HEALTH CLUSTER BULLETIN #14 March 2020 Health Workers march to create awareness on COVID-19, Addis Ababa. Photo: WHO. Emergency type: Multiple Events Reporting period: 1-31 March 2020

5.9 MILLION 1.6 M IDP 1.6 M HOST 156 WOREDAS IN NEED TARGETED TARGETED HIGHLIGHTS HEALTH SECTOR

HEALTH CLUSTER • As of 22 April, 114 confirmed cases and 20 3 deaths of COVID-19 have been IMPLEMENTING PARTNERS reported in Ethiopia, 14,900 cases and MEDICINES DELIVERED TO HEALTH 700 deaths reported in 45 African FACILITIES/PARTNERS countries. 244 ASSORTED MEDICAL KITS • 27,178 people in 14 kebeles of Gurage HEALTH CLUSTER ACTIVITIES zone benefited from a yellow fever ring vaccination campaign, and a mass OPD CONSULTATIONS campaign is planned soon, with the 112,982 backdrop of the COVID-19 outbreak. VACCINATION • In line with global guidance to all VACCINATED AGAINST 5,874 MEASLES countries, Revision of Ethiopia 2020 Humanitarian Response Plan has EWARS commenced in order to incorporate CONFIRMED COVID-19, POLIO,

COVID-19 response. 5 YELLOW FEVER, CHOLERA, MEASLES OUTBREAKS FUNDING $US 95 M REQUESTED

1.4% FUNDED 1.3 M 93.7 M GAP

Situation update Since the declaration of the COVID-19 outbreak in March, Ethiopia has so far recorded 114 cases in 4 regions. Through the national and subnational PHEOC, the country with support from partners continues its concerted efforts for readiness and response. In addition to previous government measures to reduce movement and gatherings, a state of emergency was declared on 10 April, and it is hoped that this will further contribute to slowing down the transmision, while taking cognizance of direct humanitarian and socioeconomic consequences expected. At the time of writing, there were 2.5M confirmed cases and 177,000 deaths globally, including 14,900 cases and 700 deaths in 45 African countries.

Screening of returnees, Receiving PPE from Solidarity Initiative, Donation of HWF, Training on MHPSS. Photos: WHO, IOM. Useful sites for information include: Health Cluster on Humanitarian Reponse: https://www.humanitarianresponse.info/en/operations/ethiopia/health EPHI: https://www.ephi.gov.et/index.php/public-health-emergency/novel-corona-virus-update WHO: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 WHO: https://www.afro.who.int/health-topics/coronavirus-covid-19 JHU: https://coronavirus.jhu.edu/map.html 85 cases and 5 deaths were reported from the yellow fever outbreak in Ener Enor woreda of Gurage zone. Five kebeles were affected. 27,178 people in 14 kebeles benefited from the ring vaccination campaign completed at the end of the month, and a mass reactive campaign is planned. Cholera outbreaks continue in SNNPR, and Oromia regions, including Chereti, Moyale, Male, Shashemane, Shashemane town, and Wondo woredas. Measles outbreaks continued across the country with Oromia region affected most. The national weekly caseload has consistently declined from 720 cases in epidemiological week 5 to 10 cases in epidemiological week 14.

Public Health risks, priorities, needs and gaps Health risks • Following WHO’s declaration of COVID-19 outbreak as a pandemic, Ethiopia was categorized as very high risk due to its position as an air travel hub. • 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. • Conflict and population displacement leading to increased health demands to the 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. • 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. Priorities • COVID-19 outbreak readiness and response. • Delivery of essential life-saving emergency health services to vulnerable populations by ensuring sufficient quantities of quality medicines and medical supplies, and health workers teams to perform the work. • Work with and strengthen the capacity of the existing health system by training health workers and establishing humanitarian-development linkages. • 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 information 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. Needs and gaps • Significant shortages of qualified health staff to implement the response in emergency affected locations, in an already strained health system, and partners’ inability to recruit 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 during the conflict. There is need to speedily rehabilitate, re-staff and restock these facilities.

Health Cluster Action Strategy and response processes The country activated the Health sector’s scenario 3 COVID-19 EPRP once the outbreak spread beyond two regions. Objectives of the response include minimizing caseloads, deaths and the impact of the outbreak on the health system. In line with this plan, a multisectoral national plan was compiled by the ECC. The Health Cluster contributed to the monthly updated version of the COVID-19 GHRP, making considerations of the scenario 3 EPRP. Also, revision of Ethiopia 2020 HRP has commenced in order to incorporate COVID-19 response. Response to cholera and measles outbreaks continues to be structured around case management, social mobilization and risk communication, logistics and supplies, surveillance and laboratory investigation, WaSH and the use of OCV. The EPHI and RHB lead the interventions, with Health Cluster partners supporting as and when assigned by the authorities. Surge support to functional health facilities remained the main modality of response for Health Cluster partners, with some also able to offer technical support to the local health authorities. Mobile teams remain an option whenever necessary. 2020 HRP dashboard Indicator Jan Feb March 1 Number of health facilities and mobile teams supported in crises affected locations 35 88 62 2 Number of total OPD consultations 43,721 185,290 112,982 3 Number of normal deliveries attended by skilled birth attendants 46 1,403 834 4 Number of women in child bearing age receiving modern contraceptives 1,779 8,033 17,709 5 Number of community members receiving health IEC messages 50,442 99,428 93,042 6 Number of assorted emergency medical kits distributed in crises affected locations 217 90 244 7 Number of cases with injuries and disabilities treated and referred for further care 63 216 298 8 Number of cases receiving mental health and psychosocial support services - 56 97 9 Number of survivors of SGBV receiving clinical care for rape - 4 9 10 Number of epidemic-prone disease alerts verified and responded to within 48 hours 15 41 612 11 Number of children 6 months to 15 years receiving emergency measles vaccination 700 400,469 5,874

Health Cluster coordination After COVID 19 outbreak was confirmed in Ethiopia, the Health Cluster’s activities were focused on strengthening partners involvement and coordination of response to the pandemic. Both the SAG and partner’s meetings deliberated on the need for partners to support the pillars of the response. Partners highlighted the need to act on two levels: raising knowledge of their own staff members, and supporting the response at all levels. Partners agreed to work with EOC both at national an d subnational levels. During the partners meeting, participants were briefed on ongoing cholera responses in Somali, Oromia and SNNP regions. There was also a presentation on emergency SRH by Marie Stopes International. The need for diversifying resource mobilization efforts and share information with the HCC team was reiterated.

The SRH TWG held its monthly meeting focusing on expansion of MISP capacity. Members were reminded of the availability of a free online course. The cluster is now an active member of the Emergency Supply Chain TWG which was activated at a meeting held on March 3, 2020. This TWG will work closely with EOC to handle the logistics pillar of the COVID-19 response. The MHPSS TWG held an ad hoc virtual meeting to discuss the psychosocial aspects of COVID-19 and what partners can do to contribute towards the response. It was agreed to expand membership of the TWG to include more departnments of learning istitutions. Communicable diseases control and surveillance

Table 1: Number of cases reported during WHO Epi week 10-13, 2020, Ethiopia

Malaria Malaria

(Confirmed (Confirmed & clinical) Suspected Meningitis SAM Suspected AFP Suspected Measles Suspected NNT Suspected Rabbies Maternal Death Scabies

Region

Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Deaths Cases Deaths

A Ababa 243 0 16 0 174 0 1 0 65 0 0 0 82 0 2 2047 0 Afar 8203 0 5 0 909 14 0 0 176 2 0 0 0 0 3 0 0 Amhara 17372 0 11 0 2294 1 19 0 1170 8 1 2 197 0 18 11536 B Gumuz 5949 1 23 2 80 0 1 0 80 0 0 0 36 0 4 286 0 Dire Dawa 269 0 0 0 125 0 0 0 28 0 0 0 0 0 0 100 0 Gambella 6584 0 4 0 91 0 0 0 1 0 0 0 0 0 0 9 0 Harari 27 0 12 0 116 0 10 0 45 1 0 0 0 0 8 66 0 Oromia 5377 2 139 0 6736 4 11 0 2890 3 5 0 23 1 20 5774 0 SNNPR 19096 0 61 0 2180 9 15 0 332 0 10 1 1 0 6 1453 0 Somali 4134 0 47 4 5221 6 0 0 20 0 2 1 0 0 2 18 0 Tigray 8687 0 4 0 804 1 0 0 146 3 0 1 275 0 3 1720 0

Total 75,941 3 322 6 1,8730 35 57 0 4,953 17 18 5 614 1 66 23,009 0

EPHI reported that on each epi week from 10 to 13, most regions met the required 80% IDSR reporting completeness and timeliness. Training of health workers MCMDO conducted on job training for more than 112 health extension worker. MSF-Spain conducted two training sessions on COVID-19 case management to 20 key medical staff while weekly briefings were conducted to all staff in Addis Ababa on infection prevention and control. OWDA organized and conducted rollout community based surveillance training to 125 community volunteers, 38 health extension workers and 29 animal health technicians on targeted VPD and zoonoses at Galadi, Kalafo, Fer-fer, Mustahil woredas of Dollo and Shebelle zones. Provision of essential drugs and supplies WHO donated 219 emergency health kits to partners and zonal health offices in all regions. UNOPS distributed 35 Mt of humanitarian supplies including nutrition supplies, cholera treatment kits and WaSH supplies to various woredas. UNICEF distributed 21 renewables kits and 20 emergency drug kits to isolation and treatment centres in all regions, provided 40 jerricans of chlorine disinfectant, 20 chlorine sprayers to EPHI, and distributed 5 emergency drug kits to IDP s ites in Guji zone. Support to health service delivery

IMC provided lifesaving emergency IOM continued to provide primary OWDA’s two MHNT funded by Women’s health services and outbreak response healthcare sevices for IDP and host Hope International, serving 12 villages in for IDP and returnees in East and West communites in Gedeo, W. Guji and E. Danod and Daratole woredas. They have Hararghe zones. The services included Wollega zones. Medical consulations were reached and treated a total of 782 (599 OPD consultations for adults (4,865) and provided to 5,270 indivuduals , health female, 183 Male) patients for case CU5 (2,770). 229 pregnant women education and promotion for 6,106 management with different acute and attended normal deliveries by skilled individulas, screening for malnutrtion for chronic diseases; they also provided birth attendants. Also 670 WCBA 1,712 children and sexual and health education awareness creation. received comprehensive RH services reproductive health services for 779 With regard to immunization, the MNHT including modern contraceptives. 65 women of reproductive age. In addtion, reached a total of 55, 12, 5, 36, 12 cases were referred to higher level IOM supported COVID-19 response Penta1, Pent2, Pent3, TT1, and TT2 services and 97 clients received mental including demonstration for proper respectively. Comprehensive community health and psychosocial support. 5,975 handwashing for 50 officials in Nekemt house to house visits were conducted under five children (2,658 boys & 3,317 town, key prevention messaging to IOM and comprehensive health education girls) and 1,648 PLWs were screened for and UN hub staffs, community provided to 567 women in the malnutrition. Health education sessions senstization and social mobilization with reproductive age group. were conducted for 4,914 (male 1,959 & emphasis on physcial distancing and female 2,955) clients and caretakers. handwashing, was conducted in IDP sites and market places in 3 zones, reaching MSF-Spain continues to support about 50,000 people. Gambela hospital to strengthen the IRC is supporting the risk quality of secondary health care for communication and community refugees and host community. 1,650 engagement pillar of the COVID 19 WVE is providing logistics support to patients received emergency care response in SNNPR. 150,000 fliers with four Health centers (Bareda, Jelo, Kore, (mortality rate below 1%), 190 patients three different messages from EPHI Haro) in East Harargehe (Melkabello were admitted to surgical ward and 149 were translated in to 4 local languages woreda) during vaccination campaign life-saving surgical interventions were and printed. Similarly, 50,000 brochures and Vitamin A supplementation. performed. 210 deliveries were in Amharic, 10,000 posters in four Twenty-four suspected cases of measles conducted (CS rate 12%); no maternal languages with seven different messages were referred to health facilities. In death recorded for last 3 consecutive were distributed. 8 loud speakers were response to COVID-19, World Vision months. Medical consultations wre shifted from cholera to COVID 19 social deployed one health communication provided to 819 deportees from KSA mobilization. 40 plastic sheets (5X6m) expert at EOC-EPHI to provide support with 9 referrals, 1,388 deportees were provided for establishing in Risk Communication and Comunity received psycho-education upon arrival. screening areas in S Omo Zone. In BGRS, Engagement. Basic PPEs were procured 15 group sessions (130 participants) 1,600 IEC materials from EPHI were re- and supplied to Tigray, Amhara, Oromia, were done; 201 admitted to MSF trauma printed and distributed. In Oromia, 1500 and SNPPR regions. These materials and counselling centre where 284 (new fliers, 200 poters, 100 brochures were include facemasks, disposable and and follow up) individual mental health translated, printed and distributed. surgical gloves, hand sanitizer, liquid consultations were provided. 9 Medical hand soap, apron, eye google, boots, and and 11 Psychiatric cases were referred GOAL in Abaya, Medawolabu and other materials including for and supported at St Peter and Eka Dolomena & Yirgachefe woredas, handwashing. Kotebe hospitals respectively. reached a total medical consultation of 1,046; from the total cases 738 were adults and 308 are under five children; UNFPA conducted community based SCI reached 40,804 beneficiaries awareness raisingand demand creation health education was provided for 4,571 through mobile health and nutrition (1,064 male, 4,507 female) individuals activities in the area of emergency sexual teams and through compressive and reproductive health services; in the focusing on key health messages. In curative, preventive and promotive Somali (Galadi, Daratole, process reaching 9,000 women, girls, primary health care services and saved men and boys in Gedeo and West Guji woredas), a total of 1,079 patients (762 many lives of affected population adults and 317 under five children) zones through our implementing groups. In the month, there were partner. UNFPA is providing technical received medical consultation. Health outbreaks of measles and cholera in education was provided for 1,203 guidance to EPHI, MoH, Regional health Somali and Oromia where MHNTs were bureaus and other partners on how to individuals on a key health messages; engaged in response with other the beneficiaries were 254 male and 949 ensure SRH services are integrated with partners in communicating the risk, the COVID-19 preparedness and female. GOAL is participating in COVID- managing cases and providing NFIs. 19 response in its project areas. response plan.

WHO supported the EPHI and other MCMDO reached 30,057 people with USAID Transform’s Primary Health partners to conduct a reactive yellow lifesaving primary healthcare and Care is a development program fever vaccination campaign that nutrition services. 16,099 beneficiaries supporting more than 396 woredas in reached 29,600 people with a coverage received medical consultation and the four agrarian regions. As of 92.5%. The support to MoH and treatment, of which 5,748 were CU5. emergencies are constant challenges, PHEOC for COVID-19 response 1,306 WCBA received modern the project has set up a mechanism to continued. More than 1,200 health contraceptive. 998 and 600 pregnant mobilize supplementary funds to fill workers of different cadres were women attended ANC1 & 4, 12 deliveries critical response gaps. In March 2020, trained and are conducting surveillance were attended by skilled birth the support provided includes: multiple activities such as case investigation, attendants. Coordination meeting was woredas in SNNPR for cholera & Yellow contact tracing, and screening of conducted and discussion on the current Fever outbreaks (54,562.00 USD), travelers at the points of entry. The COVID-19 prevention strategy and Waghimra zone in Amhara region for EPHI laborary capacity was organizational mini action plan was measles, pertussis, malnutrition & strengthened through training of 7 developed and shared with the team. At scabies responses (39,208.35 USD) and laboratory personnel, supply of 1000 community level strong awareness Asgede Tsimbla woreda in Tigray for PPE and provision of coronavirus test creation was ongoing by MCMDO Measles outbreak response (17,669.20 kits for 1600 samples. community mobilizer with kebele level USD). This is implemented by the PHEM task force. Logistic support was structures. provided to zonal and woreda health Mercy Corps operates three MHNTs in offices. 29 cases were referred for three woredas of . They secondary level management. UNICEF continued to support the provided medical consultation for total COVID-19 response in the RCCE, logistic of 2,271 beneficiaries: 553 CU5, 362 & supply, IPC and protection pillars. between 5 to 18 years, 1,158 adults AAH provided health education Two RCCE experts are deployed at EPHI. above the age of 18 years and 198 messages to beneficiaries at host It continued to support cholera elderly people. 222 children were community and HFs focusing on response in SNNP, Somali and Oromia vaccinated for measles. 62 SAM malnutrition, hygiene & sanitation and regions. Reactive yellow fever children without medical complications COVID-19. Sensitization, orientation was vaccination campaign was conducted in wre identified and treated at outreach conducted for nutrition personnel and Enor-Enor woreda, Gurague zone of sites. In addition to general awareness government staff about COVID-19 & SNNP region targeting a total of 32,365 creation, the teams provide routine Nutrition. It supported the adoption of people in 12 kebeles (5 kebele reporting services with COVID prevention in WHO recommended precautions in cases and 7 adjacent). 20,836 medical mind: ensuring physical distance, CMAM and IYCF programming. consultations were conducted in Afar limiting the number of beneficiaries Pamphlets with MOH key messages were (17,239) and in Somali (3,597) regions gathered at outreach sites, printed and distributed in host by MHNT. There were 237 new arrivals demonstrating hand washing and community and IDP sites. It supported in Gambella; of these 152 children enabling beneficiaries wash their hands community sensitization on COVID-19 at received measles and 157 polio before getting any services. different levels. Banners with key vaccination at PoE. messages on COVID19 were printed and displayed at HFs and community. Soap MdM has continued to support and water containers were delivered to SRH/MCH in the two health centres of IDP sites and hand washing points Garbo and Molayko (Nogob Zone, established. Somali Region), with active community sensitization in the Woreda to foster utilization of MCH services. The local partner OWDA has provided support to SCs of the 2 health centres and to OTPs of 9 health posts in the Woreda. MdM will support the COVID 19 response at all levels.

Health Cluster 3W map

Plans for future response With Ethiopia already having reported 114 confirmed cases of COVID-19, the Health Cluster is working with the PHEOC to support various thematic pillars TWG. As COVID-19 EOC have been activated in all regions, partners will contribute to and participate in readiness and response efforts at subnational level. The Health Cluster through partners will continue implementing essential life-saving health services for IDP, returnees and host communities in emergency locations. Conflict affected zones with new IDP and returnees will be prioritized, while the needs of chronic IDP will be assessed from time to time. Response to on-going cholera and measles outbreaks, as well as the early warning system will be strengthened. 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 FIDO, MdM, UNICEF, Humedica, IOM, SP, ICRC, UNOPS, MSI, MCMDO, IRC, IMC, MSF-H, USAID, JSI, MSF-E, SCI, EPHI, WHO, AAH, UNFPA, ECHO.

Contacts: Dr. Wilbert Shihaji, Health Cluster Coordinator, Banchiayehu Girma, Information Management Officer, [email protected], 0953853416. [email protected], 0945184987.