HEALTH CLUSTER BULLETIN #15 April 2020 Health Education on COVID-19 and other diseases, Warder woreda. Photo: OWDA. Emergency type: Multiple Events Reporting period: 1-30 April 2020

5.9 MILLION 1.6 M IDP 1.6 M HOST 158 WOREDAS IN NEED TARGETED TARGETED HIGHLIGHTS HEALTH SECTOR

HEALTH CLUSTER • As of 22 May, 398 confirmed cases and 18 5 deaths of COVID-19 have been IMPLEMENTING PARTNERS reported in Ethiopia, 84,183 cases and MEDICINES DELIVERED TO HEALTH 2,739 deaths reported in 45 African FACILITIES/PARTNERS countries. ASSORTED MEDICAL AND PPE 449 KITS • Cholera outbreaks continue in three HEALTH CLUSTER ACTIVITIES regions of Somali, SNNP and . The woredas reporting most cases in OPD CONSULTATIONS the last three weeks include Dolo Ado, 132,219 Desenach, North Ari, and Wonago. VACCINATION • The NDRMC has reported heavy rains VACCINATED AGAINST 931 MEASLES and flooding in Somali, Afar, Oromia, SNNP, Harari, Dire Dawa. Already EWARS 470,164 people are affected, and CONFIRMED COVID-19, POLIO,

301,284 diplaced. 5 YELLOW FEVER, CHOLERA, MEASLES OUTBREAKS FUNDING $US 95 M REQUESTED

1.4% FUNDED 1.3 M 93.7 M GAP

Situation update Cholera outbreaks continue in three regions of Somali, SNNP and Oromia. The woreda reporting cases in the last three weeks include Dolo Ado, Desenach, North Ari, Wonago, Abaya, Alle, Shashemene, Uba Debretsehay, and others. The epidemiological curve for total caseloads is comparable to last year. Some of the partners supporting government response include SCI, IRC, MCMDO, IOM, WHO and UNICEF.

Transmission of Guinea worm is ongoing in Duli Village, Gog woreda, Gambela region. Ethiopia reported 7 human cases of the disease in April. Active surveillance, cleaning of ponds, distribution of water filters, health education and case management are ongoing. Measles outbreaks continued across the country with Oromia region affected most. Some of the woredas with active transmission include Ancaar, Gumbi Bordode, Tullo, kuria, , Koricha, Abay Chomen, Lemu Bilbilo, Odo Shakiso, Shashemene town, Sokoru. Partners supporting response include IMC, ACF, GOAL, MCMDO, USAID Transform project. As of 22 May, the country has reported 398 confirmed cases of COVID-19. Response continues through the national and subnational PHEOC, with support from partners in different forms. At the time of writing, there were 2.5M confirmed cases and 311, 847 deaths globally, including 84,183 cases and 2,739 deaths in 54 African countries. 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 The NDRMC has reported heavy rains and flooding in Somali, Afar, Oromia, SNNP, Harari, Dire Dawa. Already 470,164 people are affected, and 301,284 diplaced. Ongoing multisectoral response includes health interventions by partners like SCI, IOM and GOAL, guided by the recently completed response plan of $30.7M.

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, and the country now has community transmission. • 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. Revision of Ethiopia 2020 HRP is near completion, incorporating 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

Indicators Jan Feb Mar Apr Total 1 Number of health facilities including COVID-19 isolation 35 88 62 305 305 facilities and mobile teams supported 2 Number of OPD consultations 43,721 185,290 112,982 132,219 474,212 3 Number of normal deliveries attended by skilled birth 46 1,403 834 840 3,123 attendants 4 Number of women in child bearing age receiving modern 1,779 8,033 17,709 3,037 30,558 contraceptives 5 Number of community members receiving health IEC 50,442 99,428 93,042 195,325 438,237 messages including COVID-19 6 Number of assorted emergency medical kits and COVID-19 PPE 217 90 244 449 1,000 kits distributed in crises affected locations 7 Number of cases with injuries and disabilities treated and 63 216 298 54 631 referred for further care 8 Number of cases receiving mental health and psychosocial - 56 97 2,098 2,251 support services including COVID-19 9 Number of survivors of SGBV receiving clinical care for rape - 4 9 8 21 10 Number of epidemic prone disease alerts including COVID- 15 41 612 571 1,239 19 verified and responded to within 48 hours 11 Number of children 6 months to 15 years receiving emergency 700 400,469 5,874 931 407,974 measles vaccination Health Cluster coordination In April, the Health Cluster held weekly virtual meetings to regularly review partners’ contribution to the national COVID-19 response. It was noted that all partners were involved in the response in all their project locations. The monthly partners meeting was combined with the weekly meeting on April 15, 2020. Several partners have joined the cluster since the COVID-19 outbreak was declared. The cluster SAG met virtually on April 10 and 16, 2020 to discuss EHF first standard allocation. It agreed to invite partners to present proposals based on the guidance provided by EHF and the cluster’s priorities identified through the HWN TWG advocacy paper. The MHPSS TWG held meetings and discussed on coordination of service provision for people in COVID-19 quarantine centers and isolation/treatment centers. It is finalizing a project proposal to establish a hotline that would provide services to the general population, patients, health workers and people in quarantine facilities. The SRH TWG held two meetings to discuss MCH services in COVID-19 quarantine and treatment centers and ensuring continuity of essential services in all health facilities. In the context of the pandemic, its focus will mainly be on continuity of essential SRH services. Communicable diseases control and surveillance

Number of cases reported during WHO Epi week 14-18, 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 180 2 21 0 106 0 1 0 27 0 0 0 83 0 11 1623 0 Afar 8,144 1 13 0 975 5 0 0 156 2 1 0 0 0 1 0 0 Amhara 19,956 0 19 0 2,065 5 7 0 885 6 0 0 70 3 29 6,946 0 B Gumuz 6,849 0 6 0 65 0 1 0 11 0 0 0 28 0 2 166 0 Dire Dawa 181 0 0 0 83 0 0 0 5 0 0 0 0 0 0 62 0 Gambella 7,665 0 5 0 155 0 0 0 0 0 0 0 1 0 0 4 0 Harari 70 0 14 0 48 0 0 0 19 0 0 0 0 0 4 51 0 Oromia 9,073 3 224 0 8,403 8 0 0 2,073 14 11 1 12 1 52 3,833 0 SNNPR 18,721 0 20 0 2,112 8 0 0 19 0 0 1 10 0 4 1,512 0 Somali 5,020 8 56 0 7,009 3 5 0 6 0 0 6 0 0 15 10 0 Tigray 7,489 2 24 1 694 0 0 0 70 1 0 0 246 1 10 1,651 0 83,348 16 402 1 21,715 29 14 0 3,271 23 12 8 450 5 128 15,858 0 Total

EPHI reported that on each epi week from 14 to 18, most regions met the required 80% IDSR reporting completeness and timeliness. Training of health workers MCMDO provided trained 115 health extension worker on the job. IOM supported the West Guji ZHO to conduct COVID-19 case management training for 54 health workers. Provision of essential drugs and supplies WHO donated 324 emergency health kits to partners and ZHO in all regions. UNOPS distributed 26 Mt of humanitarian supplies in Somali Region. These included PPE and hygiene supplies. Support to health service delivery

IMC provided lifesaving emergency OWDA’s MHNTs provided free medical health services and outbreak response health services to venerable for IDP and returnees in East and West communities, reached a total of 4,814 Hararghe zones. The services included beneficiaries in Danod and Daratole OPD consultations for adults (2,410) IOM continued providing essential district of Doolo zone. OWDA conducted and CU5 (1,487) . 382 pregnant women services in East Wollega, West Guji and social mobilization and awareness attended normal deliveries by skilled Gedeo. IOM conducted 4,489 medical raising to the communities for the birth attendants. Also 1,890 WCBA consultations, screened 1,451 children prevention and control of COVID19 received comprehensive RH services below 5 years for malnutrition and Pandemic. OWDA surveillance teams including modern contraceptives. 131 reached 6,802 individuals with key conducted case search in house to house cases were referred to higher level health messages at HPs. 736 women visit in the target of disease surveillance services and 187 clients received received basic SRH services. 220,325 like COVID-19, AFP, Measles, NNT, mental health and psychosocial individuals were reached with COVID 19 Rabies, Anthrax and Brucellosis, and supports. 2,490 under five children and key messaging in the 3 zones using a detected 10 measles, one AFP cases . 1,356 PLWs were screened for van. IOM donated 250 blankets and 1 malnutrition. health education health infrared thermometer to Bule Hora university QC. In East Wollega, IOM promotion sessions were conducted for MSF-Spain continues to support distributed 1,850 posters with COVID 19 a total of 2,508 clients and caretakers. Gambela hospital to strengthen the key messages and demonstrated quality of secondary health care for handwashing to 600 individuals. IOM refugees and host community. 1,406 IRC established hand washing facilities seconded 19 staff in Addis Ababa to patients received emergency care; 170 at woreda offices, HCs, marketplaces, support the 5 quarantine centers. shops and restaurants in Haro limmu patients were admitted to surgical ward; district, East Wollega zone. Health 105 life-saving surgical interventions UNICEF conducted a total of 38,495 new education with hand washing were performed. 249 individuals medical consultations in Afar (19,855) demonstration were conducted at received mental health consultations. and in Somali (18,640) regions through health facility and community level 176 units of blood were collected, UNICEF supported mobile health and reaching a total of 1,093 individulas in screened and availed for transfusion. 5 nutrition(MHNT) teams. Of which 44% the woreda. In Oda Bildgilu district, group sessions of psycho-education with of them were under five children and Assosa zone, hand washing materials 211 participants were conducted in 31% were women. (soap and water tank) were donated to April. COVID-19 RCCE activities were all health facilities (1 HC and 6 HP) and started including messages on hand public hand washing points. A total of Mercy Corps had three MHNT in three washing and explanations on mandatory 3,274 residents of the woreda were woredas of Somali namely; Tuliguled, quarantine; 329 persons were reached reached with awareness creation East Imey and Bercano which will withthese interventions. messages. continue until July 31, 2020. MHNTs provided medical consultation for total GOAL in Yirgachefe, Medawolabu, of 1,822 beneficiaries of whom 153 SCI health humanitarian projects are Dolomena, reached a total medical were under five years and 570 were located in Somali, Oromia, and SNNP consultation of 567; from the total between 5 to 18 years while 967 were regions. The health responses are for cases 425 are adults and 142 are under adults above the age of 18 years and 129 IDPs, returnees and drought affected five children. Health education is were elderly people and 3 disabled communities. through mobile health and provided for 14,841 individuals on a people. A total of 159 children were nutrition teams, reached 24,203 key health messages out which 7,066 given measles vaccination. In addition, beneficiaries through compressive are male and 7,775 are females. In MC’s MHNT identified and treated 56 curative, preventive and promotive Somali (Galadi, Daratole, Bokh SAM children without medical primary health care services and saved woredas), a total medical consultation complications at outreach sites. many lives of victimized population of 2,271 clients got service; from the groups. In the month there were total cases 1,649 are adults and 622 outbreaks of cholera and flooding in under five children. Health education is Somali where our MHNTs have engaged provided for 7,614 individuals on a key in response with other partners in health messages out which 3,204 are communicating the risk, managing cases male and 4,410 are females. and providing NFIs.

MCMDO reached a total of 35,036 beneficiaries through lifesaving primary health care and nutritional service. A total of 12,318 beneficiaries got consultation and treatment service of which 2284 under-five children. In total 1,346 WCBA received modern contraceptive of which 485 long acting and 766 and 368 pregnant women received ANC1 & 4 services respectively also 18 deliveries were attended by the MHNTs Midwiferies Nurses. Health education service provided to 13,080 beneficiaries that targets COVID-19 and other communicable diseases. Logistic support was provided for zonal and woreda health offices (nutrition and other medical supplies) and screening campaign.

WHO leads the one-UN incident USAID Transform’s Primary Health management team meeting held three Care in SNNPR, Multiple woredas, HWs times a week. WHO co-led the are deployed to CTCs, sanitary materials development of the national COVID-19 are purchased, and support is ongoing. response plan, the UN contingency Yellow Fever vaccination campaign was plan and business continuity plan. also supported. In Amhara, Waghimra WHO has developed a regional support zone, integrated case-management strategy to work within regional EOCs orientation given to 93 HWs and 420 to provide much-needed support in key actors are sensitized. Routine case investigation, contact tracing, program strengthened with periodic active case search and epi-surveillance outreach service for hard-to-reach data management and capacity areas. In Tigray, Asgede Tsimbla building across all pillars. Over 10,000 woreda; Case-management training, health workers and staff from other mop-up campaign& active surveillances sectors such as airline crew, military, supported and routine EPI is being media were trained. WHO is providing strengthened. COVID-19- in addition to technical guidance on setting up technical supports, a total of 941,694 isolation/treatment centres, and has USD is mobilized is filling critical donated 2000 sets of PPEs and 200 response gaps in the four agrarian handwashing stations. regions.

AAH provided logistic support to Gimbi and Mana Sibu woredas of West Wollega and Sedal and Agalometi Woredas of Kamashi Zones for transportation of essential materials and supportive supervision for COVID- 19. AAH procured and donated different materials (mainly WASH NFI) for 60 TFP sites as part of COVID19 prevention to Itang Woreda Health office of Gamabella Region. It distributed more than 30,000 bars of soap and sanitizers to beneficiaries who cannot afford to buy soap and hand sanitizer in all ACF operational areas in coordination with woreda and zonal EOC. Health Cluster 3W map

Plans for future response The Health Cluster is working with the PHEOC to support response to COVID-19 nationally and in all regions. Through its partners the cluster 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, flooding, 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 UNFPA, IOM, DFID, WHO, UNHCR, GOAL, UNAIDS, FIDO, UNESCO, UNRCO, WVE, ECHO, MCMDO, UNICEF, ACF, USAID, GHSC-PSM, MSF-E; OCHA, CUAMM, GNE, UNDP, UN Women, Mercy Corps, Child Fund, Plan International, Nutrition International.

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