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Relief Action Plan: Health,
Medical Supplies and Vaccination
World Health Organization
January, 2000
Addis Ababa
Table of Content
Page
1. Introduction ......................................................................................1
2. Background .......................................................................................3
2.1. Tigray Region (W.Tigray) .......................................................3
2.2. Amhara Region
2.2.1. North Gondar ................................................................3
2.2.2. South Gondar .................................................................5
2.2.3. North Wollo ...................................................................7
2.2.4. South Wollo...................................................................8
2.2.5. Waghemra .....................................................................9
2.3. Borena (Oromia Region) .......................................................11
2.4. North Omo/Konso (SNNPR)..................................................12
2.5. Somali Region .......................................................................13
3. Highlights of Problems ....................................................................15
4. Strategies ........................................................................................16
5. Objectives .......................................................................................16
6. Proposal priority activities ...............................................................17
8. Summary of the costs of nonfood (health) items ..............................18
9. Implementation arrangements ..........................................................18
Attachments:
1. Sector: Health requirement for three months by zone
2. Sector: Health requirement for three months by zone
i
1. Introduction
The Belg season in 1999 together with poor responses to appeals for
food and/or nonfood (health) had caused serious concerns about the food
security situation and responses to emergency health situations in a number
of badly drought affected areas in Ethiopia.
While concerted efforts were underway to avert the above mentioned
difficulties, the 1999 Meher crops have been severely affected by all sorts of
calamities making the ongoing shortage of food and nonfood extremely
serious. It is now expected that many of the areas affected by drought and
crop failures not only experience serious shortage of food, but also expected
that diseases situation would be increasing for the worse. What makes the
current situation worse than ever was that responses to earlier attempts to
secure nonfood assistance from donor communities was far less than
expected.
In view of the serious need to avert the current situation as urgently as
possible, the Disaster Prevention and Preparedness Commission (DPPC) had
issued an appeal document in November 1999 and estimated that 5.8 million
people would need relief assistance in the first quarter of 2000. Likewise,
these seriously affected people would equally need emergency relief health
care as they become highly susceptible and vulnerable to infections diseases.
According to DPPC, the regions affected include, Tigray, Amhara, Oromiya,
Somali, Southern Nations and Nationalities Peoples Region (SNNPR).
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In view of the foregoing drought and crop failures situation of
Ethiopia and the pressing need for nonfood (health) assistance to same areas,
the UN organizations mainly WHO, UNICEF, UNFPA, UNEUE in
collaboration with federal and regional government sectors undertook rapid
assessment on nonfood requirement of the drought and crop failures affected
areas which covered Tigray (W.Tigray); Amhara (North and South Gondar,
North and South Wollo and Waghemra); Oromiya (Borena); SNNPR (Konso
and North Omo) and Somali (Gode, Liben, Afder, Fiko, Korachi, Warder
and Deghahabur).
The methodology adopted to collect the necessary data consisted of
the following:
a) Assessment teams organized from WHO, UNICEF and UNFPA
were dispatched to different regions and zones.
b) Data used in the last appeal was utilized, as the information was
still current. Wherever possible, the data was updated.
c) Recent studies, such as on nutrition, done by nongovernmental
organizations were used. Where recent studies were unavailable,
an intelligent use of available information was made.
d) Visit reports of heads of missions were also used.
2. Background:
2
The rapid assessment program has covered four regions (Tigray,
Amhara, Oromiya and Somali). The total number of zones considered for
the assessment were fifteen zones and one special woreda. The drought
affected areas in the SNNPR have been included in this health needs
document using existing current information. The summary findings of the
drought affected zones is presented below.
2.1. Tigray Region /W.Tigray/
In West Tigray Zone, Tselemti, Tahtay Adiabo, Lahlay Adiabo, Lahlay
Adiabo Medebay Zanal and Tahtay Koraso have been currently identified
as requiring food assistance (77,007 people). These areas have
experienced uneven distribution of rains, drought conditions in some
areas and water logging and hail storms in other areas. In the affected
areas, generally, a serious problem of water-born diseases was reported.
2.2. Amhara Region
2.2.1. North Gondar Zone:
In North Gondar, out of sixteen woredas seven woredas with estimated
population of 1,088124 are affected by drought 209935 people need
relief assistance. The distribution of the existing health facilities and
health workers is relatively fair. There are five health centers thirty-one
health stations and fourteen health posts in the drought affected areas.
The potential coverage of health service was 35.3%. The top five causes
of outpatient morbidity were malaria, diarrheas, intestinal parasites,
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pneumonias and tuberculosis. Likewise, the common causes of hospital
deaths are malaria, tuberculosis, bronchopneumonia, diarrheas and
septicemia. These killing diseases were often associated with
malnutrition. The infectious diseases under continuous surveillance have
slightly increasing trend. The vaccination coverage, in general, and
particularly in the drought affected areas was low (DPT3 36.1% and
measles 28.8%). Although, the existing cold chain system was
functioning properly, about 20% of the health facilities were reported to
be without cold chain system.
Laboratory facilities were available in two hospitals and nine health
centers. The laboratories undertake routine activities. The two hospitals
run HIV screening tests. Some of the health units in the drought affected
areas don’t have laboratory services. The zone health department has
taken essential measures such as training laboratory technicians to engage
health centers in HIV screening tests. HIV screening test kits are needed.
No recent data was obtained regarding current nutritional situation of
drought affected areas. However, from results of growth monitoring
activities indications of chronic and acute malnutrition were reported.
In general, shortage of drugs and medical supplies, laboratory reagents
and HIV test kits, cold chain supplies were reported as urgent needs.
2.2.2. South Gondar Zone:
4
Nine woredas out of ten are seriously affected by drought. The
estimated population of the nine woredas was 1,892,993 out of which
504112 persons are victims of the effects of drought and needing relief
assistance. There are eight health centers, sixty health stations and 37
health posts in the drought affected areas. The distribution of health
facilities and rural health workers is fair. The health centers and health
stations have adequate staff of nurses, health assistants, laboratory
technicians, sanitarians and malaria technicians.
The top five cases of morbidity were malaria, respiratory tract infections,
intestinal parasites, skin diseases and diarrheal diseases. It is worth
mentioning that these diseases are associated with consumption of unsafe
water and unhealthy sanitation practice. The common five causes of
death were tuberculosis, malaria, diarrheas, respiratory tract infections
and acute febrile infections. The killing diseases were very often
associated with malnutrition. With regard to notifiable diseases no
significant change was observed. The estimated potential coverage of
health services was 41.5%.
Vaccination coverage for the zone was satisfactory with DPT3 76% and
measles 58.1%. However, there are certain drought affected areas that
need close attention. Shortage of refrigerators and wicks was reported.
Laboratory services were provided in one hospital and seven health
centers in the zone. However, two health centers in the drought affected
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areas don’t offer laboratory services. The lack of microscopes, supplies
and reagents were reported as serious constraints, specially for health
facilities in drought affected areas. No HIV screening tests are performed
in the zone.
The shortage of drugs, medical supplies and equipment and
replenishment for the cold chain system were problems frequently cited.
In service training and workshops were being irregularly conducted in the
past to enable health workers to respond to emergency health problems,
but it was cited as inadequate. The high turnover of trained staff is
mentioned as one of the problems contributing to poor performance. The
need for continuous training to fill gaps was suggested.
There were a number of nongovernment organizations participating in the
development of health services in the zone as well as drought affected
areas but no coordination mechanism exists to maximize their
participation.
2.2.3. North Wollo Zone;
6
North Wollo Zone has nine woredas and eight are hit by drought. The
drought affected woredas have a total population of 1,372,286 out of
which 533665 persons are victims of the effects of drought and requiring
assistance. In the eight woredas there were one hospital, seven health
centers, sixty-two health stations and thirty-three health posts. The
estimated potential coverage of health services is between 50-60%. The
top five causes of outpatient consultations were tuberculosis, upper
respiratory infections, diarrheas, intestinal parasites and gastritis. The
common causes of death in hospitals were tuberculosis, relapsing fever,
fever of unknown origin, malaria and HIV/AIDS. These killing
infections diseases were often associated with malnutrition. With regard
to notifiable diseases increasing trends were recently observed for
malaria.
In service training and workshops were being conducted in the past.
First, it was cited as inadequate and second, there was high turnover of
the trained staff. Therefore, the lack of continuous training programme
was cited as a problem.
Even though few, there are nongovernmental organizations engaged in
health work in the zone. There was no coordinating mechanism set to
maximize their participation in emergency health services as partners to
government sectors.
2.2.4. South Wollo Zone:
7
South Wollo Zone has seventeen woredas and fifteen were hit by
drought. These fifteen woredas have a population of 2,262,833 out of
which 920,932 people were directly affected by drought and required
assistance. In the fifteen woredas there were two hospitals, seven health
centers (three do not function), eighty-five health stations and forty-six
health posts. The estimated potential coverage of health services was
47.7%.
The top five causes of outpatient consultations were tuberculosis, upper
respiratory infections, diarrheas, intestinal parasites and gastritis. The
common five causes of hospital death were pulmonary tuberculosis,
diarrheas, liver diseases, other tuberculosis and obstruction. These
killing diseases were often associated with malnutrition. With regard to
notifiable diseases increasing trend was observed for malaria.
Vaccination coverage was satisfactory and a large number of the health
facilities were participating in the EPI services. Recent data on the
nutritional situation of the South Wollo Zone was not obtained.
Nevertheless, the existing data from growth monitoring activities
indicated the occurrence of acute and chronic malnutrition in the zone in
general.
Laboratory services were available in the hospitals, health centers and
regional laboratory.
Shortage of reagents and HIV testing kits were serious constraints of the
service. In addition, the shortage of drugs, medical supplies, equipment
8
and replenishment of cold chain system were reported as outstanding
problems.
In service trainings were conducted in a limited scale in the past.
However, it was reported inadequate as the coverage was limited and the
turnover of health workers was high and trained persons quit the area.
The lack of sustained training programme was raised a problem.
There were a number of nongovernment organizations participating in
health activities in different woredas in the zone. The lack of
coordination mechanism to create fruitful partnership between
government bodies and NGOs was cited as a problem.
There were a number of nonfunctioning health facilities in the zone.
These health facilities must be organized at least to provide emergency
relief health services for the drought affected population.
2.2.5. Waghemra Zone:
The zone has three woredas with a population of 309564 of these 114966
persons were drought affected and were under food assistance. There
were one hospital, two health centers, eighteen health stations and eleven
health posts. The same number of health facilities cater health services to
the drought affected people.
9
The top five causes of outpatient consultations were eye infections, fever
of unknown origin, malaria, diarrheas and intestinal parasites. Among
the notifiable diseases malaria + STDs recently showed increasing trend.
Increased STDs indirectly indicate the likelihood of the spread of HIV
infections.
Vaccinations are rendered by a limited number of health facilities and
recent vaccination results showed very low coverage for DPT3 and
measles. It was reported that the cold chain system was not functioning.
Recent studies on nutritional situation were not available for the zone.
However, earlier results of growth monitoring activities undertaken in the
zone and there were indications of malnutrition.
The distribution of health facilities and health workers is fair. At least,
there were health stations in all woredas, however, one woreda is without
health center.
Laboratory services were available in the hospital and health center.
There are trained laboratory technicians and run routine tests. The
laboratories don’t run HIV screening tests due to lack of HIV testing kits.
In addition, the shortage of drugs and medical supplies and reagents were
frequently cited as serious constraints.
The increasing of STDs is associated with the in and out migration of
people. As this situation contributes to the spread of HIV infections, the
10
lack of sustained health education and counseling to alleviate the spread
of both STDs and HIV infections was raised as a serious problem.
2.3. Borena Zone (Oromiya Region):
Reports indicated that Borena Zone is among the worst drought stricken
areas over the last consecutive seasons. Health problems specially related
to drinking water problems were reported to be showing increasing trend
in the zone. The zonal DPPB and SCF-USA reported that diarrhea cases
are increasing in number to a level of epidemic situation in some areas.
According to the report of the Zonal Health Department, Some of their
pressing problems for the year 2000 were inadequate logistics support
such as transport, very small operational budget and serious shortage of
affordable essential drugs. The prices of drugs are very high and
inaccessible to poor people. To improve health services in Borena zone,
these crucial issues must immediately be addressed. A measles outbreak
has been reported in Borena Zone last month. Vaccination coverage
(35%) in Borena Zone is very poor and is attributed to the inadequate
logistic support available in the zone coupled with the longtime taken to
transport vaccines and drugs from the center. Zonal Health department
reported that: shortage of EPI cold chain equipment including refrigerator
and spare parts, syringes and needles and vaccine carriers. Other needed
equipment and supplies are steam sterilizer, pregnancy test kits, other
laboratory reagents, motorcycles, etc.
2.4. North Omo/Konso (SNNPR):
11
Reports from North Omo, Konso and other zones in SNNPR indicated
the occurrence of serious malnutrition as the prospect of the harvest
season was bad. About 420,000 people have required food assistance
during the first quarter of 2000. Likewise, these people would need
nonfood (health) assistance as they are vulnerable to infectious diseases.
It is to be recalled that the unusual discontinuation of the Belg rain had
deteriorating nutritional status and very high levels of infant and child
mortality. Currently, similar situations are prevailing in the zones and
need to be averted as soon as possible.
In North Omo, there are 8 health centers and 33 health stations providing
services in the drought affected areas. Reports indicate that these health
facilities were understaffed. Similarly, there were one health center, nine
health stations and one NGO clinic in Konso. The health units except the
health center were understaffed.
In both North Omo and Konso the top cause of morbidity are malaria,
intestinal parasites, diarrheal diseases, tuberculosis and upper respiratory
infections and malnutrition. The common causes of death in hospitals
and health centers were malaria and diarrheas often associated with
malnutrition.
Laboratory facilities are available in the hospitals and health centers,
however, reagents and functional equipment were inadequate.
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The coverage of vaccination in North Omo as well as Konso was very low.
Causes were lack of transport, non-functional cold chain system and lack
of operational cost.
In summary, the health facilities in the drought affected areas had
shortage of essential drugs and medical supplies, replenishment materials
for the cold chain system and fund for operational activities.
2.5. Somali Region:
The Somali Region has experienced inadequate or absent rainfall in 1999
in addition to similar experiences in the past consecutive five years. The
cumulative consequences of the failures of the rains have resulted in the
shortage of water and lack of vegetation for animal feeding in the
predominantly pastoral communities. This ongoing situation is causing
animal deaths and a high rate of malnutrition in the region.
Somali Region has nine zones. The estimated population is 3.5 million.
The number of zones affected by the drought are reported to be seven
zones (Gode, Fik, Afder, Korachi, Warder, Liben and Degahabur). The
number of people affected was not obtained at the time of the assessment
of the nonfood requirement. However, 40% of the total population is
used to compute for the nonfood requirement. There are
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four hospitals, 10 health centers and seventy-eight health stations in the
region. The top five causes of morbidity are tuberculosis, malaria,
diarrhea, upper respiratory infections and malnutrition. These diseases
are the common causes of death. Increasing trend of notifiable diseases
has been observed and mortality rates have been increasing among the
vulnerable groups.
Immunization programmes are very weak and sporadic. The coverage of
EPI for the region is DPT3 7.2% and measles 8.6%. The status of EPI is
extremely low in the drought affected seven zones.
Laboratory services are available in hospitals and few health centers.
Equipment and reagents are in short supply. HIV screening tests are
undertaken only in Jijiga hospital.
There are a number of NGOs participating in health activities in different
zones of the region, but, there is lack of coordinating mechanisms to
maximize their contribution.
In general, the lack of essential drugs, laboratory reagents and equipment,
HIV screening testing kits, etc. are reported.
3. High lights of Problems:
14
The coverage of health services in general and drought affected areas in
particular was low.
3.1. The top causes of outpatient morbidity:
malaria
diarrheas
intestinal parasites
pneumonias
tuberculosis
respiratory tract infections
skin diseases
3.2. Vaccinations
3.2.1. Low vaccination coverage
3.2.2. Lack and/or inadequate cold chain system
3.3. Laboratory Services
3.3.1. shortage of reagents
3.3.2. lack and/or inadequate HIV screening test kits
3.4. Shortage of drugs and medical supplies
3.5. Inadequate in service training to enable boost the performance of
health workers
15
3.6. Lack of coordinating mechanisms to promote partnership between
those working in the health sector, particularly in drought affected
areas.
4. Strategies:
The health facilities in the drought affected areas will be revitalized to
respond to the health needs of the drought hit population by providing the
necessary assistance to the health facilities, such as drugs and medical
supplies, laboratory reagents and supplies, establishing sustained and
effective cold chain system. In addition, health facilities that are not
currently functioning will be organized at least to provide emergency relief
health care. These can be done by mobilizing health workers within zone or
the region at large.
5. Objectives:
The development objective of the undertaking is to respond to the need of
emergency health care of the drought affected population in the zone of the
drought affected regions. The following are the immediate objectives.
5.1. Provide emergency health kits to the most drought affected population
5.2. Increase the vaccination coverage of the drought affected areas by
providing the supplies and strengthening existing cold chain systems.
16
5.3. Support the control of epidemics
5.4. Establish emergency health services in nonfunctioning health facilities
to broaden availability of relief services to the drought affected
population.
5.5. Undertake training of health workers to enable them quickly respond to
emergency situations such as disease management, reporting, etc.
5.6. Allocate operational cost for selected activities
5.7. Improve accessibility to emergency relief health services
6. Proposed priority activities:
6.1. Quantify the amount of drugs and medical supplies reagents, vaccines
for health facilities in the drought affected areas.
6.2. Identify and cost for vaccination related supplies to improve and
strengthen cold chain system.
6.3. Undertake training of health workers to manage epidemics, improve
reporting of and other emergency health related activities.
6.4. Determine the estimated operational cost for the mobilization of health
workers to respond to emergency health needs of the drought affected
population.
17
6.5. Introduce emergency relief health services
7. The nonfood (health) requirement for the emergency health in the fifteen
zones and one special woreda is prepared in two tables based on available
data. Where the size of the population of the drought affected areas is
not yet computed the experience observed in the other regions and
perceived severity of the region in question is used to compute the
specific requirement of the region. The number of existing health
facilities, coverage of vaccinations, number of children <5 etc. are
considered for calculation of needs.
8. Summary of the costs of non food (health) Items:
8.1. Basic and supplementary emergency drugs USD 1301005
8.2. Laboratory Kits and reagents USD 445200
8.3. Vaccines, supplies and equipment USD 390060
8.4. Syringes and Needles USD 326700
8.5. Operational cost USD 246500
Total USD 2709465
9. Implementation arrangements:
9.1. Once the response to the forthcoming appeal is positive, the assistance
to the different drought affected areas will be received by the Federal
Ministry of Health from the lead UN agency and will distribute the
emergency supplies to the regional health bureaux and the regional health
bureaux to the zones. As the woreda health offices are not established in
18
all zones and do not have the necessary capacity, the zonal health
departments by and large will be responsible to distribute the supplies to
all health facilities.
9.2. The overall supervision of the implementation at the field level will be
by the woreda health offices and zonal health departments. These offices
will submit regular activities reports on the progress of the work of the
emergency situation to the regional health bureaux. The regional health
bureaux will submit reports to the Ministry of Health and the Ministry of
Health will submit utilization report to the lead UN agency which will be
shared within the UN system.
9.3. As a result of the consecutive drought and crop failures occurrence as
well as its subsequent effects on the population, the buying ability of the
drought affected people has been eroded and currently people don’t
afford to procure health services including essential drugs. Hence, it is
suggested that the Ethiopian Government accords due attention to this
burning issue and introduces temporary free health services for the entire
population that is severely affected by drought and is directly under relief
food assistance. A special recording and data collection system can be
established in the health facilities providing emergency relief health
services.
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Sector: Health requirement for Three Months by Zone
Ser. Item North Gondar South Gondar North Wollo South Wollo Waghemra Total
No. Quantity Cost in Quantity Cost in Quantity Cost in Quantity Cost in Quantity Cost in
USD USD USD USD USD
1 Emergency Health Kit (basic & 46 108,000 111 238,000 122 262,200 202 434,000 12 26,300 1,068,500
supplementary)
2 Measles vaccines (doses) 36,000 6,450 86,000 15,480 94,000 16,920 156,000 28,080 9,000 2,450 69,380
3 Laboratory kits and Reagents 5 29,000 7 40,600 8 46,400 7 40,600 2 11,600 168,200
4 Refrigerators and spares 5 11,750 10 23,500 - - 2 4,700 5 11,750 51,700
5 HIV spot screening test 100 13,000 140 18,200 160 20,800 140 18,200 40 5,200 75,400
6 Syringes & needles 15,000 16,500 25,000 27,500 28,000 30,800 46,000 50,600 3,000 3,300 128,700
7 Vaccine carriers 50 1,600 70 2,240 80 2,560 80 2,560 100 3,200 12,160
8 Burner set 50 1,700 100 3,400 100 3,400 140 4,760 30 1,020 14,280
9 Wicks 400 800 500 1000 400 800 500 1000 200 400 4,000
10 Ice pack 500 500 500 500 400 400 400 400 350 350 2,150
11 Steam sterilizer 25 3,000 50 6,000 30 3,600 40 4,800 30 3,600 21,000
12 Operation cost (training, etc.) 19,300 38,000 38,800 59,000 6,800 161,900
Total 211,600 414,420 426,680 648,700 75,140 1,777,370
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Sector: Health requirement for Three Months by Zone
Ser. Item W.Tigray Borena(Oromia) N.Omo/Konso Somali Region Total
No. Quantity Cost in Quantity Cost in Quantity Cost in Quantity Cost in
USD USD USD USD
1 Emergency Health Kit (basic & 2 9490 11 52195 8 37960 28 132860 232505
supplementary)
2 Measles vaccines (doses) 13,000 2330 95200 17140 71400 12900 23800 42840 75210
3 Laboratory kits and Reagents - - 5 29000 9 52200 10 58000 139200
4 Refrigerators and spares - - 10 23500 9 21150 20 47000 91650
5 HIV spot screening test - - 100 13000 180 23400 200 26000 62400
6 Syringes & needles - - 40000 44000 40000 44000 100000 110000 198000
7 Vaccine carriers - - 100 3200 100 3200 200 6400 12800
8 Burner set - - 50 1700 50 1700 120 4080 7480
9 Wicks - - 500 1000 500 1000 1000 2000 4000
10 Ice pack 50 50 400 400 400 400 600 600 1450
11 Steam sterilizer - - 40 4800 50 6000 100 12000 22800
12 Operation cost (training, etc.) 1200 19000 20400 44000 84600
Total 13070 208935 224310 485780 932095
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Documents used as reference for the preparation of “the Plan of Action”:
Emergency Relief of Drugs, Medical supplies and Vaccination
1. Pre - Harvest Zone Level report Of W.Tigray, November 16,1999
2. Report on Assessment of nonfood need in N.Gondar, S.Gondar, N.Wollo,
S.Wollo and Waghemra Zones, December 11-19,1999.
3. Report on the Inter-Agency Rapid Assessment Mission on Non-Food
Need in Waghemra, June 1999.
4. Draft Report on Joint Assessment of Non-Food Needs Related to the Belg
and Meher failures, North and South Wollo Zones, June 17-25, 1999.
5. Nutrition Baseline survey of the Integrated Food Security Programme
(IFSP) - GTZ, South Gondar Ethiopia, October, 1997.
6. Preliminary report on assessment of non-food needs for Borena, Liben
and Afder zones by Robert Mc-Carthy and Alem Hadera (UNICEF), 13-
20 December 1999.
7. Report of an Inter-agency mission on the assessment of nonfood needs of
the drought affected people in N.Omo and Konso special woreda, 17 - 24
June 1999.
8. Visit to Gode zone, contribution of Dr. M. Jancloes (WHO) to the UN
assessment team on the drought related to the health sector, 14 December
1999.
9. Report on non-food assessment mission to Somali Region by UNICEF -
Ethiopia, 12 - 14 December 1999.
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10.
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