FIRST EMERGENCY APPEAL Ministry of Health Ethiopia August 2002 EMERGENCY APPEAL FOR HEALTH AND NUTRITION, WATER AND SANITATION IN ETHIOPIA I. INTRODUCTION AND BACKGROUND INFORMATION. 1.1 Geography and Climate Ethiopia is located in the horn of Africa with a total surface area of 1.25 million square kilometers. The characteristic topography of the country consists of northern and central plateaus separated from the southern plateau by the Ethiopian rift valley. More than half of the country lies at least 1,500 meters above sea level. Its climate is strongly associated with the altitude and the land relief of the country. Ethiopia is a natural museum for varied flora and fauna, ethnic mosaics with cultural diversity and short distant geographical relief difference, which contributes to its climatic comfort. With in a 100 km radius one can sense the weather contrariety. But, this situation doesn’t secure the country from burden of diseases. 1.2 Demography Ethiopia has a population of approximately 65 million, of which more than 51 million (85 percent) live in rural areas. 44.7% of the population is below 15 years of age while 17.8 % are under five years of age. The high population densities, in most of the regions, together with the poverty and illiteracy have contributed to the burden of diseases as well. 1.3 Economy More than 50 million people live in rural area and depend predominately on traditional agriculture for their livelihood. Ethiopian economy is dominated by agriculture, which during 1996/7 accounted for 51% of the GDP, 85% of total employment, and 85% of exports and for more than 70% of total export earnings. During the same year, the service sector accounted for 24% of GDP while the industrial sector contributed about 11% of GDP, 15% of export earnings and less than 2% of the labor force. Trade and transport contribute 14% of GDP. In spite of recent achievements in economic growth, poverty remains a problem. With per capita 1GNP estimated at $110 in 1996, Ethiopia ranks one of the world’s poorest countries. This low economical status of the people has influenced the pattern of disease occurrence in the country. 1.4 Political and Administrative Set up Ethiopia is a Federal Democratic Republic country composed of nine (9) National Regional States and two (2) Administrative Councils. The national regional states as well as the administrative councils are further divided into 62 zones and 523 woredas. There are also 2 zones and 7 woredas classified as special. Beyond the woreda there are about 10,000 kebeles, which are further, divided into villages. The health system management is benefiting from the on going process of democratization and decentralization. 1.5 Health Profile The Health Policy of the Federal Democratic Republic of Ethiopia (FDRE) was developed based on the critical examination of the nature, magnitude and root cause of the prevailing health problems of the country, and the awareness of newly emerging ones. Focusing on the commitment to democracy, rights and powers of the people, the health policy aims at promoting the decentralization process as the most appropriate system of the full exercise of these rights and powers in pluralistic society. 1 HSDP = Health Sector Development Program GDP= Gross Domestic Product Ethiopia is undergoing a “Health Sector Reform” through the Health Sector Development Program (HSDP). The overall goal of the HSDP is to improve the health status of the population. The structure of the health delivery system has a pyramid shape, which is broad at the bottom and narrow at the top (Primary health Care Units at the base, and the specialized referral hospitals at the apex of the pyramid). 1.6 Health Problem Ethiopia has extremely poor health status relative to other low-income countries (largely attributable to potentially preventable infectious diseases and nutritional deficiencies). The Health Service coverage is 50.4%. Nearly one out of 10 babies born in Ethiopia does not survive to celebrate his or her first birthday. Under 5 mortality is also high: one out of every six child dies before reaching his or her fifth birthday. Survey show that mortality has declined during the past 15 years, the decline having become more pronounced during the last 10 years. Under –5 mortality is 21 percent lower now than it was 5 to 9years ago. Although, there is a trend of decreasing under-5 mortality, still infant and under-five mortality rate are high at 97/1000 and 166/1000 live births respectively ( DHS 2000) The total burden of diseases, as measured by premature death from all causes is approximately 350 Discounted Life Year (DLY’s) lost per 1000 population. Communicable diseases, nutrition deficiency, and HIV/AIDS dominate Ethiopia’s burden of disease. Epidemic-prone diseases such as meningococcal meningitis, cholera, measles, and bacillary dysentery are also prominent health problem in the country. 2. THE EXTENT OF THE CURRENT DRAUGHT PROBLEM IN ETHIOPIA. A. Climatic condition The current climatic trends have caused quite a stress on food availability countrywide. The poor belg rain experienced in many areas has caused serious food shortage in several part of the country. The impact of the rain on three important sources of food has particularly been severe. These are: · The belg crops in a number of areas · Early maturing non-belg crops, which are important sources of food during the lean months before the Meher Harvest · Livestock condition in some of the pastoral areas A multi-agency team has recently completed its assessment of the above conditions and has comeback with a worrying picture of the food situation in the country in the coming two months. B. Rainfall condition The onset of this year’s belg rain in most parts of South Tigray the eastern parts of Oromia, the low lands of east shoa (Fentale area) East and West Hararge and Bale, several areas in SNNPR, most notably Sidama , Hadiya and Kembat Timbaro zones as well as Alaba special woredas, the northern parts of Somali the rain was late, its cessation early and the distribution was poor. In Afar, on the other hand, the February-May rains completely failed. In Amhara region, while several woreda did not get rain as of April, few others experienced serious frost damage. C. Crop conditions. The poor rain has caused failure of both the Belg and non-Belg crops planted in many areas. The prospect of the long cycle meher crops, Maize and sorghum, which are planted in April, is also very poor in several areas. The poor rain since April has severely affected their performances. D. Livestock condition. The poor Belg rain has caused acute shortages of water and pasture in several areas- both cropping and pastoral. The situation is much severe in Somali, pastoral areas of Oromia and Afar where the February – May rain completely failed. The rainfall situation in the preceding seasons was also poor. Water and pasture are seriously short in several areas, most notably in Abala, Beraile, Erebiti, Koneba, and Dalol woredas of zone two, Amibara, Buremedaitu and Awash Fentale woredas of zone three and Fursi Artuma and Semurobi woredas of zone five. In this areas the watering points have dried up while pasture is seriously short. Many livestock in these zones have died while the rest are in bad shape. The shortage of pasture and water has caused abnormal migration of livestock from one woreda to the others. In addition to water and pasture shortages serious live stock diseases has been reported in many area of the region. (Details can be obtained from the DPPC report). E. Food situation. The crop failure and poor live stock conditions discussed above have caused considerable food shortages in all the affected areas. The poor live stock condition in Afar and the neighboring pastoral areas of Oromia and Somali have severely curtailed the supply of milk and its impact on the population, particularly on children is serious. While the poor livestock condition has depressed their prices grain prices have been increasing considerably making it unaffordable to many. Based on the above information the climatic, rainfall, crop, livestock conditions and food situation in the country a total of 6,000,000 people expected to be affected according to data released from DPPC. The death of livelihood animals mainly for the pastoralists worsens the situation of malnutrition to children and pregnant women since the staple diets of pastoralists are based on milk and milk products. II. SITUATIONAL ASSESSMENT Different teams from the Ministry of Health, Ethiopia, WHO and UNICEF, assessed the overall health situation in Afar, Somali, Amhara, Oromiya and SNNPR. The objectives of the rapid assessment were to look at the type and magnitude of drought related health problems, identify immediate needs and assess the adequacy of existing capacity of the regions in handling the situation. The aim was also to identify most vulnerable groups, assess any indication of malnutrition and come up with plan of action for immediate measures. The following were some of the important findings of the need assessment on health, nutrition, water, sanitation and hygiene, which need interventions. The worst scenario was observed in Afar and Somali regions. Ø Deficiency diseases like anemia, in children of under-five years and pregnant mothers, are observed. The health of mothers, especially pregnant mothers, is extremely worrying as anemia is being aggravated by severe malnutrition. Ø Malaria outbreak is expected to occur in the woredas as majority of the population has migrated to water points where the outbreak is likely. More cases than usual are being reported to health institutions in the visited sites. Even though there were no cases of meningococcal meningitis seen in the woredas up to the time of visit, there is also fear by health institutions that an epidemic could occur.