation in the country has deteriorated further over the past weeks, especially the Oromia region, mostly due to the pullout and re-deployment of the Ethiopian Defense Forces (EDF) to the Tigray crisis. The re-deployment of EDF, especially from volatile locations in Oromia and Benishangul is creating a security vacuum that has led to an increase in activities of Unidentified Armed Groups (UAG). Most affected areas include western, eastern and southern Oromia, Konso zone in SNNPR, Metekel zone in Benishangul Gumuz, and parts of Afar region. Insecurity is interrupting humanitarian access to populations that are in dire need of essential services including healthcare. Many partners have suspended their operations in these locations. This situation needs to be reversed as soon as possible.

Cholera outbreaks are active in 15 woredas of SNNP, Sidama and Oromia regions in mid-November. Ethiopia has reported new cases of cholera each week of 2020. Cluster partners continue supporting the response. As of 24 November, 106,591 confirmed cases and 1,661 deaths of COVID-19 have been reported in Ethiopia, from 1.6M laboratory tests conducted.. 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. • 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 As part of the ICCG humanitarian response preparedness plan for Tigray, the health cluster requires an additional $8.7M to deliver essential life-saving services to 1.3M people targeted in 3 regions for 3 months. Services will be delivered through surge capacity for functional health facilities, mobile health teams, and rapid response teams. Priority intervention areas will include trauma care, treatment of common diseases, mental health and psychosocial support, vaccination for children under five, minimum initial services package for emergency reproductive health, and response to disease outbreaks. The country continues its multisectoral response to Covid-19, with the public’s low risk perception and minimal enforcement slowing down the prevention and control measures. Response to cholera outbreaks continues to be structured around case management, social mobilization and risk communication, logistics and supplies, surveillance and laboratory investigation, and WaSH. The EPHI and RHB lead the interventions, with health cluster partners supporting as and when assigned by the authorities. Health Cluster coordination In October, the health cluster continued its weekly virtual meetings to regularly update and guide on the ongoing partners’ contribution to essential health services and Covid-19 response. Emphasis was on partners integrating COVID-19 activities in their existing projects. Subnational coordination is ongoing in all regions and some zones. It is noted that regions and zones which had ongoing emergency response activities before the Covid-19 outbreak have stronger and more consistent coordination mechanisms. A lot of support has been provided by the national cluster to new priority locations. The cluster coordination performance monitoring (CCPM) online survey was completed by 29 partners, 97% response rate. A report will be generated and discussed later. Field Monitoring and support To strengthen coordination at the subnational level, the national health cluster coordinator, two roving coordinators and public health officer were deployed to the regions. In Gambella, the agenda for the weekly cluster meetings was expanded to include non-covid emergency events. $360k from EHF SA2 was assigned to cover 6 woredas of Gambela for 6 months. A joint meeting held with head of health bureau, hospital management, MSF-E and WHO updated on the handover process for Gambella general hospital, and agreed on the final steps for the remaining one month. This hospital serves referrals from primary healthcare facilities and refugee camps across the region. In the Hararges, it was found that health cluster coordination has improved and regular meetings are conducted. The need for strengthening woreda level coordination was emphasized. A 4W matrix was compiled for the 2 zones. In Benshangul Gumuz region, it was noted that efforts were underway to reactivate structures for health and multisectoral coordination, especially at zonal levels due to the physical barriers to access Metekel and Kamashi zones. In Afar, joint foeld visits were conducted in zones 1 and 3, and a multisectoral floods response plan developed based on identified needs and priorities. 2020 HRP dashboard Indicators Q1 Q2 Q3 October Total 1. Number of health facilities including COVID-19 isolation facilities and 88 468 1,728 768 1,728 mobile teams supported in crises affected locations 2. Number of OPD consultations 385,567 574,238 581,757 157,313 1,698,875 3. Number of normal deliveries attended by skilled birth attendants 2,297 4,428 11,593 11,123 29,441 4. Number of women in child bearing age receiving modern 32,057 28,078 49,626 7,773 117,534 contraceptives 5. Number of community members receiving health IEC messages 291,065 2,103,852 1,005,887 331,913 3,732,717 including COVID-19 6. Number of assorted emergency medical kits and COVID-19 PPE kits 551 3,900 651 35 5,137 distributed in crises affected locations 7. Number of cases with injuries and disabilities treated and referred for 577 502 1,351 1,055 3,485 further care 8. Number of cases receiving mental health and psychosocial support 153 19,881 47,397 13,259 80,690 services including COVID-19 9. Number of survivors of SGBV receiving clinical care for rape 13 15 128 65 221 10. Number of epidemic prone disease alerts including COVID-19 verified 718 915 5,931 5,637 13,201 and responded to within 48 hours 11. Number of children 6 months to 15 years receiving emergency measles vaccination 407,529 82,125 1,542,963 9,669 2,042,286 Communicable diseases control and surveillance Table 1: Number of cases reported during WHO Epi week 41-44, 2020, Ethiopia

SAM

Malaria

(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

A Ababa 215 0 5 0 182 0 3 0 5 0 0 0 186 0 3 1,955 0 Afar 10,481 0 6 1 2,135 4 0 0 1 0 0 0 0 0 7 Amhara 97,179 0 54 0 4,010 4 18 0 34 0 3 2 248 2 22 10,994 0 B Gumuz 15,729 1 14 0 150 2 0 0 3 0 0 0 33 2 1 537 0 D Dawa 317 0 1 0 130 0 3 0 4 0 2 0 0 0 1 110 0 Gambella 5,919 0 8 0 93 0 0 0 0 0 1 0 0 0 0 6 0 Harari 154 0 29 0 180 0 1 0 2 0 0 0 0 0 0 123 0 Oromia 28,127 0 170 1 15,197 7 186 0 118 0 10 2 33 3 42 9,116 0 Sidama 5,368 0 6 0 972 2 0 0 0 0 0 0 0 0 0 34 0 SNNPR 28,588 0 25 0 5,218 13 9 0 8 0 0 0 50 1 5 1,800 0 Somali 5,746 0 106 1 7,578 1 7 0 0 0 0 0 0 0 2 99 0 Tigray 22,020 0 13 0 1,079 1 0 0 2 0 0 0 101 0 2 2,363 0 219,843 1 437 3 36,924 34 227 0 177 0 16 4 651 8 85 27,137 0 Total

EPHI reported that on each epi week from 41 to 44, most regions met the required 80% IDSR reporting completeness and timeliness. Despite the Covid-19 pandemic, health cluster partners supported the government at different levels to successfully conduct round one mOPV campaign in Oromia, SNNPR, Somali, Harari, Dire Dawa, and Addis Ababa on October 7-10. Leadeship from EPHI, GPEI, WHO, UNICEF, Core Group, and CDC was important. 6.9M children under five (102% of target) were vaccinated. In the same month, almost 0.7M people (93%) 9 months - 60 years were vaccinated against yellow fever in a reactive mass campaign in 12 woredas. Training of health workers IOM conducted trainings on COVID-19 home-based isolation and care, surveillance and IPC for 55 HCW in West Guji and 40 HEW in East Wollega in collaboration with ZHB. Concern World Wide provided orientation training for 136 HDA and 139 HCW on Covid-19. FIDO conducted PHEM training for 33 HCW to ensure rapid detection, preparedness and response to public health emergencies in East Wollega and Guji zones. SCI conducted surveillance training for 24 HCW in Addis Ketema sub-city, PHEM training for 10 HCW, and COVID-19 case management training for 10 HCW in 6 health facilities. Provision of essential drugs and supplies WHO donated 626 emergency health kits and PPE to partners and zonal health offices in all regions. Support to health service delivery

Mercy Corps supported 3 CRS reached 5,452 households OWDA MHNT treated 4,412 patients MHNT in 3 woredas of Somali with health education on in Gursum, Shilabo, and Dhobawayn region which are Tuliguled, prevention of outbreak prone woredas of . MHNT East Imey and Goljano. MHNT diseases at community level. 8,742 reached 14,211 people with health provided medical consultation people were reached with key education including Covid-19 for 2,659 beneficiaries of whom Covid-19 messages in Kumbi, messages through different channels 1,199 were under five years, Siraro and Medigatola. CRS MHNT targeting different groups. OWDA 388 were 5-18 years, 912 were in Medigatola and Chinaksen provided mental health and adults above 18 years, 150 reached 7,890 patients with psychosocial support to 182 were elderly people and 10 essential health services. CRS and individuals. disabled people. 153 people partners distributed PPE and IEHK received MHPSS services. 133 in Chinaksen, Mayulmuleke, IOM delivered essential health children were vaccinated Kumbi, Siraro, Shashemene services in East Wollega, West Guji against measles. The MHNT woredas of Oromia region and and Gedeo zones. 9,927 medical identified and treated 50 SAM Babile of Somali. consultations were conducted, children without medical screened 2,724 children for complications at outreach sites. MSF-Spain continued providing malnutrition and reached 21,560 IEC messages was given for healthcare assistance at Gambela individuals with key health messages. 8,122 people. regional hospital. 1,568 patients 1, 450 women received basic sexual received emergency care, 151 and reproductive health services. MCMDO reached 27,842 patients were admitted to surgical Conducted scabies campaign in 6 beneficiaries with lifesaving ward, and 125 urgent life-saving kebeles of West reaching primary healthcare and surgical interventions performed. 1,226 beneficiaries. nutrition services in West Guji, 171 individuals received mental Gedeo and Afar. 8,973 health consultations. Migrants and Concern Worldwide reached 53,360 consultations were done at returnees response project are people in Kombolcha town markets OPD of which 2,142 were under supporting mental health and through risk communication five children. Health education health promotion at Sidis Kili campaigns. 37,816 people benefited and awareness was conducted quarantine center. 84 group from hygiene promotion. 1,101 for 14, 205 beneficiaries on sessions were conducted for 1,042 people received GBV & child Covid-19 and other participants. 4,243 consultations protection orientation. 126 HCW communicable diseases. 842 done among these, 1,151 (27%) of were sensitized in 11 health facilities mothers have received ANC them were under five. 60% of all (9HC and 2Hospital). 790 individuals consultation and 1,027 WCBA the consultations were from IDP received health education among have FP services. 1,436 clients sites. 48 hospitalized patients them 631 were female and 159 were received MHPSS services. treated MSF health facilities. male.

IMC provided lifesaving SCI provided logistics support at Plan International supported emergency health services and and Modjo Covid-19 isolation 50 health facilities including outbreak response for IDP and centers. Conducted awareness Covid-19 isolation facilities and returnees in East and West sessions for 657 persons. Provided mobile teams with logistics and Hararghe zones. OPD PPE kits for Addis Ababa health technical support in Amhara and consultations for 2,199 adults bureau. Screened 967 individuals at Afar regions. 4,283 OPD and 1,062 CU5 among them 9 service entry point. IEC materials consultations were conducted. clients were disabled. 454 with the key Covid-19 prevention 123 pregnant women delivered children were supplemented with messages were printed and under the care of skilled birth Vit-A & dewormed and 96 distributed to 684 beneficiaries. attendants. 174 WCBA received pregnant women attended by MHPSS support was provided for 967 modern contraceptives. PPE kits skilled birth attendants. 1,161 people. 3,088 persons were reached were distributed for 2,425 WCBA received comprehensive through social mobilization in Somali people. 61 cases with injuries RH services. 17 clients received and Dire Dawa. In Amhara region, and disabilities were treated and MHPSS. 720 children and 135 1,535 beneficiaries were reached referred for further care. 20 PLWs were screened for through awareness sessions on cases received appropriate malnutrition, out of which six MHPSS. Distributed IEC and visibility MHPSS services. 11 children were identified for SAM and 77 materials for 6 outpatient health who are survivors of SGBV CU5 and 23 PLW were identified facilities, COVID-19 case management received healthcare and PSS. for MAM. MHNT conducted center and 1 primary hospital. 1,320 children received measles health education and promotion vaccine. 2,554 community sessions for 1,032 clients and WVI provided support to 15 health members received key healthy caretakers. facilities on health system life and Covid-19 prevention strengthening in Goro Muti woreda of messages using locally UNICEF MHNT in Afar and Somali East Hararge zone. 3,070 adults and translated IEC materials. regions conducted 43,274 new 448 children under five received consultations, of which 38% were outpatient consultations. 7,375 adults CU5 and 36% were women. In GOAL MHNT conducted medical and 1,130 children under 5 yearss of consultations for 1,016 clients in October, 209 children received age received treatment in Habro Yirgachefe, Medawolabu, measles vaccine and 188 children woreda of Oromia region. received polio vaccine at entry Dolomena, and Abaya woredas. Additionally, WVE provided logistics Health education was conducted points in Gambella region. and transportation support for for 9,496 individuals. 114 effective service delivery of routine FIDO supported first round women in child bearing age immunization as well as during Polio received modern contraceptives. mOPV2 campaign for children 0- campaigns in three woredas of 59 months of age in Guji zone, In Somali region (Galadi, Habro, Melka Belo and Goro Muti in Daratole, Bokh woredas), and 322,610 children were West and East Harage zones. 10,460 vaccinated (120% of the target). medical consultation was people were reached with COVID-19 conducted for 1,843 clients, and FIDO extended logistics and preventive messages on frequent technical support to both health education conducted for hand washing, face mask use and 9,934 individuals. targeted woredas in the Guji physical distancing. zone.

Health Cluster 3W 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 PHC Transform, 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. Wilbert Shihaji, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer, [email protected], 0953853416. [email protected], 0945184987.