Non-Food Meher Assessment report Tigray Dec 2023

Tigray Annual Meher Assessment Report 2023

(Health)

Conducted in Northwest zone Tigray,

from Nov- Dec 2023
 Non-Food Meher Assessment report Tigray Dec 2023

Figure 1: Map of Northwest zone of Tigray and the location of Assessed woredas, Nov- Dec 2023
 Non-Food Meher Assessment report Tigray Dec 2023

Table 1: Description of the 2023 Meher assessment area

Regional name Tigray

Zones northwest Tigray

Northwest: 1) Tahtai Adiabo, 2) Seyemti Adiabo, 3) Laelay Koraro, 4) Tsimbla, 5) Shire

Woredas

Date of assessment
22 Nov 2023- 5 Dec 2023
started/completed

Table 2: List of Meher Assessment Team Members, Tigray, Dec 2023

S/N Name Organization Mobile Email

1 Ataklti Gebretsadik TRHI, Mekelle O914122801 atakltigeberttsadik@gmail.com
2 Yirgalem Teklay IRC, Shire 00920017500 Yirgalem.Teklay@rescue.org
3 Dr Bethelhem UNICEF, Mekelle 0906101313 bgodifay@unicef.org
4 Haile Tensay WHO, Shire 0914765140 tensayh@who.int
 Non-Food Meher Assessment report Tigray Dec 2023

ACRONYMS AND ABBREVIATIONS

AFI Acute Febrile Illness

AURTI Acute Upper Respiratory Tract Infection
AWD Acute Watery Diarrhea
CMAM Community Management of Acute Malnutrition
CSB++: Corn Soybean

CHD Community Health Day

CM Centi metre

CTC: Cholera Treatment Center

Co WASH Community Water Sanitation and Hygiene

DD Due date
EC Ethiopian Calander
EFY Ethiopian Fiscal Year
ENCU Emergency Nutrition Coordination Unit
EWRFSS Early Warning, Response and Food Security Sector
FGD: Focus Group Discussion
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FMOH Federal Ministry of Health

GAM Global Acute Malnutrition
GBV: Gender Based Violence
GC Gorgorian calendar
HC Health Center
HEW Health extension worker
HHs House Holds
HP Health Post
HCWs Health Care Workers
IRC International Rescue Committee
LLITNS Long lasting Impregnated Treated nets

MAM Moderate Acute Malnutrition

Mm Month
MHNT Mobile Health and Nutrition Team
MUAC Mid Upper Arm Circumference
N No
NGO Non- Govermental Organization
NF Non Functional

OTP Out-patient Therapeutic Program

PHEM: Public Health Emergency Management
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PLW: Pregnant and Lactating Women

RHB Regional Health Bureau
RDT Rapid Dignostic Test
RUSF Ready to Use Therapeutic Supplementary Food
RUTF Ready to Use Therapeutic Food
SAM Sever Acute Malnutrition
SC Stabilization Center
SIA Supplementary Immunization Activities
TFP Therapeutic feeding program
TSFP Target Supplementary Feeding program
TFU/SC Therapeutic Feeding Unit/ Stabilization Center
UNICEF United Nations Children’s Fund
Vit A Vitamin A
WASH Water Sanitation and Hygiene
WHO World Health Organization
 Non-Food Meher Assessment report Tigray Dec 2023

1. Executive summary
Introduction: In all sectors, the results are organized and presented at regional level and covering all the five basic social services
namely health, nutrition, WASH, education and social protection. In total, 2 zones and 6 woredas were visited by the assessment team.
Objective of the assessment is to assess the extent, type, magnitude, severity and likely of the different hazards (drought, human
epidemics, conflict, floods, etc) and risks to the populations in the most vulnerable woredas (including identifying the most vulnerable
populations) for health, nutrition, WASH, education and social protection related emergencies in northwest zone of Tigray region.

Summary of key findings

Introduction: In health and nutrition sectors, the results are organized and presented at zonal level. In northwest zone five woredas
were visited by the assessment team and the selection criteria of five woredas were based on their level of being affected by draught.
Accordingly, Tahtai- Adiabo, Seyemti- Adiabo, Shire indasilassie, Laelai Koraro and Tsimbla woredas were assessed.

In the assessed five woredas of northwest zone of Tigray multi-sectorial PHEM coordination forum established and reported that meetings had
been conducted in Ad-hoc base. The PHEM coordination meetings conducted in all assessed woredas lack regularity and meeting minutes not
documented. Five of the assessed woredas did not have Public Health Emergency Preparedness and Response Plan for EFY2016( July 2023- June
2024). No major disease outbreak was reported except malaria upsurge in five of the woredas in which assessment facilitated. Despite
implementing global recommendation to control malaria such as vector control( distribution of LLITN greater than 85% in all woredas), malaria
case management , epidemic early detection and response and provision of capacity building trainings to government Health Care Workers
(HCWs), it was observed that upsurge of malaria cases in northwest zone of Tigray in the year 2023 from May – October 32214 cases reported
and in last year the same period reported 8530. Due to poor utilization LLITN, non functionality of most of assessed health posts in which they did
not have the capacity to treat malaria , at woredas, the presence of risk factors for malaria outbreak, there is a possibility that malaria and other
communicable diseases outbreak may occur in the near future. Emergency medicines and medical supplies required to respond to health
emergencies such as Ringer Lactate (to treat AWD cases), ORS, TTC eye ointment, Coartem, RDT for malaria were available at health facility
 Non-Food Meher Assessment report Tigray Dec 2023

level. The assessed woreda health offices did not have emergency medicines and other supplies to respond to health emergencies. Medical supplies
like LP Set, RDT for Meningitis, were not available at visited health facilities and all woreda health offices.

The following recommendations were made ,

 To ensure rapid emergency response preposition emergency medicines and other supplies at wereda health offices.
 RHB and partners to support in resumption of health services at health post level in all woredas as >70% of malaria and cholera treatment
service is providing ther.
 Activate woreda level coordination forum with health partners, facilitate the meeting regularly , share and document minutes.
 RHB and partners to support in strenghting of laboratory testing capacities particularly hospitals and health centers to diagnosis malaria
using Microscope.
 Woreda health offices to send RRF form within the expected time to Shire EPSS and to share program drugs to Health partners in their AOR
particularly Primaquine
 Assess the LLITN utilization and reasons for underutilization and to come up with strategies to increase the utilization
 Scaling up the involvement of environmental intervention: to increase larvicidal usage in malaria breeding sites
 Treat patients particularly PF and mixed malaria per the Ethiopian FMOH and WHO malaria guide line.

2. OBJECTIVES
The purpose of the Meher assessment for the non-food or social sector includes:

 Assess the extent, type, magnitude, severity and likely of the different hazards (drought, human epidemics, conflict, floods, etc)
and risks to the populations in the most vulnerable woredas (including identifying the most vulnerable populations) for health,
nutrition, WASH, education and social protection related emergencies in Tigray region ( from May up to October 2023).
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 Assess the existing capacity of the basic social services such as health, nutrition WASH, education and social protection to address
the emergencies likely to occur. It also determines the short coming (gap) in the capacity of the existing services to address the
problem.

 Identify areas where emergency assistance might be needed and come up with reasonable estimates of the size of the population
needing emergency assistance and the duration of assistance.

 Based on the findings on the assessment of risks for, and the need to address, potential emergencies and develop necessary plans
for fostering preparedness sectors to adequately address the potential emergencies;

3. METHODOLOGY

Methodology
 Collect data on key indicators that have impacts on human health and basic social service.

 Use of structured questionnaires for all sectors and conduct meeting discussions with officials.

 Undertake interview with regional and woreda officials.

 Undertake discussions with community leaders at kebele level.

 Review existing relevant documents (secondary data) based on the agreed tools.

3.1 Study area and Period

The meher assessment was conducted in northwest zone of Tigray in five woredas ( Tahtai- Adiabo, Seyemti- Adiabo, Shire
indasilassie, Laelai Koraro and Tsimbla ).
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3.2 Data collection procedure:

The Meher assessment was conducted through discussion with zone and wereda administration, briefing by the assessment team on
the mission of the team, and which is followed by wereda admin and respective sector offices overview description of the Meher
situation in each wereda.

After joint general briefings by zone administration, the assessment team traveled to respective weredas in northwest zone starting its
mission with wereda administrator or delegate and sector representatives’ general briefing and discussion. After wereda level briefing,
the food and non-food teams were assigned in to their respective sector offices to collect the required data based on the prep-prepared
checklist and discussion guides. Socio- demographic, health profile, epidemic risk factors, health, nutrition, WaSH and education data
were collected using nationally standardized non-food Belg assessment questionnaire through semi structured interview.

The assessment was conducted by multi-sectoral collaboration composed of regional government bureaus (water, irrigation and
electricity, EWRFSS/ENCU, BoLSA) WHO, IRC UNICEF, WFP, and SP. Finally, briefing discussions were conducted with the
northwes zone administration offices and to zonal DRM TWG.
Variables: gender, age group, number of cases and deaths, risk factors, SAM cases, number of population at risk or stressed

3.3 Data management and analysis:

The analysis was done using Ms-excel 2007after the data was cleaned. Finally, it was presented in the form of graphs and tables and
narrated based on thematic areas.
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4. Major findings
4. Health
4.1 Socio demographic profile
An estimated population of 449324( 225506M, 223419F)is living in the studied five weredas. Of this total estimated population, the
number of women in the reproductive age group and number of pregnant and lactating women were estimated to be 96186 (21.4%)
and 35478 (7.9 %) respectively. Similarly, in the five weredas it was reported that there are 15 health centers and 42 health posts with
building, of which 5(33.3% health centers had access to pure water supply. The remaining 10 health centers and 39(92.8%) of health
posts were reported of not having access to water supply. (Table 1)
 Non-Food Meher Assessment report Tigray Dec 2023

Table 1: Profile of the visited Weredas for Meher Assessment, Tigray region, Nov – Dec 2023.
Woreda Populatio Male Female U5 # WRA( 15- #PLW # HCs # HPs #M #HEWs #HC with #Hp with water
n Childre 49 Yrs) HN water and and latrine
n T latrine availability
availabilit
y
Tahtai 96100 48991 47109 11223 17680 17680 5 12 3 0 0
Adiabo
Seymeti 52706 25931 26775 7689 12375 2530 1 7 1 20 1 0
Adiabo
Laelay 80484 40485 39599 11742 18898 3863 2 10 2 35 0 0
Koraro
Tsimbla 92690 46936 45754 13523 21,764 3510 3 8 1 31 0 0

Shire 127,345 63,163 64,182 18579 25,469 7,895 4 5 18 33 4 3

Total 449324 225506 223419 62756 96186 35478 15 42 25 119 5 3

2.2 WASH service in Health facilities

A total of 15 health centers and 42 health posts are providing primary health care service in the assessed Woredas. Of these
health facilities; 5 (33.3%) health centers and 3 (7.14%) of the health posts have access to improved water supply. All health
 Non-Food Meher Assessment report Tigray Dec 2023

centers have at least a single block latrine for both male and female patients. Similarly all health posts have at least two seat
latrine. However, the latrine facilities of a significant number of health posts are substandard and needs rehabilitation. Primary
health care service is being provided by 119 health extension workers (HEWs) deployed in 42 health posts.

4.1 Public Health Emergency Coordination and Preparedness

At zonal level there is health cluster coordination mechanism in which 18 partners regularly attend , for health where all relevant
government, NGOs and UN agencies represented. Northwest zone of Tigray health cluster meets regularly on bi-weekly basis and
RHB lead the cluster while WHO reported as colead agency.

In the assessed five weredas it was reported that presence of multi-sectoral PHEM coordination forum , establishment and activation
of RRT, and assignment of PHEM officers performed. Each visited Woreda health office and health centers under these visited
woredas have rapid response teams (RRT).However, looking at the presence of regular meeting documented by minutes, all weredas
reported of having irregular meetings when something is happened on their, without documentation of any sort of minute.

Out of five weredas four of them had reported the presence of public health emergency preparedness and response plan but there is no
accessible emergency response fund to respond to emergency health in five of the woredas.

Functionality of OTP services in the assessed woredas showed that Tahtai Adiabo XX%, Seyemti Adiabo 86%, Laelay Koraro 100%,
Tsimbla XX% and Shire XX%(Table 2)
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Table 2: Description of the PHEM coordination mechanisms in the five visited Weredas for Meher Assessment, Tigray region,
Nov – Dec 2023.

Coordination and Name of WoHO

Management system
Tahtai Adiabo Seymeti Adiabo Laelay Koraro Tsimbla Shire

Is there a PHEM Y Y Y
Officer at Woreda
1 1 1
Health Office level?

How many PHEM

officers are there?

Is there RRT in Y Y Y
Woreda health office?
5 7 2
If yes Number
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Are there PHEM Y Y Y

Officers/focal persons
7 1 2
at HCs? If yes No.
________

Does the Woreda Y Y Y

Health Office
regularly report
PHEM report as
scheduled dates?
Observe copies and
comment

Do the health Y Y Y
facilities and HEWs
regularly report
PHEM report as
scheduled dates?
Observe copies and
comment

Is there a multi sector Y Y Y

Health
Emergency/PHEM
1 per month 2 per month
coordination forum?
If yes, how frequently
meet?
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Is there a Public N Y Y
Health Emergency
preparedness and
response plan for
EFY 2016? Observe
and comment
(Observe and
comment) __

Is there accessible N N N
emergency response
fund? If yes, how
much allocated?

The percentage of 86% 100%

Kebelles in the
woreda with
functional OTP
services
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4.2 Leading Causes of Morbidity:

Top five morbidity causes for under five children in the assessed five woredas per magnitude of order were malaria, Non-bloody
diarrhea, pneumonia, acute upper respiratory tract infections, skin infection. Similarilly , top five causes of morbidity for above five
years age found to be malaria, Non-bloody diarrhea , Pneumonia, Acute Uper Respiratory Tract Infection (AURTI and ARI), and
Acute Febrile Illness for majority of the assessed woredas.

4.3 Status of outbreak prone diseases and occurrence of outbreak:

The morbidity and mortality situation of epidemic prone disease like AWD, Malaria, measles and meningitis has been assessed for
the period of May to October in 2023.
4.3.1 Acute Watery Diarrhea(AWD)/ Cholera:

There was no any report of AWD in the assessed five woredasof northwest zone of Tigray in past six month.

4.3.2 Malaria:

Despite implementing global recommendation to control malaria such as vector control( distribution of LLITN greater than 85% in all woredas),
malaria case management , epidemic early detection and response and provision of capacity building trainings to government Health Care Workers
(HCWs), it was observed that upsurge of malaria cases in northwest zone of Tigray in the year 2023 from May – October in which 32214 cases
reported and in last year the same period reported 8530. Due to poor utilization LLITN, non functionality of most of assessed health posts in which
they did not have the capacity to treat malaria , and presence of risk factors for malaria outbreakwill lead to high possibility of malaria out break
occurrence in near future. Generally, the burden of malaria morbidity in the visited Weredas increased 3.8 times higher in this year
comparing with the same period last year . This increment might be explained by unprotected irrigation & mosquito breeding sites in
all visited woredas that leads to malaria epidemic. No death due to malaria was reported from May to October both in the year
2015/16 and 2014/2015 E.C.
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(Figure 4 and 5)

Figure 1: Malaria cases per woreda from May 2023- oct 2023; Tigray, Dec 2023
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Figure 5: Malaria cases per woreda from May 2022- oct 2022; Tigray, Dec 2023

4.3.2 Meningitis:

There was no report of meningitis case from any of the visited five Weredas in the last three years.

4.3.3 AWD
There was no report of AWD case from any of the visited five Weredas in the last three years.
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4.3.4 Measles:
In the last quarter of 2015/2016 EFY(from 1 July 2023 – 30 Sep 2023) there was no any SIA.

4.4 Risk factors for outbreak prone diseases:

According to the assessment, access to all types of latrine facility (traditional and improved) was 39.7% while access to improved
latrine is 20%. However, it is difficult to trust the data, particularly on latrine access since there is big discrepancy with the regional
average of 67.9% and with last year ISS report. Safe water coverage was found to be 60% in the assessed woredas. In most cases,
traditional latrines are poorly constructed using local materials and cannot stop contamination of immediate environment. Shortage of
water supply may aggravate the risk of water borne diseases including AWD.
There is existing high risk at holy water sites that do not have adequate WASH services for pilgrims who visit the sites. Hand washing
practice using soap or its substitute is also low. Therefore, the occurrence of waterborne diseases including AWD in these woredas is
very high.
Five of the assessed woredas have major risk factors for malaria such as being endemic to malaria, presence of malaria breeding sites,
interrupted or potentially interrupting rivers, unprotected irrigation and and no accessible emergency response fund in the visited
woredas. Despite LLITNs coverage report in the visited woredas showed greater than 85%, information on utilization of LLITN not
available.

This result shows that with the presence of most of the risk factors almost in all weredas, an estimated population living in 449326
malarious kebeles are at risk of having malaria outbreak in the near future unless stringent attention is given for the control and
prevention measures.

4.6 Preparedness - Emergency drugs and supplies:

Per the assessment facilitated in five of the woredas in northwest zone of Tigray , emergency medicineas and other medical supplies
which were available in most of the woredas to respond to potential outbreak of cholera were ringer lactate, ORS, doxycycline,
 Non-Food Meher Assessment report Tigray Dec 2023

consumables ( syringe and glove), Amoxil syrup, TTC eye ointment, Vitamin A, Coartem, Lab and RDT for malaria. WHO Shire field
office prepositioned CTC kit which can test and treat xxx clients in case any AWD out break in northwest zone of Tigray.

However, supplies like LP Set, RDT for meningitis, and CTC kit, were not found in all visited woreda Health Offices(WoHO) and
government health facilities within the visited woredas.

4.7 Challenges outlined by wereda health office heads and experts:

The visited five wereda health offices have outlined the following points to be their challenges encountered in the past six months:

 Shortage of medicines and medical Supplies (emergency medicines and medical supplies, program drugs, vaccines for routine
immunization & NCD medicine, oxygen for critically ill neonates, HIV test kits).
 Lack of laboratory reagents and supplies for the region. The laboratory confirmation of suspected cases of disease remains a major
challenges.
 Shortage of ambulances for referral services.
 Very limited budget of RHB to strengthen HEWs program and limited number of partners supporting this course of action.
 Huge budget required for recovery, rehabilitation and reconstruction of government health infrastructure
 Risk of zoonotic diseases remains high, and cases reported (suspected rabies, anthrax) every week.
 Access to some woredas( Mai-Tsebri, Laelai Tselemti, and Tahtai Tselemti )is still challenge
 Higher risk of cholera outbreak, malaria and ARTI are the top leading causes of morbidity and a decrease of MHNT deployment
due to funding constraints despite huge needs at community, IDP site and health facility levels.
 Woreda health office challenged with shortage of vehicles to provide supportive supervision to front line HCWS, transportation of
emergency medicines and other medical supplies, to respond to alert/ rumor of potential out break disease
 High staff attrition in which currently recuritement is frozen
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 Unpaid salary of HCWs for 17 months

 No budget for emergency response fund
 No budget to revitalize HMIS
4.8 Conclusion:
Findings of the Meher assessment revealed the presence of different problems in the area of coordination, morbidity and mortality of
diseases, status of outbreak prone diseases, Preparedness, and challenges out lined by the Health sector. All the identified problems
require urgent response to avoid any risk of disease outbreak. Health sector related problems and needs have been evidently identified
at different levels including at facility, community, wereda regional health bureau levels. Generally, from the study the following
major problems were found:

 Presence of weak PHEM coordination forum without regular meetings and TOR,
 Presence of risk factors for outbreak prone diseases like AWD and Malaria, (Low water supply coverage, presence of malaria
breeding sites, No LLINs distributed for all weredas,)
 Absence of emergency drug like LP Set, RDT for Meningitis, CTC kit

Recommendations:
To avert the existing problems/gaps identified in the health sector, the following specific recommendations were forwarded:

 The existing PHEM coordination forums in the visited weredas need to be strengthened. The forum needs to have regular meeting
with minute and TOR.
 The Emergency preparedness and response plan claimed to be present in all visited weredas needs to include all components up to
the level it can solve emergency RH problems of the areas,
 Wereda administration in all visited weredas needs to allocate enough budgets to support emergency activities in the wereda.
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 To control risk factors for outbreak prone diseases water supply coverage in all weredas needs to be improved, utilization of
LLINs need to be studied and take measures should be lifted up above the minimum standard 80%, and efforts needs to be made to
abolish possible malaria breeding sites through different means by communicating with stakeholders specially at R/azebo with the
investors.
 Providing and make available some key emergency drugs and medical supplies such as Meningitis RDT, LP set, CTC kits, etc.
 Multi-sectoral integration and coordination work in all weredas in general needs to be strengthening for timely and effective
emergency preparedness and response work.
 Strengthen disease surveillance system. There is a need to provide supportive supervision to provide support on data recording,
analysis and reporting. Also, there is need to strengthen the weekly reporting system.