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Health Sector Bulletin July 2019 Managing Medical Waste in Ngarannam PHC

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Health Sector Bulletin July 2019 Managing Medical Waste in Ngarannam PHC Health Sector Bulletin July 2019 Managing medical waste in Ngarannam PHC. (Photo: PUI) Northeast Nigeria Humanitarian Response 5.3 million 5.0 million 1,755,592* 4.4 million people People in need targeted by the IDPs in the reached in 2018*** of health care Health Sector three States HIGHLIGHTS Health Sector The gaps in referral services have been strongly flagged by 45 HEALTH SECTOR PARTNERS the Health Sector partners currently providing PHC services (HRP & NON-HRP) in camps and hosting areas as a key need, specifically the HEALTH FACILITIES IN BORNO STATE** inability of patients to receive critically needed health care NON- FUNCTIONING (OF TOTAL nor timely access emergency care in hospitals. Patients in 375 (50%) 755 ASSESSED HEALTH FACILITIES) need of critical secondary or tertiary care in timely manner but unable to access it due to access, distance and lack of 292 (39%) FULLY DAMAGED resources remains a key challenge. Most at risk are pregnant 205 (27%) PARTIALLY DAMAGED 253 (34%) NOT DAMAGED mothers requiring emergency obstetric care as well as children with severe acute malnutrition and acute medical CUMULATIVE CONSULTATIONS complications. 4.9 million CONSULTATIONS**** 1490 REFERRALS One of the serious challenge is the population living in hard 320,898 CONSULTATIONS THROUGH HARD TO to reach or conflict prone areas are without any humanitarian REACH TEAMS and health support. Around 45 Health Sector Partners are EPIDEMIOLOGICAL WEEK 2018 providing health care services through mobile health teams EARLY WARNING & ALERT RESPONSE and support to health facilities in IDP camps and host communities. 268 EWARS SENTINEL SITES An addition to strengthening surveillance and early warning 223 REPORTING SENTINEL SITES system, partners are working to strengthen other 298 TOTAL ALERTS RAISED***** preparedness and response capacities in the event of an cholera outbreak particularly in hard to reach but still SECTOR FUNDING, HRP 2019 accessible LGAs/locations. The key interventions are pre- positioning of adequate cholera supplies and kits, immediate HRP 2019 REQUIREMENTS $73.7M risk assessments in communities for the timely mitigation FUNDED $10 M (14%) and response to outbreaks especially during rainy season. UNMET REQUIREMENTS $63.7 M The recent IASC EDG mission to NE Nigeria highlighted the need for extension of coordination to the LGA level to ensure coordinated response among partners who are implementing response programmes in those areas. Local level coordination mechanism is in place in high priority LGAs where mostly the NGO co-leads are performing the coordination lead role. * Total number of IDPs in Adamawa, Borno and Yobe States by IOM DTM XXII **MoH/WHO Borno HeRAMS September/October 2018 ***Number of health interventions provided by reporting HRP partners as of December 2018. **** Cumulative number of medical consultations at the IDP camps from 2019 Epidemiological Week 1- 186 ***** The number of alerts change from week to week. 1 Situation updates Malaria control operational plan: Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53 million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden. According to EWARS report of week 30, report from 223 site including 32 IDP camps showed that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported death. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1 million people are in dire need of healthcare and 6.2million are targeted for immediate attention. An analysis commissioned by the WHO Global Malaria Programme to guide the next steps in the response to the malaria interventions in the complex humanitarian emergency concluded that ‘malaria is the number one health risk that populations in the affected areas in NE Nigeria are confronting. Based on Malaria Programme Interventions in the state in 2018, challenges and recommendations, this Malaria Annual Operational Plan (MAOP) was developed with Technical Support from WHO and partners. It was aligned to the National Malaria Strategic Plan (2014 -2020) which goal is to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero. The MAOP was developed through a broad based stakeholders workshop involving malaria stakeholders. It was reviewed by the different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary – Borno State Ministry of Health. Group photograph during launch of Borno Malaria MOAP The MAOP has seven objectives among which are: To provide at least 50% of targeted population with appropriate preventive measures by 2020; To ensure that all persons with suspected malaria who seek care are tested with RDT or microscopy by 2020; To ensure that all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020. It seeks to ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020; ensure the timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020; ensure that all health facilities report on key malaria indicators routinely by 2020, and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an ‘A’ rating by 2020 on a standardized scorecard. These strategic objectives have specific objectives and targets and the MAOP takes into account the humanitarian response. Cholera preparedness plan: Cholera Preparedness and Response plan is to provide a logical framework for optimal preparedness and effective response in the event of an outbreak in Northeast Nigeria. The plan includes information on response activities, roles and responsibilities. It also determines the needs and required resources to reduce the incidence, morbidity, mortality and economic losses associated with cholera and other diarrhea disease epidemics among members of the community through effective prevention and prompt institution of appropriate control measures. The specific objectives of cholera preparedness plan are: 1. To strengthen existing coordination structure and partnerships and mobilize resources for effective and efficient response at all levels 2. To strengthen surveillance activities in affected and high-risk states 3. To reduce morbidity and mortality in cholera cases 2 4. To enhance water, sanitation and hygiene intervention at all administrative levels in affected and high-risk states 5. To rapidly detect and confirm cases. 6. To vaccinate population at risk for states in outbreak and to preposition drugs, laboratory reagents and other supplies where and when necessary 7. To intensify risk communication activities across all three states 8. To expand ongoing preparedness activities to the surrounding high-risk states Prevention of Cholera outbreak involves improved sanitation and access to clean water. Cholera vaccines can also be administered in outbreak situation and it is an oral vaccine providing reasonable protection for about six months. Oral Cholera Vaccine (OCV) plays an important role in the prevention and control measure in epidemics. The provision of safe water and adequate sanitation for IDPs is a difficult challenge but remains the critical factor in reducing the impact of cholera outbreaks. Recommended control methods, including standardized case management, have proven effective in reducing the CFR. Comprehensive surveillance data are of vital importance to guide the interventions and adapt them to each specific situation. Cholera prevention and control is not an issue to be dealt by the health sector alone. Water and sanitation, health and hygiene promotion and communication interventions are also important factors in ensuring control and prevention of cholera outbreaks. Therefore, a comprehensive multidisciplinary approach should be adopted for dealing with potential cholera outbreaks among IDPs and populations at risk. Early Warning Alert and Response System (EWARS) Number of reporting sites in week 30: A total of 223 out of 268 reporting sites (including 32 IDP camps) submitted their weekly reports. The timeliness and completeness of reporting this week were both 83% (target 80%). Total number of consultations in week 30: Total consultations were 55,417 making a decrease of 2% in comparison to the previous week (n=56,669). Leading cause of morbidity and mortality in week 30: Malaria (suspected n= 10,886; confirmed n= 6,062) was the leading cause of morbidity and mortality reported through EWARS, accounting for 35% of reported cases and 46% of reported deaths. Number of alerts in week 30: Seventy-one (71) indicator-based alerts were generated with 83% of them verified. 3 Morbidity Patterns . Malaria: In Epi week 30, 6,062 cases of confirmed malaria were reported through EWARS. Of the reported cases, 310 were from General Hospital in Biu, 254 were from Madinatu IDP Camp Clinic in Jere, 200 were from Bakassi Mongono IDP Camp Clinic in MMC, 177 were from Gwange PHC in MMC and 142 were from Briyel MCH in Bayo. Three associated deaths were reported in Azare General Hospital (2) Hawul and Yawi General Hospital (1) Biu. 8000 6000 4000 2000 0 W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W 34 39 44 49 2 7 12 17 22 27 32 37 42 47 52 5 10 15 20 25 30 35 40 45 50 3 8 13 18 23 28 8-Jul 2017 2018 2019 Under 5yrs 5yrs and Above Figure 2: Trend of malaria cases by week, Borno State, week 34 2016 - 30 2019 Acute watery diarrhea: In Epi week 30, 1,216 cases of acute watery diarrhea were reported through EWARS. Of the reported cases, 279 were from PUI mobile clinics in MMC, 277 were from Herwa Peace PHC in MMC, and 251 were from Ngaranam PHC. No associated death was reported.
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