OFFICE OF THE WHO REPRESENTATIVE FOR ETHIOPIA
ACTIVITY REPORT – WHO/ Ethiopia
1 – 31 August 2003
1. High-Level Mission of Representative of DG on Health Action in Crises and Emergency Humanitarian Action (EHA) Team:
Dr. David Nabarro, Representative of the DG on Health Action in Crises, Dr. Lianne Kuppens, EHA/Desk Officer for Horn of Africa and Southern Africa countries as well as Dr. Komla Siamevi, EHA/AFRO visited Ethiopia 5- 8 August 2003 to assess the current on-going emergency drought situation and its effects on Health. They were able to review the country office’s response to the situation.
The EHA team met Government officials including H.E. Minister of Health, Health partners, the UN Country team, the umbrella NGOs – Christian Relief & Development Association (CRDA) and the WHO CORE staff. A field trip to the Southern Region of Ethiopia was undertaken.
At the end of the mission, there were recommendations to strengthen the country office in the area of nutrition, health information promotion and advocacy.
The malaria epidemic is being seriously addressed to include proposal preparation, urgent shipment of Anti-malaria drugs and strengthening of surveillance and response.
Efforts to strengthen livelihood security will include specific health packages for child health, maternal health, hygiene & sanitation, HIV/AIDS and nutrition.
2. Update on the Current Emergency Situation:
- The country office led the Rapid Health Assessments in drought-affected areas; the latest result was used to update the Consolidated Appeal Document (CAP).
- Technical inputs were provided for the training of Health workers, medical students and nursing students to fill the human resources gaps in Therapeutic Feeding Centers in the Southern Region.
- Provided technical support for the guideline on management of severe malnutrition.
- Continues to provide surveillance of communicable diseases through the surveillance officers at zonal, regional and National levels.
- Provided technical support for measles campaigns; about 50% of the country has been covered.
- Procured and distributed 325 Emergency Health Kits in collaboration with the Ministry of Health (1 Kit serves 10,000 people for about 3 months).
- Provided about USD 560,000 for maintaining water quality in affected Regions and USD 91,500 for malaria control activities in the Southern Region (SNNPR).
3. Meeting of the Health Population & Nutrition (HPN) Donors’ Group with the Minister of Health:
WHO is the secretary of the Health, Population and Nutrition (HPN) Donors Group, which meets once per month.
In the last meeting, it was decided that the Health Management Information System (HMIS) committee will be reactivated to include all partners and stakeholders.
The HPN group will continue to advocate for higher visibility of Nutrition and Population/Reproductive Health Issues into the Health System.
The main indicators to be used for monitoring & evaluation of the Health Sector Development Programme (HSD) were agreed upon.
4. The Inter country workshop on Macro economics and Health at the UN Conference Center in Addis Ababa:
- The workshop was attended by Representatives of 14 African countries, namely from English, French and Portuguese speaking countries. The participants were 61.
- The workshop was opened by H.E. Dr. Kebede Tadesse the Minister of Health. The Minister shared with the participants of the workshop the progress and status on the macroeconomics and Health in Ethiopia.
- The organizers of the workshop were:
- WHO Country Office, Ethiopia
- The workshop was successfully conducted as per the programme schedule
There were several presentations such as:
Workshop objectives, expected outcomes
CMH findings and recommendations
Global perspective: the very forward, HQ support to countries
Regional perspective and the way forward were identified.
At the end of the workshop, participants were clearer on the concepts of Macroeconomics and Health and were motivated to make a change in their respective countries.
Ethiopia Experiences and Processes of Macroeconomics and Health at PPD, FMOH
Comments made on the presentation of Ethiopia: "Experiences and Processes of Macroeconomics and Health" were as follows:
- The population of Ethiopia as per UNFPA is projected to be 69 million instead of 67 million (2002).
- The topic under natural resources should also include the arable land in percent, Gold and other minerals should be indicated where available
- Sources of data should be indicated e.g. life expectancy 54 years in Ethiopia as per Health and Health related indicators.
- Gross and net school enrolment ratio should be in line with the data of the Federal Ministry of Education.
- HSDP should be presented in line with the Health policy and democratization.
- Programmatic Issues:
Status of Malaria Situation:
- Malaria is currently increasing in incidence and localized epidemics are reported from regions mainly associated with climate anomalies.
- Insecticides such as DDT and Malathion have been procured and distributed to regions based on the amount they transferred to the FMOH.
- Overall supply of anti-malarial drugs is inadequate and quinine injection has been brought into the country by WHO
- AFRO’s Mission (Dr. Job Sagbohan and Dr. Charles Paluku) were in Ethiopia to assess the current malaria epidemic and propos interventions to reduce morbidity and mortality.
- There is an urgent need to strengthen the existing IDSR System to be able to detect and report epidemics on time.
- The RBM Partners/Committee is being reactivated to have functioning sub-committees for: Advocacy/Social Mobilization, Technical/Surveillance and Operational Issues.
- The country office urgently needs a Malariologist to work with Federal Ministry of Health and regions to combat the epidemic and a National Logistician to follow the supply issues.
Provided technical assistance to MOH and Regional Health Bureaus
- Involved in Recruitment and Training of Final year Nursing and students of Awasa and Yirgalem Health Professionals Training Schools. The students have been deployed to Therapeutic Feeding Centers throughout the Southern Nations & Nationalities Peoples Region to work during their vacation as Nutrition Assistants and Field monitors for the distribution of Emergency Health Kits.
- Prepared progress activity and financial reports of emergency funds re: Belgium, Norway, Sweden, and Netherlands funds.
Objectives of the Country Coordination Mechanism/Ethiopia (CCM/E) workshop
To create an in depth familiarization with the Global Fund (principles, intention of funds, progress, lessons learned from different countries-Gov, Civil, private);
To appreciate and adequately understand the CCM/E TOR, Technical Review Panel (TRP) relationship with Local Funding Agent (LFA;
To gain common in depth knowledge/information on the three proposals of the Global Fund;
To develop a plan of action on the information and oversight of the Global Fund in Ethiopia.
Composition of the workshop participants
- CCM members;
- The experts group that prepared the three proposals (HIV/AIDS, Malaria and TB);
- Federal MOH, HAPCO and MOFED (relevant officials).
A Nutrition Assessment Conducted by (Dr. Elizabeth Poskitt) WHO Consultant
- She has visited and interviewed 25 institutions among them two hospitals and one Health center where therapeutic feeding center is established and TFCs.
- It is unfortunate that nutrition is not of high priority in health. Nutrition is understood as a food security.
- Decentralization is weakening some services.
- There is a high demand for Ethiopian Nutrition Research Institute.
- There is no policy and strategy on nutrition. There is a need for attitudinal change regarding nutrition at all levels.
- The therapeutic feeding centers visited are doing well.
- The staff working at therapeutic feeding centers strictly follow the guideline. A lot of Health Workers are posted at therapeutic feeding centers. There might be a lack of health workers if the number of therapeutic feeding centers will be increased.
- Lack of folic acid is observed.
- Children at therapeutic feeding centers are doing fine and weight gain is observed; 13-14 gr increase per day.
- Children stay at therapeutic feeding centers in the average 31 days, a little bit long but not too bad. At Bushilo HC the death rate is 6%. In general the mortality is from 8 - 10%. The situation is much better than earlier it used to be in crises.
- Defaulters are adults. The relapse in Somali Region is estimated at 60%.
UNDP Focal person for the National Coalition for Food Security:
- There was a workshop organized by the Prime Minister’s Office on resettlement that was attended by 100 participants, namely the Prime Minister, Cabinet Ministers, Regional presidents, Ambassadors, UN Agencies, donors etc.
- The Deputy Prime Minister, constituted a Technical group meeting to do a technical study in different sectors to address the chronic food insecurity in Ethiopia.
- As of July 1st, 2003 the Task Force on National Coalition on Food Security was established.
- A TOR was prepared for the Technical Group.
- The technical group is drafting a National Strategic Paper on Food Security.
Decisions and conclusions:
- The efforts made were recognized and highly appreciated
- A small committee comprised of WHO, UNICEF, USAID and MSF Holland was created to help improve the Health Chapter
- The final draft will be further reviewed by a small working group before presentation at a donors conference for Ethiopia
- This is the first effort to have a National Strategic Plan on food security for 3-5 years in the country
Development Assistance Group (DAG)
- Lack of economic growth has resulted in food insecurity
- The agriculture should show growth rates of 6-7 percent per annum that are needed to reduce the food in secured people by half by 2013.
- The existing weak infrastructure has to be strengthened
- All sectors especially health has a significant role to play to improve the chronic National Food Insecurity.