ADDIS ABABA – The heads of the United Nations World Food Programme and UNICEF in Ethiopia have made a joint visit to Somali Region of Ethiopia to see firsthand how people affected by recent violence and civil unrest are being assisted.
WFP Country Director, Steven Were Omamo and UNICEF Representative in Ethiopia, Gillian Mellsop visited the regional capital Jijiga on Monday 13 August, where they assessed what further support was needed and emphasized the importance of strong partnerships in improving the situation.
A humanitarian coordination committee comprising both government and humanitarian partners has been established to identify food distribution points in the city, after thousands of people were forced from their homes amid the disturbances.
“The people here are facing enormous challenges, and we have been doing all we can to support them through food distributions over the past few days,” said Omamo. “It is encouraging to see how the situation is stabilizing through the efforts of the Government and the support of humanitarian partners, and federal and regional authorities.”
“Children and women still face enormous challenges in accessing basic services such as water and health,” said Mellsop. “Working with the regional government and our partners, we are doing our best to ensure that support continues to reach them even as we restore currently-suspended programmes for other vulnerable populations.”
UNICEF is providing high-energy biscuits to children and women, buckets, blankets, soap and water-treatment chemicals. Before the conflict, UNICEF was supporting the treatment of approximately 132,000 children and 110,000 pregnant and breastfeeding women for moderate malnutrition and 8,500 children for severe acute malnutrition. The support is expected to resume once the situation improves.
WFP is providing rice, pulses, oil, corn soya blend, and the supplement Plumpy’Sup to 52,000 people seeking shelter in temporary accommodation. It hopes to resume its regular operations in the coming days as the security situation continues to improve.
WFP usually provides food assistance to some 2 million food-insecure people in the Somali Region. Another 311,000 drought-affected people receive complementary WFP food assistance under the government-led Productive Safety Net Programme.
Addis Ababa, 7 August 2018 – The Ethiopian Ministry of Health has launched a preventive measles vaccination campaign to immunize 928 000 children aged 6 months to 15 years among the internally displaced and host communities in Gedeo Zone of the Southern Nations, Nationalities and Peoples Region. The campaign will also involve administering vitamin A to children aged six months to five years and deworming of children aged two to five years. Plans are underway for a similar campaign targeting 516 000 children in West Guji Zone of Oromia Region.
There are close to one million internally displaced persons (IDPs) in Gedeo and West Guji zones sheltering in schools, unfinished buildings, and tents. The make-shift camps are crowded with limited access to safe water, hygiene and sanitation, posing an increased risk for the spread of communicable diseases. Children and pregnant and breastfeeding mothers are at high risk of malnutrition.
“Conducting vaccination campaigns for the displaced and host communities is key to preventing an outbreak of infectious diseases such as measles. Malnutrition also needs to be addressed, which is why this campaign is integrated with vitamin A distribution and deworming for young children,” Dr Akpaka Kalu, WHO Representative in Ethiopia, said. “WHO teams are on the ground in Gedeo working with government staff for technical, operational and logistical support to the campaign and to the overall health emergency response.”
UNICEF is procuring 750 000 doses of the measles vaccine while the balance of 900 000 doses is being bought by the Ministry of Health.
“In an emergency of this nature, it is often the children who endure the greatest suffering,” said UNICEF Representative in Ethiopia Ms. Gillian Mellsop. “In these very difficult times for the children of Gedeo and West Guji zones, it is critical that we are present, together with the government and other humanitarian partners, to provide vaccination and other much-needed lifesaving support to children and women.”
With little access to food and safe water, children and women are facing a rapidly deteriorating nutrition situation. UNICEF has provided malnutrition treatment supplies, deployed trucks to ferry safe water in West Guji, and distributed soap, jerry cans, water tanks, and other non-food items. Technical experts are on the ground to support the immunization campaign, monitor the screening and treatment of children with malnutrition, and mitigate violence against women and children.
The World Health Organization is providing technical and operational support including microplanning for the campaign, training of supervisors and facilitators, coordination, logistics, and monitoring and supervision of the quality of campaign.
As part of the response to the humanitarian crisis, WHO has deployed four international and more than 30 national public health experts to the affected zones to provide technical support on the ground. The organization has also donated medicines and medical supplies enough to provide emergency treatment to more than 200 000 people.
More than US$ 500,000 has been allocated from the United Nations Central Emergency Response Fund (CERF) to WHO and UNICEF towards supporting the preventive measles campaign led by the Ministry of Health of Ethiopia through its regional health bureaus in the Southern Nations, Nationalities and Peoples and Oromia regions. The campaign in Oromia Region is expected to commence on 10 August 2018.
Addis Ababa, 18 July 2018 –The Federal Ministry of Health has procured over 6,000 Solar Direct Drive (SDD) refrigerators for health posts and woreda (district) health offices in areas without reliable electricity. The devices will store vaccines at health facilities which will help keep millions of children alive and healthy. The Federal Ministry of Health fully funded the procurement of these solar refrigerators at a total cost of US$ 31.4 million. The procurement was supported by UNICEF given its global expertise in handling such large-scale purchases in a short time.
Prequalified by WHO, the SDD refrigerators are expected to expand immunization coverage in Ethiopia through significantly reducing the time and resources required for vaccine transportation. The devices will ensure the availability and safety of vaccines in remote areas where the country’s most vulnerable children live.
The procurement follows a unique bundled procurement services approach which includes warranty, delivery of spare parts, and training of supply chain and immunization focal persons both at federal and regional levels. In addition, a project management team led by the Ministry of Health and UNICEF will regularly review the progress and efficiency of operations.
At the ceremony, H.E Dr Kebede Worku, State Minister of Health, said, “The Government of Ethiopia underlines its commitment to equip all health posts, health centres and hospitals with optimal cold chain equipment to ensure quality and improve access of the immunization programme.”
“The Solar Direct Drive devices we are being rolled out are the successful outcome of the strong partnership built between the Ministry of Health, UNICEF and other health partners to ensure that no child is left behind on immunization,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia.
Immunization is one of the most cost-effective health investments. By protecting children against vaccine preventable diseases, immunization plays a central role in ending preventable child deaths. Despite significant improvements over the past decades, in Ethiopia, only 38.5 per cent of children between 12 and 23 months receive all basic vaccinations. There are also great disparities in terms of access to vaccination services between rural and urban areas.
One of the key strategies to improve access and utilization of immunization services is to improve the cold chain system, especially at health post level. Therefore, the Ministry of Health invested in solar powered refrigerators which are more cost effective and sustainable than refrigerators using gas or kerosene, in remote areas where there is no electricity.
Ethiopia’s Health Sector Transformation Plan (HSTP) has set ambitious goals to improve equity, coverage and utilization of essential health services at all levels by 2020. Achieving these goals will require significant investments, including in innovative technology.
While it remains important to achieve high coverage rates of essential health services, such as immunization of mothers and children, continued efforts are required to provide quality health services to all citizens regardless of differences in socio-economic status or geographic location.
Addis Ababa, 9th July 2018: UNICEF signed annual workplans with the Government of Ethiopia for the Ethiopian Fiscal Year 2011. The workplans were signed by Mr Admasu Nebebe, State Minister in the Ministry of Finance and Economic Cooperation (MoFEC), Ms Gillian Mellsop, UNICEF Representative to Ethiopia and heads of Regional Bureaus of Finance and Economic Cooperation. UNFPA also attended the signing ceremony, as one of the UN agencies signing annual workplans with the Government of Ethiopia under the UN Development Assistance Framework (UNDAF 2016-2020). UNFPA was represented by Mrs. Bettina Maas, UNFPA Country Representative to Ethiopia.
The workplans will create a platform for the implementation of integrated child-focused development interventions in Ethiopia’s regional states and city administrations. This year, with support from MoFEC, UNICEF has managed to reduce the number of work plans from 143 to 89 by integrating related programmes that are currently being implemented by different implementing partners. The reduction will strengthen collaboration and coordination among implementing partners and will contribute to efficient utilization of resources by reducing operating costs and facilitating joint programme implementation, monitoring and evaluation.
In his remarks, Mr. Admasu Nebebe said the continued support and resources mobilized by UNICEF and UN agencies in the past decades has been valuable to Ethiopia’s development. In particular, he singled out the participatory process used to develop the workplans as a key to enhance mutual accountability and ownership of programmes.
Ms. Gillian Mellsop said UNICEF highly values its partnership with MoFEC and the Regional Bureaus. Appreciating the fact that the vast majority of resources are allocated to the regions, Ms. Mellsop said UNICEF is grateful for the support and collaboration of the regional government partners to deliver results for children and women in general and to reach the most disadvantaged and vulnerable children in particular.
The workplans will be implemented by more than 140 regional and federal government partners covering 12 programme areas that include health, nutrition, water, sanitation and hygiene, education, early warning and disaster preparedness, violence against children, ending child marriage and FGM, birth registration, child rights, communication, public finance for children, evidence generation, and programme coordination, monitoring and evaluation.
Kejelo, Tiro AFETA, Oromia, 14 June 2018: Inside the small room of Kejelo health post, health extension worker Amelework Getachew carefully monitors her stock of medicines stacked on a small wooden shelf. She checks to make sure that an Oral Rehydration Salt (ORS), a fluid replacement used to prevent and treat diarrhoea, Amoxicillin Dispersible Tablet and Gentamicin injection, antibiotics used to treat children with pneumonia and serious bacterial infections, are available in good quantity. She cross checks the numbers on each bin card and the actual quantities on the shelf. “I can’t afford to run out of these medicines,” says Amelework, pointing towards a stock of sachets of ORS and packs of amoxicillin tablets and gentamicin injections. “They are lifesaving.”
After Amelework is done taking inventory, she collects her essential job-aids for home visits and attends to five-month-old Aziza in her home as part of her routine house-to-house visit. This way, Amelework makes sure that pregnant women and newborn babies get health follow-ups.
When Aziza was only 45 days old, she suffered from pneumonia, the common killer of infants in Ethiopia. “I was so worried when my child was sick,” says Rawda, Aziza’s mother. “She was struggling to breathe and had it not been for ‘doctor’, my child would not have survived.”
“I was so worried when my child was sick. She was struggling to breathe”
Amelework, whose name also means “a golden character,” is a committed health worker. Her nine-year journey as a health extension worker started in a remote village of Kereyu Dodo when she was given the daunting task of changing people’s attitudes on a range of health-related misconceptions. It wasn’t easy for her to convince people to dig toilets or use bed nets to keep them safe from malaria. “They used to call us names like the ‘toilet controllers’ or ‘bed net checkers,” she remembers.
But Amelework is now dubbed ‘doctor’, a name bestowed to her out of love and respect by the village women. She is key to the livelihoods of the community, saving mothers and newborns including little Aziza in the small village of Kejelo.
Although Ethiopia has managed to significantly reduce its under-five child mortality, newborn deaths have declined at a much slower pace. Twenty-nine newborn babies die out of every 1,000 live births from preventable causes such as complications due to prematurity, birth asphyxia, and infections like sepsis, and pneumonia. Newborn deaths also account for a greater and growing share of all deaths among children under 5; almost 44 per cent.
Supported by UNICEF, the Government of Ethiopia introduced the Community Based Newborn Care (CBNC) strategy in 2012. CBNC aims to empower health extension workers, such as Amelework, with skills to provide maternal and child health services during pregnancy, childbirth and postnatally. Heath extension workers are also trained to identify and treat newborns with severe bacterial infections or sepsis where referral is not possible. They provide treatment for sick children both at the health post and in houses during their regular visits.
“The treatment we are providing is free of charge,” says Amelework. “This is encouraging mothers to bring their children early when they are sick. It is also helping us to save young children from serious illnesses like pneumonia.”
Amelework is trained to provide CBNC services by JSI Research & Training Institute, Inc/ The Last Ten Kilometers Project (JSI/L10K), which is implementing the programme with technical and financial support from UNICEF. She also gets constant support and follow-up from the CBNC supervision team who regularly visit her health post to make sure that she is applying the standard operating procedures.
“We train and support Amelework to deliver her very important work by effectively identifying sick children in the village during her regular immunization outreach work and when she is providing house-to-house postnatal care,” says Wosen Darge, the CBNC Regional Technical Officer from JSI/L10K. “We also monitor and evaluate her records to ensure key information is recorded and stored in the treatment book.”
Amelework is also provided with guidance and support on supply management. She keeps track of her medical supplies to avoid shortages of crical drugs that she needs for immediate use.
“Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses”
UNICEF is supporting the scaling up of CBNC services with funds from the Margaret A. Cargill Foundation. Working in coordination with the Ministry of Health, it is expected that the positive experiences observed in villages like Kejelo will be expanded to pastoralist areas.
A humble hard worker such as Amelework embodies Ethiopia’s hope to end preventable newborn and child deaths within this generation. “Nothing is more fulfilling than seeing a mother’s happy face when her child is recovering from such illnesses,” she says, “I am a mother myself and I know the feeling.”
Aziza is growing up healthy, her mother’s wish is to see her daughter becoming a ‘doctor’, like Amelework. “She [Amelework] saved my child’s life and I want my daughter to also do the same when she grows up,” says Rawda, with eyes full of hope to see a bright future for her baby daughter.
Kule Refugee Camp, Gambella, Ethiopia, 29 May 2018: Nyaluak Kun, 24, is a refugee at Kule Refugee Camp in Gambella, western Ethiopia. Originally from South Sudan, the mother of six has just received three long-lasting insecticide treated mosquito nets for her family. She says malaria has been a threat to her health and that of her family since the rainy season started.
“I am happy to receive these mosquito nets. I hope this is the right time that we have received the mosquito nets. Several times I have been sick with malaria. There was no solution for me. I get medicine, after a few weeks, I get sick again because of mosquito bites.”
For Nyaluak, the mosquito nets will not only keep the family safe from mosquito bites but also from other poisonous insects that enter homes during the rainy season.
Malaria is endemic to the Gambella Region and is one of the top three causes of sickness and death across all the refugee camps. The epidemic occurs mostly from April to June and September to November every year. Mosquito nets, in-door and out-door residual spraying, and environmental management are the most recommended malaria prevention and control interventions.
The standardized expanded nutrition survey of 2017 indicates that the proportion of households with access to at least one mosquito net is below 50 per cent in all the refugee camps, except for Kule at 54 per cent and Pugnido II at 60 per cent. With inadequate mosquito nets, malaria is rampant: last year alone, 128,520 cases and 33 deaths were recorded, 25 of them children under the age of five.
Distribution of mosquito nets to vulnerable groups, such as under five and malnourished children, pregnant and lactating women, and newly arrived refugees, is ongoing in all the refugee camps of Kule, Tierkidi, Nguenyyiel, Jewi, Pugnido I, Pugnido II, and Okugo.
However, the 2018 blanket distribution, targeting 386,000 refugees, started on 29th May in Kule Refugee Camp. It was combined with general food distribution using lists obtained from UNHCR population and household databases. With the overall coordination of the Administration for Refugee and Returnee Affairs (ARRA), UNHCR and UNICEF, refugees received mosquito nets at distribution centres managed by MSF-Holland, an implementing partner. Upon presentation of a mosquito net coupon obtained at the food registration centre showing the family size, the refugees would receive a mosquito net free of charge based on the UNICEF standard of one mosquito net for every two individuals.
UNICEF monitored the distribution exercise and conducted awareness and demonstration on slinging the mosquito nets. The awareness was done by Community Outreach Agents. Special messages with visuals were developed for under five children and pregnant and lactating women. The monitoring team also conducted interviews with refugees to ascertain their knowledge levels on utilisation of mosquito nets.
Nyaluak says the demonstrations were important although the refugees faced difficulties in fixing the nets because of the type of housing and beddings they had.
In all, 163,000 mosquito nets were distributed. They were procured by UNICEF with funds from the European Commission (ECHO) under a project to provide lifesaving and resilience-building health and nutrition interventions for South Sudanese refugees and host communities in Gambella.
South Gondar Zone, Ethiopia: Enalem Asnakew (40) had no idea why her one-year-old son Misganaw Asmare would not stop vomiting. His arms, legs, and abdomen were swollen and his appetite was failing. After about a month, she had had enough and decided to bring him to the local hospital.
“He was put on blood transfusion for three days,” she says in a barely audible voice. “Then, they administered [therapeutic] milk through his nostrils in addition to [intravenous] medicine. The nurses frequently visited my child and now, after nine days, the swelling has disappeared, the vomiting is almost gone, and my child takes therapeutic milk orally.”
Misganaw was diagnosed with severe acute malnutrition, a serious but entirely preventable and treatable condition which the WHO estimates accounts for 35 per cent of deaths among children under five globally. Typically, severe acute malnutrition is treated in a hospital but the advent of ready-to-use therapeutic foods has enabled children like Misganaw to be treated at home if they have no underlying medical complication requiring hospitalization.
In general, Ethiopia has made strides in reducing undernutrition in children, with stunting in particular dropping from 58 per cent in 2000 to 38 per cent in 2016. However, the number of children with severe acute malnutrition spikes up during the ‘lean’ season between June and August, the period when most households will have exhausted their food stocks as they await the next harvest beginning September. Prolonged and chronic humanitarian crises, such as droughts and floods, also contribute to increased malnutrition in children.
Inadequate food however is not the only cause of malnutrition. Multiple factors, such as the child’s size at birth and the mother’s weight, predispose a child to malnutrition. Acute illnesses and poor feeding practices are other contributing factors. The key to preventing malnutrition therefore lies in improving the nutritional status of the mother, ensuring the child has access to an improved and diverse diet, providing safe water and sanitation, improving hygiene, and building a strong and supportive system at community level.
In 2011, with a US$ 50 million grant from the Government of Canada, UNICEF embarked on a project to improve nutrition in children and women in 100 food insecure districts in the Amhara, Oromia, and SNNP regions of Ethiopia. The six-year project, later extended for another year, was to improve the use of health and nutrition services by children, adolescent girls, and breastfeeding mothers, and increase the availability of water and sanitation services. The project focused on the community level, where efforts were made to increase the scope and coverage of nutrition activities. These included multi-media campaigns, education of mothers and caregivers on nutrition, promotion of breastfeeding, and increasing production of local complementary foods. Wells were drilled to supply safe water to communities and households were encouraged to construct their own improved latrines.
To improve service delivery, 2,000 community-based health extension workers responsible for mobilizing people and agriculture development agents were trained in nutrition. Water was supplied to health posts and committees to oversee water, sanitation, and hygiene activities were established at kebele level (smallest administrative unit in Ethiopia).
In total, the number of community-based nutrition activities doubled and 24 per cent more households cultivated a garden (the largest increase was observed among the poorest households). Nutrition knowledge among health workers and health extension workers increased from 51 to 80 per cent while exclusive breastfeeding increased from 71 to 80 per cent. The proportion of mothers stating that water should not be given to babies under six months of age increased from 61 to 78 per cent.
The project also marked a milestone as the first ever in Ethiopia to target nutrition for adolescents (children aged between 10-18 years). Deworming of adolescents was first introduced under the project as a pilot but was subsequently scaled up to national school deworming campaigns, reaching 3.9 million school children.
These results were achieved against a backdrop of unforeseen challenges, such as the civil unrest of 2016 which limited travel and access and the El Nino drought in 2016 which shifted attention and resources. Notwithstanding, a survey at the end of the project showed that stunting among children had declined from 40 per cent to 35 per cent and the prevalence of underweight children from 22 per cent to 17 per cent. Put differently, the odds of children in the 100 districts being stunted or underweight had been reduced by 19 per cent and 20 per cent respectively.
The education, mobilization, and support given to the 100 districts in Amhara and the other two regions will ensure that mothers like Enalem will never have to wonder again why their children are vomiting, or why their abdomen and limbs are swollen. They will also ensure that children like Misganaw can grow up healthy and strong, free from dangerous yet preventable conditions like malnutrition.