COUNTRY PROFILE 2020 SNAP- A 70-YEARS DOCTORS SHOT HISTORY WITH AFRICA Doctors with Africa CUAMM is 2,000 currently People have left CUAMM operating in Italy and other Angola, Central countries to work African Republic, on projects: Ethiopia, of these, Mozambique, 515 returned Sierra Leone, on one or more South Sudan, occasions Tanzania and Uganda through: 232 Hospitals 23 served Hospitals

01 43 08 02 03 127 Countries Districts of intervention 04 (for public health activities, mother-child 05 care, fight against AIDS, 06 tuberculosis 07 and malaria, 01 SIERRA LEONE training) 02 SOUTH SUDAN 03 ETHIOPIA 04 UGANDA 3 05 TANZANIA Nursing 06 ANGOLA schools 07 MOZAMBIQUE 08 CENTRAL AFRICAN REPUBLIC 1 University Doctors with Africa CUAMM (Mozambique) has been the first NGO working VALUES in the international health field – «With Africa»: to be recognized in Italy and the organization works 4,777 is the largest Italian organization exclusively with African Human for the promotion and protection populations, engaging Resources of health in Africa. It works with local human resources a long-term developmental at all levels. perspective. To this end, in Italy – Experience: CUAMM 605 and Africa, it is engaged in training, draws on over sixty-six International research, dissemination of scientific years of work to support Professionals knowledge, and ensuring developing countries. the universal fulfilment of the – Specific, exclusive fundamental human right to health. expertise in medicine and health. Doctors with Africa is for everyone who believes in values like dialogue, cooperation, volunteerism, exchange PRIORITY between cultures, friendship between people, the defense of human rights, ISSUES respect for life, the choice to help – Reproductive, maternal, the poor, the spirit of service, and newborn, child and those who support the organization’s adolescent health. action criteria. – Nutrition. – Infectious diseases. – Non communicable diseases (NCDs) and traumas. – Universal Health Coverage (UHC).

Doctors with Africa Ethiopia p. 2 CUAMM OUR WORK IN ETHIOPIA

Doctors with Africa CUAMM operates in Ethiopia since 1980, when it started its intervention at Gambo leper ERITREA colony in Region. YEMEN CUAMM gradually expanded SUDAN its activity to rural hospitals DJIBOUTI and other regions of the Gulf of Aden country.

South West Shoa Zone Addis Today, CUAMM aims to integrate Abeba WOLISSO DHARWANAAJI HC GAMBELLA JIJIGA maternal and child healthcare Somali interventions with measures Gambella to prevent NCDs, HIV/AIDS, SOUTH SUDAN South Indian tuberculosis, and hepatitis B. Omo Ocean CUAMM operates in South West TURMI HC Shewa Zone, South Omo Zone, SOMALIA along with supporting refugees KENYA and host population in Gambella Region, at the border with South Sudan, which is still a very fragile context.

1997 2014 2017 2020 SOUTH WEST SOUTH GAMBELLA MULTI- SHOA ZONE OMO ZONE REGION REGIONAL An agreement signed with the CUAMM started its A three-years project started Ethiopian Bishops’ Conference, intervention in South Omo to address the inequity of PROJECTS leading to the construction of St. Zone in SNNP Region. access to health services of Luke Catholic Hospital of Wolisso Gambella Region compared The NICU project, started in with an attached school for to the national average, plus a 2018, aims at improving midwives and nurses. project to mitigate the effect newborn care both at hospital of immigration from South level (St. Luke of Wolisso, Sudan. CUAMM is active to Tulubolo and St. Paul Hospitals) strengthen the health system and at community level. 2000 and to assist the resident and A wide program at national refugee population. level is underway, focusing on non-communicable diseases 1980 ST. LUKE and involving 15 hospitals and ARSI ZONE, CATHOLIC 2016 45 health centres. OROMIA HOSPITAL, “MOTHERS AND CHILDREN REGION WOLISSO FIRST. 1,000 DAYS” PROGRAM First doctor sent to the Inauguration of St. Luke “Mothers and Children First. 1,000 Days” program started. Period from Gambo leper colony. Catholic Hospital of Wolisso. the beginning of pregnancy up to 2 years of age. p. 3 MULTI- MULTI-REGIONAL REGIONAL PROJECTS PROJECTS 2020

NEONATAL CARE 4,473 newborn admitted in the 3 hospitals’ NICUs 4% reduction in neonatal mortality rate in the 3 hospitals AWARENESS- RAISING 32,447 pregnant and lactating women sensitized on health TRAINING

photo Reed-Young photo 53 NICUs’ nurses trained Doctors with Africa CUAMM is engaged Furthermore, Doctors with Africa in the management of various projects CUAMM aims to contribute to the covering both different thematic and reduction of newborn mortality in the NCDs geographic areas of operation. Among country by: improving quality and others, CUAMM is developing a wide accessibility of Neonatal Intensive 4,403 program to face the growing challenge Care Unit services (NICUs) in three n. of patients treated at of Non-Communicable Diseases hospitals (St. Paul, St. Luke Wolisso, established/strengthened (NCDs), in particular diabetes mellitus and Tulubollo); strengthening the clinics (DM) and hypertension (HTN) by capacity building of skilled staff for increasing prevention, access and NICUs, and increasing the availability of quality of health care services. The standards and methodologies for the project involves 15 hospitals and 45 evaluation of neonatal care services. health centres in Oromia, Amhara, The project then expands to 15 Kebele SNNPR, Tigray and Gambella regions in different Woredas, actively involving and in Addis Abeba area, reaching a the communities in awareness raising population of nearly 2 million people. activities on good practices of newborn care particularly.

Doctors with Africa Ethiopia p. 4 CUAMM WOLISSO, OROMIA REGION, GORO AND SOUTH WEST DISTRICTS SHEWA ZONE 2020

OUTPATIENTS 383,440 total outpatient visits 103, 550 U5 visits MATERNITY 4, 851 total skilled deliveries NCDs 671 women screened for cervical cancer with VIA 13 n. of VIA+ 8 n. of VIA+ treated Doctors with Africa CUAMM operates in The public health activities are led by an with cryotherapy the districts of Goro, Wonchi, Wolisso expatriate public health specialist along Urban and Rural to strengthen the with local health professionals, as peripheral health structures. CUAMM midwifes, nutritionists, environmental works with the most vulnerable, in experts and public health nurses, particular women and children, working alongside the zonal and district providing quality health services to health authorities. the communities. CUAMM is also expanding the The intervention focuses on the intervention to 50 villages in the supervision of the peripheral health woredas of , Goru, units, the training and support of health and Wolisso Zuria with an integrated extension workers (HEW) as well as initiative to prevent and treat child the provision of drugs and consumables malnutrition, along with promoting to guarantee access to safe delivery. healthier diet and care habits. Through the community based activities, CUAMM aims to improve newborn, child and maternal care and to promote cervical cancer screening with VIA and treatment with cryotherapy for VIA+.

p. 5 ST. LUKE ST. LUKE CATHOLIC HOSPITAL CATHOLIC AND NURSING AND MIDWIFERY HOSPITAL OF WOLISSO SCHOOL, WOLISSO 2020

OUTPATIENTS 65,615 total outpatient visits INPATIENTS 12,167 total admissions MATERNITY 4,015 total deliveries 704 caesarean sections 826 n. of MDOC treated ANC VISITS photo Reed-Young photo 1,728 Since 2001 Doctors with Africa CUAMM Among the most relevant, the hospital first antenatal care visits continues to support St. Luke Catholic provides emergency and outpatients Hospital and the Nursing and Midwifery services, along with orthopaedic and School attached, in partnership with the physiotherapy ones. Moreover, a NCDs Ethiopian Catholic Church, owner of the Therapeutic Feeding Unit (TFU) is hospital, and Oromia Health Bureau. operational in the paediatric ward. 226 women screened for cervical CUAMM ensures 24/7 presence of As regards training, CUAMM supports cancer with VIA medical staff in order to guarantee high the Nursing and Midwifery School quality obstetric and paediatric where 30 students on average per year 32 services. Wolisso hospital and the enrols. Since the school started its n. of VIA+ health facilities in its referral area are activities in 2000, 721 students have involved in “Mothers and Children First. graduated, in particular 155 midwives 11 1,000 Days” program, which ensures and 566 nurses. n. of VIA+ treated with every mother free access to a safe cryotherapy delivery and focuses on nutrition during the mother’s pregnancy and for the first two years of the baby’s life. TRAINING 109 total n. of students in the three years 13 n. of midwives graduated 14 n. nurses graduated

Doctors with Africa Ethiopia p. 6 CUAMM HAWARA SOMALI REGION, DISTRICT HAWARA DISTRICT 2020

TRAINING 31 HEW received refresher training on HEW package 16 Midwives trained on BEmONC AWARENESS- RAISING 60 clan and religious leaders, and community representatives participated in community mobilization activities

DHARAWANAJI Somali Region is the second largest basic infrastructure works in the HCs, region in the country and among the the provision of a generator to HC most disadvantaged in terms of health. guarantee electricity supply in case (Data Oct.2019-Sep.2020) Doctors with Africa CUAMM focuses its of emergency, along with basic intervention in Hawara Woreda where equipment and a stock of essential there are only two health centres and medicines. Finally, CUAMM promotes more than 60% of the population does trainings for both HCs staff and Health OUTPATIENTS not have any access to primary Extension Workers (HEW) aimed at healthcare. Therefore, CUAMM aims to: improving knowledge on maternal and 6,486 choose a public health expert to child health, with a specific focus OPD visits coordinate the project and provide on the management of obstetric technical support to the HCs’ staff and emergencies. the local authorities; organise mobile Furthermore, the communities have MATERNITY clinics to provide services to the been involved in mobilization and communities in the most distant areas, awareness rising activities, aimed at 478 referring the most complicated cases to stimulating the demand for services Total deliveries the HCs. Moreover, the project includes and their use. ANC VISITS 486 first antenatal care visits 270 4 antenatal care visits

p. 7 TURMI HEALTH SOUTHERN REGION, CENTER SOUTH OMO ZONE 2020

OUTPATIENTS 13,368 total visits INPATIENTS 263 total admissions MATERNITY 593 total deliveries 19 caesarean sections 47 MDOC ANC VISITS photo Paolo Casagrande 1,405 Doctors with Africa CUAMM has cognitive stimulation and development first antenatal care visits operated in South Omo Zone, in the of children. The intervention includes Southern Nations, Nationalities, and training, capacity building and Peoples’ Region (SNNPR) since 2014. supervision of health professionals and This semi-nomadic rural area has high community health workers. rates of neonatal and infant mortality, Furthermore, rehabilitation of health above the national average, and facilities, supply of medicines, JINKA HOSPITAL strongly related to high rates of consumables and equipment have been malnutrition. Therefore, CUAMM ensured, in particular 8 health centres intervention aims to increase access (2 in Male, 3 in Hamer and 3 in to quality health services for mothers, Dasanech) supported. The support to OUTPATIENTS newborn and children under five, the referral system through ambulance including nutritional services, focusing is guaranteed as well as community 79,846 on two key facilities of the regional awareness raising activities. Moreover, total visits health system: Jinka District Hospital CUAMM team promotes prevention, and Turmi health centre, in Hamer screening and treatment of cervical woreda. Nutritional services are cancer, HIV/AIDS, tuberculosis and INPATIENTS integrated with Early Childhood hepatitis B. Development in order to promote 5,169 total admissions MATERNITY 2,859 total deliveries 500 caesarean sections 545 MDOC treated

Doctors with Africa Ethiopia p. 8 CUAMM GAMBELLA GAMBELLA GENERAL REGION HOSPITAL 2020

OUTPATIENTS 321,100 total visits 78,616 U5 OPD visits INPATIENTS 5,960 total admissions MATERNITY 2,172 total deliveries 218 caesarean sections 38 MDOC treated photo Nicola Berti

Gambella is a remote western region rehabilitation of the maternity ward and ANC VISITS of Ethiopia, right up against the border 7 health centers. with South Sudan. Thousands of 1, 673 refugees poured over the border Furthermore, since August 2017 first antenatal care visits escaping from famine and civil war, Doctors with Africa CUAMM has been increasing the burden on an already operating into Nguenyyiel Refugee fragile health system and hosting Camp, which accommodates 82,826 communities. Moreover, this region persons of concern1. The action is hardly attracts and retains qualified mainly focused on strengthening staff due to its complexities. infrastructures, training health ACTIVITIES personnel and supporting emergency Doctors with Africa CUAMM focuses transport to Gambella regional hospital. IN 3 DISTRICTS on maternal and child health and (Gambella Town, nutrition in three districts of the region Due to the Covid-19 epidemic outbreak, Gambella Rural, Abobo) – Gambella Town, Gambella Rural and an emergency intervention has Abobo – in order to mitigate the started in addition to that already unequal accessibility to health services. underway, providing support also to In particular, Gambella regional hospital Tierkidi and Jewi Refugee Camps. OUTPATIENTS has been supported with the 18,062 U5 OPD visits MATERNITY 1,296 total deliveries ANC VISITS

1 UNHCR Ethiopia, ARRA, Camp Profile Gambella: 2,746 Nguenyyiel Refugee Camp, May 2020. first antenatal care visits p. 9 THE COVID-19 EPIDEMIC: UNDERTAKEN WHAT WE HAVE DONE ACTIONS

PROVISION of personal protective equipment (PPE), such as surgical masks, FFP2 or N95, visors and goggles, disposable gowns and gloves; SUPPLY of materials for disinfection of spaces (liquid soap, floor detergents, sodium hypochlorite, etc.); DEFINITION of a triage path at the entrance, with mandatory hand washing, temperature screening, and clinical evaluation to identify potential infectious patients and possibly send them to predefined areas of isolation; PROCUREMENT At the outbreak of the Covid-19 capacity, trying to ensure the continuity of medical equipment: epidemic, Doctors with Africa CUAMM of essential health services. Among infrared thermometers, pulse took action to cope with the spread of several challenges, CUAMM had to deal oximeters, oxygen the virus, prioritizing the safety of the with the fear of a new disease, along with concentrators, etc.; 23 supported hospitals, health workers the negative impact on the population and communities in the 8 countries of caused by restrictive containment operation. The most urgent need in measures, jeopardizing the access and STRENGTHENING Ethiopia, as in the other contexts, was use of basic health services. of knowledge of health to ensure: In Gambella Region, particularly at personnel on on prevention, • personal protective equipment for Gambella regional hospital, CUAMM diagnosis and treatment of healthcare personnel and cleaners, as guaranteed medical equipment and Covid-19; well as the material necessary for the protective devices’ supply. In July 2020, disinfection of rooms; in collaboration with local authorities, a • essential equipment for diagnosis training for the health personnel was AWARENESS- and clinical management of the organized on how to prevent and patients affected by Covid-19; manage suspected cases of Covid-19. RASING • tents to set up triage areas and Moreover, CUAMM has started an of the communities on the isolation units; emergency intervention to reduce the disease prevention and on • training of personnel for the risk of Covid-19 spread in the refugee the risks associated with the management of suspected cases of camps of Nguenyyiel, Tierkidi and Jewi virus; Covid-19; where the epidemiological risk is really • awareness-raising activities at the high due to the large number of community level by promoting good refugees who live there. An CONTINUITY practices. extraordinary support has been then in the provision provided to the isolation centers set up of essential services, In the Oromia Region and at Wolisso in the same refugee camps and at also thanks to the supply Hospital, CUAMM has contributed to regional level. The intervention focused of medicines’ stocks. the definition of the emergency response on staff training and promotion of good plan by Oromia regional health hygiene, sanitation and nutritional authorities, rescheduling the activities in practices to prevent the main progress. The strategy aimed to communicable diseases. strengthen the emergency response

Doctors with Africa Ethiopia p. 10 CUAMM BEHIND THE NUMBERS: FACES AND STORIES OF REAL PEOPLE

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01 03 05 A mother and her newborn in Gambella Region, Ambulance referral system, A village of the Dassanech community, photo Nicola Berti photo Nicola Berti South Omo Zone, photo Nicola Berti

02 04 06 Community health extension workers, A south sudanese girl at Nguenyyiel A nurse feeding a newborn at Neonatal Ward photo Nicola Berti Refugee Camp in Gambella Region, in Wolisso Hospital, photo Andrea Frazzetta photo Nicola Berti p. 11 Contacts Addis Ababa - Coordination South West Shoa Zone Doctors with Africa CUAMM Office St. Luke Catholic Hospital Headquarter Italy, Padua Sub city Bole Kebele 03/05 t. 00251.113410800 via San Francesco, 126 House nr. 4040 [email protected] 35121 Padova, Italy P.O. Box 12777 Addis Ababa 0039 049 8751279 t. 00251,116612712 [email protected] t. 00251.116620360 f. 00251.116620847 [email protected]

Cover photo A mother with her children in a village in Gambella Region, photo Nicola Berti

Back Women and children during a “coffee ceremony” in a HC in Gambella, photo Nicola Berti