HEALTH CLUSTER BULLETIN #23 Group counselling session by IOM MHPSS staffs in Mekelle IDP sites, April & May 2021 May 2021 Photo by: IOM. Emergency type: Multiple Events Reporting period: 1-30 April & 1-31 May 8.7 M 2.9 M 1.6 M 220 PEOPLE IN NEED IDP TARGETED HOST TARGETED WOREDAS HIGHLIGHTS HEALTH SECTOR

• The health cluster require US$48.2M to HEALTH CLUSTER 30 IMPLEMENTING support partners sustain operations in PARTNERS for the next 8 months (From MEDICINES DELIVERED TO HEALTH May to December 2021). FACILITIES/PARTNERS

• Healh cluster is targeting 2.3M out of the 751 ASSORTED MEDICAL KITS estimated 3.8M people in need of health HEALTH CLUSTER ACTIVITIES care services in Tigray.

• From January to May 2021 the health 394,693 OPD CONSULTATIONS cluster reached a cumulative of total of 1,421,169 people with health IEC messages. VACCINATION VACCINATED AGAINST 9,040 MEASLES • Majority of IDPs live in host communities (over 90%),only a small number live in EWARS sites. North has 253,000 IDPs and CONFIRMED COVID-19,

POLIO, YELLOW FEVER, S. zone 105,000; the IDPs need 5 food, ES/NFIs, WASH and healthcare. CHOLERA, MEASLES OUTBREAKS FUNDING $US • As of 23 May 2021, Ethiopia recorded 140 M REQUESTED 269,194 confirmed COVID 19 cases,with M % FUNDED 4,076 deaths and 228,757 recoveries. M GAP have been reported in Ethiopia.

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Situation update The situation in the Tigray region was becoming protracted with increased humanitarian needs. Hence, the available resources in the country would be insufficient to meet the growing need to rapidly respond to the public health consequences of the conflict. Physical access to certain affected rural areas remained difficult due to pockets of conflicts and insecurity; by implication affected population in those locations were denied access to public health and other social services. Health partners providing MHNT services could not reach up to 22 woredas with those services. The conflicts were in parts of North West zone; Eastern zone (Wukro, Hawzen); Central zone; Western zone and Southern zone (Maychew - 130Kms South of Mekelle and in Samre and Gijet, 60KMs South East of Mekelle). For woredas that were becoming accessible, there was need to sustain the operations of MHNTs and the few functioning health facilities. More medical supplies were required to address the pipeline issues and to ensure that the MHNTs and hospitals do not runout of the essential supplies. A number of health facilities remained non-functional because of insecurity, health worker shortage, attacks on healthcare – for instance looting, vandalism and military occupation of some few facilities. To ascertain the motive for the vandalism and looting of some these health and/or public facilities, investigations would be required to identify the people. Development of the Northern Ethiopia Response Plan was finalized in May 2021. Health cluster require US$48.2M to support partners sustain operations in Tigray region for the next 8 months (From May to December 2021). The cluster is targeting 2.3M out of the 3.8M people in need of essensial health services. The priority objective of the cluster is to reduce avoidable morbidity and mortality among IDPs, and vulnerable conflict affected population in the Tigray region. The funds would support SGBV/MHPSS, Covid19 response, MHNT, medical supplies, referral systems (ambulances), coordination in Mekelle and shire, disease surveillance and emergency preparedness among others. According to the inter-agency assessment report in North Showa and Oromo special zones of , from 3 to 6 May, the security situation was calm, normalcy returned to Debre Berhan, Debresina, Shoa Robit, , Artuma Fursi. Ataye town is abandoned: Burned down, no people in the town. There are 253,000 IDPs in North Shewa, 105,000 IDPs in Oromia S. zone and majority of the IDPs live in host communities (over 90%), only a small percentage are in sites. The priority needs include food, ES/NFIs, WASH and healthcare.

Figure 1: HC MHNTs operating in Tigray as of 30 May 2021

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There was suspected Cholera outbreak is in Oromia region, however no suspected Cholera cases and death were reported in week 19. A total 43 suspected measles cases without deaths were reported in week 19 in Amhara, Oromia, Gambela and region. Up to 77% (33) of those cases were from Amhara region, 19% (8) were from Oromia region, 2% (1) were from Gambela and 2% (1) from Addis Ababa region. In the same week, 16 suspected Polio cases were reported. Up to 50% (8) of them were from Oromia region, 32% (5) were from Amhara region, 12% (2) were from SNNP and 6% (1) from . As of 23 May 2021, Ethiopia had recorded a total of 269,194 confirmed COVID 19 cases with 4,076 deaths and 228,757 recoveries. Response activities continued through the national and subnational PHEOC, with partners supporting various pillars at all levels. Public Health risks, priorities, needs and gaps Health risks • With ongoing community transmission of COVID-19, Ethiopia remains at high risk of increasing caseloads and mortalities, thereby straining the health system. • Communicable disease outbreaks due to low literacy levels, poor and congested living conditions, poor WASH facilities and practices, mass gatherings and activities, and low vaccination coverage remains a huge public health concern. • Conflict and population displacement leading to increased health demands on facilities due to new and pre-existing conditions and diseases, mental health burden, sexual and gender-based violence, and other sexual and reproductive health needs outtretches existing capacities in the facilities. • Food insecurity and malnutrition, resulting from erratic rains and drought in some locations, which contribute to higher vulnerability of children and other people to infectious diseases and other disease conditions is another area of critical concern. Priorities • COVID-19 outbreak readiness and response preparation is among the top on the list. • Revitalization of the healthcare delivery system in Tigray region to cope with the increased need for healthcare services. • Delivery of essential life-saving emergency health services to vulnerable populations by ensuring sufficient quantities of quality medicines and medical supplies and availability of health workers to deliver the services. • Work with and strengthen the capacity of the existing health system by training health workers and establishing humanitarian-development linkages that would enable easy transition and ensure sustainability of the outcomes. • Enhance quality of the response through field level coordination, monitoring and support to partners with the main focus on IDP/return locations and new incidents. • Improve the collection and collation of data and information from partners, present it in the information of products and use it for decision making, resource mobilization and guiding the response. • Support joint and integrated approaches with other Clusters targeting the same locations and populations with humanitarian response to avoid duplication and maximize resource utilisation. Needs and gaps • Shortage of qualified health staff to implement the response in emergency affected locations, in an already strained health system, and partners’ inability to recruit the appropriate staff adequately. • There is need to strengthen the regular supply chain for medicines, and harmonize it with the emergency streams to reduce incidents of stock-outs at health facilities, and address delays in emergency funding. • Health facilities in many return locations were fully or partially destroyed by the conflict, floods and other causes. There is need to speedily rehabilitate, re-staff and restock these facilities.

Health Cluster Action Strategy and response processes The cluster focused on ensuring availability and expansion of essential health services in Tigray and other conflict affected parts of the country. Expansion of mental health and psychosocial support servces to conflict affected populaions including survivors was also a major area of focus for the cluster. Emergency health kits were provided to North Shewa and Oromo

3 special zones of Amhara after intercommunal violence that erupted in several locations. Encouraging partner presence in North Shewa and Oromo Special Zones of Amhara region is a major concern for the cluster. Health Cluster coordination As for Tigray response, the Health cluster continued to provide leadership to the health response, partner coordination, technical and operational support in response to both Regional Health Bureau and partner efforts. In March, WHO activated a second Sub National Health Cluster coordination forum in Shire in addition to the existing one in Mekelle with participation of nine partners. The central cluster continued to participate in the coordination meetings held at Chagni (for Metekel) and Gonder. However, this participation became difficult due to overlapping committments and shortage of human resources. The health cluster continued its regular weekly virtual meetings where updates and guidance on ongoing partners’ contributions to essential health services and the emergency response in Tigray is shared.

Monthly health cluster partners’ 4W and HRP for the whole country is collected and anlysed. Currently the cluster has 19 partners of which 3 are UN agencies, 13 are International NGOs, and 3 are National NGOs. These partners operate in 220 woredas in different parts of the country. Over the period, January – May 2021, the cluster reached out to a cumulative total of 1,421,169 people with IEC messages. Field Monitoring and Support The Health Cluster Public Health Officer (PHO) participated in a multisectoral assessment in North Shewa and Oromo Special Zones of Amhara region where it was noted that the needs are high on the ground but partner presence was very limited. There cluster partners have not provided emergency response to the two zones apart from emergency health kits delivered earlier through MSF E. The lessons learned through the assessment were shared with cluster partners and the ICCG.

2021 HRP dashboard

Indicators Q1 April May Total

1.1.1. Total number of kits distributed 946 401 350 1,697 1.1.2. Total Number of OPD consultations 404,991 223,732 170,961 799,684 1.1.3. Number of normal deliveries attended by skilled birth 4,884 4,036 756 9,676 attendants 1.1.5. Number of children 6 months-15 years receiving 16,063 7,403 1,637 25,103 emergency measles vaccination 1.1.5. Number of children 6 months-15 years receiving - - 482 482 emergency POLIO vaccination 1.1.6. Total number of emergency patients / maternal - 95,000 38 95,035 referrals conducted for specialized lifesaving services 1.1.7. Number of community members receiving health IEC 480,090 340,536 600,543 1,421,169 messages 1.2.1. Number of alerts investigated and responded to 486 871 83 1,440 timely within 48 – 72 hours of notification 1.2.5. Number of Health workers trained and have the 151 571 18 740 capacity to manage an outbreak 1.3.1. Number of individuals needing mental health and 73,310 40,487 16,819 130,616 psychosocial support and receiving it 1.3.2. Number of eligible survivors of rape receiving post- exposure prophylaxis within 72 hours of an incident or from 13,364 88 - 13,452 exposure, and emergency contraception within 120 hours of an incident or from exposure. 1.3.4. Number of individuals with injuries and disabilities 498 2 54 554 treated and referred for further care 1.4.4. Number of Health facilities conducting integrated 476 96 71 476 diseases surveillance and reporting 1.4.5. Number of Health facilities with minimum staffing level to offer essential package of health care delivery 1 27 15 15 services

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Training of health workers IMC provided on-the-job training for 12 health workers and 20 health extension workers, and conducted sensitization session for 58 religious and community leaders on prevention and control of communicable diseases in Liban, Goro Dola and Saba Boru woredas. IOM in collaboration with ZHDs, IOM conducted COVID-19 related trainings to 150 health workers and 25 religious leaders and public mass media focal person in Gedeo, Konso and East Hararge zones. In close cooperation with RHBs, IOM also cascaded trainings on Cholera for 35 government health workers in Shire. OWDA together with RHB MCH team,OWDA provided PMTCT training to 15 health workers working in Danod and Daratole districts; 12 participants were females and 3 were males. UNICEF trained a total of 23,326 Health Extension Workers (HEW) and 1,812 HEW supervisors on COVID-19 Risk Communication and Community Engagement (RCCE). 1,008 HEW and 188 HEW supervisors also completed Integrated Refresher Training on RMNCH. Currently they have enrolled 4,200 HEW and 443 supervisors for a similar training. FIDO in April, trained 28 health workers from certain woreda health offices and prioritized health facilities on COVID-19, IPC, Risk Communication and Surveillance and also trained 14 health workers and 10 community volunteers on basic skills of psychosocial support and MHPSS .The participants were from targetted woredas of Itang, Akobo and Lare of Gambella region. In May, FIDO trained 10 community volunteers and 16 HEW on MHPSS; they also trained these participants on COVID-19 RCCE,and prevention and control measures in Dedesa woreda of Buno zone, in Oromia region. IRC provided training to 23 participants from project woredas in Gambella region on community based surveillance of vaccine preventable and maternal and neonatal death surveillance and response. They also trained 39 other particpants on Comprehensive Management of Acute Malnutrition (CMAM). The participants included medical doctors, health officers, nurses and health extension workers.

Provision of essential drugs and supplies WHO donated 538 IEHK module, 56 TESK set, 152 cholera kits, different nutrition medicine equipment, PPE materials to partners and zonal health offices in all regions in April & May 2021.

Support to health service delivery

AAH in April, continued to support the government in awareness raising activities through distribution of locally translated IEC materials and mass awareness by field staff in all areas that AAH was operating. They broadcasted key messages on national and local radio stations under UNICEF grant. They also supported Zonal and Woreda health offices and Rapid Response Teams (RRT) by assigning vehicles for community and facility- based surveillance and mobilization efforts.

GOAL in April and May, MHNTs conducted medical consultations for 1,310 clients in and woredas. They provided health education to 8,329 individuals. In (Galadi, Daratole, Bokh woredas),they provided medical consultations to 4,227 clients and health education to 12,826 individuals. In Tigray (Enderta, Sasie, Endagahamus, Kilete Awulalo, Kola Temben and Hintalo Wajirat), they provided 1,744 clients medical consultation and 3,693 individuals health education. FIDO in April, FIDO conducted EPI outreach activities with health extension workers in Kuerliey Health Post, Pilual Kebele, Lare woreda , Nuer zone of . In May, they distributed 20 Tippy Tap and 180 boxes of surgical face masks to 3 facilities through the Woreda health offices. They also posted posters conveying COVID-19 messages in locally translated language in market places, schools, churches and health facilities. They also provided mass education to social workers on psychosocial support and coping strategy for COVID- 19 to IDPs in Dembi site, Dedessa woreda.

MC MHNT in April and May, reached 4,572 beneficiaries with medical consultation in Hariso IDP site of Gablalu woreda, 949 of which were children under 5 years, 639 were between 5 to 18 years, 2,676 were above 18 years, 268 were elderly people and 40 were people with disabilities. 117 children were given measles vaccination. The MHNT delivered IEC messages on COVID-19 to 3624 individuals. They also provided MHPSS services to 544 clients, and six (6) women of child bearing age received moderate contraceptives. Additionally, MC MHNT identified and treated 78 SAM children without medical complications at theoutreach sites.

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MCMDO MHNT response project in Tigray, Benishangul Gumuz, Afar and SNNPR regions, reached 87,227 beneficiaries with life-saving health and nutrition services. Of that total, 21,999 beneficiaries were from and Metekel zones (Kamash,, , and woredas), 51,878 beneficiaries from Tigray region and 3,419 beneficiaries from Amibara woreda of and 9,931 beneficiaries from Wanago woreda of Gedeo received consultation and treatment, ANC, FP, delivery, PNC, EPI, nutrition screening and OTP service, Vitamin A and deworming. UNICEF MHNT in Afar and Somali regions conducted 59,698 medical consultations of which 41% were with children under 5 and 35.8% were women. They also continued to support the Gambella RHB to vaccinate South Sudanese refugee children at entry points and refugee camps. 1,283 children were vaccinated against polio and 1,101 children were vaccinated against measles at entry points in Gambella. In April and May, a total of 4,189 children were vaccinated for measles at refugee camps. UNICEF supported IDP health response in SNNP (Konso, Dasanach, Alle, Dereshe) on continuation of essential services through provision of 13

Emergency drug kits (EDKs. Additionally, they provided operational funds to deploy health workers to IDP hosted woredas. Similar support was also provided to Benishangul Gumuz region IDP health response; 10 EDKs provided to IDP hosting woredas of Metekel zone. Five and ten EDKs with operational cost were provided to Afar and Amhara regions respectively. In May UNICEF reached 7,300 people with messages delivered through community outreaches by social mobilizers and using mass media. UNICEF provided 16 EDK to Amhara (North Shoa (13), Waghimera (3)), 40 EDK to Somali region, 19 EDK to Afar region. UNICEF also provided 58,000 N95 mask and 33,169 bottles of hand sanitizers to Amhara region, 58,000 N95 mask and 36,500 bottles of hand sanitizers to Tigray, 25,000 bottles of hand sanitizers to Afar region, 20,000 bottles of sanitizers to Gambella RHB. UNICEF supported 28 MHNTs across Tigray region. The MHNTs provided 39,869 clinical consultations in May; they also supplied 40 EDKs to Tigray RHB for provision of essential health services through MHNTs and fixed health facilities. UNICEF also rented three long trucks and deployed them to assist Tigray RHB on ferry supplies to 36 health facilities in 30 woredas. 20,000 LLINs were also distributed to

Shire IDP sites for the prevention of malaria transmission. 58,000 N95 masks and 26,520 bottles of hand sanitizers were distributed toRHB to protect health workers against COVID 19 when providing essential health services. IOM continued supporting provision of essential health services in East Wollega, West Guji, , (Karat Zuriya woreda in 2 IDP sites; Gelabo and Belebel), (Moyale Woreda in 3 IDP/returnee sites; Laga Sure, Danbi Hara & Bede), (Guchi woreda intwo IDP/returnee site; Saden and Kalkalcha), Somali region (Qoloji IDP site), (millennium site) and East Hararge (Kersa, Goro Gutu) IDP camps. In response to the Northern Ethiopia crisis, IOM supported two IDP camps in North and central Gondar, 13 sites in Mekelle and one in Shire. Cumulatively they conducted 34,220 medical consultations, screened 7,306 children for malnutrition and provided surgical masks and hand sanitizers for IDPs households in Dire Dawa Millenium IDP site and demonstrated use of PPEs. IOM also provided logistic support for West Guji zonal health office for health workers orientation on Astra Zeneca vaccine at woreda level. They also reached 102,848 individuals with key health messages; 4,679 women received basic SRH services and they conducted RCCE sessions on COVID-19 in Kercha and Hora woreda secondary school for 100 students and 60 teachers. They distributed UNFPA donated Dignity kits to 1,468 beneficiaries/IDPs in Debark and round two distribution for 700 girls and women of reproductive age in Kebero Meda IDP site. IOM also donated medicine and medical equipment to Sasiga, Gutu Gida and Wollega Referral Hospitals.

IMC deployed MHNT to provide lifesaving emergency health services and outbreak response for IDP and Host community in . The MHNT reached 4,204 individuals with medical consultation at 12 IDP sites of Goro Dola, Liban and Saba Boru Woreda. 1,878 individuals were provided health education on Cholera prevention and control of other emergency prone diseases, and child and maternal health. They also screened 1,082 children for malnutrition; three were found with uncomplicated Severe Acute Malnutrition (SAM) and 10 with Moderate Acute Malnutrition (MAM) and 456 Pregnant and Lactating Women (PLW)were also screened and 127 of them were found with MAM and linked to HEW for OTP and TSFP services respectively. 1,939 women of reproductive age received comprehensive RH services. 110 under five year children received Albendazole for deworming. In Shire, IMC provided consultation services to 2,978 under 5 children and adults. They also provided MHPSS counselling and care to 43 individuals. The MHNTs at Shire, Sheraro and Axum towns provided family planning services to; 54 women. The MHNTs also provided routine EPI and Vaccination against Covid-19 for target individuals in IDPs site.

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MSF S through its migrants project for returnees coming from Arab countries, conducted OPD consultations for 3,700 individuals, health promotion for 8,738 in 893 sessions, mental health consultations for 364 individuals and 309 GMH. Through Metekel project, MSF conducted 3,186 OPD consultations, 30 ANC, 21 PNC, 50 mental health for 12 groups and 38 individuals and 5 Ambulatory therapeutic feeding programs. MSF in Tigray has also been serving more than 13 woredas, they conducted 469 hospitalizations, 145 surgeries, 2,025 vaccinations, 1,456 ANC, 16 SAM admissions, 176 mental health groups, 1,689 OPD consultations, 647 mental health individual sessions, 1153 deliveries, 6011 mental health beneficiaries, and 96 neonatal ICU. MSF also developed referral system for some war wounded patients in the different woredas in Tigray. Accordingly, they supported 208 pediatric hospitalization, 1,053 adult hospitalization, 274 OR interventions, 1269 children vaccination, 19 admissions, 628 under 15 OPD consultations, 916 deliveries, 166 C-section, 66 NICU admissions, 1557 ANC consultations, 378 mental health individual sessions, 356 mental health group sessions.

IRC delivered office supplies, furniture, IPC materials and stationaries to Adelle PHCU and stationary materials to Woreda health office in Oromia. They also conducted community mobilization and awareness creation campaign at Adelle town/IDP site (market) for 2217 participants. IRC also tTransported WHO kits and medications from the woreda health office to Adelle Health Centre (HC); furniture and IPC supplies from Adelle HC to Adelle Health Post (HP) and Yebalo HP. They also conducted pregnant women conference, ANC and family planning services for IDPs and the host community. In Gambella region IRC conducted community mobilization and awareness creation using mobile vans int town each of the woredas of Dima, Makuey, and Wanthoa including markets and community gathering places. They assigned vehicles to Dima, Wanthoa and Makuey woredas to support immunization activities by transportation the vaccines, other supplies and the supervisors; they also supported the routine immunization services financially.

WVI in May WVI distributed lifesaving medicines and medical supplies to 15 health facilities in Mekele and 5 districts in Raya Alamata, Raya azebo, Raya Chercher, Olfa and Mehone districts. Move than3,110 people visited health facilities and received OPD consultations in Alamata District. WVE also supported the transportation and referral of 15 individuals with severe injuries to higher hospitals for further care. As part of the COVID 19 campaign, WVI reached more than 16,570 people with awareness messages. They also provided supportive supervision to 23 health facilities and logistics to PHEM Team in 6-targeted woredas in Mekele, Raya Alamata, Raya Cherecher, Olfa, and Mehone.

OWDA MHNTs working in Deka, Kohle, Gashamo, and Moyale woredas of Somali region provided free medical healthcare services to 6,108 individuals through consultation and case management. OWDA also provided 267 individuals for mental health and psychosocial support services during the MHNTs site consultations and other health education occasion sessions across the four districts. With regard to health education, OWDA reached 2,523 individuals with comprehensive messages on COVID-19 prevention discipline and control measures.

Plans for future response The health cluster will continue working with the government departments to deliver essential life-saving healthcare services to the most in need populations. Partners will contribute to and participate in readiness and response efforts at subnational level. The cluster’s priority target populations will include IDP, returnees and host communities in emergency locations. New conflict and flood induced IDP and returnees will be prioritized, while the needs of chronic IDP will be assessed from time to time and appropriate response effoorts formulated and implemented. Response to the ongoing cholera outbreaks, as well as strengthening of the early warning system. Surge support to the existing network of health facilities and outreach services will be preferred as much as possible, with Mobile Health and Nutrition Teams (MHNT) reserved for locations and populations of limited access.

Health Cluster meeting partners National

GOAL, WVE, ECHO, MCMDO, UNICEF, ACF, OWDA, SCI, IRC, IMC, PIN, CARE, CRS, CCM, CWW, USAID Transform PHC, UNAIDS, FIDO, UNESCO, FHI360, MSF-E, MSF-H, CUAMM, PIN, UNDP, UN Women, Mercy Corps, Child Fund, Plan International, UNFPA, IOM, WHO, MS, SP, MTS, MIS, Humedica e.V., UNHCR, OCHA.

Contacts:

Dr. Patrick Abok, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer, [email protected], +251 967897964 [email protected], 0945184987

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