CGPP and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

Highlights:

Somalia: No new cVDPV cases reported during December 2018. The number of cVDPV2 cases remains as 5, while cVDPV3 cases remain 6.. In 2018 so far, cVDPV2 & cVDPV3 have been isolated from 19 and 12 sewage samples in Mogadishu respectively. One case is confirmed with coinfection with both cVDPV2 and cVDPV3 isolates.

Kenya: No new cVDPV cases reported during December 2018. In 2018, two cVDPV were isolated from Kamukunji, .

Objective 1: Build effective partnerships Polio and GHSA activities

• The CGPP Secretariat held discussions with Comitato Collaborazione Medica (CCM) Kenya and Somalia Country representative and team on possible collaboration on One Health activities in Marsabit County. CCM is due to start implementing a One Health project in Marsabit County. • Garissa County Zoonotic Disease Unit Meeting: The inception meeting requested by CGPP to introduce the implementation of the Global Health Security Agenda (Community-Based Surveillance of the Priority Zoonotic Diseases). The meeting was attended by the Director of Health, County Epidemiologist, County Health Promotion Officer, Representative from Veterinary services (Animal Health), ARC Senior Program Officer and myself. • The project faciliated a joint MOH/CGPP support supervision of the Garissa County Polio Project. The objective of the visit was to review the situation on the ground-administrative, security, and programmatic issues, assess progress in approaches for mobile and hard to reach populations and cross-border strategies for polio eradication activities and routine immunization. The supervison visits were done for 9 border health facilities along the Kenya-Somalia border. • CGPP conducted a joint support supervision in Lower Juba, Somalia. The project supervision and monitoring visit was to contribute to the strengthening of implementation and coordination project activities. Three border health facilities were supervised during the visit.

Figure 1: Supervision visit to Liboi and Dadajabula Health Centers

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

Objective 2: Strengthen routine immunisation systems

Training

Routine Immunization Micro Planning training was conducted in Somalia (Kismayo) on the 8-13th December. The main objective of the training is to enable the participants to understand the objectives, priorities and components of the RED/REC micro planning approach to ensure best practices are implemented in delivering quality immunisation services. A total of 25 health managers from Jubaland State of Somalia were trained on the RI microplanning.

Immunization outreach Services Figure 2: RI microplanning training session in Kismayo, Somalia

A total of 92 outreach sessions were conducted in 5 (56%) Number of children < 12 Months out of the 9 CGPP Counties ( Garissa ( Dadaab, Fafi, reached by County Hulugho), Lamu (Lamu East), Lower Juba (Afmadhow, Badhadhe), (lafey , Mandera South, Mandera West) and Wajir (Wajir East, Wajir North, Wajir South) which 0 500 1000 1500 2000 2500 reported in week 50-52. Eighty-one (88%) out of the 92 Garissa 162 outreach sessions conducted were supported by the local CGPP partners. During the outreach sessions a total of 2,259 Lamu 99 children < 1 year of age were reached with various antigens as indicated in Fig. 3. Lower Juba 58

Mandera 416 A total of 71 children were recorded as having received OPV birth dose Males were 33 (46%), and Females were 38 Wajir 1524 (54%).The total number of children < 1yr who received OPV 3 in the CGPP areas were 652. Two hundred and ninety-four Total 2259 (45%) were males while 358 (55%) were females. As Fig 3: Children reached during outreach services indicated in table 1 below. Figure 3: Number of children < 12 Months reached by County during outreach session

Table 1: Children < 1 yr vaccinated with OPV 0 and OPV 3

< 1yr 1 OPV Birth < 1yr 1 OPV Birth <1 yr. OPV3 Males <1 yr. OPV3 Females County dose Males dose Females No. % No. % No. % No. % Garissa 5 15 8 21 42 14 50 14 Lamu 2 6 5 13 26 9 37 10 Lower Juba 4 12 8 21 16 5 20 6 Mandera 2 6 0 0 158 54 206 58

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

Wajir 20 61 17 45 52 18 45 13 Total 33 100 38 100 294 100 358 100

It is also worth noting that 21 children were recorded as Zero doses out of which 8 (38%) were Males while the females were 13, (62%). The highest number of zero doses cases were reported in Lamu County 8 (38%) followed by Mandera 7 (33%).

A total of 282 children < 12 Months were reported as fully Immunized, 134 (48%) were males while Females were 148 (52%) as indicated in Fig 5. below. The number of children reported as fully Immunized under the category of 12-23 months were 244 (Males 118 (48%), Females 126 (52%) as per fig .4 below.

Number of Fully Immunized children Number of Fully Immunized children 12- <12 months by Gender N= 282 23 months by Gender N= 244

0% 20% 40% 60% 80% 100%

0% 20% 40% 60% 80% 100% Garissa 76 79 Garissa 26 27 Lamu 2 4 3 5 Lower Juba 19 22 Lower Juba 11 15 Mandera 18 19 30 48 Wajir 64 53 Wajir 3 2 134 148 Grand Total 118 126

Males Females Males Females

Figure 4: Number of Fully Immunized children < 12 months by Gender and 12-23 Months

Figure 5: Targeted immunization outreach for nomadic-pastoralist communities in Wajir County

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

A total of 2,750 children who defaulted the immunisation services No. of Children traced through defaulter were tracked by the community mobilizers working in the CGPP supported areas. The highest number of children traced were in tracing,N=2,750 Wajir 1,803 (66%), Lamu 373 (14%) while Gedo team managed to trace 11 (0.4%) as indicated in fig. 6 below.

3000 2000 2750 1000 1803

192 373 249 0 11 67 55

Figure 6:Number of Children traced during defaulter tracing

Social Mobilization Indicators:

Table 2:Social mobilization activities conducted by Social Mobilizers.

# # # SM House # # < # one Community group activities County Hold Families 5s on one Mobilizers meetings in border Visited Reached reached contacts engaged held / Migrant Garissa (Dadaab, Fafi, 27 710 3705 515 710 134 80 Hulugho) Gedo (Bardere, Gerilet, Belet hawa, Elwak and 28 106 1547 5784 1481 2 1 Dollow) Lamu (Lamu East) 18 1909 3369 349 252 26 18 Lower Juba (Afmadhow 24 996 5320 339 994 152 99 & Badhadhe) Mandera (Banissa Lafey Mandera East, Mandera 15 475 2900 830 400 20 30 North, Mandera South, Mandera West. Nairobi (Kamkunji) 15 150 75 150 0 0 Turkana (Loima, 57 1490 2090 533 356 42 42 Kibish, Turkana West) Wajir (Wajir East Wajir 18 1199 1199 1863 1863 32 32 North, Wajir South) Total 202 6885 20280 10288 6206 408 302

A total of 202 Community Mobilizers from the 8 (89%) CGPP supported area were involved in social mobilisation activities. Six thousand eight hundred and eighty-five (6,665) House Holds were visited, the CMs managed to reach

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

20,280 families with social mobilization messages on Routine and Surveillance, 10,288 children <5 years reached,one on one contact established with 6,206 persons , 408 group meeting held and lastly the CMs were able to conduct 302 Social mobilization activities along the border.

Cross-Border

Table 3:Cross-border and vaccination posts

# CBHC # of No. meetings No. Functional No. of Frequency CBHC of attended special special vaccination County CBHF that vaccination by vaccination vaccination border meetings Meets transit CGPP Posts posts posts regularly route post Staff Garissa (Dadaab, Monthly 27 11 4 2 22 25 Fafi, Hulugho) Gedo (Bardere, Gerilet, Belet Monthly 2 2 16 9 10 0 Hawa, Elwak and Dollow) Lamu (Lamu East) Monthly 30 3 0 0 2 0 Lower Juba (Afmadhow & Monthly 12 4 6 4 7 27 Badhadhe) Mandera (Banissa Lafey Mandera East, Mandera Monthly 14 0 0 0 0 2 North, Mandera South, Mandera West. Turkana (Loima, Kibish, Turkana Quartely 0 0 0 0 3 0 West) Wajir (Wajir East Wajir North, Wajir Quarterly 3 1 32 32 30 0 South) Total 88 21 58 47 74 54

As per table 3 above, 88 Community meetings were held on a regular basis, and 21 (24%) of the meetings were attended by the local CGPP partners on the ground. Fifty-eight facilities were special vaccination post, and only 47 (81%) were found to be functional. The CGPP partners also reported 74 border vaccination posts and 54 transit vaccination post during the reporting week. New linkages with Zoonotic team, Nutrition, AWD and, Maternal referral were enhanced.

Objective 3: Support supplemental polio immunization activities (SIA)

No SIA conducted during the reported period.

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

Objective 4: Support efforts to strengthen AFP surveillance

The project monthly review meeting was conducted in Marsabit County. The meeting was attended by 19 community mobilizers, MOH community strategy focal persons, County Director of Health, WHO surveillance officer. The community mobilizers were trained on and issued with smartphones for reporting purpose.

The project held a sensitisation and a planning meeting for Kamukunji Community Health Committees (CHCs), the meeting was to strategise on how to strengthen community-based AFP surveillance in Kamukunji sub-county, Nairobi.

Figure 7: CMs during a practical session on the use of ODK in Active Case search reporting in Marsabit County

Table 4: Active case search conducted in CGPP supported area

# AFP # Capacity # AFP # of # cases AFP # of Building # # # cases Silent Femal report cases Timel No. No. CMs HH males reported AFP County es ed by reporte y Males Femal engag visite reach by CMs Sub reache CMs d by AFP CMs e CMs ed d ed (Female Count d (Males Nomad cases Traine traine s) y ) ic d d Garissa 27 710 1330 1525 0 0 0 0 0 35 10 Gedo 22 1042 697 860 0 0 0 0 0 224 36

Lamu 18 1909 332 427 0 0 0 0 0 15 3 Lower 27 1052 1344 2882 0 0 0 0 0 17 5 Juba Mandera 66 1650 3696 4004 0 0 0 0 0 0 0

Turkana 57 1514 1081 775 0 0 0 0 1 24 25 Wajir 14 1116 1047 892 0 0 0 0 0 0 0

Total 231 8993 9527 11365 0 0 0 0 1 315 79 No cases of suspected AFP were reported by the CMs and Nomadic focal point person during an active case search which was carried out by 231 Community Mobilizers. Eight thousand nine hundred and ninety-three (8,993 households were visited, 64, Twenty thousand eight hundred and ninety-two ( Males, 9527 (46%) persons were, and Females 11,365 (54%) were reached during the active case search. Regarding Capacity building on Routine Immunization and Surveillance a total of 394 Community Mobilizers (Males 315 (80%) and females 79 (20%). One sub-counties still silent remain silent in Turkana County.

Integrated Support Supervision (ISS)

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

A total of 126 facilities were visited ( Garissa 17, Mandera 54, Marsabit 3, Turkana 24 and Wajir 28)

Figure 9:Health facilities visited during the ISS Figure 8:Facilities found to have stock out of OPV & IPV

No cases of unreported AFP were found during the support supervision. In Somalia Lower Juba region, joint Support supervision (CGPP Secretariate, ARC, MOH and Somali Aid) were carried out between 15 – 22nd December as indicated in Fig.10 below:

Figure 10: Joint support supervision in Lower Juba, Somalia

CGPP Kenya and Somalia Weekly Project Implementation Updates 10 December – 31 December 2018 (week 50 - 52)

Security and other Challenges

Security

- Cross-border fighting in Ethiopia resulted in the influx of Internally Displaced Person (IDPs) in (Kenya/Somalia border), and there was also report of attacks by Somalia-based militants on Kenyan security personnel patrolling the Kenya-Somalia borders.

Other challenges

- Poor roads due to rains, security border restrictions - Fear of insurgency in Garissa County

Planned activities week 1, Jan 2019.

1. Attend/support Polio coordination meeting 2. Sensitisation of Chvs and traditional healers in Loima 3. Support tracing suspected measles cases 4. Participate and support EPI outreach sessions. 5. Support community dialogue sessions 6. Support active case search for AFP 7. Support nomadic population tracking

Figure 11: Kamukunji Community Health Committee Meeting