DROUGHTRELATED HEALTH

PROBLEMS INETHIOPIA

SECOND APPEAL DOCUMENT

MINISTRY OF HEALTH

DECEMBER 2002

1

TABLE OF CONTENTS

1. INTRODUCTION AND BACKGROUND INFORMATION. ................5

1.1 Geography and Climate........................................................................................ 5

1.2 Demography ........................................................................................................... 5

1.3 Economy ................................................................................................................. 5

1.4 Political and Administrative Set up ..................................................................... 6

1.5 Health Profile .......................................................................................................... 6

1.6 Health Problem ...................................................................................................... 7

2. SITUATIONAL ASSESSMENT ON THE EXTENT OF THE

CURRENT DRAUGHT PROBLEM IN ETHIOPIA. ...............................8

2.1 Climatic condition .................................................................................................. 8

2.2. Rainfall condition .................................................................................................. 8

2.3 Crop conditions. ..................................................................................................... 8

2.4 Livestock condition. ............................................................................................... 9

2.5 Food situation......................................................................................................... 9

3. HEALTH NEED ASSESSMENT ....................................................10

4. OBJECTIVES OF THE APPEAL...................................................13

5. GOVERNMENT POLICY AND ACTIONS......................................14

6. ACTIVITIES TO BE PERFORMED BY THE HEALTH SECTOR. ...15

7. IMPLEMENTATION OF THE APPEAL..........................................16

7.1 Institutional operational modalities. .................................................................. 16

7.2 Collaboration ........................................................................................................ 16

7.3 Monitoring and evaluation.................................................................................. 16

8. FINANCIAL REQUIREMENT SUMMARY .....................................17

2

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.

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Malaria outbreaks are very likely in some of the worst affected areas. Eventhough currently there are no reported outbreaks of meningococcal meningitisthere is great potential for epidemics in drought-affected areas. Existing watersources, mostly rivers and stagnant ponds, are potentially contaminated. Bloodydiarrhoeal disease outbreaks have affected both adults and children since mid2002. Basic health service infrastructure in regions like Afar and Somali is poor inall aspects - this applies both to preventive and curative services. Many mothersand 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 scatteredall over drought-affected pastoral areas polluting the environment and causingserious 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:

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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 inresponse for the first appeal document was good. We thank all the organizationswho are full heartedly working with us in our “ Health response task force”.

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EMERGENCY APPEAL FOR HEALTH AND NUTRITION, WATERAND SANITATION IN ETHIOPIA(SECOND EMERGENCY APPEAL)

1. 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

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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

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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 do not survive to celebrate his or her first birthday. Under 5 years

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

years 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 (DHS22000)

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 DHS = Demographic Health Survey

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2. SITUATIONAL ASSESSMENT ON THE EXTENT OF THE

CURRENT DROUGHT PROBLEM IN ETHIOPIA.

2.1 Climatic condition

The current climatic trends have caused quite a stress on food availability

countrywide. The poor Belg and Mehar 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. Theses are:

• The belg and Meher crops in a number of areas failed to grow

• Early maturing non-Belg crops, which are important sources of food during

the lean months before the Meher Harvest and the Meher rain also failed

• 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.

2.2. Rainfall condition

The onset of this year’s Belg rain in most parts of South Tigray, the eastern parts

of Oromiya, the low lands of east Shoa (Fentale area), East and West Hararge

and Bale, several areas in SNNPR, most notably Sidama, Hadiya and Kembata

Timbaro zones as well as Alaba special woredas, the northern parts of Somali

was either late, its cessation early or the distribution was poor. In Afar, on the

other hand, the February-May rains completely failed.

In Amhara region several woreda did not get rain as of April and few others

experienced serious frost damage.

2.3 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 Meher3 crops, Maize and sorghum,

3 Meher is equivalent to SpringBelg is equivalent to Autumn

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which are planted in April, is also very poor in several areas. The poor rain since

April has severely affected their performances.

2.4 Livestock condition.The poor Belg and the Meher rain has caused acute shortage of water and

pasture in several areas- both cropping and pastoral. The situation is much

severe in Somali, pastoral areas of Oromiya 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

Abala, Beraile, Erebiti, Koneba, and Dalol woredas of zone two, Amibara,

Buremedaitu and Awash Fentale woredas of zone three and Fursi, Artuma and

Semurobi woredas of zone five. In these 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 shortage serious live

stock diseases has been reported in many area of the region. (Details can be

obtained from the DPPC report).

2.5 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 Oromiya 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, in contrary, 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 15,000,000 will be affected according

to data released from DPPC (Early forecast of population needing). The death of

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livelihood animals mainly for the pastoralists worsens the situation of malnutrition

to children and pregnant women since the staple diets are based on milk and

milk products.

3. HEALTH NEED ASSESSMENTDifferent 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, eastern part of Oromiya 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.

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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 affected

regions. Routine EPI is non-existent in some of the regions.

Ø The health service provision in regions like 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.

Ø All reports from informants and teams’ 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 the population is completely dependent up on livestock, camels and their

products for their subsistence, high rate of malnutrition is eminent. Some

signs of malnutrition in children of under-five years are already 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. It is believed that 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

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management of all existing resources (financial, material, and human

resources) was observed in both regions (Afar and Somali).

Based on the findings the teams it was concluded that:

1. The drought situation in Afar, Somali, neighboring regions of Amhara and

Oromiya, Tigray 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. Some of the Regions do 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 areas 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 in all regions and high mobility from place

to place makes it a reality to consider existence of more problems mainly in

the two regions Afar and Somali

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.

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4. OBJECTIVES OF THE APPEALA. Health

• To provide emergency equipment, drugs and medical supplies

(Emergency health kits) where intervention is mandatory.

• To procure additional M.Meningitis vaccines, diluents and AD syringes.

• To develop capacity building in proper case management of malnutrition

related infections, acute nutritional conditions and diarrhoeal diseases.

• To establish temporary treatment shelters to facilitate services when the

need arises.

• To conduct active surveillance and Strengthening integrated Disease

surveillance for epidemic preparedness and response.

• To implement Measles immunization campaign for all less than 15 years

children in the affected areas.

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 quality of water distributed to the community.

• To provide health education to the community on water use,

communicable diseases and waste disposal.

C. Nutrition

• To improve case management of malnutrition for 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 supplementation.

• Coordinating technical assistance Provision in nutrition surveys and

feeding programmes.

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5. 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 on “Health problems due to natural

calamities” composed of different departments and services of the

Ministry.

B. Revitalized the “Health response task force” composed of International,

bilateral agencies and NGOs.

C. Deployed essential drugs from the available stock (33 Kits) to the priority

areas identified by the DPPC.

D. Deployed Health manpower since the beginning of August 2002 to those

priority areas to participate in the surveillance, treatment and assessment

activities.

E. Reassessed the vaccination and cold chain status of Afar and Somali

regions before the materialization of mass campaigns.

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F. Worked with donors and partners closely to secure funds. Proposals were

prepared based on the area of donor’s interest.

6. ACTIVITIES TO BE PERFORMED BY THE HEALTH SECTOR.

The following are activities that need to be performed to save lives of people

affected by the drought and its consequences:

A. Procurement and distribution of emergency drugs and medical supplies.

B. Supply of measles, Meningitis vaccines and Vitamin A capsules.

C. Epidemic preparedness and response, particularly Meningococcal

meningitis by strengthening Integrated Disease surveillance, training of

health workers and community members on epidemic diseases

management.

D. Environmental clearing. (Burning of carcasses)

E. Maintenance and quality control of water supply system.

F. Community education (Health education)

G. Malaria epidemic prevention and control activities.

H. Technical assistance in nutrition surveys and feeding programmes.

I. Monitoring and supervision of all activities already in place.

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7. IMPLEMENTATION OF THE APPEAL

7.1 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.

7.2 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.

7.3 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.

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8. FINANCIAL REQUIREMENT SUMMARY

ACTIVITIESTOTAL COST

USD

TOTAL COST

ETB

Emergency health kits 7,646,503 65,530,531

Drug distribution, monitoring and

supervision

382,052 3,274,186

Meningitis vaccine & accessories 1,446,980 12,400,619

Measles & Vitamin A campaigns including

cold chain equipment

6,418,352 55,005,277

Training of health workers in management&

surveillance health and nutritional

emergencies & social mobilization

813,649 6,972,972

Environmental sanitation & hygiene, water

quality control

1,688,152 14,467,463

Malaria prevention and control (ITNs,

training, lab supplies, Antimalarial kits)

1,400,000 11,998,000

Monitoring technical support & project

support

1,260,000 10,798,200

Supplementary and therapeutic food

(In kind)

IN KIND

TOTAL 21,055,688 180,447,247

1 USD = 8.57 ETB

Refer table 5 for the regional details and related annexes.

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Thus, a total of 21,055,688 USD is needed for this appeal document based

on the natural calamity of the B4elg and Meher rain failure. The total

population assumed to be vulnerable by this calamity is 15,000,000 according

to data released from DPPC. The budget calculated for emergency health kits

is based on the Pharmaceutical Administration Supply Services catalogues

average price list.

The cost for measles vaccine and vitamin A supplement is referred from the

UNICEF catalogue and other expenses for activity implementation were

calculated from the past experiences with SNID’s4

The rest activities Environmental clearing, awareness raising workshop,

updating on epidemic management, monitoring and supervision, health

education and drug distribution are calculated based on the past and current

experiences.

The details of each activity budget break down is attached on tables 1&2 and

annexes 1,2 & 3

The above-mentioned amount of money is needed for the activities

mentioned and assumed to be a priority area for intervention by the Ministry

of Health, Ethiopia. In different from the first appeal document in this appeal

document, additional activities like malaria control support, maintenance of

cold chain, therapeutic foods, HIV/AIDS awareness activities, Quality control

of water resources, capacity building of health man power, strengthening of

IDSR for early detection of epidemics and capacity building are included.

The detail of activities and budget break down will be submitted upon request

or interested donors partners and agencies to work on this line.

4 Belg is equivalent to Autumn5 SNID Sub National Immunization Days

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TABLE 1. RESOURCE REQUIREMENT FOR AFFECTEDPOPULATION NEEDING ESSENTIAL DRUGS AND MEDICALSUPPLIES.

S/N Region Population

affected

Number of

kits required

Estimated

cost (ETB)

Remark

1 Tigray 1,756,000 176 7,697,888

2 Afar 811, 700 82 3,586,516

3 Amhara 4,907,000 491 21,475,358

4 Oromiya 4,421,000 443 19,375,934

5 Somali 1,259,000 126 5,510,988

6 SNNPR 1,572,000 158 6,910,604

7 Gambela 106,500 11 481,118

8 Dire Dawa 85,200 8 349,904

9 Harari 21,300 3 131,214

10 B/Gumuz 60,300 2 87,476

TOTAL 15,000,000 1500 65,607,000

• The price for 1 kit at an average is 43,738.00 ETB (5097.67 USD)

• 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 rounded to thousands.

• See annex - 1 for the detail.

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Table 2. Operational cost for measles SIAs

Region Affected pop Targeted pop. No of No of No. of Microplanning Training Socmob M&E Transport Personnel Total cost

< 15 posts supervisors volunteers in USD

Tigray 1,756,000 790,200 1,317 132 1,317 13,170 44,251 39,510 26,340 39,510 157,968 320,749

Afar 811,700 365,265 609 61 609 6,088 20,455 18,263 12,176 18,263 73,020 148,264

Somali 1,259,000 566,550 944 94 944 9,443 31,727 28,328 18,885 28,328 113,258 229,967

Oromia 4,421,000 1,989,450 3,316 332 3,316 33,158 111,409 99,473 66,315 99,473 397,708 807,534

Amhara 4,907,000 2,208,150 3,680 368 3,680 36,803 123,656 110,408 73,605 110,408 441,428 896,306

Benshangul 60,300 27,135 45 5 45 452 1,520 1,357 905 1,357 5,425 11,014

Gambella 106,500 47,925 80 8 80 799 2,684 2,396 1,598 2,396 9,581 19,453

SNNPR 1,572,000 707,400 1,179 118 1,179 11,790 39,614 35,370 23,580 35,370 141,415 287,140

Dire Dawa 85,200 38,340 64 6 64 639 2,147 1,917 1,278 1,917 7,664 15,563

Harari 21,300 9,585 16 2 16 160 537 479 320 479 1,916 3,891

Total 15,000,000 6,750,000 11,250 1,125 11,250 112,500 378,000 337,500 225,000 337,500 1,349,381 2,739,881

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Table.3 Vaccines and materials needed for measles SIAs

Region Affected pop. Targeted pop. Measles dose AD syringe Mixing syringe Safety box

Vit A

caps.

< 15 Number Cost number Cost Number Cost Number Cost

100,000

IU Cost

Tigray 1,756,000790,200 987,750 137,297 877,122 70,170 98,775 7,902 9,759 6,246 772,640 7865

Afar 811,700 365,265 456,581 63,465 405,444 32,436 45,658 3,653 4,511 2,887 357,148 3636

Somali 1,259,000 566,550 708,188 98,438 628,871 50,310 70,819 5,666 6,997 4,478 553,960 5639

Oromia 4,421,000 1,989,450 2,486,813 345,667 2,208,290 176,663 248,681 19,894 24,570 15,725 1,945,240 19803

Amhara 4,907,000 2,208,150 2,760,188 383,666 2,451,047 196,084 276,019 22,082 27,271 17,453 2,159,080 21979

Gambella 106,500 47,925 59,906 8,327 53,197 4,256 5,990 479 592 379 46,860 477

Benshang 60,300 27,135 33,919 4,715 30,120 2,410 3,392 271 335 214 26,532 270

SNNPR 1,572,000 707,400 884,250 122,911 785,214 62,817 88,425 7,074 8,736 5,591 691,680 7041

Dire Dawa 85,200 38,340 47,925 6,662 42,557 3,405 4,793 45 474 303 37,488 382

Harari 21,300 9,585 11,981 1,665 10,639 851 1,198 60 118 76 9,372 95

Total 15,000,000 6,750,000 8,437,500 1,172,813 7,492,500 599,400 843,750 67,126 83,363 53,352 6,600,000 67188

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TA BLE 4.ESTIMATED MINIMUM CONTINGENCY STOCK OF M.M VACCINES AND DRUGS BY REGIONS FOR 2003 G.CNo Region Total

populationIn(Million)

Targetpopulation(Million)(72.0%)

10%contingencypopulation(Million)

Shareof theregionsin %

Total doses ofM.Meningitisrequired forcontingencystock

TotalAmpoules ofoily CAFrequired forcontingency

Estimatedcost ofvaccines inUSD

Estimatedcost ofdrugs inUSD

MinimumamountrequiredbyRegionsIn USD

1

2

3

4

5

6

7

8

9

10

11

Oromiya

Amhara

SNNPR

Tigray

Somali

Addis Ababa

Afar

Benishangul

Gambella

Diredawa

Harari

23.0

16.7

12.9

3.8

3.8

2.57

1.24

0.55

0.36

0.33

0.16

16.0

12.0

9.0

3.0

3.0

2.0

0.9

0.4

0.26

0.3

0.2

1.6

1.2

0.9

0.3

0.3

0.20

0.09

0.04

0.026

0.03

0.02

34.2

25.2

19.2

6.3

6.3

4.3

2.0

0.9

0.6

0.6

0.4

1,614,240

1,189,440

906,240

297,360

297,360

202,960

94,400

42,480

28,320

28,320

18,880

6053

4460

3398

1115

1115

762

354

160

106

106

71

487,500

359,210

273,684

89,803

89,803

61,294

28,509

12,829

8,553

8,553

5,702

6416

4728

3602

1182

1182

808

375

170

112

112

75

493,916

363,938

280,100

90,985

90,985

62,102

28,884

12,999

8,665

8,665

5,777

TOTAL 65.3 47.2 4.72 100 4,720,000 17,700 1,425,440 18,762 1,506,304

23

Table 5: Health and nutrition requirements by region for 2003.Region Emergency

health kits(Quantity)

Drugdistribution,monitoring

&supervision

(USD)

Meningitisvaccine (USD)

Measles &vitamin A

Campaignsincl. cold

chainequipment

(USD)

Training ofHWs in

management&

surveillancehealth andnutritional

emergencies& social

mobilizationincl

HIV/AIDS(USD)

Environ-mental

sanitation &hygiene &

water qualitycontrol (USD)

Supplementaryand TherapeuticFood (in kind)

Malariaprevention &control (ITNs,training, labsupplies etc)

(USD)

Monitoring ,technical support &project support costs

(USD)

Total (USD)

Afar 82 55,000 28,848 490,935 90,000 300,000Amhara 491 91,000 363,938 1,837,570 200,000 336,000Benshangul-Gumuz

2 5,000, 12,999 28,894 9,000 20,000

Dire Dawa 8 10,000 8,665 46,360 15,000 40,000Gambella 11 13,000 8,665 63,371 15,000 40,000Harari 3 7,000 5,777 12,638 15,000 40,000Oromiya 443 86,000 493,916 1,785,286 200,000 380,000SNNP 158 26,052 280,100 808,574 47,349 100,152Somali 126 66,000 90,985 594,498 177,300 332,000Tigray 176 28,000 90,985 750,226 45,000 100,000AddisAbaba

62,102

Sub-total 1,500

Based on15% global

malnutritionrates and 2%

severemalnutritionrates, 37,500

MT ofsupplementa

ry food and4,050 MT of

therapeuticfood will berequired for

6 months.

ITNs to betargeted to

pregnantwomen and <5

children inmalariousdrought-

affected areasdepending onthe prevailing

situation.

$1,260,000 formonitoring , technical

support & projectsupport costs

TotalUSD

7,646,503 382,052 1,446,980 6,418,352 813,649 1,688,152 In kind 1,400,000 1,260,000 21,055,688

24

Annex I. List of drugs and medical suppliesS/N Description UNIT1 Acetylsalicylic acid 300 mg 1000 tabs2 Almunium hydroxide 500mg 1000 tabs3 Aminophyline 25mg/ml, 10ml 50 amps4 Ampicillin 125 mg/5 ml dry powder for susp. 100 ml5 Amplicillin 250 mg 1000 tabs6 Atropine 1mg/ml, ml 50amps7 Benzathine penicillin 2.4 MIU 50 vial8 Benzoic acid 6% salicylic acid 3% oint, 500 gm 80 tin9 Benzylbenzoate application 25% 1 lt10 Butylscopolamine Bromide 10 mg 1000 tabs11 Cetrimide 15% + chlorhexidine di-gluconate Lt12 Chloramphinicol 125 mg/5ml susp 100ml13 Chloramphinicol 250 mg 1000 cap14 Chlorpromazine 25mg/ml, 2ml 20 amps15 Co-trimoxazol 400mg+80 mg 1000 tabs16 Cotrimoxazol dry powder (200+40)mg/5 ml susp. 100 ml17 Dextrose 5%, 500 ml+sets Bottle18 Dextrose 50%, 50 ml 25 vials19 Diazepam 5 mg/ml, 2ml 100 amps20 Epinepherine 1mg/ml 1ml (=adrenaline) 100 amps21 Ergometrine malate 0.5 mg/ml, 1ml 100amp22 Ferous sulphate 300mg+folic acid 0.25 1000 tabs23 Lidocaine hcl 1%, 50 ml 25 vials24 Mebendazol 100mg 500 tabs25 Methy dopa 250mg 500 tabs26 Metronidazol 125 mg/5ml susp. 100ml27 Metronidazol 250mg 1000 cap28 Normal saline 0.9% of 1000 ml Bag29 ORS for 1000 ml 50 such30 Paractamol 100mg 1000 tabs31 Paractamol 100 mg/5m syrup 100ml32 Paractamol 500 mg 1000 tabs33 Phenobarbital 50 mg 1000 tabs

25

34 Phenox methylpenicllin 250mg (pen V) 1000 tabs35 Procain penicilin 3 MIU/Benzylpenicillin 1 MIU 50 vial36 Promethazine hcl 25mg coated 500 tabs37 Promethazine hcl 25mg/ml,2ml 50 amps38 PVP iodine 10% solution 200 ml39 Ringer lactate solution 500ml+ sets Bottle40 Tetracycline hcl 250 mg 1000 cap41 Tetracycline hcl eye-oint 1%;5 gm 1000 tub42 Vitamine A 200 000 IU 1000 cap43 Vitamine A 50 000 IU 1000 cap44 Vitamine C 250 mg (Ascorbic acid) 1000 tabs45 Water for inj 10 ml 100 amps46 Zinic oide oint 10%, 800 gm Tin

Emergency medical supplies (Kit B)

S/N Description unit1 Adhesive tape 2.5 cm x 5m Roll2 Cotton wool 500gm PCS103 Elastic bandage 8cm x 4cm roll4 Bandage crepe 8cm x 4cm 10PCS5 Guaze compresses 10x10, 12 poly 100PC6 Hydrophilic bandage 7.5 x 10m 10roll7 Tablet bag reusable 60 x 80 mm mini g 500pcs8 Blades for surgical knives size 22 100pcs9 Catether folly two ways no 12 ballon 5-15ml 10pcs10 Catether folly no 14 ballon 5-15ml 5pcs11 Catether folly no 16ballon 5-15ml 5pcs12 Surgical gloves size 7 sterile 50pcs13 Surgical gloves size 7.5 sterile 50pcs14 Iv placement unit 20G PCS15 Iv placement unit 25G PCS16 Scalp vein infusion set 25G 100pcs17 Suture vicryl 1/0, 3/8 ct ndl 30mm, 36pcs18 Suture vicryl 2/0, 45 cm ct needle 18.30mm 36pcs19 Syringe lure, 2 ml disposable 100pcs

26

20 Syringe lure, 5 ml disposable 100pcs21 Syringe lure, 10 ml disposable 100pcs22 Tongue depressor, wood 100pcs23 Feeding tube ch..5 dispo. 40 cm lure 20pcs24 Feeding tube ch.8 disposable 50pcs25 Needle lure,21Gx1.5” (0.8x38mm) 100pcs26 Syringe 50 ml lure, disposable pcs27 Urine collection bag 2000ml pcs28 Autoclave tape, 50 meter roll29 Battery for ottoscope, alkaline pcs30 Bulb for Ottoscope,mini,Heine pcs31 Hydrophilic gauze 90cmmx90m roll32 Scalp infusion set 21G 100pcs33 Exami9nation gloves, latex Small disposable 100pcs34 Examination gloves, latex medium disposable 100pcs35 Examination gloves, latex large disposable 100pcs

27

Emergency medical supplies (Kit C)S/N Description unit1 Clinical thermometer Arm pit type pcs2 Dish, Kidneys/s 24 cm pcs3 Instrument tray 30x20x2cm pcs4 Drum for cotton wool & gauze dia. 15cm ht. 15 pcs5 Forceps artery pean 14.5cm, straight pcs6 Gallipot s/s without lid 300ml pcs7 Scissors surgical bl/bl straight, 14.5 cm pcs8 Dressing instrument sets pcs8 Instrument box with lid s/s 20x10x5cm pcs8 Forceps, artery, pen 14.5 cm straight pcs8 Forceps dissecting 14.5 pcs9 Measuring-tape, flexible pcs10 Otoscope "mini" with battery handle (complete set) pcs11 Scale, dial type 25kg , 100g graduation pcs12 Adult scale , Automatic reading wiyh height

measurementpcs

13 Sphygmomanometer, anaeroid, simple pcs14 Stethoscope, Lithman type double light pcs15 Stethoscope, fetal metal(aluminume type) pcs16 Prestige double-rack 7503 phc-sterilizer+acess 20 liters pcs17 Tourniquate (arm) pcs18 Stove kerosene, hypolyto 36 ( for 20 lt sterilizer) pcs19 Stretcher army type pcs

28

Emergency drug list (Kit D)S/N Description Unit1 Chloroquine 150 mg base 1000 tabs2 Chloroquine 50 mg base/5ml. Dry

powder60ml

3 Quinine 300mg film coated tablets 1000 tabs4 Sulphadoxine 500

mg+pyrimetamine 25mg1000 tabs

29

Annex: IIPlanning 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

30

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.

31

ANNEX III. Plan of action and Budget Break down for the Emergency Sanitations based on the

reports Submitted from all Regions.

S/No.

Activities Budget Planned(Birr)

1 Latrine Construction 2,114,5192 Preparation of communal solid waste

disposal pit421,550

3 Carcass disposal 35,0004 Purchasing of construction tools 50,0005 Procurement of body soaps and cloth

soaps1,800,900

6 Procurement of Halazole Table of tin fordisinfections at house hold level whenwater borne diseases are emerged asan epidemic

225,000

7 Hygiene Education on personal andenvironmental hygiene and preventionof communicable diseases

322,700

8 Purchase of sleeping bags for healthworkers

55,000

9 Purchase of tents for health workers 70,00010 Insect vector and rodent control 21,25011 Sensitizing different community

members on basic environmentalsanitation

34,000

12 Establish WASHE Committees and trainon ESHE promotion

63,500

32

13 Home visits, inspection, Monitoring andEvaluations

510,167

14 Perdiem for Health Professionals 180,772.3015 Water quality control and monitoring 8,570,000

Total 14,474,350

33

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 theconsequence of food absence and shortage.

2. To participate on active surveillance and share the data (information)3. To coordinate actions for the control of epidemics4. 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 composition1. MOH (DPCD. FHD, HSTD, PASS, PR,)2. MSF (B)3. MSF (F)4. MSF (H)5. MSF (CH)6. WHO7. UNICEF8. ERCS9. EHNRI10. USAID11. DPPC

Ø The task force will meet on Wednesdays at 9:00 as long as the draught condition is ongoing.

5

5 DPCD= Disease Prevention and Control Department

34

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)

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

FHD =Family Health Department HSTD = Health Services and Training department PASS = Pharmaceutical Administration Supply Services PR = Public Relations

35

10. How was the situation ofA. 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… )

36

13. Do you think that you have enough manpower to mobilize in case if the need arises to move totemporary 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 yesplease 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…

37

17. Are there any institutions in your area that can serve as a temporary treatment shelter if the needarises? Please state them (Schools, military barracks, Stores…) Likely places mentioned need to beregistered.

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

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

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

38

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. __________________________