Rapid Assessment of Factors for Access to Malaria Prevention and Control Interventions Among Migrant Workers in Seven Regional States of Ethiopia

RAPID ASSESSMENT OF FACTORS FOR ACCESS TO MALARIA PREVENTION AND CONTROL INTERVENTIONS AMONG MIGRANT WORKERS IN SEVEN REGIONAL STATES OF ETHIOPIA

Private Health Sector Project

The Private Health Sector Project is a technical assistance project to support the Government of Ethiopia. The Private Health Sector Project is managed by Abt Associates Inc. and is funded by the United States Agency for International Development (USAID), under Contract No. AID-663-LA-16-00001

Recommended Citation: Rapid Assessment of Factors for Access to Malaria Prevention & Control Interventions Among Migrant Workers in Seven Regional States of Ethiopia, April 2017, Ethiopia. Bethesda, MD: Private Health Sector Health Program, Abt Associates Inc.

Submitted to: Dr. Mesfin Tilaye: Agreement Officer’s Representative, Health Network Program Advisor USAID| Ethiopia Addis Ababa, Ethiopia

Submitted by: Dr. Mesfin Teferi, Chief of Party USAID| Private Health Sector Project

RAPID ASSESSMENT OF FACTORS FOR ACCESS TO MALARIA PREVENTION & CONTROL INTERVENTIONS AMONG MIGRANT WORKERS IN SEVEN

REGIONAL STATES OF ETHIOPIA

DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government

CONTENTS

Acronyms and Abbreviations ...... iii Acknowledgments ...... v Abstract ...... 1 1. Introduction ...... 3 2. Study Background ...... 5 3. Objectives...... 7 3.1 General Objective ...... 7 3.1.1 Specific Objectives ...... 7 4. Methodology ...... 9 4.1 Study Design ...... 9 4.2 Study Area and Period ...... 9 4.3 Study Population ...... 9 4.4 Sampling and Sample Size ...... 10 4.5 Data Collection Tools ...... 11 4.6 Data Quality ...... 11 4.7 Data Processing and Analysis ...... 11 4.8 Operational Definition ...... 12 4.9 Ethical Considerations ...... 12 5. Results ...... 13 6. Recommendations...... 29 7. Concluson ...... 31 Annex A: Information Sheet ...... 29 Annex B: የየየየ የየየየ ...... 37 Annex C: Bibliography ...... 57

i List of Tables

Table 1: Malaria Incidence Per 1000,000 Population At Risk in 2016 (FMOH 2015/16) ...... 9 Table 2: Number of Organizations and Their Respondents, and Key Informants by Region, Zone and Wereda, September 2016...... 10 Table 3: Summary of Themes and Subthemes in Reporting the Findings of the Study ...... 13 Table 4: Still needs Title ...... 16 Table 5: Size of Migrant Workers by Sex Employed in the Different Types of Business Categories in Seven Regions in Ethiopia, October 2016 ...... 16 Table 6: Size of Permanent and Long Term Employement in Seven Regional States of Ethiopia, October 2016 ...... 17 Table 7: Mapping of Seasonal Migrant Workers by Destination and Origins in Seven Regional States of Ethiopia, October 2016...... 50 Table 8: Personnnel Assigned to Collect Data ...... 55

List of Figures

Figure 1: Number of Major Business Categories Which Employ Migrant and Mobile Workers in Ethiopia, October 2016 ...... 14 Figure 2: Size of Migrant Workers by Destination Weredas, October 2016...... 15

ACRONYMS AND ABBREVIATIONS

ACT Artemisinin Combined Therapy ANRS Amhara National Regional State ARS Afar Regional State BGNRS Benishangul Gumuz National Regional State CQI Continuous Quality Improvement FMOH Federal Ministry of Health IOM International Organization for Migration IRS Indoor Residual Spray ITN Insecticide Treated Nets LLIN Long Lasting Insecticide Treated Nets MOP Malaria Operational Plan ONRS Oromia National Regional State PFSA Pharmaceutical Fund and Supply Agency Pf Plasmodium falciparum PMI President’s Malaria Initiative PPM Public Private Mix Pv Plasmodium vivax RDT Rapid Diagnostic Tests RHB Regional Health Bureau SNNP Southern Nations Nationalities and Peoples SNNPRS Southern Nation Nationalities and peoples Regional State THO Town Health Office TNRS Tigray National Regional State USAID United States Agency for International Development WHO World Health Organization

iii

ACKNOWLEDGMENTS

We would like to express our sincere gratitude to Afar, Amhara, Benishangul Gumuz, Gambella, Oromia, Southern Nations, Nationalities and People (SNNP) and Tigray Regional States Health Bureaus for their endorsement of this formative assessment. We are also thankful to all the respondents for their invaluable time and sharing us their opinions.

ABSTRACT

Background: Mobile or migrant workers are at a higher risk of acquiring malaria infection, and can be the primary source of reintroduction of the disease in unstable transmission areas. The aim of this formative assessment is to describe access to malaria prevention and control services among migrant and mobile workers in seven regional states of Ethiopia. Methods: A prospective cross-sectional, exploratory and descriptive study was conducted from August 11 through October 12 2016. Interviewer-administered questionnaires, semi structured key informant in-depth interviews, and content analysis was used to gather the information to describe access to malaria prevention and control interventions among seasonal migrant workers. The qualitative data were analyzed through four themes and thirteen subthemes. Results: The study included 58 organizations that employ seasonal migrant workers and 23 key informants. In addition, secondary data were collected from sector offices including departments for Agriculture, Mining, and Investment in the study regions. The results show that there are about one million seasonal migrant and mobile workers working for different business categories which include large scale crop cultivating farms (sesame, sorghum, ground nuts, and soy beans), sugar cane plantations, horticulture, road and house construction works, and gold mining and panning. Both bidirectional and circular movement of migrant workers was documented. Seasonal workers employed in sugar plantations, horticulture, and floriculture crop production move from their origin to current employers’ locations for longer periods of time (October through June). While seasonal migrant workers who were employed in crop cultivation (sesame, soya bean, sorghum, maize, groundnut, etc.) move to and from their origin and destination locations for a shorter periods (June through November) but their movement is circular and during the high transmission season. Moreover, these workers frequently change employers within destination woredas. Housing facilities vary based on employment relationship. Relatively well-structured houses are constructed for permanent and long-term staff. Unfortunately, the housing structure for seasonal migrant workers is poor and over-crowded, making the risk of acquiring malaria high. Seasonal migrant workers spend the whole night in the field when employment includes watering farm lands, harvesting sesame, and transporting sugar cane from the field to factories. Moreover, the routine malaria prevention and control activities do not target these seasonal migrant workers. Government-owned large scale farms and construction sites offer basic health services to all seasonal migrant workers. Unfortunately, the majority of migrant workers who are employed with private farms are not offered basic health services and seek care from public health facilities such as health centers and health posts, as well as private health facilities. Some of the efforts made by the regional state health bureaus to improve healthcare for the workers include organizing test and treat campaigns, deploying seasonal health workers in these woredas, and assigning additional health extension workers. While the risks of acquiring malaria among seasonal migrant workers are found to be very high, malaria prevention and control interventions in place are sub-optimal. Therefore, it is recommended that the national malaria control program together with all stakeholders develop and implement a comprehensive strategy to address malaria control and prevention among migrant workers.

1. INTRODUCTION

According to International Organization for Migration (IOM 2004:41), migration is defined as a “process of moving, either across international border or within a state”. It encompasses any movement of people, whatever its length, composition and causes. It includes migration of refugees, displaced people, uprooted people and economic migrants. Despite the gains in reducing malaria-related morbidity and mortality globally, special vulnerable groups including ethnic minorities, mobile and migrant workers are at a high risk of acquiring malaria. The high risk could be due to several factors. Evidence shows that in many malaria endemic regions, mobile and migrant workers are suffering disproportionally from the burden of malaria (President’s Malaria Initiative [PMI] 2015 - 2020:17). In addition, migrant and mobile workers are not targeted by national malaria prevention and control programs. In the era of malaria elimination, the World Health Organization (WHO 2015) recommends package of core interventions to prevent infection and reduce morbidity and mortality which includes: vector control, chemoprevention, diagnostic testing, and treatment. The WHO outlines three pillars. The first pillar is about ensuring universal access to malaria prevention, diagnosis, and treatment. The second pillar is to accelerate efforts towards elimination of malaria and attainment of malaria–free status. The third pillar is to integrate malaria surveillance into core interventions. Studies conducted in Great Mekong sub-region in Asia and in sub-Saharan African countries have demonstrated a link between travel related factors, population dynamics, work patterns and higher malaria transmission (Hlaing, et al 2015; Yukich et al 2013, Alemu et al. 2014 & Schicker et al., 2015; WHO 2015: 76). In addition, PMI has recognized that older boys and men in Ethiopia may be at a special risk for malaria from occupational and travel-related factors such as engaging in in seasonal migrant farm work. (PMI Malaria Operational Plan [MOP] 2016). The United States Agency for International Development (USAID) and the President’s Malaria Initiative (PMI) funded Private Health Sector Project aims to contribute to the national malaria prevention and control program by establishing an effective Public Private Mix (PPM) partnership approach for malaria case management. The project is implemented under the stewardship of Regional Health Bureaus, and targeted at the formal private health sector, which consists of private for-profit, private not-for- profit and work place facilities to improve access to standard malaria care service. Considering the emerging data that men and older boys are at increased risk for malaria transmission because of their engagement in seasonal farm works in the low land parts of the country where malaria transmission is very high, USAID|PMI has the interest to know more on the availability of malaria prevention and control interventions in the parts of Ethiopia where migrant workers are heavily deployed. Therefore, this formative assessment seeks to better understand the size of the migrant work force and access to malaria prevention and control interventions among migrant and/or mobile workers in order to design proper health care delivery modalities.

2. STUDY BACKGROUND

Ethiopia achieved significant reductions in malaria morbidity and mortality over the past decade. Aregawi, Lynch, Bekele, Kebede, Jima et al. (2014) affirm the decline of confirmed malaria cases among all age groups by 66.0% (95% CI: 44–79%) compared to the level predicted by pre-intervention trends. This breakpoint of trend lines was attributed to the implementation of well-coordinated and effective national malaria prevention and control interventions. However, in Metema and West Armacho Woreda of North Gondar zone, vulnerable mobile and migrant workers still run a higher risk compared to the general population who resides in malaria endemic areas (Schicker et al. 2015). Wai et al (2014:1) assert that one fifth of (19.6%) migrant workers were working from dusk to dawn in Myanmar. In Ethiopia, Yukich et al. (2013), Alemu et al. (2014) and Schicker et al., (2015) revealed that there is a history of travel from highland fringe places to malaria endemic areas, and found that older boy and men migrant workerswere at a higher risk of acquiring malaria. Moreover, migrant workers were a potential risk for reintroduction or resurgence of malaria in once controlled unstable malaria transmission areas. In Ethiopia, private entrepreneurs and government implement big development projects in agriculture, mining, construction, and energy in low lands and malaria endemic parts of the country. These projects demand the mobilization of hundreds of workers from the country’s highlands. This mobile workforce is susceptible to malaria, and contributes to the resurgence of outbreaks of malaria when workers return to their permanent residence areas. The magnitude and distribution of this workforce and workers’ living situations, working conditions and access to malaria and prevention interventions in their workplaces are not well known. The PMI-funded Private Health Sector Project wants to fill information gaps and describe modalities to address the malaria-related health care needs of the migrant and/or mobile workers. The aim of this formative assessment is to explore malaria-related situation of migrant and/or mobile workers in seven regional states of Ethiopia.

3. OBJECTIVES

3.1 General Objective The general objective of this study was to assess access to malaria prevention and control interventions among migrant and/or mobile workers in seven administrative regions in Ethiopia.

3.1.1 Specific Objectives The specific objectives of this study were:  To map and characterize the workplaces where the migrant and mobile workforce is deployed  To estimate the size of the migrant and mobile workforce  To characterize the workforce by those employed in seasonal versus perennial workplaces  To assess the availability of, and access to, malaria prevention and control services in the workplaces of migrant and mobile workers  To assess the availability of health facilities with the capacity to diagnosis and treat malaria in or around workplaces of migrant and mobile workers  To identify gaps in access to malaria treatment and health care for migrant workers in their workplaces

4. METHODOLOGY

4.1 Study Design This cross-sectional, exploratory and descriptive study was conducted using mixed methods. Quantitative data was collected through interviewer-administered questionnaires and data abstraction forms, and qualitative data was collected through key informant in-depth interviews. 4.2 Study Area and Period This formative assessment was conducted in seven regional states of Ethiopia, including Afar, Amhara, Benishangul Gumuz, Gambella, Oromia, Southern Nation Nationalities and Peoples (SNNP), and Tigray Regions. According to the Annual Performance Report of FMOH (2016), the malaria incidence per 100,000 populations for 2016 ranges from 900 in Oromia to 30,431 in Benishangul Gumuz region (Table 1). This study was conducted from 22nd August through 12th October 2016. Table 1: Malaria Incidence Per 1000,000 Population At Risk in 2016 (FMOH 2015/16)

Cases Population Region Incidence per 100,000 at at risk Number Percent risk population Afar 1,863,902 81,619 3.6% 4,379 Amhara 15,790,154 583,988 25.5% 3,698 Benishangul Gumuz 815,589 248,192 10.8% 30,431 Gambella 419,955 76,800 3.3% 18,288 Oromia 23,161,304 208,542 9.1% 900 SNNP 12,238,426 713,532 31.1% 5,830 Tigray 3,763,267 252,173 11.0% 6701 National* 61,429,786 2,294,568 100% 3,753 NB: *: the difference 5,633,939 at risk population is live in Somali, Hareri, Dire Dawa and Addis Ababa; 129, 722(5.6%) of cases also reported form these regions.

4.3 Study Population The study population for this study was comprised of sector offices (Health, Agriculture, Labor and Social Affaire, Investment, etc.) in regional states, woredas (districts) that attract migrant and/or mobile workers, and employer organizations. Furthermore, the study targeted mobile/migrant workers with four different economic livelihoods large scale farms of crop cultivation (i.e. horticulture, floriculture, cotton, sesames, groundnut, soy bean, maize and sorghum farms), sugar plantations, gold panning or mining, and construction sites. Those interviewed for this study included experts of regional states, woreda health offices, migrant workers and managers/supervisors of employing organizations.

9 4.4 Sampling and Sample Size A purposive sampling method was employed. First, all seven administrative regions where the Private Health Sector Project targets malaria interventions were included in the rapid assessment. Then, a line list of woredas and workplaces which attract migrant workers was developed. From this list, key informants were selected in consultation with experts of regional states’ health bureaus and managers of selected organizations. Both quantitative and qualitative data were collected from employer organizations, service providers and the public sector. Table 2: Number of Organizations and Their Respondents, and Key Informants by Region, Zone and Wereda, September 2016

No. No. No. Key Ser. Region Zone Woreda Employing espondents informants no. Organization (M/F) (M/F) Zone 1 1 1 1/0 3/0 1 Afar Zone 3 2 2 2/0 Awi 2 2 2/0 2/0 2 Amhara West Gojam 1 1 1/0 3 Bemishangul Gumuz Metekel, & Assossa 1 2 2/0 6/0 Zone 1 1 2 2/0 2/0 4 Gambella Zone 2 2 2 2/0 East shoa 6 18 11/7 6/1 Horo Gudrun 1 1 1/0 Arsi 2 2 1/1 5 Oromia Jimma 1 1 1/0 Guji 1 1 1/0 Finifine Zuria 1 1 0/1 East Wollega 1 1 1/0 Dawuro 1 1 1/0 1/0 Gamo Gofa 3 4 4/0 6 SNNP South Omo 4 11 10/1 Bench Mahi 1 2 2/0 7 Tigray Western 2 3 3/0 2/0 Total 7 19 34 58 48/10 22/1

Qualitative data were collected from 23 key informants (six experts from RHBs, three Public Health Emergency Management (PHEM) core process owners at zone health departments, and 14 health team leaders found in seasonal migrant worker employing organizations). Qualitative data were collected until the point of saturation, which was judged by redundancy of information. Table 2 shows the sampled regions disaggregated by zone, woreda and number of respondents. The study was conducted in seven regional states, 19 zones, 34 woredas and in 58 organizations. Furthermore, we collected secondary data on the size of migrant workers and list of employers by woreda from the Investment, agriculture, Labor, and Social Affair bureaus.

Key Informants and Questionnaire Respondents:  Regional experts (Health Bureau, Agriculture Bureau, Labor and Social Affair Bureau, Investment Bureau)  District experts (Health Bureau, Agriculture Bureau, Labor and Social Affair Bureau, Investment Bureau)  Managers or supervisors (Private farms, constriction sites, gold mining and panning etc.) 4.5 Data Collection Tools Data were collected using tools that were developed based on the objectives of the study. The following tools were developed:  Inventory tool: This tool was adminstreted to the departments of Agricalutre, Investment, Labor and Social Affairs, and Health in the study regions to capture the organizations or companies in the regions which employ migrant and mobile workers and their area of operation. This step helped to locate the companies and migrant workers in the region.  A semi-structured questionnaire which was administered to the managers and supervisors of the migrant workers. This questionnaire captured data on the type of business, size of land, size of migant worker and permant worker populations, duration of stay and mobility patterns of the workers, housing conditions, and access to malaria care and prevention services.  An in-depth interview guide was developed and administered to key informants in the Regional Health Bureaus and Woreda Health Offices to assess the burden of malaria in the region, and how the regions and woredas are handling malaria prevention and control for migrant workers. 4.6 Data Quality Data collectors were oriented on the protocol and tools. The questionnaires were pre-tested in Fifine Zuria Zone of Oromia Region, and amended based on the findings of the pilot test. Completed questionnaires, and document reviews were assessed for accuracy on a daily basis. Completed questionnaires were cleaned and entered into computer software by the principal investigator.

4.7 Data Processing and Analysis All data were checked for completeness, cleaned manually, and were entered into computer using Microsoft Office Excel 2010 (Microsoft Corporation, Redmond, Washington, USA 2010). Descriptive analysis was made using frequencies, tables, and graphs. Moreover, epidemiological and geo-spatial analysis based on information about destination and origin regions and zones was conducted using ArcGIS 10.1. The qualitative data were transcribed and translated into English. Following this, transcripts were coded manually and collated into sub-themes. Then, thematic analysis was conducted, based on a conceptual framework of information uses in coordination of care (Gardner et al 204). This conceptual framework categorizes relationships into Micro, Meso, and Macro levels of coordination of care. These three categories were used to guide analysis of qualitative data. The data were also interpreted by triangulation using information obtained from quantitative data and observations. Finally, content analysis of the selected thematic areas was made.

11 4.8 Operational Definition According to Win (2015), mobility dynamics of migrants are divided into two categories:  Bi-directional movements, i.e. to and from the place of origin and current work site; for this study, the bi-direcdtional movement is the movement of migrant workers from their origin to their employers and return to their home district within a year.  Circular movements, i.e. moving from one place to another, in particular seasonal movements depending on the presence or absence of job opportunities. For this study, we defined circular movement as the movements of migrant workers from their origin to current employers, as well as changing employers within or outside of their destination district, and finally their return home within a year. 4.9 Ethical Considerations The protocol of this study was submitted to all seven regional state Health Bureau Research and Technology Transfer Core Processes for ethical clearance. Written permissions were obtained from all seven Regional States Health Bureaus. Managers were also informed about the purpose of the formative assessment and its future contributions in designing effective and efficient interventions. Data collectors were trained in methods of data collection and ethical principles. All the respondents were read the information about the purpose of the study and then requested to give verbal consent to respond to the questions and to voice record from the key informants.

5. RESULTS

The study investigated the malaria situation among seasonal migrant workers in seven regional states, 19 zones, 38 woredas and 58 workplaces in Ethiopia. Nine human resource managers, 14 farm managers or supervisors and 35 health team leaders provided the data from the organizations. The mean age of the interviewee was 37.7 (± SD 10.6) years. There were 23 key informants, of which 10 were experts of RHBs, and 13 were head of health departments. The study assessed large scale government-owned farms and projects, large scale private farms, gold mining and panning associations and construction sites. The results and discussion of this study are presented under four themes and thirteen subthemes (Table 3). Table 3: Summary of Themes and Subthemes in Reporting the Findings of the Study

Category Themes Subthemes (a) Mapping Characteristics of workplaces and I Micro (b) Size of migrant workers migrant workers (c) Dynamics of seasonal migrant workers Settlements Risk of acquiring malaria Access to malaria prevention and 2 Micro Packages of malaria related services control services Access to long-lasting insecticide treated bed nets Access to Indoor Residual Spraying

(a) Availability of public health care services Access to curative health services 3 Meso (b) Availability of private health care services (c) Technical and financial support Challenges of health care services 4 Macro Gaps and proposed solutions Proposed interventions

Theme 1: Characteristics of Workplace and Seasonal Migrant Workers All seven regional states have employment opportunities for migrant seasonal workers. The most common business categories which attract migrant workers were: crop cultivation, sugar-cane plantation, floriculture and horticulture production, construction, and gold mining and panning. Out of the 58 employing organizations assessed, 28 were engaged in large-scale farming, followed by 12 sugar development projects. The third largest employer business category was floriculture or horticulture farms (Figure 1).

13 Figure 1: Number of Major Business Categories Which Employ Migrant and Mobile Workers in Ethiopia, October 2016

1 7 Crops cultivation (cotton, sesame,coffee, spices, maize, sorghum, soya bean, cattles rearing, Poltury, processing etc) Sugar cane plantations and factories 10 28 Floriculture and horticulture

Gold mining and panning

12 Construction (dam, water cannal, housing)

The place of origin and destination of seasonal migrant workers is presented below. According to the data collected from Benishangul Gumuz Regional State Agriculture Bureau, there are over 211 officially registered large scale farm owners. The maximum leased land by a single employer organization is 50,000 hectares by S and P biofuel Solution and the minimum is 10 hectares. These 211 organizations leased 166,036 hectares of land. In 2016, close to half (72,894.54 hectares) of the leased land has been developed. Gambella region has leased 236,652 hectares land. The maximum size of land leased per organization is 100,000 hectars and the minimum was 40 hectars. In Tigray region an estimated 129,788 hectares of land was leased for agricultural development. Subtheme 1a: Mapping This section presents the destination of seasonal migrant workers in each of seven regions. Detailed characteristics of employing organizations by region and zone with suggested location of (origin) or home woredas of seasonal migrants are presented in Annex table 13.  In Afar region, of the five zones and 30 woredas, the study documented destinations of migrant workers in two zones (Zone 1 and Zone 3), and seven woredas, namely Assayita, Dubti, Afambo, Dulecha, Fentale, Amibar and Gewane.  In Amhara region, of the 11 zones and 167 woredas, the study revealed presence of business entities in four zones (Awi, East Gojjma, North Gondar, West Gojjam). In these zones, thirteen woredas, namely Ankesha, Jawi, Baso, Debere Elias, Gozamen, Machakel, Metema, Quara, West Armachiho, Tegede, Tach Armachiho, Bure, and Wemberma) were identified. According to the report of the Labor and Social Affair Bureau, there were over 653 employers in ten woredas.  In Benishangul Gumuz region, business entities which attract migrant workers were found in all the three zones and one special woreda. The ten woredas with business entitities are Bamasi, Yoso, Belo, Guba, Dangur, Bulen, Pawe, Oda godere, Mao Komo, Menge). According to Benidshagul Gumuz Bureau of Agriculture Development Bureau, there are over 211 officially registered employing organizations in the region.

 In Gambella region, of the three zones and thirteen woredas, the study docuemtned the presence of large scale farms and gold panning in two zones (zone 1 and zone 2). There are six woredas which have employment opportunities for migrant workers: Itang, Godere, Dimma, Abobo, Gog, and Mengashi.  In Oromia region, of the 18 zones and 346 woredas, there are seven zones which have the potential for attracting migrant workers (East Shoa, Horo Gururun Wellega, East Wellega, Arsi, Jima, Guji, and Finfine Zuria). In these zones, there were fifteen woredas with business entities for seasonal migrant workers.  In SNNP region, of the 22 administrative zones or special woedas and 133 woredas, there are four zones that have sites that attract migrant workers. These zones include Dawro, South Omo, Gamo Gofa and Bench Maji. In these zones, 18 woredas with business entities were identified.  In Tigray region, of the seven zones and 52 woredas, there are two zones (North Western and Western Zone) that have employment opportunities for migrant workers, and four woredas were identified to have business entities. Kaftahumera and Wolkayit employ seasonal migrant workers for crop cultivation. According to records of the Tigray Investment Bureau, there are over 1112 employing organizations in the region. In addition, three woredas, Atsegedetsimbila, Laelay Adiyabo, and Tahtay Adiyabo, have gold mining and panning opportunities for over 570 associations with 5291 members. Subtheme 1b: Size of Migrant Worker Population This study showed that there were one million seasonal migrant workers across seven regional states of Ethiopia. Slightly less than half (434,241) of seasonal migrant workers were employed in ten woredas of Amhara Region, while 291,349 seasonal migrant workers were employed in three woredas of Tigray Region (Figure 2). Figure 2: Size of Migrant Workers by Destination Weredas, October 2016.

15 The months with the largest number of migrants employed were from October through December followed by July to September (Table 4). Crop production is the most predominant business category attracting most of the migrant work force. In Afar, Oromia and SNNPR horticulture and floriculture contribute to employment of migrant worker throughput the year (table 5). Across all four seasons, male migrant workers comprised of 80%–90% of all migrant workers, while females comprised 10–20 %. Table 4: Size of migrant population employed during four seasons in seven regions of Ethiopia, October 2016

October - July - September December January - March April - June Femal Femal Region Male e Male e Male Female Male Female Afar 10089 854 25565 2124 25565 2124 25565 2124 Amhara 403558 30683 402958 30483 1800 1300 3200 1300 Benishangul Gumuz 65420 9651 57183 8197 10732 0 10795 11 Gambella 122739 8736 122739 8736 0 0 0 0 Oromia 45100 12888 59773 18232 23573 15422 23533 15262 SNNP 6242 2388 8602 1997 4450 406 5325 676 Tigrai 271046 20303 251046 20253 13160 498 8160 448 Grand Total 924194 85503 927866 90022 79280 19750 76578 19821 Proportion 91.5% 8.5% 91.1% 8.9% 80.0% 20.0% 79.4% 20.6%

This study found the presence of 87,070 long-term or permanent employment opportunities. The list of jobs created for long-term employees were mangers, supervisors, operators, store managers and chefs. Almost half of the permanent positions were reported to be found in Oromia Region (Table 6). Among permanent or long-term employees, the majority (90.0%) were males. Table 5: Size of Migrant Workers by Sex Employed in the Different Types of Business Categories in Seven Regions in Ethiopia, October 2016

Region Male Percent Female Percent Employing Organizations

Afar 25565 92.3% 2124 7.7% Floriculture and horticulture 10089 92.2% 854 7.8% Sugar Cane Plantation & Factory 15476 92.4% 1270 7.6% Amhara 402958 93.0% 30483 7.0% Crops Production 400158 93.2% 28983 6.8% Sugar Cane Plantation & Factory 2800 65.1% 1500 34.9% Benishangul Gumuz 57183 87.5% 8197 12.5% Crops Production 57183 87.5% 8197 12.5% Gambella 122739 93.4% 8736 6.6% Crops Production 122739 93.4% 8736 6.6% Oromia 59773 76.6% 18232 23.4%

Region Male Percent Female Percent Employing Organizations

Construction 104 99.0% 1 1.0% Crops Production 42049 90.7% 4314 9.3% Floriculture and horticulture 3067 25.1% 9133 74.9% Gold Mining 20 100.0% 0 0.0% Sugar Cane Plantation & Factory 14533 75.2% 4784 24.8% SNNP 8602 81.2% 1997 18.8% Construction 2064 92.8% 160 7.2% Crops Production 3763 81.2% 872 18.8% Floriculture and horticulture 386 66.1% 198 33.9% Sugar Cane Plantation & Factory 2389 75.7% 767 24.3% Tigrai 251046 92.5% 20253 7.5% Crops Production 247886 92.6% 19855 7.4% Sugar Cane Plantation & Factory 3160 88.8% 398 11.2% Grand Total 927866 91.2% 90022 8.8%

Table 6: Size of Permanent and Long Term Employement in Seven Regional States of Ethiopia, October 2016 October - July - September January - March April - June Region December Male Female Male Female Male Female Male Female Afar 5389 1014 5389 1014 5389 1014 5389 1014 Amhara 3221 1458 3221 1458 3167 1453 3167 1453 Benishangul Gumuz 12317 3560 12317 3560 12317 3560 12317 3560 Gambella 8971 1292 8971 1292 8971 1292 8971 1292 Oromia 19195 10342 19195 10342 19195 10342 19195 10342 SNNP 9289 2214 9299 2217 9162 2687 9179 2687 Tigrai 7019 1789 7019 1789 7019 1789 7019 1789 Grand Total 65401 21669 65411 21672 65220 22137 65237 22137

Subtheme 1c: Dynamics of Seasonal Migrant Workers This section addresses the dynamics or movements of migrant workers. The findings describe the movements of migrant workers based on business category and socio-economic characteristics of migrant workers. Furthermore, the study describes whether dynamics of different groups of migrant workers are considered to be bidirectional or circular in nature. In central Oromia, the movement of many of temporary or migrant workers, who are employed by horticulture and floriculture farms, is more limited than those of employees who work for farms with crop (cereals) cultivation. In the former, once temporary workers acquire the desired skills and know how to perform unique tasks, they stay around work sites looking for similar job opportunities.

17 Almost all sugar cane plantations and development projects recruit migrant workers at their places of origin. The highest number of temporary staff is employed for nine months, from October through June. This is a typical bidirectional movement of migrant workers from place of origin to current worksite. The following in-depth interview clearly describes the dynamics of this type of migrant worker:

“Every year, [name of organization] hires migrant workers for seven to nine months. Then, in the month of June, we have an arrangement to return almost all migrant workers to their place of origin SNNPR. [HR Manager]

The study revealed that the movements of migrant workers employed by private-owned large-scale farms of crop cultivation (sesame, sorghum, cotton and soya bean production) were both bidirectional and circular. The following quotation of a farm manager illustrates the circular nature of migrant workers’ movement:

“We hire temporary or migrant workers here in early April for farm land preparation; then, we hire additional labor forces in July through September for two to three sessions’ of aggressive weeding activities. In September, migrant workers want to return to their home town to celebrate New Year with their family. In addition, some migrant workers are students who don’t return for labor work during harvesting season. The third season of hiring migrant workers is from early October to November for harvesting activities; many of them have history of working with us. ”

[Farm manager]

The dynamics of migrant workers are complex. Movement of people usually crosses regional state boundaries. One of the key informants explained the need for collaboration across regional states:

“Unless regional state health bureaus work together and share basic information on movement of migrant workers and situation of malaria, it is difficult to ensure effectiveness of our national malaria prevention, control and elimination strategies.”

[Oromia RHB]

Theme 2: Access to Malaria Prevention and Control Services

Subtheme 2a: Settlements This study documented various types of housing facilities. Private-owned large scale farm settlement houses are typically bamboo structures with grass roofs. Large-scale government-owned or foreign investor-owned organizations have permanent super-structures made of mud, cement and agro stones, with roofs made of corrugated iron sheets.

Photo1: Hamlet (Barracks) housing for temporary or migrant workers Amibar, Afar (Photo: Argaw MD)

Photo 2: Agro stone hall housing for temporary or migrant workers Kessem, Afar (Photo: Argaw MD)

Photo 3 Temporary housing for migrant workers Dangur, Benishangul Gumuz (Photo: Argaw MD)

19 Photo 4: Temporary housing for migrant workers at Arsi, Oromia (Photo: Argaw MD)

Subtheme 2b: Risk of acquiring malaria (duty hours) This survey revealed that there are some business categories which demand night work, such as sesame and sugar-cane plantations. Activities that require night work include harvesting sesame, transporting sugar cane, keeping watering canals, working with more than one employer, and being a factory worker. A key informant explains:

“Migrant workers prefer to be employed with [organizations] like the one which offer them fringe packages like housing facilities and free health care services. Employed migrant workers spend 8 hours on work with us, and then during the night they work with another employment at private farms.”

[Plantation Manager, Oromia Region]

Subtheme 2c: Packages of malaria related services Malaria vector control is one of the main strategies to prevent transmission of malaria. The national malaria program recommends two main vector control strategies: achieving 90% and more coverage either using long-lasting insecticide treated bed nets (LLINs) or indoor residual spray (IRS). Subtheme 2d: Access to Long Lasting Insecticide Treated Bed Nets (LLINs) Large-scale farms and government-owned projects have access to public health interventions. Half (29) of assessed facilities have access to free distribution of LLINs. All permanent and seasonal migrant workers were targeted in community LLINs distribution (Photo 9–10). The main challenges reported in the management of LLINs were: failure of seasonal workers to bring the LLINs back with them for subsequent employments, and difficulty of hanging LLINs in all sleeping spaces in large halls. Private farms reported that they are not part of LLIN distribution. There are also myths about LLINs. Some believe the nets prevent pests other than mosquito, and others say they harbor bed bugs (Cimex lectularius) in sleeping rooms. The following views describe that shortage of LLINs and over-crowed rooms are two of the main reasons for low levels of coverage and utilization of LLINs by seasonal migrant workers:

“There is shortage of LLINs and the distribution was made first considering permanent residents.”

[Officer, Woreda Health Office, Benshangul Gumuz.]

“On an average, about 30 temporary workers should live in a single room. Some of us would rather spend the night in the open due to bed bug infestation of the rooms.”

[Supervisor, Pribate farm in Benishangul Gumuz ]

21 Subtheme 2e: Access to Indoor Residual Spraying IRS is implemented in collaboration with woreda health offices and large-scale projects. While the chemical and technical support has been the contribution of woreda health office, the operational cost has been covered by the projects. The study revealed different factors which deter the implementation of IRS in seasonal migrant worker destination woredas. Among them, the major factor identified is absence of IRS activities in areas where sesame farming occurs.

Photo 6: LLINs use by Long term staff Dangur, Benishangul Gumuz (Photo: Argaw MD)

Photo 7: LLINs utilization by temporary or migrant workers Kessem, Afar (Photo: Argaw MD)

Theme 3: Access to Curative Health Services The study showed that public health facilities (health centers and health posts) are the main sources of health care services for migrant workers. Formal private health facilities (medium clinics and primary clinics) are alternative points of access to malaria care services for these workers. This study revealed that out of 58 migrant worker employers, two-thirds 41(70.0%) have well-organized health facilities and 17 of the employers do not have no any workplace health facility. The type of health facilities available in these workplaces are predominantly health posts (Fig 3). The distribution and type of health facilities varies widely from a well-developed network of hospitals and health centers observed at sugar development projects, to organizations with only primary clinics. Employers have different relationships and partnerships with the RHBs and local woreda health offices, with some partnering in the provision and distribution of LLINs and anti-malarials, or benefiting from the deployment of health extension workers (HEW) to farm areas.

Figure 3: Type and number of health facilities available in forty one organization , October 2016

Subtheme 3a: Availability of Public Health Care Services Government-owned development projects have well-structured health care services. These organizations work in collaboration with town and district health offices. The established partnerships help organizations access antimalarial drugs and supplies, which include Artemether Lumefantrine (AL), Artesunate, Rapid Diagnostic Tests (RDTs) and LLINs. All workplace hospitals and health centers diagnose and treat both uncomplicated and severe malaria cases. Health posts diagnose malaria using RDTs and treat only uncomplicated malaria cases. Unlike well-organized government-owned development projects, small-scale private-owned farms don not typically have health facilities. Moreover, stakeholders described that farm owners or managers that are engaged in selling antimalarial drugs offer these drugs for all febrile illnesses and deny sick leave for migrant workers. The following quote illustrates the situation:

“One of our patients reported that he took coartem from his current employing organization, but the laboratory investigation reported relapsing fever, not malaria...”

[Health Officer at work place clinic, Oromia Region]

“To retain migrant workers, employers delay payments and deny sick leave; thus, migrant workers cannot seek treatment; furthermore, they don’t comply with the national malaria guideline recommendations for undifferentiated fever to seek early treatment [within 24 hours] from health facilities. That is why migrant workers develop malaria-related complications and/or life threatening situation.”

23 [Officer,Woreda Health Office, Benishangula Gumuz]

Subtheme 3b: Availability of Private Health Care Services Private health facilities are available in semi-urban areas of destination woredas of migrant workers. Some seasonal migrant workers seek malaria diagnosis and treatment services from private outlets. This study documented that private farms often lease medical services from the nearest private health facilities:

“There are 12 medium clinics and 44 primary clinics in Metekel zone. The primary beneficiaries in facilities are seasonal migrant workers.”

[Metekel Zone Health Department]

”....., large scale floriculture and horticulture farms lease health care services from our Hospital.”

[Medical director, Work place Hospital, Oromia Regiona].

“.... Every week a medical doctor and owner of private a medium clinic provide us health care services...”

[Migrant worker, Humera, Tigrai Region]

Subtheme 3c: Technical and Financial Support The regional state health bureaus strive to address the health needs of seasonal migrant workers. In order to do this, they described employing the following strategies: recruiting and deploying temporary health workers, assigning health extension workers, and establishing test and treat campaigns. At times, government stakeholders reported insufficient resources to maintain services for migrant workers. The following quotes from stakeholders provide greater detail:

“We recruit and employ 98 to 100 health workers (mainly diploma nurses) who can provide test and treat malaria services for four to five months in woredas where migrant or mobile workers moved for employment.”

[Amhara RHB]

“The passive malaria screening, arranged by South Gondar Zone Health Department through establishing

temporary testing and treatment sites in bus stations were among the strategies executed to prevent reintroduction of malaria in highland fringe woredas. But due to lack of budget they couldn’t maintain provision of similar services.”

[South Gondar Zone HD ARHSB]

“...our regional health bureau deploys about 15 health workers from highland fringe neighboring woredas to where large numbers of migrant workers are found and the health personnel provide both preventive and curative services.”

[Tigrai Region]

Theme 4: Gaps and PROPOSED SOLUTIONS Subtheme 4a Challenges of Health Care Services Most employers reported following informal procedures in recruiting laborers. This creates greater health risks for their employees, especially for malaria. This is in part because it is difficult to plan and implement an effective intervention without knowing the size and movement of seasonal workers.

“... a lot of migrant workers are getting limited health services and other protective supplies because the Regional State Health Bureau dispatch supplies based on the statistics of local/permanent residents.”

[In-depth interview respondent, Gambella region]

“[Given] the nature of the work [crop production] it is difficult to implement planned routine malaria prevention strategies; IRS is not recommended, and LLINs couldn’t be properly hanged on sleeping places. Looking for interventions like repellant, mass test and treat campaign should be considered.”

[in-depth interview respondent, Amhara region]

25 “The lease documents singed by Ministry of Agriculture and owners don’t have clearly articulated roles and responsibilities on health, safety and risk of all stakeholders.”

[In-depth interview respondent, Amhara region]

The majority of organizations that employ seasonal migrant workers do not offer free access to basic health services. They expect these services to be delivered by the public health system. For example, in Benishangul Gumuz region, only 15 projects out of 215 have created access to some form of primary health care services. Stakeholders interviewed explain:

“We used to visit health posts and health centers to know the cause of fever. It is malaria, typhoid fever or something else. Once we get the result, we buy AL (Coartem) for 40.00 ETB; Chloramphenicol for 30.00 ETB. There are no anti-malarial drugs free of charge in health post or health center; medicines in health posts are much more expensive than private providers.”

[in-depth interview respondent, Benishangul Gumuz Region]

“I am guard in one of the [farm] large scale farms in Dangur woreda. During the last sixty days, I was infected with malaria three times. I went to a health center to confirm my illness and bought the drug [Coartem/AL] from black market for 100.00 ETB.”

[in-depth interview respondent, Benishangul Gumuz Region]

“Farm owners or managers have antimalarial drugs in hand; they sell the drugs for migrant workers…”

[in-depth interview respondent, Amhara region]

When employer organizations do offer health services, these services are not always appropriate or reliable. The malaria diagnosis and treatment, and vector control interventions in some employing organizations do not follow national recommendations. One stakeholder from a large farm reported, “In our camp all malaria cases which consist of Pf or Pv or clinical cases are treated with Chloroquine.” Reliable access to malaria services requires a functional supply chain management system that ensures uninterrupted access to antimalarial drugs and supplies. Unfortunately, the majority of seasonal migrant worker employing organizations reported stock outs. Frequent changes in supply systems also affect the quality of services in their facilities. These challenges are elaborated on in the stakeholder perspectives below:

“We used to collect essential malaria drugs from Health Centers and Town Health Offices when we submitted our report and requested drugs. However, we are informed that the drug supply system is integrated

27 to Pharmaceutical Fund and Supply Agency (PFSA). Then, we requested, but we couldn’t get any supplies as they were under inventory. Thus, we are facing increased malaria cases without any drugs at hand.”

[Medical Director of Work place Hospital, Key Informant, Oromia Region]

“... it is stressful and tough time for health care providers after diagnosing malaria in pregnant mothers.... we don’t have quinine or other safe drugs at hand.”

[Medical Director of Hospital, Oromia Region]

6. RECOMMENDATIONS

This assessment shows there is huge migrant workforce at high risk of malaria. The malaria prevention and control activities in many of the work places, particularly private large farmas is suboptimal. The RHBs and WHO recognize that the migrant workforces are their major sources of malaria burden and they have limitations of resources to meet the needs for malaria intervention by the migrant work forces. Therefore, it will be essential to bring together all the stakeholders with interest in migrant workers to design a national strategy to coordinate and address the malaria prevention and control activities in migrant and mobile workers. The major government institutions with a stake in the migrant workforce are the Ministry of Agriculture, Ministry of Health, Ministry of Labor and Social Affairs, Investment commission and their line structures in the regions and woredas. Other stakeholders include owners of companies employing migrant workforce, the private sector, civil society, and migrant workers themselves. Based on the findings of this study the following recommendations are made at different levels. National Level 1. All national level actors should work together to ensure the safety and health of migrant workers. Lease agreements should have some articles which address the tools and required services recommended with regards to health, safety and risk to be implemented at all levels. 2. Create a national task force that can advance a comprehensive strategy. The taskforce may consist of Ministry of Agriculture, Ministry of Labor and Social Affairs, Ministry of Health, and other stakeholders. The task force can also support various technical needs, such as development of sound lease documents. 3. The national malaria program should look for adequate resources to ensure availability of uninterrupted antimalarial supplies, provision of malaria case management trainings, implementation of behavior change communication activities, and deployment of health workers in these areas. 4. National malaria program should look for innovative interventions to control malaria like testing and treating of asymptomatic carriers, and chemoprophylactic approaches. Regional States Level 1. Regional states should establish a mechanism to document the size, mix, safety, risk, work places and employers of migrant workers. 2. Regional states should develop and implement clear roles and responsibilities of stakeholders involved in the employment and health of migrant workers. 3. Regional states should require that large-scale farm owners that hire seasonal migrant workers submit reports on the number of employees and their turnover to the responsible government body in the region. 4. Regional states should consider deploying health extension workers (HEWs) to the sites of major employment organizations to provide critical malaria diagnosis and treatment services. 5. Strengthening health care services in both public and private sector facilities through provision of case management training and ensuring availability of uninterrupted antimalarial supplies is recommended. 6. Develop SBCC materials on malaria prevention tailored to seasonal migrant workers

29 Employing Organizations Level 1. Organizations that employ migrant and seasonal workers should have a system to cover the basic health care needs of the employees (with in work place or out of work place by procuring service from private or public health facilities).

7. CONCLUSON

The paper described the situation of malaria among seasonal migrant workers in seven regional states of Ethiopia. In addition, the size of migrant workers and their dynamics were discussed based on destinations of seasonal migrant workers and their origin woredas. We found varied variety of business categories that attract seasonal migrant workers in all seven regions studied. Some of the employing organizations are engaged in large scale farms with crop cultivation (sesame, cotton, maize, sorghum, soya bean, and groundnut), construction of roads and housing, and gold mining and panning. The movement of seasonal migrant worker is both bidirectional and circular. Bidirectional movement dynamics is a feature of migrant workers on sugar plantations, floriculture, and horticulture farms. The movement of those employed at large scale crop cultivation farms is circular in nature. About one third of migrant workers move to low lands in three phases: for land preparation, weeding, and then harvesting season. The circulation of the workers within the work site may maintain transmission in the area, and the movement to and from origin place may contribute to resurgence of malaria transmission in other areas. Basic health services are available at large-scale government or foreign national owned organizations. However, the major of seasonal migrant worker private employers don’t offer access to health services. Seasonal migrant workers often face challenges and health risks including acquiring malaria in their destination woredas. There is a need to recognize the challenges faced among seasonal migrant workers by establishing strategies which address their health needs and protect their rights. Some of major gaps include: insufficient information on size, mix and movement of seasonal migrant workers, limited health care capacity at woreda level, and interruption of antimalarial supplies. In addition, lease agreements do not have articles that outline the roles and responsibilities of all actors in relation to the health, safety and risk of seasonal migrant workers. Routine malaria prevention and control strategies are not enough to address the situation of malaria among seasonal migrant workers. Therefore, on top of implementing routine malaria prevention and control strategies, additional remedies which include using repellants as physical barriers, identifying asymptomatic carriers with mass test and treat campaigns, deploying additional health workers, and ensuring availability of uninterrupted antimalarial supplies should be considered. The implementation of these interventions requires coordination and partnership between government stakeholders at the national and regional state levels, and private stakeholders within the health sector and at organizations that employ migrant workers.

ANNEX A: INFORMATION SHEET

Information sheet and consent form for the Formative Assessment on situation of Migrant and/or mobile workers in Severn reginal states of Ethiopia. Name of the principal investigators: Mesele D., Asfawesen GY., and Eshetu G. Name of the Organization: Private Health Sector Project

Information Sheet and Consent Form

My name is (INTERVIEWER NAME) and I am working with Abt Associates. One of Abt’s projects in Ethiopia is the USAID-funded, Private Health Sector Project (PHSP). One mandate of PHSP is to improve access to affordable and quality malaria diagnosis and treatment services through the in private health facilities including work place clinics. Currently due to extensive development projects going on in the low land and malaria endemic areas throughout Ethiopia, huge migrant/mobil work force who are vulnerable to malaria. Moreover, these migrant workers are potential threat to the resurgence of malaria outbreak when they return to their home villages. Therefore, PHSP would like to conduct a formative assessment to assess the situation of migrant and or mobile workers and their malaria related health needs in seven regional states of Ethiopia. The purpose of the assessment is to estimate the magnitude of the migrant workforce, asses their housing condition and mobility pattern, assess their access to malaria diagnosis and treatment and prevention services. Based on the findings of this assessment the project will come up with recommendations and intervention appropriate to control and prevent malaria among the migrant and mobile workers in Ethiopia. You are selected for this interview because we have learned that there are migrant and mobile workers working in your organization. If you are voluntary I would like to ask you few questions regarding magnitude of your workers, where and how they access malaria diagnosis and treatment, access to prevention on malaria, mobility pattern and housing condition. The information you give us will be confidential. Your participation in this study will not have any risk or immediate benefit to you or your organization. However, the information we help PHSP and the government on how to improve the malaria prevention and control activities in work places where migrant and mobile workers are deployed. The interview will take between 45–60 minutes, and your participation in this interview is completely voluntary. The interview will be recorded. All responses you give will be kept strictly confidential. Recordings and transcripts will only be shared with those conducting the study. Results will only be reported in aggregate to ensure anonymity. You may refuse to participate in the evaluation, and you may also stop the interview at any time by letting me know. If we come to any question you don’t want to answer, just let me know and I will go ahead onto the next question.

29 Do you have any questions for me about this interview? (ALLOW INTERVIEWEE TO ASK ANY QUESTIONS) Should you need any further clarifications, feel free to call the following contact person: Tenagnework Antifu Health Research and Technology Transfer Core Process Owner, Amhara RHB Phone: 251918814226 Bahir Dar

Contact Person: Dr Asfawesen Gebreyoahnnes Phone: 251-944 11 0002 Email: [email protected] OR

Mesele Damte Malaria Program Manager USAID| Private Health Sector Project I www.abtassociates.com Abt Associates Inc. Haile Gabreselassie Avenue | Addis Ababa, P.O.Box 2372 Code 1250 O: 251.11.661.3551| M: 251.911.10. 2287 F: 251.11.661.3559 Email:[email protected] If you have no further questions, I would like to obtain your verbal consent to conduct this interview. Do you agree to be interviewed? ___ Yes ___No Date: ______Interviewer signature certifying that the informed consent has been given verbally: a. Name……………………. Signature…………………………… b. Date…………………… month………………………..2016

Rapid Assessment Tools

Rapid assessment tool on situation of mobile and/or migrant workers and malaria.

Introduction This rapid assessment tool is designed to explore the mobility dynamics and malaria related health care service available for migrant and/or mobile workers in seven regional states of Ethiopia. Private Health Sector Project will analyze the data and synthesis the information for evidence based decision making at various level of the health tire system. The result of this study will be used to identify and design malaria prevention and control interventions to address the health needs of risky group of population. Please note that the information you give us will be kept confidential and used only to fill the information gap at the health tire system. Formative Assessment: Health, agricultre, investiment, And Labor and Social affaire 1. Inventory sheet of organizations and locations employing and deploying migrant/mobile workforce Direction: The purpose of the table below is to have directory of organizations and their locations in the region so that the study team will go and do the rapid assessment on situation of malaria prevention and control. Region:______Circle Source of the information (Regional Health/Agriculture/investment Bureau): Name of the organization Location of the work place employing and Estimated size S. No. Sector deploying of workers migrant/mobile Zone/Wereda Kebele/village workers

Key: Sector: Agriculture ( Sesam, cotton, sorghum, maize, others); Construction ( Dam, road, ); Mining ( gold, other), Other ( specific)

31 1. PROFILE OF THE WORK PLACE 1.1 Interviewee’s description: Number Age:______Sex:____ Position in the organization: Profession:______Phone number:______1.2 Name of the organization Office Address: Wereda HNo. Phone No. 1.3 Where is/are the work place located Region Zone Woreda Village GIS coordinate 1.4 Please describe the sector your organization is currently actively working by employing migrant/mobile workers A: Agriculture: 1. Sesame Farm 2. Sorghum Farm 3. Cotton Farm 4. Sugar cane plantation B: Mining: 1 Gold mining and panning C: Construction: 1. Dam, 2. Road 3. factory 4. other 7. Others: specify 1.5 Can tell us the estimated number and characteristics of works employed by your organization as described in the table below

Estimated number of employee Long term or Temporary or Month Remarks permanent employee mobile or migrant Male Female Male Female July – September October – December January – March April – June

NB: Long term or permanent employee is worker who is working in the organization continuously for more than ______months Temporary or mobile/migrant workers who are employed seasonally and working for less than ______months in the year

1.6 Where do majority of migrant workers come from? Pls tell us the region and wereda Region: , Wereda: 1.7 Where do the majority of the migrant/mobile workers go when upon termination of their employment? 1. Return to their home villages/towns: Yes No 2. Stay in this village looking for other job: Yes No 3. I do not know (Interviewer: document other remarks from the interviewee) 1.8 If you have permanent employees, where do the workers live? A. Inside camp B. In the nearby town

1.9 If living inside a camp in the workplace, what is the typing of housing? A. Temporary shelter B. House (with permanent structure and roof) C. Open field (outside) D. Tent E. Other (specify) 1.10. Where do majority of the migrant workers live during the work season? A. Inside camp B. In the nearby town/village 1.11. Can you characterize the type of house inside camp? A. B. C. 1.12. How many workers do sleep together in one room?...... (Put range or average number.) 1.13 When are the working hours of the migrant/mobile workers? A. Day time B. Night time C. Both

2. On Access to Prevention and Control 2.1. Where do the workers access medical care when they are sick? A. The organizations clinic B. Near by private facility C. Near by public health facility D. Either B or C 2.2. If the organization has its own work place clinic, what is the level or type of health facility? Circle which is appropriate: primary/medium/specialty clinic/specialty center/hospital Health post/health center. (Interviewer: if the organization has more than one facility, please describe and characterize all types in terms of level and their distribution.) 2.3. If your organization has a health facility, does it have the capacity A. to diagnose malaria with microscope or RDT or Both (circle appropriate) B. to treat uncomplicated malaria C. to treat complicated and severe malaria 2.4. Where does your facility get antimalarial drugs and reagents from? A. Organization procures from private distributers B. Gets regular supply of Anti-malaria drugs from Town Health Office [THO]/RHB/ Pharmaceutical Fund and Supply Agency [PFSA] C. Gets regular supply of staining reagents or RDT from THO/RHB/PFSA

33 2.5. Do your employees have Long Lasting Insecticide Treated Nets [LLIN] or Insecticide Treated Nets [ITN]? A. Yes, B. No. 2.6. If yes, where does your organization get the LLIN/ITN? A. The organization procures and distributes it to its employees B. The organization is supplied by RHB/THO and distributes it to its employees 2.7. If answer to Q2.5 is no, why are they not utilizing? A. Organization has financial limitation to buy and provide bed nets B. RHB/THO has refused to provide bed net C. Other reason (specify):------2.8. If your organization is providing bed nets to employees, how are you managing it? A. Employees are given the bed net to be returned when they leave B. Employees are given the bed net and take it with them when they leave C. The houses they live in have bed nets D. Other: (Bed nets are sold at subsidized prices) 2.9. Tell us your challenge in managing bed nets.

2.10. Do the living quarters receive seasonal Indoor Residual Spray (IRS) services? A. Yes, B. No. 2.11 If yes to Q 2.10, who does provide the IRS? A. Your organization B. The town health offices 2.12 Do mobile/migrant workers receive routine testing and treatment for malaria before departing to their home places? A. Yes, B. No. 2.13. Tell us your organizations working relationship with THO or RHB in relation to malaria prevention and control? Receive drugs: A. Yes B. No Receive reagents or RDT: A. Yes B. No Receive bed nets: A. Yes B. No Receive seasonal IRS: A. Yes B. No Receive testing and treatment of cases when sick in public health facilities: A. Yes B. No Submit performance or survelillance report: A. Yes B. No What kind of support does your organization need to address the malaria health needs of migrant workers? Case management: Malaria vector control:

Thank you so much.

3. In-depth Interview Guidelines 3.1. Can you tell us the situation of malaria control and prevention this season? 3.2. How big is malaria in relation to migrant workers workplaces? 3.3. What does the region/ woreda Health Office doing to prevent/control malaria in these areas? (Probe: supply i.e., Arthimicinin Combined Therapy [ACT], Chloroquine, RDT, LLINs; set up temporary clinic, etc.). 3.4. What are the major challenges you encountered in controlling and preventing malaria in work places? (Probe: ask also issue of malaria resurgence from returning migrant workers.) 3.5. What are your plans to improve the situation of malaria in work place? What kind of support do you propose? Thank you so much!

ANNEX B: THE AMHARIC VERSION OF QUESTIONER

በበበበበበ በበበ በበበበ በበበበበበ በበበበበበ በበበ በበበበ በበበበበ በበበ በበ በበበበበበ በበበበበ በበበ በበበ በበበ በበ በበበበበበ በበበ በበበበ በበበ በበ በበበበበበ በበበበ በበ

በበበ በበ በበበ በበበበበ (በ.በበ. በበ. በ)

በበበ በበበበበበበ በበበ በበበ በበበ በ በ/በ በበበበበበ በበበበበበበበ በ/በ በበበ በበበበ

በበበበበ በበበ- በበበ በበ በበበ በበበበበ (በ.በበ. በበ. በ)

የየየየ የየየየ የየየየየየ የየየየ የየ በበ (በበበበ በበ) በበበበበበ በበበበ በበበበበበ በበ በበበበበበ በበበበበበ በበበ በበ በበበበ በበበበበበ በበበበበበ በበበበበ በበበበበ በበበበ በበበበ በበበበ (USAID) በበበበበበ በበበበበ በበበ በበበበበበ በበበ በበ በበበ በበበበበ በበበ በበበበ በ.በበ. በበ. በ. በበበ በበበ በበበበበ በበበ በበ በበበበበበ በበበ በበበበ በበበበበ በበ በበበ በበበ በበበ በበበበበ በበበበ በበበበበበ በበበበበበ በበበበ በበበበበበ በበበበበ በበበበ በበበ በበበበ በበበበ በበበ በበበበበበ በበበ በበበ በበበበ በበበ በበበበ በበበበ በበበ በበበበበ በበበበበበ በበበ በበ በበበበ በበበበበበ በበበበበበ በበበ በበበበ በበበበ በበበ በበበ በበበበ በበ በበበ በበ በበበበበበበ በበበበበ በበበበበበ በበበ በበበበበ በበበበ በበበበ በበ በበበ በበ በበበበበበበ በበበበበ በበ በበ በበበበበ በበበበበበ (በበበ በበ) በበበ በበበበበበ በበበበ በበበበበበ በበበበ በበበ በበበበበ በበ በበበበበ በበበበበበበበበ በበበበ በበ በበበበ በበበበበበ በበበበ በበበበበበበ በበበበበ በ.በበ. በበ. በ በበበበበበ በበበ በበበበ በበበበ በበ በበበ በበ በበበበበበበ በበበበበበ በበበ በበ በበበ በበ በበበበበ በበበበበበበበበበ በበበበበበ በበበበበ በበበበበበበ በበበበ በበበ በበበበ በበ በበበ በበ በበበበበበበ በበበ በበበ በበበበ በበበበበ በበበ በበበበበበበ በበበበበ በበበ በበበበበ በበበበ በበበበበ በበበበበበ በበበ በበበበበበበበ በበበበበ በበበ በበበበበ በበበበ በበበበበ በበበ በበበበ በበበበበ በበበበበበ በበበበ በበ በበበ በበ በበበበበበበ በበበበበ

37 በበበበበበ በበበበ በበበ በበበበበበ በበ በበበበበበ በበበበ በበበ በበበበበ በበ በበበበበ በበበበበበ በበበበበበበ

በበበበ በበበበበ በበበ በበበበበበበ በበበበበ በበበበ በበበ በበበ በበበበበበ በበበበበ በበበበበበ በበ በበበበበበ በበበበበበበበ በበበ በበበ በበበበበበበ በበበበ በበበ በበበበበ በበበ በበ በበበበበ በበበ PHSP በበ በበበበበ በበበበበበ በበበበበ በበበበበበ በበበ በበበ በበበበ በበበበበበ በበበበበ በበበበበበ በበበበ በበበበበበ

በበበበ በ45 – 60 በበበ በበበበበበ በበበበበ በበበበበ በበበበበ በበ በበበበ በበ በበበበ በበበበበ በበበ በበበበበበበ በበበበበ በበበ በበ በበበበበበበበ በበበበ በበበበበበበ በበበበበበበ በበ በበበበ በበበበበ በበበ በበበበበበ በበ በበበበበበበ በበበበ በበበ በበበበ በበበበበ በበ በበበበበ በበበበ በበበበበበበ

በበበበ በበበበበበ በበበበበ በበበበበ በበበ በበበ በበበበበበ በበ በበበበበ በበበበ በበበበበበ በበበበ በበበበበበ በበበ በበ በበበበበ በበበበበበበ በበ በበበበ በበበ በበበበበበበበበ

በበበበበ በበበበበበ በበበበበበበ በበበበበበ በበበ በበ? (በበበበበ በበበበበበ በበበ በበበ)

በበበበ በበበበበ በበበበበ በበበበበ በበበበበበበበ በበበ በበበበ በበበበበበ በበበበበበበ በበበበ በበበ በበበበበ በበበበበ በበበበ በበ በበ በበበ በበበበበ በበበ በበበ በበ በበ በበበበ 251918814226 በበበ በበ

በ በበበበበበ በበበበበበበ በ.በ. 251 944 11 0002 Emailበ [email protected]

በበበ

በ በበበ በበበ በበበ በበበበበ በበበበ በ. በ. 251 911 10 2287 Emailበ [email protected]

በበበበ በበበ በበበበበ በበበበበ በበበበበ በበበ በበበበበ በበበበ በበበበበበበበ በበበ በበበበ በበበበ በበበበ?

------በበበ ------በበበበበበ በበበ ------

በበ በበበበ በበበበበ በበበ በበበበበ በበበበበበ/በ በበበበበ በበበ

በ. በበ ------በበበ ------

በ. በበ ------በበ ------2008

የየየየ የየየየየየ የየየየ የየየየ

በበ በበበበ በበበ በበበ በበበበበበ በበበበ በበበበበበ በበበ በበበ በበበበ በበበ በበበበበ በበበ በበ በበበበበበበ በበበበበ በበበበበበ በበበ በበበ በበበ በበበበበበበ በበበበበበበ በበበበበበበበበበበ በበበበ በበ በበበበ በበበበ በበበበ በበበበበበበ በበበበበበ በበበበበበበ በበበበ በበበበ በበበ በበበ በበበ በበበበበ በበበበበበበበ በበበ በበበበበበበ በበበበበበበ በበበበ በበበበበ በበበበበበ በበበበበ በበበበበ በበበበበበ በበበበ በበበ በበበበበ በበበ በበበበ በበበበ በበበበበበ በበበ በበ በበበበበበበ በበበበበ በበበበበበ በበበ በበበ በበበበበበ በበበበበበ በበበ በበበበ በበበበበበበ በበበበበ በበበ በበበበበበበ በበበበበ በበበ በበበ በበበ በበ በበበበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በ በበበበበ በበበበ በበበበ በበበበ በበበበበ በበበበ

በበበበ በበበ በበበ በበበበበበ በ- በበ በ በበበበበ በበበበበበበበበ በበበበ በበ በበበበበ በበበ በበበበ የየየየየ የየየ የየ የየየየየየየ የየየየየ የየየየየ የየየየየየ የየየየየየ የየየ የየየየየየየ የየየየየ የየየየየ የየየየየ የየየየየየ የየየ በበበበ በ በበበ በበበ በበበበበበ በበበበበ በበበበ በበበበበበ በበበበበ በበበ በበ በበበበበበበ በበበበበ በበበበበበ በበበ በበበ በበ በበበ በበበበ በበበበበበበ በበበበበ በበበ በበበበበበ በበበበበበ በበበበበበ በበበበ በበበበበበ በበበበበ በበበበበበ በበበበበ በበበበበበበ

በበበ:______

በበበበበበ በበበ በበበበ( በበ በበበ በበበበ በበበ በበበበበበበ በበበ በበበበ በበ በበበበበ በበበ በበ) የየየየየ የየየ የየ የየየየ የየየየየየየ የየየየየየ የየየ የ. የ የየየየየ የየየየ የየየ የየየየየ የየየ የየ/የየየ የየየ/ የየየየ የየየ የየየየ የየ

በበበበ( በበበበ በበበበ (በበበበ በበ‹ በበበ‹ በበበ‹ በበበ ..) በበበበ ( በበበ‹ በበበበ)በ በበበበ ( በበበ‹ በበበ ) በ በበበ በበበ በበበበ (በበበበ ……..) 1. የየየ የየ የየየየየ የየየ 1.1 በበበበ በበበ በበበበበበበ በበ በበበ በበበ:______በበ:____ በበበ በበበ : በበ:______በበበ በበበ :______1.2 በበበበበ በበ በ በበ በበበበ : በበበ በበበ በበበ በበበ በበበበ

1.3 በበበ በበበ በበበበበበ በበበበ በበበ በበ በበበ በበበበ :………………………………..

በ.በበ. በበ በበበበበበ

1.4 በበበበ በበበ በበበበበ በበበበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበበበ በበበ በበበበበ በበበበበበበ በበበ በበበበ በበበበበ

በ)በበበበ : 1. በበበበ በበበ 2. በበበበ በበበ 3. በበበ በበበ 4. በበበበ በበበ በ)በበበበ : 1. በበበበ በበበበ በ) በበበበ 1. በበበ, 2. በበበበ 3. በበበበ በ)በበበ (በበበበ )

1.5 በበበበበበ በበበ በበበበበ በበበበበበበበ በበ በበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበበ በበበ በበ በበበ በበበበ በበበ በበበ በበበበበ በበበበበ በበበበበበ

በበበ በበበበ በበበበበ በበበ በበበበ በበ በበ በበበበ በበ በበበበ በበበ በበበ በበበበበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበ በበበ በበ በበበ - በበበበበ በበበበ - በበበበ በበ- በበበበ በበበበ - በበ መመመመመ በበበበ በበ በበበበበበ በበበበበበበ በበበበ በበበ በ 6 በበበ በበበ በበበበበበበበበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበበ በበ በበበበበበበበ በ 5 በበበ በበበ በበ በበበበበ በበበ በበበበበ በበበበበበበ በበበ በበበበ 1.6 በበበበበበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበ በበበበበ?በበበበበበበ በበበበ በበበ በበበበበ? በበበ: በበበ: 1.7 በበበበበበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበበበበበ (በበበበ በበበበበ በበበበ) በበ በበ በበ በበበበበ? 1. በበ በበበበ በበበበ (በበ በበበበበ በበበበ) በበበበበ በ በ. በበ በ. በበበ 2. በበ በበበበበ በበበ በበበበበ በ. በበ በ. በበበ 3. በበበበበ (የየየ የየየየየ በበበበበ በበበበ በበበ በበበ በበበበበ ) 1.8 በበበበበ በበበ በበበበ በበ በበበበበበበ በበበበበ በበበ በበ በበ በበበበበ? በ. በበበ በበበ በ. በበበበበበ በበበበ በበበ 1.9 በበበበ በበበ በበበበ በበበበበ በበበ በበበበበ በበበበበበ በበ በበበበበ? በ. በበበበ በበበበ በ. በበ (በበበ በበበበ በበ በበ በበበ) በ. በበበበ በ. በበበ በበ (በበበ በበበበ) በ. በበ (በበበበ) 1.10. በበበበበ በበበበበበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበ በበበ በበ በበ በበበበበ? በ. በበበ በበበ በ. በበበበበበ በበበበ 1.11. በበበበ በበበ በበበበ በበበበበ በበበ በበበበበ በበበበበበ በበ በበበበበ? በ. በ. በ. 1.12. በበበበ በበበ በበበ በበበበበ በበበበበ በበበበ?...... (በበበበበ በበበ በበበበ)

41 1.13 በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበበ? በ. በበ በ. በበበ በ. በበበበ (በበበ በበበ)

2. የየየ የየየየየየ የየየየየ የየየየ የየየየየየ 2.1. በበበበበ በበበ በበበበ በበበበበበ በበበበበ በበበበበበ በበበ በበ በበበበበበ? በ. በበበበበ በበበበ በ. በበበበበበ በበበበ በበበ በበ በበበበ በ. በበበበበበ በበበበ በበበበበ በበ በበበበ በ. በበ በበበበ

2.2. በበበበበ በበበ በበበ በበበበ በበበ በበበ በበበበ በበበ በበ በበበበ በበበበ? (በበበበ በበበ በበበበበ በበ በበ በ በበበበበበ በበበበበ በበበበበ በበ በበበበ በበበበበ) (የየየ የየየየየ በበበበ በበበ በበ በበበበ በበበ በበበበበበበ በበበበ በበበ በበ በበበበ በበበበበ በበበ በበበበበበበበ በበበበበ )

2.3. በበበበበ በበበ በበበ በበበበ በበበ በበበ በበበ በበበበበበበ በበበበበበ በበበበ በበበበበበ በበበ በበበበ በበበበበ? በ. በበበ በበበበ i. በበበበበበበበ ii. በበበበ በበበ በበበበበበ (በበ.በ.በ) iii. በበበበ (በበበበበበ በበ በበ.በ. በ.) iv. በበበበበ በበበበበ በበበበ በበበበ (በበበበበ) በ. በበበበበበበበ በበበበበ በበበ በበበ በበበበበበ በበበ በበበ በበበበ በ. በበበበበበበ በበበበበ በበበ በበበ በበበበበ በበበ በበበ በበበበ

2.4. በበበ በበበበ በበበ በበ በበበበበበ በበበበበበ በበበበ በበ በበበ በበበበበ በበበ በበ በበበበበበ? በ. በበበ:-በበበ በበበበበበበ በበበበበበበ በ. በበበበበበበ በበ በ/ በበበ በበበ በበ በበበ በበበበበበ በበበበ በበበበበ በበበበ በበበበበ በበበ በበ በበበበበ በበበበ በ. በበበበበበበ በበ በ/ በበበ በበበ በበ በበበ በበበበበበ በበበበ በበበበበ በበበበ በበበበበ በበበበበበ በበበበበ በበበ በበበ በበበበበበ (በበ.በ. በ.) በበበበ

2.5. በበበበበበበ በበበ በበበበበ በበበበ በበበበ በበበበበ? በ. በበ በ. በበበ

2.6. በበበበ በበበ 2.5 በበበ በበ በበበ? በ. በበበበ በበበበ በበበ በበበበበ በበበበበ በበበበ በበበበ በ. በበበበ በበ በበበ በበበ/በበበ በበ በበ በበበበ በበበበበ በበበበ በበበበበ; በ. በበ በበበበ

2.7. በበበ በበበ 2.5 በበ በበበ በበበበ በበበበ በበበ በበበ በ. በበበበ በበበበ በበበ በበበበበበ በበበበበ በ. በበበበ በበ በበበ በበበ/በበበ በበ በበ በበበበ በበበበ በበበበበበ በ. በበ በበበበ

2.8. በበበበበበበ በበበበበ በበበበበ በበ በበበበበ? በ. በበበበበ በበበበበበበበ/ በበበበበበ በበበበ በበበበበበ በበበበ በ. በበበበበ በበበበበበበበ/ በበበበበበ በበበበ በበበበበበ በበበበበበ በ. በበ በበበበ

2.9. በበበበበበበ በበበበበ በበበበበ በበ በበበበበበ በበበበበበ በበበበበ ?

2.10. በበበበበበበ በበበበበበ በበበበ በበበበ በበበ በበበ በበ- በበ በበበበ በበበ በበበበ በበበበበ ? በ. በበ በ. በበበ

2.11. በበበ በበበ 2.10 በበ በበበ በበበበበ በበ- በበ በበበበ በበበ በበበ በ. በበበበ በበ- በበ በበበበ በበበ በበበበበበ በ. በበበበ በበ በበበ በበበ/በበበ በበ በበ በበ- በበ በበበበ በበበ በ. በበ በበበበ

2.12. በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበ በበበበ በበበበ (በበ በበበበበ በበበበበበ) በበበበበበበ በበበ በበበ በበበበበ በበበበ በበበበበ ? በ. በበ በ. በበበ

2.13. በበበበበበበ በበበበ በበ በበበ በበበ/በበበ በበ በ/በበ በበበ በበበ በበበበበበ በበበበበ በበበበበ በበበ በበበ በበበበ በበበበበበ በበበበበ? በ. በበበበበ በበበበበ በ. በበ በ. በበበ በ. በበበበበበ በበበበ በበበበበ በ. በበ በ. በበበ በ. በበበበ በበበበበ በ. በበ በ. በበበ በ. በበበ በበበ በበበ -በ በበበበ በበበ በ. በበ በ. በበበ በ. በበበ በበበበበ በበበበ በበበበበበ በበበበበበ በበ በበበበ በበበ በ. በበ በ. በበበ በ. በበበ በበበበበ በበበበበ በበ በበበበ በበበ በበበበ በ. በበ በ. በበበ 2.14 በበበበበበ በበበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበ በበበበበበ በበበበበ በበ በበ በበበ በበበበበበበ? በ. በበበ በበበበ በ. በበበ በበበ በበበበ በ. በበበ በበበበበ በ. በበ በበበበ

በበበ በበ በበበ በበበበበበበበበበ

3. የየየየ የየየየ የየየየ የየየየ - የየ የየ /የየየ የየ የ/የየ 1. በበበበ በበበ በበበበ በበበ በበበ በበበበበበ በበበበበ በበበ በበበበበበ ? 2. በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበበበበ በበበበበ በበበ በበበ በበበበ በበ በበበ በበ ? 3. በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበበበበ በበበበበ በበበ በበበበ በበበበበበበበ በበበበበበ በበ በበበ/ በበ በ/በበ በበ በበበበ በበበበበ

43 በበ? ( በበበበበ ? በበበበ በበበ በበበበበ በ በበበበበበ በ በበበ በበበ በበበበበበ (በበ በ በ)በ በበበበ በበበበ በበበበ… በበበ ). 4. በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበበበበ በበበበበ በበበ በበበበ በበበበበበበ በበበበበበ በበ በበበበበበ በበበበበበ ? ( በበበበበ በ በበበ በበበ በበበበ በበበ በበበ በበ በበበበበበበ በበበበበ በበበበበ በበበበ በበ በበበበ በበበበበ በበበበ በበበበ/በበበ በበበ በበበ ) 5. በበበበ በበበበበ በበበ በበበበ በበበበበበበ በበበበበ በበ በበበበ በበበ በበበ በበበበ? በበበ በበበበበበ በበበበበ በበ በበበበበ በበ በበ በበበ በበበበበበበበ?

በበበ በበ በበበ በበበበበበበበበበ

49 Table 7: Mapping of Seasonal Migrant Workers by Destination and Origins in Seven Regional States of Ethiopia, October 2016

Migrant Workers destination Organization Region Zone and woreda Migrant Workers Origin Region, Zone and woreda Ser Name of employing number Region Zone Woreda Region Zone1 Zone 2 Zone 3 Region2 Zone1 Woredas Organization Assayita & Tendaho Sugar Development 1 Afar One SNNPR Kembata Hadiya Wolayita Welayita Dubti Project I Awash Fentale Kesseme Sugar 2 Afar Three SNNPR Kembata Hadiya Wolayita & Dulecha Development Project 3 Afar Three Awash Fentale Amibara Agricult Deve PlC. SNNPR Kembata Hadiya Wolayita Kuraz Sugar Development South Welayita & 4 SNNP South Omo Selamago SNNPR Wolayita Project I Omo Ari kuraz Sugar Development 5 SNNP Bench Maji Decha SNNPR Wolayita Hadiya Keffa Project III 6 SNNP Dawro Toma Gibe III, Salini SNNPR Dawro 7 SNNP Gamo Gofa arbamich Zuria Lucy Farm SNNPR Gamo Gofa Kemba 8 SNNP Gamo Gofa Mirab abay a South Agro Industry PLc SNNPR Gamo Gofa Dega Birbir Arbaminch Textile share 9 SNNP Gamo Gofa Arbamich SNNPR Gamo Gofa Arbaminich Cam Amibara Agriculture Deve 10 SNNP Gamo Gofa arbamich Zuria SNNPR Wolayita Welayita pLC Tebekew Melaku coffee 11 SNNP South Omo South Ari SNNPR South Omo South Ari Processign indu South Welayita or 12 SNNP South Omo Bena Tsemay Nassa Farm Devel SNNPR Wolayita Omo ari South 13 SNNP South Omo Dasenech Desalegn Agr deve PLC SNNPR Wolayita Omo 14 SNNP South Omo Dasenech Free A1 Ethiopia fram PLc SNNPR Wolayita Jinka Kuraz Sugar Factrory abd South 15 SNNP South Omo Selamago SNNPR Wolayita Plantation I Omo 16 SNNP South Omo Selamago Metech_Kuraz Sugar Factory SNNPR South Omo South Ari 17 SNNP South Omo Selamago Federal Water Cobtraction SNNPR South Omo South Ari 18 SNNP South Omo Selamago Mesfin Edustrial Egneering SNNPR South Omo Selamago 19 SNNP South Omo Selamago Yerga alem construction SNNPR South Omo Selamago 20 SNNP South Omo Selamago Eney Road Construction SNNPR South Omo Selamago Kuraz Sugar factrory and 21 SNNP Bench Maji SNNPR Wolayita Bench maji Plantation III

Migrant Workers destination Organization Region Zone and woreda Migrant Workers Origin Region, Zone and woreda Ser Name of employing number Region Zone Woreda Region Zone1 Zone 2 Zone 3 Region2 Zone1 Woredas Organization Beles Sugar Development Jawi, Bnaja, 22 Amhara Awi Jawi Amhara Awi Project I Chagni West 23 Amhara Jabitenah Birr Farm Development Amhara WestGojjam Sekela Gojjam 24 Amhara Awi Ankeshal Ayehu Farm Developmetn Amhara WestGojjam Sekela Kelem 25 Gambella Agnuak Abobo Saudi Star Agr Deve Plc Oromia dombidolo Wollega Gambella Shambel Ashebir Farm Kelem 26 Gambella Agnuak Oromia dombidolo (anuel) Develop Wollega Gambella Kelem 27 Gambella Agnuak Temesgen Bahiru Agr PLC Oromia dombidolo (anuel) Wollega 28 Gambella Majang Mengeshi Teppi Gree Coffee state S.C SNNPR Bench Maji Keffa Kefa, bonga Western Welkayit Sugar North North Tselemt & 29 Tigrai Welkayit Tigray Westrern Central Amhara Zone Development Project I western Gondar Telemt Western North North Tselemt & 30 Tigrai Kafta humea Almicom Agric Develop PLC Tigray Westrern Central Amhara Zone western Gondar Telemt Were leke, kola Western North North 31 Tigrai Kafta humea Hiwot Mechanize d Farm Tigray Westrern Central Amhara temben, Zone western Gondar Tselemt & Telemt Benishangul Kehedam Farm 32 Metekel Dangur Amhara West Gojjam Sekelea Gumuz Development Benishangul 33 Metekel Dangur Manbuk Farm Development Amhara West Gojjam Jabihtenan Gumuz Horo Fincha Sugar Development 34 Oromia Gudru Abay Choman SNNPR Kembata Hadiya Wolayita Oromia HoroGurun Welayita Project I Wellega East Arjo Dedessa Sugar 35 Oromia Jimma Arjo Oromia East Wollega Arjo Bedelle Wellega Development Project Wonji Sugar Development 36 Oromia East shoa Adama SNNPR Kembata Hadiya Wolayita Welayita Project Finifine finfine 37 Oromia Sululta Dereba Cement Oromia Oromia Sululta Zuria Zuria Upper Awash Agor Industry 38 Oromia Arsi Merti SNNPR SNNPR Kembata Wolayita Oromia Arsi Welayita Enterprise Jeju , 39 Oromia Arsi Tibila Africa Juice Tibila Juice Oromia Arsi East shao SNNP Kembata Bosenti

51 Migrant Workers destination Organization Region Zone and woreda Migrant Workers Origin Region, Zone and woreda Ser Name of employing number Region Zone Woreda Region Zone1 Zone 2 Zone 3 Region2 Zone1 Woredas Organization Adami Tulu Pesticide Share Adami tulu 40 Oromia East shoa Adami tulu Oromia East Shoa Campany & Zeway 41 Oromia East shoa Batu Zeway Sher Ethiopia Floriculture Oromia East Shoa zeway 42 Oromia East shoa Batu Zeway Castel Winery PLC Oromia East Shoa zeway 43 Oromia East shoa Batu Zeway Costic Soda share Campany Oromia East Shoa zeway Ada'a & 44 Oromia East shoa Ada'a VegPro PLC Oromia East Shoa Bshoftu Ada'a & 45 Oromia East shoa Ada'a Olij Roses PLC Oromia East Shoa Bshoftu Ada'a & 46 Oromia East shoa Ada'a Joy Tech Fres h PLC Oromia East Shoa Bshoftu Ada'a & 47 Oromia East shoa Ada'a Rohinara PLc Oromia East Shoa Bshoftu Ada'a & 48 Oromia East shoa Ada'a Sola Agro PLC Oromia East Shoa Bshoftu Dugda Floriculture Devet Ada'a & 49 Oromia East shoa Ada'a Oromia East Shoa PLC Bshoftu Ada'a & 50 Oromia East shoa Ada'a Minaye flower Plc Oromia East Shoa Bshoftu 51 Oromia East shoa Lome Dessa Plants PLC Oromia East Shoa Igersa 52 Oromia East shoa Lome Jittu horticulture PLC Oromia East Shoa Lome 53 Oromia East shoa Lome Florensis Ethiopia Oromia East Shoa Lome 54 Oromia East shoa Lome Syngenta Ethiopia cuttings Oromia East Shoa Lome 55 Oromia East shoa Lome Red fox Ethiopia PLC Oromia East Shoa Lome 56 Oromia East shoa Fentale Metehara Sugar Factory SNNPR Kembata Haidya Wolayita Shisindie Goma, Limu 57 Oromia Jimma Limu Coffee farm SNNPR Wolayita Kosa, Chora Midroc Legedmbi Gold Oddo 58 Oromia Guji Oddo Shakiso Oromia Guji Mining Shakiso Benishangul 59 Assossa Bambasi Amhara West Gojjam Awi Gumuz Benishangul 60 Assossa Odda Bildigilu Amhara West Gojjam Awi Gumuz Benishangul 61 Assossa Menge Amhara West Gojjam Awi Gumuz

Migrant Workers destination Organization Region Zone and woreda Migrant Workers Origin Region, Zone and woreda Ser Name of employing number Region Zone Woreda Region Zone1 Zone 2 Zone 3 Region2 Zone1 Woredas Organization Benishangul 62 Assossa Kurmuk Amhara West Gojjam Awi Gumuz Benishangul 63 Metekel Dangur Amhara West Gojjam Awi Gumuz Benishangul 64 Metekel Guba Amhara West Gojjam Awi Gumuz Benishangul 65 Metekel Pawe Amhara West Gojjam Awi Gumuz Benishangul 66 Metekel Bulen Amhara West Gojjam Awi Gumuz Benishangul West 67 Kemashi Yaso Oromia East Wellega Amhara Gumuz Gojjam Benishangul West 68 Kemashi Belo Oromia East Wellega Amhara Gumuz Gojjam Benishangul 69 Mao Komo Mao Komo Oromia West Wellega Gumuz North South 70 Amhara Metema Amhara North Gondar gondar Gondar North South 71 Amhara Quara Amhara North Gondar gondar Gondar North West South North 72 Amhara Amhara North Gondar Tigray gondar Armachiho Gondar Western North Tach South North 73 Amhara Amhara North Gondar Tigray gondar Armachiho Gondar Western North South North 74 Amhara Tegede Amhara North Gondar Tigray gondar Gondar Western West 75 Amhara Bure Amhara West Gojjam Gojjam West 76 Amhara Sekela Amhara West Gojjam Gojjam West 77 Amhara Wenberma Amhara West Gojjam Gojjam 78 Amhara East Gojjam Baso Amhara East Gojjam 79 Amhara East Gojjam Machakel Amhara East Gojjam 80 Amhara East Gojjam Gozamen Amhara East Gojjam 81 Amhara East Gojjam Debre Elias Amhara East Gojjam 82 Tigrai Western Kafta humea Tigray North Central Amhara North

53 Migrant Workers destination Organization Region Zone and woreda Migrant Workers Origin Region, Zone and woreda Ser Name of employing number Region Zone Woreda Region Zone1 Zone 2 Zone 3 Region2 Zone1 Woredas Organization zones Western Godar Horo West 83 Oromia Gudru Oromia Horo gudrun Amhara Gojjam Wellega East West 84 Oromia Oromia East Wellega Amhara Wellega Gojjam South West 85 Afar Zone 1 Afaambo Amhara North Wollo Oromia Wollo Harregie West 86 Afar Zone 3 Gewane Oromia East Shoa Harrergie Kelem 87 Gambella Zone 1 Itang,Gam ella Oromia Wollega Gog. Kelem 88 Gambella Zone2 SNNPR Bench Maji Oromia Abobo,Godere Wellega

Table 8: Personnnel Assigned to Collect Data

Place, time , person and resource Ser no. Activity description Remark Place /Zone Time Person Resource 1 Oromia Addis Ababa July 26 – 28/16 Mesele Taxi Horo, East Wellega, Illuaboara, July 26 –Aug15/16 Lakew H. Jimma Finfine Zura, Gujii, Arsi, East July 26- August 7/16 Berhane A. Car Shoa, 2 SNNP Hawassa July 26 – Augst 15/16 Amsalu G & Mazengia A Gamo Gofa, South Omo, July 26 – Augst 15/16 Amsalu G & Dawero Mazengia A. 3 Amhara Bahir Dar October 1 12 – 22/16 Mesele Air fare +Habtamu Oromia Zone, July 26 – Aug 15/16 Melkie A North Wollo West Gojjam July 26 – Aug 15/16 Habtamu A. Car Awi North Gondar July 26 – Aug 15/16 Hatamu A Car 4 Tigray Mekelle Augst 31 – Sept 30/16 HabtamuA Western Zone Augst 20 – Sept 5/16 Hatamu A North Western Zone Augst 20 – Sept 5/16 Habtamu A 5 Afar Semera Zone 3 & 1 July 30 – Augsut 3/16 Mesele Car 6 Gambella August 8 – 20/16 Berhane A Car 7 Benshagul Gumuz Assossa August 26 – Sept 30/16 Mesele Car

ANNEX C: BIBLIOGRAPHY

Alemu K, Worku A, Berhane Y (2013) Malaria Infection Has Spatial, Temporal, and Spatiotemporal Heterogeneity in Unstable Malaria Transmission Areas in Northwest Ethiopia. PLoS ONE 8(11): e79966. doi:10.1371/journal.pone.0079966 Alemu K, Worku A, Berhane Y, Kumie A (2014) Men Traveling Away from Home Are More Likely to Bring Malaria into High Altitude Villages, Northwest Ethiopia. PLoS ONE 9(4): e95341. doi:10.1371/journal.pone.0095341 Aregawi M, Lynch M, Bekele W, Kebede H, Jima D, et al. (2014) Time Series Analysis of Trends in Malaria Cases and Deaths at Hospitals and the Effect of Antimalarial Interventions, 2001–2011, Ethiopia. PLoS ONE 9(11): e106359. doi:10.1371/journal.pone.0106359 Butrapom P, Chusak Prasittisuk SK, ChareonjaiI P. Behaviors in self-prevention of malaria among mobile population in east Thailand. population. 1995 Jun;126(2). Bowling, A. 2014. Research methods in health: investigating health and health services. McGraw-Hill Education (UK). CSA. Summary and statistical report of the 2007 population and housing census. Federal democratic republic of Ethiopia population census commission, Addis Ababa, Ethiopia, 2008: pp.1-10 CSA. Population Projection of Ethiopia for all Regions, at wereda level from 2014 – 2017. CSA Addis Ababa 2013. From: http://www.csa.gov.et/images/general/news/pop_pro_wer_2014-2017_final. Accessed 20 October 2016. Deressa W, Ali A and Berhane Y: Review of the interplay between population dynamics and malaria transmission in Ethiopia. Ethiopian Journal of Health Development, 2006; 20(3). FMOH. National Strategic Plan for Malaria Prevetion, Control and Elimination in Ethiopia: 2010 - 2015. Addis Ababa, Ethiopia: FMOH, 2009. FMOH. National Strategic Plan for Malaria Prevetion, Control and Elimination in Ethiopia: 2014 - 2020. Addis Ababa, Ethiopia: FMOH, 2014 FMOH. Annual Performance Report of the Year 2008 EFY (2015/16). Addis Ababa, Ethiopia: FMOH, 2016 Gardner K, Banfield M, McRae I, Gillespie J and Yen L: Improving coordination through information continuity: a framework for translational research. BMC health services research 2014;14(1), p.1. Gemechu Beffa Defi, Ayele Belachew, Adamu Adissie, Zegeye Hailemariam. A Malaria Outbreak in Ameya Woreda, South-West Shoa, Oromia, Ethiopia, 2012: Weaknesses in Disease Control, Important Risk Factors. American Journal of Health Research. Vol. 3, No. 3, 2015, pp. 125-129. doi: 10.11648/j.ajhr.20150303.12 Hlaing, T., Wai, K.T., Oo, T., Sint, N., Min, T., Myar, S., Lon, K.N., Naing, M.M., Tun, T.T., Maung, N.L.Y. and Galappaththy, G.N., 2015. Mobility dynamics of migrant workers and their socio-behavioral parameters related to malaria in Tier II, Artemisinin Resistance Containment Zone, Myanmar. BMC public health, 15(1), p.1. IOM. International migration low: glossary on migration.2004 International Organization for Migration, Geneva, Switzerland.

57 Khamsiriwatchara A, Wangroongsarb P, Thwing J, Eliades J, Satimai W, Delacollette C, Kaewkungwal J. Respondent-driven sampling on the Thailand-Cambodia border. I. Can malaria cases be contained in mobile migrant workers. Malar J. 2011 May 10;10:120. Nyunt MH, Aye KM, Kyaw MP, Kyaw TT, Hlaing T, Oo K, Zaw NN, Aye TT, San NA. Challenges in universal coverage and utilization of insecticide-treated bed nets in migrant plantation workers in Myanmar. Malar J. 2014 Jun 2;13(211):10-1186. Schicker RS, Hiruy N, Melak B, Gelaye W, Bezabih B, Stephenson R, et al. (2015) A Venue-Based Survey of Malaria, Anemia and Mobility Patterns among Migrant Farm Workers in Amhara Region, Ethiopia. PLoS ONE 10(11): e0143829.doi:10.1371/journal.pone.0143829 Wai KT, Kyaw MP, Oo T, Zaw P, Nyunt MH, Thida M, Kyaw TT. Spatial distribution, work patterns, and perception towards malaria interventions among temporary mobile/migrant workers in artemisinin resistance containment zone. BMC public health. 2014 May 17;14(1):463. Wangroongsarb P, Satimai W, Khamsiriwatchara A, Thwing J, Eliades JM, Kaewkungwal J, Delacollette C. Respondent-driven sampling on the Thailand-Cambodia border. II. Knowledge, perception, practice and treatment-seeking behaviour of migrants in malaria endemic zones. Malar J. 2011 May 9;10(117):10-186. WHO. Malaria in migrants and mobile populations. 2015. Available from: http://www.who.int/malaria/ areas/high_risk_groups/migrants_mobile_populations/en/. Accessed 18 March 2016. Yukich JO, Taylor C, Eisele TP, Reithinger R, Nauhassenay H, Berhane Y, Keating J. Travel history and malaria infection risk in a low-transmission setting in Ethiopia: a case control study. Malar J. 2013 Jan 24;12:33. ESRI. 2011. ArcGIS Desktop: Release 10. Redlands, CA: Environemental Systems Research Institute. Microsoft Corporation. 2010. Microsoft Office Excel. Redmond, Washington, USA; Microsoft Corp.; 2010. Last name Beitz, J, H Srimuangboon, A Lion-Coleman, R Transgrud, J Hutchings, M Weldin. 2003. Youth- Friendly Pharmacy Program Implementation Kit: Guidelines and Tools for Implementing a Youth-Friendly Reproductive Health Pharmacy Program. Seattle, WA: PATH.