Biweekly health sector operational updates 1-15 December 2020

Ongoing activities, accomplishments, issues and challenges for the reported period and upcoming plans Name of organization (1-15 December 2020) ACF AICS CEFA Chemonics Common Feedback During the month of December, we answered 41 callers (39% were female callers), 90% were refugees, 16%, while returnee and Mechanism (ETS sector) non-displaced made up of 10% combined. Those calls were mostly from the West (96%). Callers were requesting information (83%) about the registration to the health services, needed an emergency medical intervention and Requesting reproductive health services and new-born vaccinations, while beneficiaries calling to provide feedback were 17%. Currently also being used as a national COVID-19 informational hotline, we received calls from 65 callers,25% were female callers, 17% were suspected cases and were advised to contact the nearest emergency centre, the rest (83%) they were asking for information which include the awareness messages, the useful numbers and location of emergency centres and all calls came from the West region. Emergenza Sorrisi Expertise France GIZ Improve functionality of 5 PHC centres (PHCCs) through IMC in Garabulli (Algarabouli Polyclinic) and Janzour (Abduljalil Martyrs PHCC), Nalut (Sidi Khalifa PHCC), Al Bawanis (Tamanhant PHCU), Zintan (Al Kawassim Western PHCC). The intervention was concluded in November – an end line assessment will be conducted in Jan. 2021.

The support to 2 PHCCs in the East (Brega and Ajdabiya) is in preparation. A Health Needs Assessment looked at the overall health needs (phase I) in Brega, Ajdabiya, and Tobruk. In phase II, the functionality and service availability of the PHCCs in Brega and Ajdabiya (identified with ICO as most in need) will be assessed.

GIZ agreed terms with the Health Information Center of the MoH to roll out DHIS2 trainings and IT equipment to PHC and hospital staff of 10 municipalities (Msallata, Al-Shargia, Nalut, Wadi Al Bawanis, Jadu, Hay-Al Andalous, Zliten, Tawergha, Tahuna and Al Jufra). The trainings are planned to begin end of December in Hay-Alandalus.

Support to National COVID-19 Response Plan, a collaborative GIZ Libya Programme COVID-19 response, which is supported by the EU and the German Government. Pillar 2: Risk Communication and Community Engagement - To further strengthen the integration of mental health and psychosocial support (MHPSS) in the COVID-19 response, the project is establishing a network of MHPSS Focal Points among the COVID-19 Coordination Committees from all 16 GIZ partner municipalities* and Tawergha. A one week workshop on the fundamentals of MHPSS, the development of a common understanding and objective of the established network as well as the preparation of actions plans was conducted from 29.11-03.12. - An introductory meeting in was held on 16.12. to introduce and adapt the revised COVID-19 national plan to the municipal level together with the MECs of the 16 partner municipalities* plus Brak and Tawergha. Pillar 3: Surveillance, RRTs and case investigation - Through IMC: Provision of PPE and training RRTs targeting 8 municipalities**are ongoing. Pillar 6: IPC: - Ongoing support to Women Training and Development Centres in production of PPEs Pillar 9: Maintain Essential Services - 5 PHCCs (Al Qassabat PHCC Msallata , Hun and Wadan PHCC in Al Jufra, Western Rawajeh PHCC in Garabulli and Ghadamis PHCC) were selected by MoH to be supported by IMC in the areas of NCDs management, MCH, and mental health services and provision of IHEKs – online trainings will start end of December and procurement of essential medicine and equipment was initiated.

* 16 municipalities: Nalut, Ghadamis, Al Zintan, Jadu, Hay-Alandalus, Garabulli, Msallata, Janzour, Zliten, Misurata, Tarhouna, Al Jufra, Al Bawanis, Al Shargia, Edri El Shati, Al Shweyrif ** 8 municipalities: Nalut, Ghadamis, Al Zintan, Garabulli, Msallata, Janzour, Al Jufra, Wadi Al Bawanis Handicap International Helpcode Within the framework of the EUTF/AICS funded project “Restoring quality health care services in Zawya and Ghat District in Libya” the following activities were implemented: • Training on the Job Medical Team deployed and operating in Ghat district covering Ghat, Tahala and Awainat; • Rehabilitation works at Al Harsha Health Center in Zawya ongoing and almost completed; • Rehabilitation work for the Health Centers in Tahala and Awainat awarded; • Tender for provisioning of medical equipment for Zawya selected health facilities was launched. ICRC IFRC IMC OFDA funded activities: Despite all challenges around the pandemic, IMC maintained the schedule to support 19 PHCC with medical staff and the required medication and equipment. IMC’s mobile medical teams are rotating between those facilities on a fixed schedule to maintain essential services. In the OFDA supported health facilities, IMC medical personnel treated 843 patients in the regular OPD activities. The gender breakdown shows that there were 311 male and 532 female patients in the consultations. Most common morbidities seen during the consultations were hypertension (205 cases), diabetic conditions (162 cases) and upper respiratory tract infections (131 cases). Other patients suffered mostly from gastro-intestinal diseases (79 pat), genito-urinary tract infections (70) and cardiovascular conditions (45). Those common diseases do reflect the overall health conditions in Libya and no specific outbreaks have been observed. In addition to the regular medical consultations, IMC received and followed up 4 male and 15 female patients for mental health conditions. During and/or after medical consultations, IMC distributed 336 dignity kits and 18 hygiene kits to female beneficiaries. IMC, with the involvement of our community health workers, who are part of the mobile medical units, carried out regular health awareness sessions for the patients at the primary health care centers. During the first 2 weeks of December, IMC educated 200 male and 331 female patients on various topics of general health. These awareness sessions are held in groups but still taking the threat of COVID into consideration. This explains why the number of people educated are lower than in the previous months, but still continue uninterrupted. The topics are not only decided by IMC staff but also by wishes of the beneficiaries. The range is from general hygiene to communicable diseases including the current threat of COVID19 related issues. OFDA supported activities in the facilities include a routine screening and triaged for COVID-19. In the first two weeks of December, 845 patients were screened, which included 532 female and 313 male patients. No suspect case was identified during this screening activity, thus no referral for follow-up required. It should be noted that people who have a slight suspicion for COVID19 go to hospital facilities directly and they do not or rarely attend PHCC services.

GIZ funded activities: With the support of GIZ, IMC continued its ongoing assessment of primary healthcare centers in the East. Coordinating with the necessary authorities, IMC’s team of enumerators continued visiting PHCCs to conduct needs assessments covering structural needs as well as gaps in technical capacity at the primary healthcare level. As the assessment comes to a close, IMC’s medical team is busy analyzing the data and drafting the final report to be shared later in 2021.

UNFPA funded programs: The highlight of IMC’s UNFPA program in the first half of December was the second training of healthcare providers on the clinical management of rape that was conducted in Tripoli from 6. – 12. December. 25 medical professionals, including senior management staff have been trained on CMR. The training was done in collaboration with Ministry of Health. IMC also carried out special trainings on HIV/AIDS in pregnant women for doctors and 24 medical staff in Fashloum, Alqadisia and Aljadeed PHCCs. Taking the sensitivity of the subjects into consideration, IMC is proud to have been able to implement these trainings at the primary healthcare level where they are needed most. IMC’s mobile medical units were able to carry out 388 consultations in the UNFPA supported facilities, seeing 308 females and 80 males. As COVID19 is also a main concern in the medical activities, IMC staff screened 814 patients for signs and symptoms in the first two weeks of December. Of these, 358 were male and 456 were female attendees of the medical services. No suspected case was found that required referral. IMC carried out health awareness sessions on various health topics during half of December. 629 people have received health awareness education during their waiting period for the consultations. 349 female and 280 male patients have been reached through these activities. Also of note here is the fact that the sessions were given following COVID19 precautions of distancing and correct mask usage.

EUTF-funded activities under the PEERS project in consortium with CESVI: With the funding of EUTF in collaboration with CESVI, IMC provided medical consultations for 82 patients. Among these were 39 male and 43 female patients. Leading causes of morbidities were hypertension (17 cases), diabetes (14) and upper respiratory tract infections (10 cases). No specific outbreaks or signs for other communicable disease have been found; however, IMC’s team continues to screen patients for TB and triage patients for COVID-19. The 2 supported facilities are located in Central Tripoli (Gharghour PHCC and Al Medina Al Kadima PHCC). In the mental health component of the EUTF/CESVI supported activities, IMC psychiatrist in Misrata saw 6 male patients for consultation and follow up in the first two weeks of December. 412 beneficiaries have been reached through the IMC health awareness activities under this grant. Among them were 143 female and 269 male beneficiaries.

EUTF funded COVID19 response activities: During the first two weeks of December, IMC together with 5 specialist medical doctors, supported the intensive care units of Tripoli Central Hospital and Al-Qadisia as well as Al Medina Al Kadima PHCCs. The COVID19 specific health awareness activities under EUTF funding reached 1617 patients so far in December. 1183 male and 434 female people attended those sessions. 336 patients have been screened and triaged for signs and symptoms of COVID19 in that period. 188 female and 148 male patients were screened and 14 have been identified as suspected cases and referred accordingly. During the 2-weeks reporting period, 76 patients have been for consultation at the ECUTF COVID supported facilities. The main morbidity seen is diabetes (typ II) with 25, 9 cases of hypertension, 8 musculo-skeletal complaints and 8 urinary tract infections. Main morbidities seen in the clinics under this grant were upper respiratory tract infections (265 cases), dermatological conditions (194), musculo-skelatal (184) and gastro-intestinal conditions. No outbreaks were observed in the reporting period. With EUTF funding under this grant, 320 people have been supported with hygiene kits. Among the 168 female and 152 male beneficiaries.

AICS funded activities: During the first week of December, IMC distributed medical equipment and associated materials in the 2 project sites of Janzour Village Hospital and Zuwara Al Marain Hospital. IMC was able to provide disinfectants (hand and surface) for the staff and the facilities to increase their capacity to prevent the spread of COVID-19 within the facilities. For Janzour Village Hospital, IMC provided also a complete upper and lower gastro-intestinal endoscopy set for the department of internal medicine, an echocardiography device for the cardiology department, one CTG for pregnant women, a complete set of surgical instruments for the operation theatre and a steam sterilizer. In addition to the donations of medical equipment, IMC is supporting Zuwara Al Marain Hospital in rehabilitating the medical warehouse and bring it up to a recognized standard. The construction works began on December 1st and are set to finish in February. IOM Primary Health Care Consultations and Referrals

IOM medical teams provided a total of 3,684 primary health care consultations to migrants, IDPs and host community members and referred 27 migrants to secondary and tertiary health facilities for further medical investigation, treatment and management.

1. DCs: IOM medical teams provided primary health care consultations for 596 migrants in detention (551 men and 45 women) in six detention centres: namely, Dahr Aljabal, Tariq Al-Sikka, Abu Issa, Ganfouda, Tokra and Kufra DCs. 14 migrants were referred from these detention centers to the secondary and tertiary hospitals for further clinical management.

2. PHC clinics: Through its support in six primary health care centres (Shouhada Abduljalel PHC, 17 Feb Polyclinic, Wadi Qatara PHC, Zwetina PHC, Alsiraj PHC and Al-Aoeanea PHC), IOM provided 738 primary health care consultations (361 men and 377 women) to the IDPs and host community members, along with supporting the centers with medicines, medical consumables and IEC materials on COVID-19.

3. Medical outreach: IOM mobile teams (Health program and Migrant Resource and Response Mechanism (MRRM) program) are providing primary health care services for migrants, IDPs and host communities in urban settings. Project locations cover Hai Al-Andalus, Ghot Alshaal, Ain Zara, Alsirraj, Souq Aljumaa, Abdulsalam, Janzour, Tajoura, Zwara, Sabha, Qatroun, and Bani Waleed. IOM medical outreach teams reached 2,350 migrants and IDPs (1958 men and 392 women), out of which 13 migrants were referred to the secondary and tertiary health facilities for clinical management.

Fitness to Travel Screening: IOM medical teams provided pre-departure medical screenings for 415 migrants to assess fitness to travel (FTT) under the Voluntary Humanitarian Return and Reintegration (VHR) program.

National Health System Strengthening: IOM donated the necessary medical equipment, medical consumables and medications to three medical hub hospitals in Tripoli (Tripoli Central hospital, Abusaleem hospital and Tripoli University hospital), Nalut COVID- 19 isolation center and Misrata Medical Center to support national health system for maintaining continuity of essential health care services across the continuum of care while managing the COVID-19 response.

COVID-19 response

1. Risk Communication and Community Engagement (RCCE): IOM medical team conducted 45 outreach campaigns and awareness raising sessions in Sebha, , Tripoli and Benghazi. A total of 2,018 migrants improved their awareness and knowledge of the COVID-19 prevention methods and health seeking behaviors when having the suspected symptoms. IOM also provided life-saving hygiene kits including masks, hand sanitizer, gloves and soaps to 200 migrants in Benghazi.

2. Points of Entry (PoEs): IOM Medical teams supported the NCDC staff at Ras Jedir and Wasen PoEs by providing medical check up to all passengers returning to Libya as part of IOM COVID-19 response plan. A total of 37,849 cross-border travelers (32,765 men, 3,116 women, 1,064 boys and 904 girls below 18 years old) were screened by checking temperature and general condition. IOM provided the necessary furniture, PPEs, medical consumables and medications to the National Center for Disease Control (NCDC) to set up health screening stations and isolation units at Mitiga Airport and Ras Jedir PoE.

3. Surveillance, rapid response teams and case investigation: IOM donated necessary PPEs, medical consumables and medications to NCDC to support the national COVID-19 rapid response teams. IOM also conducted two capacity building training on IPC and COVID-19 case management for 26 RRT members of Gharian, Maya and Baniwaleed RRTs.

4. Infection Prevention and Control (IPC) and Case Management: IOM conducted three capacity building training on IPC, COVID- 19 case management and migrant-sensitive health service provision for 29 health care workers from public health facilities in Gharian and Baniwaleed as well as for 9 IOM medical staff. IRC Mobile medical teams: During the period of 1st-15th December 2020, the International Rescue Committee (IRC) has provided over 900 beneficiaries (Migrants, refugees, Internal Displaced People (IDP) and local host communities) with primary healthcare services and conducted about 1,854 consultations in 10 locations. 6 locations in Tripoli and 4 in Misrata.

Tripoli: With support from RDPP, the mobile medical team supporting Elmgarief and Alnosb Altedkari PHCCs have conducted about 308 370 consultation with 12 medical referrals to secondary and tertiary private and public hospitals. We are still following the preventive measures of COVID-19 at the PHCCs.

With support from SIDA, activities at Sikka DC and ALharat PHCC continue with IRC medical team conducting a total of 385 consultations (161 at SIKKA DC and 224 at Alharat PHCC) with 29 medical referrals. There were two main challenges at the DC: Severe shortage of medical supplies, which is not covering a variety of our medical cases or the huge number of beneficiaries at the detention center. An issue of filtration (Triage) as the number of inmates is too high in comparison with the locations.

With support from UNHCR, one IRC medical team in Tripoli operate daily at the CDC in Gurji and have conducted over 275 consultations which include General, Reproductive and Mental health services, along with more than 53 referrals to public and private clinics. In addition to following the Covid-19 prevention protocols, we continue relying on appointments and phone consultations while making exceptions for emergencies. Our team is also helping POCs who are showing symptoms of Covid-19 in their contact with the NCDC and this has been done through our agreement with the LRC. During the period of December 1st to 15th; through the 24/7 hotline, the medical team assisted a total of 24 PoCs (16 females and 8 males) of which 3 assisted with medical referrals.

The IRC mobile medical team continue to support Zawyet Aldhmani PHCC and have conducted over 191 consultations which include General, Reproductive and Mental health services, along with more than 24 referrals to public and private clinics.

Donations: 3 donations were made including PPE materials and equipment: On December 9thand 10th, to Al Dahmani PHCCs. On Dec. 15th, to Elharat PHCC.

Misrata: During the period of 1st – 15th of November the IRC MMT In Misrata with support from UNHCR continued to support beneficiaries in 3 PHCCs (Al Jazeera, AlSkirat and Sidi Mbarak) and LRC shelter with focus on POCs.

A total of 633 consultations were provided to over 190 beneficiaries including primary health care, reproductive health and mental health consultation. About 300 medical referral cases to secondary and tertiary public and private hospitals were also made. Health awareness sessions regarding COVID19 and other common health issues were also conducted.

The IRC continues to host 44 POCs at the Misrata-LRC shelter providing them with essential needs, accommodation, food, and primary and specialized health care and referral of cases as needed, protection, psychological support and they are staying in the shelter under our responsibility waiting to be evacuated. Covid-19 precautions are taken to ensure shelter inhabitants are safe.

Challenges include Covid-19 risk as beneficiary numbers increase due to the IRC’s good reputation of providing PHC services, lifesaving referrals and health awareness sessions.

AICS2 project: During the reported period, the lines of communication channels with MOH managers and the stakeholders have been open with information exchanges regarding trainings medical equipment donation and any updated work plans as well as the minor rehabilitation needs.

Donation of medical equipment and minor enhancement needs: Donation certificate for minor enhancement needs (such as air- conditioning, desktop computers, chairs for waiting room etc.) requested by the health facilities has been prepared. Donation dates are planned for the following: December 16th at Qasr Ahmed polyclinic; December 17th at central dental clinic and central blood bank; December 20th at Almahjoup neuro clinic. The donation process is going to take place in the presence of the local municipality. The medical equipment donations are still in progress.

Training activity and plans: The clinical mentors have completed preparations to conduct training in the second half of December. The invitation letters have been sent to the targeted health facilities regarding the protection and humanitarian principals training which is going to held on the 28th of December and pharmaceutical stock management training which will be held on the 30th and 31st of December. In addition, the mentors are going to conduct infection control training to two health facilities staff on 22nd and 23rd and after meaningful consultation with the heads of infection control department of the targeted facilities about the common mistakes of the health providers. The mentors of the AICS2 have finished preparing full package training material under the protection and humanitarian principal’s title in order to be given to the staff of the targeted facilities after receiving full approval. Online meeting has been conducted with M&E senior officer to discuss the indicators and discuss the upcoming work plan to achieve the targeted indicators.

Internal trainings activity: The AICS2 clinical mentors participated in two day training on the 1st and 2nd of December on Humanitarian and protection principals and GBV mainstreaming .The aim of the training is to have an idea on The Humanitarian Charter, Humanitarian Principles, Protection Principles and Basic Concepts of Gender-Based Violence.

Awareness sessions: The community outreach volunteers (COVs) remained active and have delivered awareness health sessions to targeted communities; session this month were conducted in several settings such as blacksmith workshops, homes, group migrants’ housings, cafes/restaurants, community centers, PHCCs supported by IRC and labor concentration points in different districts around the city, reaching directly 220 beneficiaries (110 males and 110 females).

A total of 27 health education sessions were conducted during the reporting period, which included (but not limited to): non- communicable diseases such as diabetes Miletus and hypertension; COVID-19 awareness prevention and control; personal hygiene and tuberculosis in addition to disseminating information about IRC health services. During the sessions, the IRC ensured preventative measures for COVID-19 like social distancing and wearing masks. In addition, the COVs referred 1 PWD case to Handicap International.

During the reporting period, the COVs continued providing sugar and blood screenings during health sessions to beneficiaries and advised those with high blood sugar and pressure results to visit a physician to start treatment and control their health conditions through constant follow-up visits.

Achievements of awareness sessions: Equal number of beneficiaries reached from both genders. Reaching more beneficiaries through conducting health sessions at PHCCs supported by IRC. The magnitude of the outreach campaign is promising. Measuring blood sugar and pressure during health sessions is encouraging more beneficiaries to attend.

AICS3 project: During the reported period, the assessment phase is nearly completed which is led by M&E department with cooperation with MTLS in Alkhoms and Baniwalid and Misrata. On 1st and 9th of Dec, two official meetings were made with Misrata local council in order to review list of medical equipment and renovation specification for targeted schools in Misrata. On 8th of Dec, an official meeting was held between Alkoms Municipality representative Ms. Mona Hadea and Aiman Shelawh, Alkhoms MTL, regarding progress of AICS3 project in Alkhoms. In Baniwalid, our MTL Dr. Abdulaziz complete specification assessment for garbage car by serial communication with Baniwalid Municipality and Government Sanitation Company in Baniwalid. Capacity building to MoH staff: The clinical mentors in Alkoms and Baniwaild with supervision from MTLS are preparing a training plan for upcoming periods. Project proposal has been reviewed with M&E senior officer to discuss training indicators.

Activities: FGD has been conducted with two groups of PWD at the Social Solidarity Centre in Alkhoms city. Special health needs in addition to the challenges and difficulties in meeting these needs were discussed with 12 people for this community. Security training course (IRC READI Training), provided by Kenneth Kjaer, was held in Misrata Office for three consecutive days (29Nov- 1Dec). Alkhoms team attended in order to raise their knowledge and capacity of security knowledge.

Challenges: Delay in receiving the medical equipment which might adversely reflect on the communication channels with stakeholders however providing a minor rehabilitation needs early in December would be great achievement. Number of the beneficiaries targeted by the awareness campaign might be difficult to be achieved in the current circumstances because of COVID-19 and flu season. Difficulty in reaching male refugees from Syria and Palestine without a male COV. The registration and reception Departments of the selected health facilities lack the necessary IT tools, which are required for upgrading of the HIMS.

Health support system: Under IRC’s EU-funded program, the IRC has prioritized continuity of essential services at the PHCCs in a system building approach including care of patients with NCDs as well as supporting the MoH to address the impact of the COVID-19 pandemic.

Meetings and participations: Participated in the Libyan MoH priority setting activity held in Tripoli. Participated in the Universal Health Coverage celebration day that was organized by the PHC Institute. Participated in the IPC sub-working group meeting

Activities: Activation of the referral system and protocols in the targeted facilities with prioritization of the most vulnerable population. Service utilization data collection for December is in progress and monitored by HMIS mentors. Continued mentoring activities to all pilot PHCCs by our mentors, where they visit the centers, fill in the mentoring checklist and give advice to staff. The mentoring team includes well trained MHPPS, pharmacy, nurse, health promotion and clinical mentors. The targeted pilot sites along with their respective targeted health facilities are as follows: Souq Aljomoaa: (Alharte, Arada, Alheshan) PHCCs; : (Gharyan PHCC, Awlad Ben Yaqup PHCC, Alqwasim PHCC, Abuzayan PHCC); Zlitan: (Alqasaba PHCC, Hay Almoalimeen PHCC, Elzdo Aljanobi PHCC, Algwilat PHCC). The IRC has also sponsored vulnerable referrals from the targeted facilities.

Trainings: In Souq Aljomoaa: In coordination with the Health Information Center (HIC)/ MoH, Health Information System (DHIS2), refresher training was conducted for the targeted facilities for 2 days, where the data entry personnel (8, all are females) were trained. It was a practical training where real health data from the facilities were used, and the output was entering all the data for 2019 To Nov 2020 into the DHIS2 platform.

In Gharyan & Zlitan: Capacity building training for pharmacists on warehouse management and good dispensing practices for 2 days. Number of participants were 18 pharmacists (7 males & 11 females). Coordinating for refresh training for DHIS2 for targeted facilities this week is ongoing. In Zlitan: In coordination with the National Centre for Disease Control (NCDC), RRT training on COVID-19 Infection Prevention and Control (IPC), Case management & Triage system, was conducted for 2 days that targeted 20 participants (18 males & 2 females).

Donations: In Souq Aljomoaa: Distribution of waste management equipment to Bab-Tajoura PHC. Donation of lab supplies to Arada polyclinic and Alharat PHC, which is aimed to ensure the availability of all the essential laboratory investigations. Donation of tablets to Community Health Workers (CHW) to start their proposed health promotion activities. In Gharyan: Donation of CHW tablets for Gharyan PC & Awlad Ben Yaqoup PHC to start their proposed health promotion activities. LPFM LRC MSF France MSF Holland Abu Salim DC: Migrants still being brought in from Disembarkation points. Food situation improved after a catering company started delivering meals to the DC. 101 medical consultations were performed and 145 participants from the migrants attended our MH sessions in the DC during the reporting period.

Shara Al zawiya DC: More women and children were brought to the DC from Disembarkation points. 107 medical consultations and 255 MH consultations were done.

COVID-19 cases testing positive rate is declining in the triage sites (maybe due to masking effect by tests done for travelers), some even traveling from a far to be attended to in Tripoli. Continuation to conduct psychosocial education at Dahmani triage area and ensuring proper hand hygiene and general IPC measures are properly in place during our presence in the polyclinic. The MSF activity in polyclinic increased and the number of clients reaches more than 70 clients each day during our working hours in the polyclinic due to the increase of visitors from the community. The numbers of clients (individual/ groups) in the reporting period has reached 2083 beneficiaries. We plan to increase our activities in Covid19 HP, Psychosocial support and raising awareness to Tripoli University Hospital triage unit

TB activities (Abusetta Hospital): Activities still continue in the facilities, increase in the number new TB cases, 11 new admissions (sputum positives) diagnosis and may be a result of contact tracing. DR-TB treatment still not initiated for RR- positive cases no possibility to send samples for baseline cultures. Renovation process in Abusetta Hospital is still ongoing. The main building is still empty. The work by MSF-H on the AFB laboratory is almost done. Bacteriological Laboratory for AFB tests is still not available in hospital, and samples are sent to NCDC. Abusetta OPD remains closed due to Covid19 suspected cases showing up in the OPD. MH support to Abusetta hospital and NTP (Patients, contacts and caretakers) is continues with 50 beneficiaries participating in sessions during the reporting period. MSF still support by providing investigations through private labs.

Challenges: construction work on the TB MDR Unit from MoH has stopped for the last 12 weeks.

NCDC/NTP: Number of patient consultations in NTP 108 patients reviewed during the reporting month. MSF MDs and nurses support NTP MDs and nurses in the patients’ management. MSF MH continue to conduct psychosocial sessions for patients in NTP with 59 individual sessions done during the reporting period. MSF – Holland managed to diagnose & organize 2 MDR TB patients handover process from NTP to OCP. Patients are in Misrata OCP Unit for MDR TB treatment.

Challenges: No Approved TB Guidelines yet, this has been a very slow process! 2nd line TB drugs are not available. No admission facility for MDR-TB patients in Tripoli.

Referrals from community: Many calls from community especially during the weekends looking for assistance from MSF and 38 cases were referred to Rayan clinic from both DCs and Community PUI TdH With funding from the CERF-Health project “Supporting health institutions and communities respond to COVID-19 in Aljabal Algharbi, Azzawya, Misurata, and Tripoli” the procurement of medical supplies and equipment, training, and other activities were completed as of December 15th, 2020.

6 Training packages have been prepared after site consultations, and to date, six training packages have been delivered in October 2020, November 2020 and December 2020: • COVID-19 Basics • Infection Prevention Control • PSS Risks to Health and Safety • Arterial Blood Gas Interpretation and Acid Base Disorders • Collection, Storage, and Transportation of Specimens for COVID-19 Diagnosis • PPE for Suspected and Confirmed Cases of COVID-19

To date, training has reached ten of the fifteen health sites which will be supplied under the CERF project in Aljabal Algharbi, Tripoli and Misurata. Training packages have been delivered in-person and via remote Zoom presentations to staff from the following sites: • Tawergha General Hospital • National Cancer Institute • Early Detection Center • Misurata Hospital for Tuberculosis and Chest Disease • General Hospital of Zintan • Zintan Isolation Center • Gharyan Rapid Response Centre • Rejban Rapid Response Centre • Tripoli Children’s Hospital • Tripoli University Hospital

Further analysis of training results is still underway, and static online resources will be finalized and published by end of the month. Sites not yet reached will continue to be engaged, but alternative delivery mechanisms are being prepared.

RCCE activities will soon launch in the second half of December 2020. The strategy planned will include social media posts and promoted ads, distribution of printed materials, possible television/radio spots, and in-person sessions with students and caregivers returning to school, community groups, etc. TdH-It is planning to integrate these RCCE activities with hygiene promotion activities in schools starting in January 2021. The World Bank UNDP UNFPA Through its partners IMC and LRC, UNFPA continued supporting the provision of essential reproductive health services in Tripoli, Sabha and Ghat. Mobile medical units assisted 668 women, 148 children and 78 men, and ensured the safe delivery of 15 newborns targeting migrants and host communities. The community health workers reached 759 individuals with awareness sessions on COVID-19 & pregnancy/reproductive health and conducted seven MHPSS consultations. Also assisted the triage of 986 cases according to NCDC guidelines. UNFPA also conducted training sessions on PNC, Phlebotomy, and STDs, reaching 28 health care providers in Tripoli & Sebha.

UNFPA launched leadership, management and governance ToT training 15th - 21 Dec in Turkey. The program is components of advanced midwifery and specialized nursing projects to uplift the status of M&N in Libya targeted 18 midwives from Tripoli, Misrata and Sebha to furthermore cascaded to train midwives and nurses across Libya. UNHCR UNICEF Missions and meetings: Continued to participate in the national COVID-19 preparedness and response steering committee and Ministry of health meetings to provide technical assistance for the introduction of COVID19 vaccine; Continued to co-lead the Risk Communication and Community Engagement Working Group; Continued to participate in the presidential COVID-19 scientific advisory committee meetings when requested.

COVID-19 Risk Communication and Community Engagement: (Emergency response): UNICEF further delivered 10,000 vaccination cards that incorporate COVID-19 precautionary and awareness messages and will address the shortage of the cards which directly affect the continuity and consistency of the vaccination of the children. During the reporting period, UNICEF in partnership with the National Centre for Disease Control – School Health Department, produced 25,000 colouring books under the theme ‘Our Safety in Our protection’ that incorporate COVID-19 messages. The colouring books to be distributed in schools and Temporary shelters. As part of the RCCE, UNICEF submitted 40,000 vaccination cards to the National Centre of Disease Control. The cards incorporate COVID-19 precautionary and awareness messages. UNICEF is currently producing further 10,000 cards to address the shortage of the cards which directly affect the continuity and consistency of the vaccination of the children. The cards are kept by the beneficiaries’ care givers and parents for two years until the children complete their required vaccines.

Emergency response: UNICEF’s H&N team is closely monitoring the COVID-19 impacts and responded by aligning the EUTF and other MCH projects to support the targeted municipalities to ensure the availability of essential PHC and emergency services.

PHC services support: As a follow up for the per the integrated Maternal and Child Health, immunization and nutrition package that have been dispatched for 34 health facilities across the country, we continued doing monitoring visits. As part of the EUTF and USAID projects, IYCF training has been conducted targeting 14 master trainers from 13 PHCC and Municipalities. EPI support: The cold chain inventory is ongoing, as of Dec 15th, the inventory has completed 93% of vaccination centers nationwide.

Nutrition: UNICEF’s partner, EMDAD, continue to distribute Emergency Food Rations (BP-5) at DCs.

Health Information System (HIS): Two DHIS2 trainings have been completed in Al Khoms Municipality for the second group targeting 22 participants from 22 health facilities and Algraboili Municipality targeting 23 participants from 23 health facilities.

Medical supplies and equipment: UNICEF distributed the second batch of PPEs (115,600 Face masks and 17,040 bottles of hand sanitizers). This support targets 213 vaccination centers in 27 municipalities Eastern region which is sufficient to cover the needs of vaccinators in these vaccination sites for 3 to 4 months. Voluntas Policy Advisory WeWorld-GVC Southern Libya: As stated in previous reports, WW-GVC is implementing an integrated Health (funded by AICS), WASH (funded by CERF) and protection (funded by SDC) response to COVID-19 in Sebha, in close collaboration with its local partner, MIGRACE. As the ongoing projects continue, over the past two weeks: - The contractor for the rehabilitation of seven healthcare facilities has been selected. A new timeline for the rehabilitation in the healthcare facilities has been set, thus the works will start in late December and will last one month. - A survey to test the knowledge of the schools and healthcare facilities staff on COVID-19, handwashing and disinfection procedures has been undertaken. - Training materials concerning the abovementioned topics has been finalized, as well as the planning of the training for the Hygiene Promoters. The training will start before the end of the year. IPC will not be part of the initial sessions of the training since during the last IPC working group, it has been stated that the Libyan MoH and NCDC will provide a clear common guideline on IPC training. - PPE procurement procedures reached the final phase. Regular provision of PPE for HPC workers will start before the end of the year.

Western Libya: As part of a broader intervention funded by EUTF North Africa/AICS and implemented in consortium with other INGO (IRC lead applicant, PUI, ACTED), WW-GVC intervention will focus on Al Maya, Al Mamoura, Sabratha, Sorman Municipalities, targeting seven healthcare facilities for rehabilitation and equipment/medical supplies distribution. At the beginning of December, the kick-off meeting with the Sabratha Municipality was carried out, with the aim of introducing the parties for the implementation of the planned interventions. Based on a first field assessment in coordination with the Municipalities, targeted healthcare facilities in Al Maya have been changed: Northern Maya Medical Center and Al Twebya Health Care Center, previously selected, are already part of a strategic reconstruction plan defined by Al Maya Municipality and the Libyan Administrative Center of Development. Therefore, these facilities have been replaced by Al Mukhatat Medical Center and Tina Medical Center. As regards the other areas of intervention, here is the list of the targeted facilities: Al Mamoura Village Hospital in Al Maamoura; Makhlouf Primary Health Care Center in Sorman; Tweela Southern Medical Center, the Emergency Unit, and the Cardiac Center in Sabratha. WHO See separate report