FIRST EMERGENCY APPEAL

Ministry of Health

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 , Beraile, Erebiti, , and Dalol woredas of zone two, , Buremedaitu and 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.

Ø The water supply that the communities are using for all purposes is potentially contaminated. Most are from rivers and stagnant small water bodies. Bloody diarrhoeal diseases have affected both adults and children since four months back. Ø Although no cases were seen and no reports were made to health institutions recently, there is a potential threat for measles epidemic in the areas visited particularly zone three of , as the routine EPI is non-existent and previous attempts of mass immunization were not successful. This may reflect the picture of the whole region.

Ø There are numerous cases of whooping cough (Pertusis) in children of under- five years in Andido town. There are reports that children in neighboring kebeles are also experiencing the same type of disease for the last two to three months.

Ø There is critical shortage of drugs and medical supplies in all health institutions visited in both woredas of Afar Region.

Ø The health service provision in Afar and Somali is tragically poor in all terms, i.e. all public health programs like vaccinations, health education, and environmental sanitation activities are either nonexistent or very low and limited to static sites. EPI out reach activities are totally nonexistent in both Regions.

Ø All reports from informants and our observations indicate that so many mothers and elderly remain behind at home only due to "lack of strength" as they express, which could be due to ill health and starvation.

Ø As a result high rate of malnutrition is eminent, as the population is completely dependent up on the livestock, camels and their products for subsistence. Signs of malnutrition in children of under-five years are apparent in these areas, including specific deficiency diseases like anemia.

Ø Carcasses were scattered all over the whole areas visited, some being in and around the rivers. We think the cause of such massive death of livestock and camels are not only shortage of pasture and water, but also some other diseases. Offending smell from carcasses has polluted the areas and made the environment unhealthy. Ø Gross absence of logistics supplies such as motorcycles, cars (pick-ups), etc, poor preparedness for disaster prevention and emergency handling, poor management of all existing resources (financial, material, and human resources) was observed in both Regions. Based on the findings the teams concluded that: 1. The drought situation in Afar, neighboring regions of Amhara and Oromiya, and SNNPR is an emergency. Although there is no overt malnutrition observed on the vulnerable groups, unless supplementary feeding is provided within short period of time, large number of these vulnerable groups will be affected.

2. The Afar Regional Health Bureau does not have the capacity to deal with this emergency. Unless urgent and timely interventions are made, the impact on health of the people could be disastrous.

3. The pastoralists have already lost their livestock. The loss is expected to increase as a result of disease and long tracking. Therefore, shortage of food will remain in the area for longer period of time.

4. Massive accumulation of carcasses created unhealthy environment, which endangers lives of humans and remaining livestock.

5. Information gathered from the health facilities and residents on disease condition and malnutrition is only a tip of an iceberg. The fact that there is no habit of utilizing the health facilities and high mobility from place to place makes it a reality to consider existence of more problems in the region. 6. EPI activities are more or less discontinued; there is shortage of essential drugs and supplies in these regions. Population in the affected areas (all regions) could not afford to pay for medical expenses due to massive death of their livestock and failure of crops.

III. OBJECTIVES OF THE APPEAL

A. Health · To provide of emergency equipment, drugs and medical supplies (Emergency health kits) where intervention is mandatory. · To develop capacity building in proper case management of malnutrition related infections, acute nutritional conditions and diarrhoeal diseases. · To build temporary treatment shelters to facilitate services when the need arises. · To conduct surveillance to monitor the health situation before the worst comes. · To implement Measles immunization campaign for those under five years of age and conduct assessment on under 10 and 15 years.

B. Water, sanitation and hygiene. · To participate and control of the proper disposal of carcasses and related environmental sanitation. · To control the proper waste disposal in concentration camps. · To control the water quality of water distributed to the community. · To provide health education to the community on water use and waste disposal. C. Nutrition · To improve case management of malnutrition in under five children at the health facility level. · To strengthen the referral system of acutely ill malnourished children. · To ensure the provision of Vitamin A supplement. IV. GOVERNMENT POLICY AND ACTIONS

The Ethiopian government had established Disaster Prevention and Preparedness Commission (DPPC) to monitor trends of disasters related to food shortage and other unusual events that needs massive intervention. The health sector part was fully delegated to the Ministry of Health, Ethiopia. Thus health related consequences would be fully addressed by the ministry. Diseases related to Malnutrition (Marasmus, Marasmus Kwashiorkor, Kwashiorkor), Malaria, Diarrhea both bloody and watery, Measles and epidemics like meningitis and cholera are expected while people are coming together to a concentration camps and food distribution centers.

The primary principles and intention of the health sector according to the health policy is to prevent likely happenings before it comes to reality. Beside the prevention aspect there is also a need to prepare the fertile ground for treatment approaches. The over all aim is to decrease morbidity and mortality related to the disaster situation of the country. Specific activity of the health sector was already mentioned above. The government efforts done so far to address the health related problems were: a. Established a committee “Health problems due to natural calamities” composed of different departments and services. b. Revitalized the “Health response task force” composed of International, bilateral agencies and NGOs. c. Deployed essential drugs from the available stock (21 Kits) to the priority areas identified by the government. d. Deployed Health manpower (8 health workers from the center and Addis Ababa health bureau) to those priority areas to participate in the surveillance and treatment procedures. e. Reassessed the vaccination and cold chain status of Afar and Somali regions before the materialization of mass campaigns. f. Working with WHO closely to secure funds from emergency fund for the above mentioned activities. g. Working with the Netherlands embassy to secure funds for drugs that can be locally purchased. h. Daily communicates the regions and collect update information about the situation. V. ACTIVITIES TO BE PERFORMED BY THE HEALTH SECTOR.

In order to implement the above-mentioned tasks, there is a need of: A. Supply of essential drugs (Emergency health kits) and medical supplies. B. Supply of for measles, Meningitis vaccines and Vitamin A. C. Environmental clearing. (Burning of carcasses) D. Maintenance and quality control of water supply system. E. Awareness raising workshops to the community leaders F. Updating health workers on epidemic diseases management. G. Transport, fuel cost and daily subsistence allowance to health workers deployed from the center and other regions.

VI. IMPLEMENTATION OF THE APPEAL

6.1 Institutional operational modalities. According to the Health delivery system of Ethiopia as described above, the implementation of this appeal document will utilize the existing health care facilities as well as temporary treatment shelters, food distribution centers and mass campaigns. · The Ministry of health will provide the technical support in the area of coordination and capacity building in collaboration with the WHO, UNICEF and other partner agencies. · The focus will be health institutions to implement preventive as well as curative procedures. Chiefs and other leaders will be other active partners in the implementation of the appeal document. 6.2 Collaboration · The appeal document will be implemented by the Ministry of Health, Ethiopia in collaboration with different partners, NGOs, International and bilateral agencies. The Ministry of Health, Ethiopia is the overseer of the appeal document implementation.

6.3 Monitoring and evaluation. · Monitoring and supervision will be conducted through the use of the existing government guideline and regulations. · Supervisory checklist for health facility assessment will be used during the monitoring process. TABLE 1. RESOURCE REQUIREMENT FOR AFFECTED POPULATION NEEDING ESSENTIAL DRUGS AND MEDICAL SUPPLIES. S/N Region Population Number of kits Estimated cost Remark affected required (ETB) 1 Tigray 949,000 95 4,155,067 2 Afar 767, 000 77 3,367,791 3 Amhara 1,588,000 158 6,910,533 4 Oromiya 1,039,000 104 4,548,705 5 Somali 687,000 69 3,017,891 6 Benishangul 9,000 1 43,737 7 SNNPR 910,000 91 3,980,117 8 Gambela 28,000 3 131,212 9 Dire Dawa 10,000 1 43,737 10 Harari 13,000 1 43,737 TOTAL 6,000,000 600 26,242,527 · The price for 1 kit at an average is 43,737.55 ETB · 1 Kit is assumed to be enough for 10,000 people for three months. · The population data was obtained from the assessment teams and DPPC taken in average. Annex: II Planning Logistics for Measles immunization Activities

A. Calculating the size of the target population:

Target age group 6mon-15yrs are approximately 45% of affected pop 15,000,000 * 45% = 6,750,000

B. Calculating measles vaccine requirements: - Vaccine requirement = 6,750,000*1.25= 8,437,500 doses=843,750 vials.

C. Calculating AD-syringes requirements: - AD-syringe =6,750,000*1.11 = 7,492,500

D. Calculating Mixing syringes: - Mixing syringes = No of vials / 10 = 84,375

E. Safety box requirements: - Safety boxes = AD-syringes + Mixing syringes / 100 = 83,363.

F. Number of vaccination posts: - No of posts = No of target / 600 = 11,250

G. Calculating No of health personnel {vaccinators}: - No of vaccinators = No of posts = .11,250

H. Calculating No of volunteers: - No of volunteers = No of vaccinators = 11,250

I. Calculating Vat A Capsules: - Vit A capsules {100,000 Iu) = children 6-59mon *2.2 = 6,600,000 capsules.

Financial requirement: - A Costs for micro planning + Training 112,500+378,000 = 490,500 USD B Costs for soc mob + Monitoring & Evaluation 337,500 + 225,000 = 562,500 C Costs for Transport + Personnel 337,500 + 1,349,381 = 1,686,881 D Costs for Measles vaccines + syringes + vit A cap + safety boxes. = 1,172,813 +666,526 + 53,352 + 67,188=1,959,878 USD

Overall cost = 4,699,759 USD * 8.58 =40,323,932 ETB ANNEX III. Plan of action and Budget Break down for the Emergency Sanitations based on the reports Submitted from all Regions.

S/ Activities Budget Planned No. (Birr) 1 Latrine Construction 2,114,519 2 Preparation of communal solid waste 421,550 disposal pit 3 Carcass disposal 35,000 4 Purchasing of construction tools 50,000 5 Procurement of body soaps and cloth 1,800,900 soaps 6 Procurement of Halazole Table of tin for 225,000 disinfections at house hold level when water borne diseases are emerged as an epidemic 7 Hygiene Education on personal and 322,700 environmental hygiene and prevention of communicable diseases 8 Purchase of sleeping bags for health 55,000 workers 9 Purchase of tents for health workers 70,000 10 Insect vector and rodent control 21,250 11 Sensitizing different community 34,000 members on basic environmental sanitation 12 Establish WASHE Committees and train 63,500 on ESHE promotion 13 Home visits, inspection, Monitoring and 510,167 Evaluations 14 Perdiem for Health Professionals 180,772.30 15 Water quality control and monitoring 8,570,000 Total 14,474,350 ANNEX IV:

Terms of Reference for the Health response task force on draught related epidemic control. (TOR)

1. To ensure all partners follow the policies and strategies for prevention and control of disease related to the consequence of food absence and shortage. 2. To participate on active surveillance and share the data (information) 3. To coordinate actions for the control of epidemics 4. To mobilize resources for insuring appropriate action. 5. To monitor the resources for the epidemic response and brief the partners periodically (every month). II. Task force composition 1. MOH (DPCD. FHD, HSTD, PASS, PR,) 2. MSF (B) 3. MSF (F) 4. MSF (H) 5. MSF (CH) 6. WHO 7. UNICEF 8. ERCS 9. EHNRI 10. USAID 11. DPPC Ø The task force will meet on Wednesdays at 9:00 as long as the draught condition is ongoing. Annex: V Checklist for Health institutions on emergency preparedness. 1. Region ______2. Zone ______3. Woreda ______4. Population served by the catchments______5. Health Institution name and type ______6. Health man power available (No) ______7. No of available transportation Facilities (Vehicles, motorcycles…) ______8. List the three common diseases of the ten tops in your area. ______9. Are there unusual events in your area in the past three months? (If yes please state) ______10. How was the situation of A. Malnutrition No of cases ______B. Measles No of cases ______No of deaths ______C. Diarrhoehea Any No of cases ______No of deaths ______D. Typhoid fever No of cases ______No of deaths ______E. Malaria No of cases ______No of deaths ______(Pleases refer to the past fiscal year 4 th quarter report) 11. Do you think that there is a tendency of increasing number of cases of the above-mentioned diseases and situations in your area? ______12. Is there a drug shortage in your health institution? If yes what types? Please list them in groups (Anti pyretic, IV fluids… )

13. Do you think that you have enough manpower to mobilize in case if the need arises to move to temporary treatment shelters?

14. Please state health professionals available by category of profession. A. Health assistants. ______B. Nurses. ______C. Pharmacists ______D. Doctors ______E. Specialists ______15. Is there any epidemic preparedness committee (EPR) or health committee in your area? If yes please state the jobs performed by the committee.

16. Do you have materials at hand or in your area for temporary treatment shelters like tents, mattress… 17. Are there any institutions in your area that can serve as a temporary treatment shelter if the need arises? Please state them (Schools, military barracks, Stores…) Likely places mentioned need to be registered.

18. Have you ever had epidemic situation in your area? If yes please state the type of the disease and control measures under taken? State your experience.

19. How do you see the disease pattern, food scarcity and rainfall condition of your area in comparison to the past years?

20. State the health consequences you expect from the situation and preparedness you suggest if any.

21. What are the likely assistances you expect from other sources? Please state them.

22. Name of NGO’s that are active in your area. Please list them. 1. ______2. ______3. ______SUMMARY

Ethiopia has an extremely poor basic 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 do not survive their first year. Under 5 years mortality is also high: one out of every six child dies before the age of 5. Communicable diseases, malnutrition, micronutrient deficiencies, and HIV/AIDS dominate Ethiopia’s burden of disease. Epidemic-prone diseases such as meningitis, malaria, cholera, measles, and shigellosis are also prominent health problems.

The worst drought-affected areas with high morbidity are Afar, eastern part of Oromiya and Somali regions. High levels of malnutrition, vitamin A deficiency and other micronutrient deficiencies in children under-five years, pregnant and lactating mothers are widespread and common. High levels of acute malnutrition have been identified in several nutrition surveys carried out in the affected areas during the last few months. More nutrition surveys are planned and required to monitor the condition of malnourished populations and to target health and nutritional services effectively.

Severely malnourished children (based on nutrition survey data, 2% of the under- five drought-affected child population or 54,000 children) will require therapeutic feeding and immediate assistance. Moderately wasted children under five years (based on nutrition survey data to date, 15% of the under-five drought-affected population or 400,000 children), and pregnant and lactating women, who are at high nutritional risk and who constitute 5% of the total population, or 750,000 women, will require supplementary food to prevent severe malnutrition. The need for supplementary and therapeutic food for the above target population (approximately 1.2 million women and children) is estimated at 37,500 MT and 4,050 MTs respectively for a period of six months. Malaria outbreaks are very likely in some of the worst affected areas. Even though currently there are no reported outbreaks of meningococcal meningitis there is great potential for epidemics in drought-affected areas. Existing water sources, mostly rivers and stagnant ponds, are potentially contaminated. Bloody diarrhoeal disease outbreaks have affected both adults and children since mid 2002. Basic health service infrastructure in regions like Afar and Somali is poor in all aspects - this applies both to preventive and curative services. Many mothers and elderly remain behind at home due to "lack of strength" as they express, which could be due to ill health and starvation. Livestock carcasses are scattered all over drought- affected pastoral areas polluting the environment and causing serious health risks.

Routine EPI coverage is as low as 5% in Somali and Afar Regions. The under- five population in the affected areas is particularly vulnerable not only to acute malnutrition and micronutrient deficiencies, but also to communicable diseases such as measles, diarrhoeal diseases, malaria, Upper Respiratory Tract, skin and eye infections. These problems need to be addressed in a comprehensive manner.

The drought situation in Afar, Somali, neighboring regions of Amhara and Oromiya, Tigray and SNNPR requires urgent health and nutritional interventions such as supplementary feeding, therapeutic feeding, capacity building of health workers in management of health and nutritional emergencies, provision of essential drugs and insecticide treated nets, disease prevention and epidemic control to prevent further deterioration in the existing condition of drought affected and displaced population.

The climatic and weather forecast prediction of the country shows that the situation goes worse and the sole victims of the famine situation increase exponentially. This is the second appeal document prepared based on the population figure 15,000,000. The activities are more or less a continuation of the first appeal document. The total budget required for current draught situation is 180,447,247 Birr or 21,055,688 USD. Major activities included in this appeal document were: Procurement of Emergency health kits and distribution to epidemic sites, Procurement of Measles and Meningitis vaccine and Vitamin A supplementation, Environmental sanitation and hygiene, Awareness raising workshops, Updating health workers on epidemic management, Health education team with audio visual mobile car, and DSA for stationed health workers. In addition long-term activities were included in this appeal document assuming that the draught situation might continues sometime longer than the expected next Belg rain crop yields. Thus activities like Malaria control, Maintenance of cold chain, Therapeutic foods (F-100, F-75), HIV/ AIDS awareness, Quality control water resources, Capacity building of health man power in disaster management, strengthening, IDSR activities and Monitoring and evaluation

The promises made by different international, bilateral organizations and NGO’s in response for the first appeal document was good. We thank all the organizations who are full heartedly working with us in our “ Health response task force”. ANNEX 1 Emergency Drug List for Ethiopia LIST OF EMERGE NCY DRUGS. S/N DESCRPIPTION UNIT QTY 1 Acetylsalicylic acid 300 mg 1000 tabs 15 2 Almunium hydroxide 500mg 1000 tabs 10 3 Aminophyline 25mg/ml, 10ml 50 amps 1 4 Ampicillin 125 mg/5 ml dry powder for 100 ml 200 suspension 5 Ampicillin 250 mg 1000 tabs 20 6 Atropine 1mg/ml, 1ml 50amps 1 7 Benzathine penicillin 2.4 MIU 50 vial 1 8 Benzoic acid 6% salicylic acid 3% oint ,500 gm 80 tin 2 9 Benzylbenzoate application 25% 1 lt 2 10 Butylscopolamine bromide 10 mg 1000 tabs 5 11 Cetrimide 15% + chlorhexidine di-gluconate lt 2 12 Chloramphinicol 125 mg/5ml susp 100ml 200 13 Chloramphinicol 250 mg 1000 caps 5 14 Chlorpromazine 25 mg/ml, 2ml 20amps 1 15 Co-trimoxazol 400mg + 80 mg 1000 tabs 20 16 Cotrimoxazol dry powder ( 200+40)mg/5 ml 100 ml 200 suspension 17 Dextrose 5%, 500 ml + sets bottle 100 18 Dextrose 50%, 50 ml 25 vials 1 19 Diazepam 5 mg/ml, 2ml 100 amps 2 20 Epinepherine 1mg/ml 1ml ( =adrenaline) 100amp 1 21 Ergometrine malate 0.5 mg/ml, 1ml 100amp 1 22 Ferous sulphate 300mg + folic acid o.25 1000 tabs 20 23 Lidocaine hcl 1%, 50 ml 25 vials 2 24 Mebendazol 100 mg 500 tabs 5 25 Methyl dopa 250mg 500 tabs 1 26 Metronidazol 125 mg/5ml susp. 100ml 200 27 Metronidazol 250mg 1000 caps 4 28 Normal saline 0.9% of 1000 ml Bag 200 29 ORS for 1000 ml 50 such 40 30 Paractamol 100 mg 1000 tabs 4 31 Paractamol 100 mg/5m syrupl 100ml 200 32 Paractamol 500 mg 1000tabs 15 33 Phenobarbital 50 mg 1000tabs 1 34 Phenox methylpenicillin 250 mg (pen V) 1000 tabs 4 35 Procain penicillin 3 MIU/ Benzylpenicillin 1MIU 50 vial 18 36 Promethazine hcl 25mg coated 500 tabs 1 37 Promethazine hcl 25mg/ml, 2ml 50amps 1 38 PVP iodine 10% solution 200ml 10 39 Ringer lactate solution 500ml + sets bottle 200 40 Tetracycline hcl 250 mg 1000 cap 15 41 Tetracycline Hcl eye-oint 1%; 5 gm 1000 tube 10 42 Vitamine A 200 000 IU 1000 cap 1 43 Vitamine A 50000 IU 1000 cap 2 44 Vitamine C 250 mg ( Ascorbic acid ). 1000 tabs 2 45 Water for inj 10 ml 100 amps 1 46 Zinc oide oint 10%, 800 gm tin 2

Emergency medical supplies List for Ethiopia S/N DESCRIPTION UNIT QTY 1 Adhesive tape 2.5 cm X 5m roll 20 2 Cotton wool 500gm PCS10 10 3 Elastic bandage 8 cm X 5 m roll 20 4 Bandage crepe 8cm X 4cm 10pcs 10 5 Gauze commpresses 10X10, 12 poly 100pc 10 6 Hydrophilic bandage 7.5 X 10m 10roll 30 7 Tablet bag reusable 60X80 mm mini g 500pcs 40 8 Blades for surgical knives size 22 100 pcs 1 9 Catether folly two ways no 12 ballon 5-15ml 10pcs 1 10 Catether folly no 14 ballon 5-15ml 5pcs 1 11 Catether folly no 16 ballon 5-15ml 5pcs 1 12 Surgical gloves size 7 sterile 50 pcs 3 13 Surgical gloves size 7.5 sterile 50 pcs 2 14 I v placement unit 20G PCS 15 15 I v placement unit 25G PCS 15 16 Scalp vein infussion set 25G 100pcs 3 17 Suture vicryl 1/0, 3/8 ct ndl 30mm, 36pcs 1 18 Suture vicryl 2/0, 45 cm ct needle 18. 30mm, 36pcs 1 19 Syringe lure, 2ml disposable 100pcs 5 20 Syringe lure, 5ml disposable 100pcs 4 21 Syringe lure, 10ml disposable 100pcs 1 22 Toungue depresor, wood 100pcs 1 23 Feeeding tube ch.5 dispo. 40cm luer 20pcs 1 24 Feeding tube ch.8 disposable 50pcs 1 25 Needle luer, 21 GX1.5' ' ( 0.8 X38 mm ) 100pc 20 26 Syringe 50 ml luer, disposable pcs 20 27 Urine collection bag 2000ml pcs 10 28 Autoclave tape 50 meter roll 2 29 Battery for otoscope,alkaline pcs 6 30 Bulb for otoscope, mini , heine pcs 2 31 Hydrophilic gauze 90cm X90m roll 2 32 Scalp infussion set 21G 100pcs 1 33 Examination gloves latex, small disposable 100pcs 2 34 Examination gloves latex , medium disposable 100pcs 2 35 Examination gloves latex largel disposable 100pcs 2 Emergency medical instruments list for Ethiopia S/N DESCRIPTION UNIT QTY 1 Clinical thermometer Arm pit type pcs 10 2 Dish, Kidneys/s 24cm pcs 2 3 Instrument tray 30X20X2cm pcs 2 4 Drum for cotton wool & gauze dia. 15cm ht.15 pcs 2 5 Forceps artery pean 14.5cm, straight pcs 2 6 Gallipot s/s without lid 300ml pcs 1 7 Scissors surgical bl/bl straight, 14.5cm pcs 2 8 Dressing instrument sets pcs 2 9 Instrument box with lid s/s 20X10X5cm pcs 1

10 Forceps, artery, pen 14.5cm straight pcs 1 11 Forceps dissecting 14.5 cm pcs 1 12 Measuring-tape, flexible pcs 2 13 Otoscope "mini" with batry handle ( complete pcs 1 set ) 14 Scale, dial type 25kg, 100g graduation pcs 1 15 Adult scale, Automatic reading with hieght pcs 1 measurment 16 spygmomanometer, anaeroid,simple pcs 1 17 Stethoscope, littman type double light pcs 2 18 Stethoscope, featal metal ( Aluminume type ) pcs 1 19 Prestige double-rack 7503phc-sterilizer+acces pcs 1 20 liters 20 Tourniquet (arm) pcs 2 21 stove kerossine, hypolyto 36(for 20 lt sterilizer) Pcs 1 22 strecher army type 1

Malaria treatment drugs S/N DESCRIPTION UNIT QTY 1 Chloroquine 150mg base 1000 tabs 10 2 Chloroquine 50 mg base/5ml.dry powder 60ml 200 3 Quinine 300mg film coated tablets 1000 tabs 2 4 Sulphadoxine 500mg+pyrimetamine 25mg 1000 tabs 3 Total FOB NLG Insurance & Frieght Handling Cost Total CIF Addis Ababa NLG