HEALTH ACTION IN CRISES, MONTHLY UPDATE FEBRUARY 2008

1. Health Coordination WHO/HAC participated in a number of coordination meetings during the month of February 2008 aimed at improving health response coordination at the national and district levels Cluster coordination; The programme supported monthly Health, Nutrition and HIV/AIDS cluster coordination and working group meetings at the national and district level. During these meetings partners were briefed on the various epidemics that are affecting Uganda. In the districts of Amolatar and Oyam the monthly Health, Nutrition and HIV/AIDS cluster coordination meetings were held for the first time during which, the National professional officer based in Lira made a technical presentation on the cluster approach.

Other coordination meetings; WHO also participated in a meeting convened by UNHCR where a rapid assessment tool was developed to be used to carry out an assessment of the Kenyan refugees in Mulanda, district. The programme also supported MoH to convene a stake holders meeting on the ongoing epidemic outbreak of Hepatitis E in and participated in the preparatory meeting for the planned joint UN, HIV/AIDS vulnerability assessment in the return areas of Acholi and Lango sub-regions. In Karamoja region, the agency participated in the Karamoja 2008 Relief Intervention planning meeting organized by WFP, in this meeting, members were briefed on the progress of the Health coordination in the region and participated in the development & design of nutrition interventions for the region along with other partners. Still in karamoja sub region the programme attended a meeting convened A WHO/HAC Staff meets with Local leaders at by the Honorable Minister of Health Dr Stephen Malinga Madi Opei Sub County in Kitgum district to to discuss ways of contain Hepatis E review the status of Moroto hospital and briefed him on WHO operations and commitment to scale up her presence in the region. In Kitgum and , the programme participated in the bi weekly Humanitarian coordination meetings and provided updates on Hepatitis E outbreak.

WHO/HAC also participated in a two day training workshop organized by UNOCHA aimed at strengthening the cluster management and develop intervention matrix for partners in collaboration with other agencies. Lastly, WHO/HAC participated in the Regional planning meetings to assist in incorporating PRDP in the district plan for all the districts in Northern Uganda, Karamoja and Teso region.

2. Gap Identification and Filling Support was provided to update the Sleeping Sickness database for Lango sub region through a visit to Lwala hospital in . In Lira the programme also visited Aboke HC IV, Aduku HC IV, and DHO in Apac on a fact finding mission on ART sites services in the district, during the mission WHO was able to identify that Aboke did not have ordering forms which was immediately provided. In Kitgum district, the programme is providing technical support to the ongoing Hepatitis E epidemic response through support to surveillance activities, training of health workers and members of the Village Health Teams. In Pader the programme facilitated transportation of stool samples to Lacor hospital for further analysis, one of which was found to contain cholera.

In and WHO/HAC supported the district to conduct drugs and medical equipment inventory at all health units and to conduct drug monitoring exercise for . Result of this exercise is expected early next month. The programme further provided logistic support to Gulu district to transport essential drugs from to Health Centers. WHO with the support of the DHO and other partners updated the gap monitoring format which will be used by the cluster to develop Cluster POA for 2008. In Karamoja region, WHO pre-positioned medical supplies in strategic locations in preparedness for any meningitis outbreak in the area. The programme also held a meeting with CUAMM in to discuss the possibilities of exploring a joint research venture on neglected tropical diseases in Karamoja region.

3. Health System Strengthening To strengthen the health system in northern Uganda and Karamoja sub regions, WHO/HAC technically and financially supported several training and sensitization activities in the districts during the month. Overall, For further information, please contact: 1 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected] HEALTH ACTION IN CRISES, UGANDA MONTHLY UPDATE FEBRUARY 2008

60 health workers were trained in the six districts of Teso region in Epidemic preparedness and response and sub county authorities in all sub counties in were sensitized on the VHT concepts as part of the ext strategy from the emergency flood response. To strengthen HMIS/IDSR reporting by health facilities, all radio calls in were repaired. In Kitgum district to help contain the Hepatitis E epidemic, air time was given for the village phone and to DSFP person to facilitate reporting of cases. The programme also supported an on-job training of health workers on HEV and training of 55 VHTs from Madi Opei in Participatory hygiene and sanitation transformation (PHAST) approach and communication skills. In Pader district the programme supported training of 53 in charges of health units and 5 HSD staff on drug supply chain management. The training is expected to build capacity of health A VHT trained by WHO/HAC sensitizes women workers in drug quantification, storage and to improve an hygiene in Madi Opei sub county recording of drug use which are the main problems in the health facilities in the district.

The programme further provided technical and financial support to the DHO, district surveillance focal person and the district drug inspector to conduct assessment of the waste management shortfalls in Puranga HC III.In Amuru and Gulu districts the DSFP were supported to sustain surveillance reporting and while in Amuru district a review meeting with the in- charges of the HC’s in Kilak Sub County was also supported. In its effort to contain an outbreak of Meningitis in district, WHO/HAC delivered oily chloramphenicol, TI media, drugs and supplies to the district. In Karamoja sub region the programme supported the districts of Kabong, Abim, Nakapiripirit and Moroto districts with motorcycles to strengthen IDSR/HMIS reporting

4. Measurement of ill health (HMIS/IDSR and A WHO/HAC hands over a motorcycle to CUAMM Assessments) technical advisor Dr. Jovani who receives it on In Lira and Oyam districts WHO/HAC participated in behalf of DHO Abim districts meningococcal meningitis epidemic outbreak investigation of suspected cases. The result of the investigations was negative for meningococcal meningitis Figure 1; Completeness of IDSR reporting for Acholi, Lango and Karamoja region however, Klebsiella species was isolated in the specimen from Lira 120 district. In Kitgum district the programme supported the 100 investigation of suspected cases by RRT. The programme also 80 supported Gulu district Health Team in the investigation of 60

Week suspected meningitis cases.

40 4.2 IDSR Data

20 As part of WHO/HAC core function, HAC-Uganda continues 0 to support HMIS/IDSR activities in 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 all districts of northern Uganda % completeness of reporting and Karamoja through the provision of technical, financial

For further information, please contact: 2 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected] HEALTH ACTION IN CRISES, UGANDA MONTHLY UPDATE FEBRUARY 2008 and logistic support to the district surveillance focal persons to conduct support supervision activities.

4.2.2 Completeness of Figure II; Reported cases of Malaria in Acholi, Lango and Reporting Karamoja region

All districts in Acholi, Lango and 18,000 Karamoja sub-region had over 80% 16,000 completeness of IDSR reporting. 5 14,000 of the 14 districts had 100% 12,000 completeness of reporting. See 10,000

Figure I on completeness of IDSR 8,000 # ofcases # reporting. However, timeliness of 6,000 reporting by the health units still 4,000 remains a major challenge. WHO is 2,000 supporting the districts to address 0 the issue. 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 epi-weekl 4.2.3 Disease Trends Acholi Lango Karamoja 4.2.4 Malaria Diseases; Acholi and Lango sub-regions still reported the highest incidence of Figure IV; Reported cases of dysentery in Acholi, Lango and Malaria. As seen from Figure II Karamoja region below. Analysis of this figure 700 reveals an apparent increase in incidence of malaria in Acholi and 600

Lango sub-region. However, on 500 comparison of malaria trend in 2007 and 2008 in Lango sub-region, 400 we note a 50% raise in the number 300 of cases in 2008 as compared to ofcases # 200 2007. 100 0 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 4.2.5 Diarrhea disease Epi-week

The incidence of dysentery cases Acholi Lango Karamoja has remained relatively constant for all regions. Acholi sub-region still reports the highest incidence of dysentery. See figure IV. On Figure VI; Epi-curve of Hepatitis E cases in Madi opei sub- comparison of the weekly incidence county Kitgum district 28th October 2008 of dysentery in Acholi sub-region in 2007 and 2008. 25

20 2.1 Other priority diseases

Two cases of cholera were reported 15 during the week. One case was from Patongo prison in Pader

# of cases 10 district and the other case was imported from Pageyo in southern 5 Sudan. The epidemic outbreak of Hepatitis E still continues unabated 0 in Madi Opei Sub-county, Kitgum 5-Jan 2-Feb 9-Feb 1-Dec 8-Dec 12-Jan 19-Jan 26-Jan 17-Nov 24-Nov 16-Feb 23-Feb district. The cumulative number of 15-Dec 22-Dec 29-Dec Date of registration cases as of 28th February 2008 is 415 with 11 deaths (CFR 2.7%). The weekly incidence of registered cases has increased from 35 in epi week 5 to 49 in epi-week 9.

For further information, please contact: 3 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected] HEALTH ACTION IN CRISES, UGANDA MONTHLY UPDATE FEBRUARY 2008

5. Conclusions In general implementation of WHO/HAC activities have gone well during the month of February. Enabling factors include the commitment and hard-work of the programme staff, support from the WR and WCO staff, regional office and HQ. Key challenges during the month were; • The inadequate human resource for health still remains a serious challenge. For instance, Gulu district has up to now not been able to recruit health workers because of non-functional district civil service commission. • Staff absenteeism is still a serious problem. The incentive provided last year seems to have had no effect on staff performance. • Rehabilitation of health centers and construction of staff quarters is still a serious challenge especially in return areas were most staff are forced to commute from far away places • Many health facilities have inadequate medical equipments • The drug supply chain still remains a challenge as most health units lack tracer drugs.

6. Plan for February 2008 ƒ Continue to support Hepatitis E epidemic response activities in Kitgum district ƒ Continue to support Implementation of exit strategy activities in the flood affected district of Teso. ƒ Organize a health cluster retreat to discuss health recovery in northern Uganda and develop cluster plan for 2008. . The cluster work plan will include exit strategy for the cluster. ƒ Continue providing technical support to the DHT to sustain completeness and timeliness of HMIS/IDSR reporting above 80% ƒ Continue providing support to the district and MoH to develop a comprehensive plan for the PRDP districts.

7. Acknowledgements The progress achieved so far by WHO/HAC Uganda was made possible through contributions from the following partners:

For further information, please contact: 4 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected]