Module – One:

Public Health Emergency Situation

in Ethiopia
 Module - Outline

Definition of Public Health Emergency

Situation of diseases outbreak in Ethiopia
Describe the emergency situation in Ethiopia
 Module Objectives
Objective:

The general objective of this module is to understand the public health emergency

situation in the country subjected to risk communication.

Specific objective:
By the end of this module, participants will be able to:

• Identify the existing and potential outbreaks in Ethiopia

• Describe the emergency situation of the country

• Prioritize conditions for emergency risk communication

 Introduction
 El Nino driven drought that started in 2015 impacted health and nutrition status

 Moreover, erratic, delayed rain falls throughout 2016 and including suboptimal
spring rains in 2017 have resulted in critical water shortage in parts of the country
 2017 drought added additional woredas and communities in the southern belt
and Somali region
 Health services are had been challenged by shortage of skilled health personnel,
weak disease notification and surveillance system, lack of potable water and
sanitation
 Continued
 Ethiopia has experienced deadly natural and man-made calamities for a long time.
 The most common natural disasters are drought, famine and flooding.

 Heavy rainfall and floods lead to destruction of community livelihoods, properties

and infrastructures.
 They threaten the lives of many with consequent diseases such as diarrhea, scabies,
sever acute malnutrition...
 Continued
Disease outbreaks occur at different times and cause loss of life in different
parts of the country.
The location, intensity and frequency of vector-borne diseases such as,
 Malaria,
 Leishmaniasis,
 Dengue fever,
 chikungunya and
 yellow fever ...
have been increased in different parts of the country as a result of increased
temperature, weather and climate variations.
 Continued
Disease outbreaks occur at different times and cause loss of life in different
parts of the country.
The location, intensity and frequency of vector-borne diseases such as,
 Malaria,
 Leishmaniasis,
 Dengue fever,
 chikungunya and
 yellow fever ...
have been increased in different parts of the country as a result of increased
temperature, weather and climate variations.
Map: 2015
Map: 2016
Map: 2017
 Definitions
1. Health:
It is a state of complete physical, mental and social wellbeing and not merly
the absence of diseases of infirmity (WHO, 1948)
2. Diseases Outbreak:
It is the occurrence of cases of disease in excess of what would normally be
expected in a defined community, geographical area or season or
 Definitions
1. Health:
It is a state of complete physical, mental and social wellbeing and not merly
the absence of diseases of infirmity (WHO, 1948)
2. Diseases Outbreak:
It is the occurrence of cases of disease in excess of what would normally be
expected in a defined community, geographical area or season or
 Continued
2. Diseases Outbreak:
 The emergence of a previously unknown disease, may also constitute an outbreak and
should be reported and investigated.
An outbreak may occur in a restricted geographical area, or may extend over several
countries.
It may last for a few days or weeks, or for several years.
 Public Health Emergencies in Ethiopia
2. Diseases Outbreak:
 The emergence of a previously unknown disease, may also constitute an outbreak and
should be reported and investigated.
An outbreak may occur in a restricted geographical area, or may extend over several
countries.
It may last for a few days or weeks, or for several years.
 Chikungunya Fever
It is a mosquito-borne viral disease which is transmitted from human to human by the
bites of infected female Aedes aegypti or Aedes albopictus mosquitoes,
The two species which can also transmit other mosquito-borne viruses, including
dengue.
These mosquitoes can be found biting throughout daylight hours, though there may
be peaks of activity in the early morning and late afternoon.
The disease is characterized by an abrupt onset of fever frequently accompanied by
joint pain.
Other common signs and symptoms include muscle pain, headache, nausea, fatigue
and rash.
The joint pain is often very debilitating, but usually lasts for a few days or may be
prolonged to weeks. Hence the virus can cause acute, sub-acute or chronic disease.
 Exercise
Group 1.
•What Diseases Outbreak were occurred in your region/Ethiopia:
•Type of diseases outbreak
•Cause and risk factors
•Preparedness and response experiences
•Major challenges you faced

Group 2.
•What are the anticipated Public Health Emergency in your working area?

•Preparedness and response preparation practices

Major Responses
 AWD Response
Activation of the PHEOC
 Plays the pivotal role for the emergency responses in daily collecting information from

the ground and arranging a daily briefing to the responsible personnel, the weekly

summary report for the high level decision making process.

 The EOC was providing a holistic support and to do so it comprises sub team established

from surveillance, WASH, logistics, case management and social mobilization.

 MOH in collaboration with RHB including deployment of 560 HWs from Addis Ababa,

Dire-dawa city administration, Tigray, Harari and Amhara Regions for more than 3

months to support case management at CTCs and HFs levels in Ethiopia Somali Region.
 Cont…
 In addition to the above mentioned HWs, team of experts from WASH, surveillance,

social mobilization and communications were deployed from FMOH, EPHI and

partners to provide capacity building activities on case management/infection

prevention, strengthening the rapid response and surveillance team, support the social

mobilization activities

 Logistics and supply management: Mapping of the available resource from MOH and

partners were done ahead of time which enables to avoid duplication of resources.

Preposition of supplies closer to the AWD affected areas contribute to an rapid

response for the outbreaks and containment of it with in a limited areas

 Achievements
 Multidisciplinary team deployed down to lower level to support response

 Outbreak investigation conducted and potential risk factors identified

 Resources inventory and mapping conducted

 Emergency supplies requests have been received and replaced in collaboration with partners

 Predict national, cultural and religious mass gathering and early preparation

 Biological and environmental specimens collection and laboratory confirmation

Challenges
 Low coverage of WASH facilities and functions will remain a challenge for not only AWD but
also most of the communicable diseases. This was aggravated by the prolonged drought
effects.

 At Woreda level the capacity for preparedness, data analysis and use for decision making is
limited.

 Emergency risk management principles are not yet well developed and being implemented
in that sense of urgency in many places.

 Lack of standards in areas where large Public gatherings happen in terms of communicable
diseases/outbreaks

 Lack of Standard for WASH and poor services in different Government and private
investment areas including sugar factory ,large scale framings etc which attract mobile work
forces or daily laborers
 Challenges cont…
 Critical Surveillance and case investigation problems at regional levels

 Lack of health workers commitment due to extended period public health emergency responses effects (exhaustion)

 Lack of standard list and delay in the procurement of commodities resulted in haphazard response to the requested supplies by

the RHB

 Competing priorities due to increased number of IDP as a result of the conflict challenged the AWD response in terms of HR

shortage, budget and logistical challenges

 In some areas, multi sectoral coordination was found to be sub optimal including partners

 Early warning alert system and surveillance system was poor in some areas especially event based surveillance.

 Lack of emergency oriented or sensitive response mechanism at all levels

 The way forward
A multidisciplinary approach is a key for controlling epidemics and reducing
deaths
 Local capacities for improving diagnosis and for collecting, compiling and
analyzing data, need to be strengthened
The long-term solution lies in universal access to safe water and adequate
sanitation
Building Resilient Health system for
Health and Nutrition Emergencies in
Ethiopia
Rationale of the Resilient Solution for the above Challenges
 It is cost effective (human and logistics)

 It is a proactive approach (before the PHE Occurred)

 It has a value added outcomes on HSTP

 Most of the AWD outbreak was associated with:

 Religious gatherings

 Public or social gatherings

 Holly water sites

 Developmental corridors

 poor hygienic practices at hh or community level

 Poor WASH infrastructure at SC, diseases outbreak response centers, investment corridors, holly water

and public gathering sites

Objective

General Objective

To build resilient health system responsive to health and nutrition emergencies

Specific Objectives
 Avail functional and ready HFs that responds to health and nutrition emergencies

 Improve access and ensure utilization of EHN care services including for IDPs

 Reduce the risk of fecal contamination and AWD morbidity by improving WASH services in holy

water and religious/social gathering sites

 Strengthen demand creation and proper WASH services utilization practices through enhanced

advocacy, social mobilization and interpersonal communication activities

 To strengthen the coordination, monitoring and evaluation of overall implementation the

Priority Results
Results Interventions
Result # 1: Improved functionality of 58 permanent a] Enhancing the functionality of Isolation wards/CTC; with skilled personnel, equipment, infrastructure and supplies
‘Isolation Wards /Treatment Centers'

Result#:2 200 SCs & OTPs (in HFs) in high risk a) Establishing/strengthening of standard SCs and OTPs (in HFs) with skilled personnel, equipment, infrastructure and
zones. supplies

Result # 3: Protection of vulnerable people a) Support intensified routine immunization activities focused on measles and Vitamin A supplementation
from preventable conditions such as measles,
b) Enhancing malaria elimination Advocacy for Malaria and Dengue fever protection
malaria & dengue fever

Result # 4: Sustainable prevention of AWD and a) Protection of Holy Water sites;

other water borne diseases in 16 Holy Water
b) Construction of water, sanitation and hygiene, including hand washing, facilities;
Sites in Amhara, Tigray, Oromia, and Afar

Result # 5: Emergency School Health and a) It is an interim strategy to address the emergency school health problems in the pastoralist area.
Nutrition program under stabilization center
in priority 1 woredas b) It builds resilience capacity in preventing health problems of the school children by intervening on Behavioral changes
and life skill, Nutrition, WASH, emergency preparedness and readiness.

Result # 6: Enhance health, nutrition and wash a) Advocate communities members and other key actors which play a role in demand creation for the services
services seeking behavior by the community
and improve utilization practices b) Mobilize stake holders which can facilitate target audience engagements positive behavior change for sustanable
WASH, health and nutrition services utilization at specific sites
c) Empower the target audiences (holly water users, students, health workers) to develop the desired behaviors
d) Build capacities of HEWs, Religious leaders, community leaders to use the available services sustanably
 Priority Results …
Improved functionality and surge capacity of 58 Isolation wards in woredas identified at high
risk of resurgence of water borne diseases
 Provision of equipment (small diagosis tools) and medical furnishing for the 58 Isolation wards

 Provision of a small surge medical stock (medicines and renewables) for the treatment of 200 cases for each Isolation Center

 Full hardware (including equipment, renovting existing rooms/building rooms, with functional WASH component – tanks, piping, hand

washing facility ) CTC kit ……1 per each targeted isolation center and 3 as additional surge for each targeted region .

 This will allow rapid expansion of inpatient capacity of isolation centers with 15-20 beds tented facility

 Infrastructural works to ensure appropriate infection prevention and circuit of patients I.e. at least 2 blocks of additional latrines, hand

washing facilities in each room and staff quarter; opening new entrance and fence to separate the circuit of patients and staff from

general wards and isolation ward; and waste management

 Training of the senior staff as trainers for management of isolation centers and training of available staff

 Incentives for 18 staff / Isolation center for 3 shifts operation for 90 days to support the ongoing response to AWD
 Priority Results …
Improved functionality and Quality of care in 200 SC and OTPs (in HFs) in high risk woredas

Procurement and distribution of SAM Nutrition supplies for 42,000 /376,397

children

Procurement of 2nd line drugs for SC

SC equipment (beds, tents, bed pans, mattress,)- 20 Tents, 600 beds, 2000 bed

pans, 2000 mattress

Improve water availability of 200 SCs in the P1 woredas (200 Roto tanks, spring

protection, pipe lines and 400 Hand washing facilities containers)

Priority Results …
Sustainable prevention of AWD and other water borne diseases in 16 Holy Water Sites in Amhara, Tigray
and Oromia

 The initial proposal considers interventions in 16 main holy water sites (Specific location to be

selected by RHB using different criteria)

 Holy water sites with records of spreading AWD or with high risk of spread

 Holy water sites with poor WASH facilities

 Holy water sites with large number of pilgrims, including “regular” visitors and “peak” gatherings

during particular festivals/events.

 Poposed number of holy water sites are: 3 , 7, 6 holy water sites in Tigray, Amhara and Oromia

Regions, respectively
 Specific activities includes construction of latrine blocks, construction of handwashing facilities near

latrines, chlorinated water supply, management of the WASH infrastructures, hygiene promotion
and IEC materials and solid waste management
Results Result - Indicators Target Mean of Verification Disaggregation Lead technical
Monitoring and evaluation
agency/cluster
coordinator

Result 1. Result # 1: Improved 1.1 Number of functional 58 Regional Health Bureau woreda, region FMOH,WHO
functionality of 58 permanent Isolation wards/CTC with skilled report and/or
‘Isolation Wards /Treatment personnel, equipment, evaluation/monitoring
Centres’ and 200 SCs & OTPs (in infrastructure and supplies; survey
HFs) in high risk woredas.

1.2 Number of SCs and OTPs (in 200 Regional Health Bureau woreda, region FMOH,UNICEF
HFs) with skilled personnel, report and/or
equipment, infrastructure and evaluation/monitoring
supplies survey

Result 3. Sustainable prevention 3.1 Number of holy water sites 16 Regional Health Bureau woreda, region FMOH, UNICEF
of AWD and other water borne with functional WASH facilities report and/or
diseases in 16 Holy Water Sites in evaluation/monitoring
Amhara, Tigray, and Oromia. survey
Thank You!