Requirement of nonfood Items for the drought affected
Annex 1: List of persons contacted in the Amhara Region
Annex 2: Distribution of health workers in drought affected
zones - Amhara Region
Annex 3: Population in Drought Affected Areas - Amhara
The zones of North Wollo, South Wollo, Waghemra, North Gondar and South Gondar were reported to be severely affected by the past Belg (short season) and by the late and heavy Meher (long season) rainfall. Consequently, an emergency appeal is to be staged by UN in January 2000 on food and non-food requirement for drought affected people in the localities of the above zones. At the interagency meeting held on December 6, 1999, consensus was reached to dispatch interagency teams to immediately visit North and South Gondar to collect data on non-food requirement at zonal levels as well as to update existing recent information of South and North Wollo and Waghemra at the regional level. In addition, drought affected zones in Somali Region, Afder, Liben and Gode will be visited for similar assessment. Data will be collected at zonal levels.
1.1. Objectives of the Assessment:
Make rapid assessment of North and South Gondar.
Update the information used for the immediate past appeal of North Wollo, South Wollo and Waghemra.
Identify and prioritize the basic non-food needs of victims of drought affected areas.
Draw an action plan that would facilitate the mobilization of resources and rapid intervention.
The teams traveled to regional and zonal levels and collected data on drought affected areas. Interviews, briefing and debriefing of relevant personalities were held at regional and zonal levels. The areas visited consisted of:
Relevant regional bureaux at Bahir Dar.
North and South Gondar Zones.
The updating of information on North and South Wollo and Waghemra zones was accomplished by contacting mainly the Amhara Region Health Bureau and Disaster Prevention and Preparedness Commission of same Region. The list of officials contacted in all visited areas is attached as annex 1.
The collection of data was undertaken using a six-page pre-designed questionnaire covering information on general situation, health facilities and prominent diseases, vaccination coverage, data and sanitation, nutritional status, availability of drugs, reagents, ORS etc., laboratory services, prevention and control of diseases, training of health workers, health education; reporting system and coordination of health activities in drought affected areas, NGOs and other organizations participating in drought health activities and reproductive health. Through out the process of collecting data, focus on the drought-affected areas was maintained.
According to predetermined assessment approach data for updating information on N. Wolo, S. Wollo and Waghemra was collected at the regional level health bureau. Although, the officials and staff of the regional health bureau were extremely helpful and cooperative, the information at regional level on the above mentioned zones was inadequate as reports sent to the region from the zones were incomplete and delayed. On the contrary, collecting data at zonal level was relatively more complete.
The assessment team that traveled to Northern Ethiopia was composed of:
Ms. Nina Strom ………………. UNFPA
Mr. Hailu Meche ……………… WHO consultant
The Amhara Region is made up of ten zones, hundred-five woredas and Bahir Dar (Special Woreda). There are a total of 877 Kebeles. The population of the Region is 16,380,178 (July, 1999) out of which 8,458,549(51.6%) and 7,921,629(48.6%) are male and female respectively. The distribution of children population by age shows 635558(<1), 1,771,589(<3) and 2,772,192(<5).
There are fifteen hospitals with 1634 beds, seventy-three health centers with 492 beds, five hundred thirty-five health stations and three hundred six health posts operated by the Regional Government. In addition, there are 159 private clinics. The health service coverage of the Region is less than 50%. The health service coverage by zone and woreda varies significantly. The number of health workers and health facilities by category of the Amhara Region and drought affected zones are shown in annexes 2 and 3.
Due to heavy rains in some areas and shortage in others, late in 1998 followed by poor Belg season in 1999, a number of localities in the Amhara Region were severely affected by crops failure and drought which led to food assistance as well as needs for expanded EPI coverage, malaria control, control of water and sanitation related diseases, additional medical and health supplies and training of health workers to cope with the management of diseases emerging due to the consequences of drought. Recognizing this fact, the UN country TEAM had staged appeal for non-food assistance to the severely drought affected areas in Ethiopia including the Amhara Region. The response from the donor community was not impressing.
Likewise, the Meher season became generally unfavourable in several drought and famine prone localities of the Amhara Region for the following reasons:-
late on-set of the rains in most parts of the region, coupled with an early cessation of the Meher rains;
excessive rains and hailstorm inflicting heavy damage on crops in some pocket areas;
failure of long cycle crops in most parts of the region due to the failure of the 1999 Belg rains;
death of large number of domestic animals due to the prolonged drought earlier in the year which has caused depletion of assets of most households, and
outbreaks of black beetles, army worms and other pests that have created yield losses.
Most of the current relief beneficiaries are expected not to recover as the expected Meher harvest is poor. In addition, considerable size of the current relief beneficiaries are Belg dependent who don’t benefit much from Meher and assistance to these group must extend to the next Belg harvest hoping that situations will change. Consequently, about 2.8 million people will seek relief assistance in the first quarter of 2000.
As the situation of drought becomes severe in the affected areas, equally the health of same population rapidly deteriorates and disease conditions change for the worse and people easily fall from malaria, diarrheal diseases, pneumonias, outbreak of measles etc. and nutritional deficiencies. The conditions observed in the five zones (North and South Gondar, North and South Wollo and Waghemra) of the Amhara Region is in the same cycle of continuous deterioration of the health situation of the population and rising trend of diseases.
In the five zones of the Amhara Region, 42 Woredas consisting of 1342 Kebeles are affected by drought (annex 4). In these affected areas there are four hospitals, twenty-six health centers, two hundred fifty-six health stations and 141 health posts (annex 3). As the general health services of the region is inadequate with less than 50% health service coverage, the stress on the health facilities to meet the needs of the drought affected population is severe. The health facilities generally experience shortage of drugs and medical supplies. The situation of the areas affected by the drought, no doubt require immediate action in order to put the alarming situation under control.
As indicated earlier, Five zones were included in the rapid assessment of non-food needs of the drought-affected areas in the Amhara Region. The zones covered were North and South Gondar, North and South Wollo and Waghemra. The approach adopted for the data collection of the zones was the following:
In North and South Gondar data was collected at the zonal level. The sources for the data were primarily the zonal health department and the zonal disaster prevention and preparedness bureau.
Regarding North and South Wollo and Waghemra, data collection was undertaken in the regional health bureau as well as the regional disaster prevention and preparedness commission. This approach was followed because the purpose of the assessment was to update existing current information.
The details of the findings of each zone is presented below:
3.1. North Gondar Zone:
In North Gondar out of the sixteen woredas seven are affected by drought. The seven woredas have a total population of 1,077,124 out of which 209 935 people are victims of the effect of drought requiring assistance (annex 4). The population of the <5 from the total drought affected population is 35,890. The health facilities in the drought-affected woredas are five health centers, thirty-one health stations and fourteen health posts. The estimated population of the zone with access to safe water is about 23%. Similarly, the estimated population that has good practice of sanitation is about 5% however, sanitation practice is inadequate in general.
In North Gondar the distribution of health facilities is relatively even in terms of health centres, health stations and health posts. The health manpower distribution is fairly even with regard to the core rural health workers such as the nurses, health assistants, laboratory technicians and junior nurses. However, some of the health facilities in the drought-affected areas are understaffed even with the above mentioned health workers. The above mentioned health workers are mainly assigned to health posts, health stations and health centers.
The top five causes of morbidity of outpatient 1998/1999 were malaria, diarrheas, intestinal parasites, pneumonias and tuberculosis. The common causes of death of hospital admission for the same period were malaria, tuberculosis, B. pneumonia, diarrheas and septicemia. These killing diseases were often associated with malnutrition. The diseases under surveillance showed the following trend:
Most of the above reportable diseases except for typhoid fever, show decreasing trend, although, it was not possible to associate the data with the drought affected areas.
When the list of top causes of morbidity is expanded to ten, eye infections, anemia, malnutrition, bronchitis and skin diseases come to forefront. Similarly, heart diseases, malnutrition, anemia, fever of unknown origin and tetanus become additional causes of death in hospitals.
The common diseases observed as related to deficiencies in water supply and sanitation are intestinal parasites, eye infections, diarrheas, and skin diseases. These diseases are associated with poor sanitation habits and consumption of unsafe water by communities.
The coverage of vaccinations in North Gondar in 1998/1999 was 52.9% for DPT3 and 40.6% for measles. Similarly, the average vaccination coverage for the seven drought affected woredas was 36.1% for DPT3 and 28.8% for measles. Although, vaccination coverage in the zone is low in general, it is extremely low for the drought-affected areas. Among these areas there was one woreda (Beyeda) which has zero percent coverage for DPT3 and measles. The reason given was that most of the areas are inaccessible and that there is difficulty to bring services to the communities. The existing cold chain system is functioning properly. 20 - 25% of the health facilities don’t have cold chain system.
No recent data was obtained for North Gondar regarding the current nutritional situation. However, as growth monitoring was being conducted data reported from health facilities (July - Sept.1999) indicate that out of 5214 children monitored 2803 fall between 60 - 80% and showed edema and marasmus - Kwashiorkor 836 fall <60%. This was a clear indication of prevailing malnutrition in the areas. Again, the data didn’t show specific situation for the drought-affected areas, but, generally for the zone.
Laboratory facilities are available in two hospitals and 9 health centers in North Gondar. The laboratories commonly run routine tests on urine, stool, blood, hemoparasites, sputum, etc. The two hospitals do also blood screening for HIV infection. However, some of the health facilities in the drought-affected areas don’t have laboratory services. The zonal health department is prepared to engage all health centers in blood screening for HIV infection by training laboratory technicians in health centers. However, the zonal health department has not received a single test kit to date. In general, it was reported that there is shortage of laboratory reagents in all health facilities.
With regard to prevention and control activities against malaria and HIV/AIDS in general and drought affected areas in particular, health education primarily for HIV/AIDS and the already set strategies for malaria control were cited. With regard to malaria situation, out of the 527 Kebeles in the zone 346 kebeles are malarious. Consequently, the following report on malaria was received for the following three months.
No. of cases
No. of confirmed cases
Malaria is having an increasing trend since August 1999 and Control measures have been carried out. In general, the current episode is said to be mild as compared to last year’s malaria situation. Problems indicated with regard to malaria control activities are shortage of transport facilities, spray pumps and their spare parts and insecticides.
In the area of reproductive health it was reported that delivery kits were available but inadequate. Similarly, it was reported that contraceptives were available and adequate with regard to oral contraceptives, however, injectables were inadequate as the demand for such contraceptives is high. The distribution and adequacy of condoms was not raised as a problem, but the utilization of it was questionable. Although, the government policy supports the establishment of two-way functional referral system in the health service, in general, there is no established functional referral system in the zone and logistics for such service by and large is absent. Patients engage themselves in self-referral services.
Although, the capacity of nongovernment organizations working in North Gondar Zone is questioned by the Head, Zonal Disaster Prevention and Preparedness Department, there are quiet a good number of NGOs working and mostly engaged in the construction of health posts, training of frontline health workers, sanitation activities, protection and development of springs and HIV/AIDS activities. The list of NGOs include:
Reports of health activities from health facilities are sent to the woreda health offices on weekly (notifiable diseases), monthly (morbidity reports) and quarterly on activities performance. The woreda health office sends the compiled reports to the zonal health department. The interaction between the zonal health department and woreda health office is unsatisfactory. Feedback and measures taken at each level must be communicated. In general, the system of data collection and analysis locally is inadequate, as the personnel have no training particularly at the woreda level and there are no supporting facilities such as computers, and/or calculating machines.
In the case of drought affected areas, in the event of epidemics there are several channels of reporting. The woreda health office reports to the zonal health department as well as notifies the woreda administrative office. The woreda administrative office reports to the zonal administrative office as well as the zonal health department. Where communication is difficult to report to the woreda health office, the health facilities directly report to the zonal health department. In addition, there are committees to oversee the situation of the drought affected areas at Zonal and Woreda levels, and health is represented and opportunities are there to receive reports on the health situation of the drought affected areas.
3.2. South Gondar Zone:
South Gondar has ten woredas with an estimated population of 1,920,243 and nine of them are affected by drought. The nine woredas have an estimated population of 1,892,993 out of which 504 112 people are victims of the effects of drought. The population of <5 children from the drought affected population is 85,699. There are eight health centers 60 health stations and 37 health posts in the drought-affected areas. The estimated population of the zone with access to potable water is about 10-15% and the access to good practice of sanitation is about 7%.
In South Gondar the distribution of health facilities is even in terms of health centers, health stations and health posts. There is only one hospital in the zone. The health manpower distribution is satisfactory with regard to the core rural health workers such as nurses, health assistants, laboratory technicians, malaria technicians, and sanitarians, etc. but doctors and pharmacists. The existing health centers and health stations have adequate staff of Nurses, health assistants, laboratory technicians, sanitarians and malaria technicians.
The top five causes of morbidity of 1998/1999 were malaria, lower respiratory tract infection, intestinal parasites, skin diseases and diarrheal diseases. If the list is expanded to ten top diseases, tuberculosis, eye infections and upper respiratory tract infections are included. The common causes of death of hospital admissions for the same period were tuberculosis, malaria, diarrheas, respiratory tract infections and acute febrile illnesses. These killing diseases were often associated with malnutrition. The diseases under surveillance showed the following trend:
The above reportable diseases showed decreasing trend, although, it was not possible to associate the data with drought affected areas and the report was in complete for the months of October and November 1999.
The common diseases reported related to deficiencies in water supply and sanitation were intestinal parasites, skin diseases, eye infection diseases, baciliary dysentry, typhoid fever, etc. These diseases are associated with poor sanitation habits and consumption of unsafe water by communities.
The coverage of vaccinations in South Gondar in 1998/1999 was 76% for DPT3 and 57.2% for measles. Similarly, the average vaccination coverage for the nine drought affected woredas was 76.0% for DPT3 and 58.1% for measles. Although, vaccination coverage in the zone and drought affected areas is satisfactory, woredas such as Dera, Fogera, etc. need close attention. Shortage of refrigerators and wicks was raised as constraint for better success in vaccinations.
Recent data on nutritional situation was not obtained for south Gondar. However, growth monitoring conducted in July-Sept. 1999 by health facilities and a study undertaken in 1997 on protein Emerging Monitoring assessment by GTZ(IFSP) were used. The study by GTZ (IFSP) was done on three woredas namely, Lay Gaint, Tach Gaint and Simada. The year 1997 was recognized as a period of good harvest then. The results of the two undertakings were the following.
Growth monitoring was performed on a total of 7949 children. The result showed 37.45% > 80%; 35.50% between 70-80%; 18.13% between 60-70% and 8.92% <60%.
The other study indicated that in general 54.4% were underweight, 57.3% stunted and 11.4% wasted.
Both studies clearly indicated that there existed acute and chronic malnutrition in the zone in general, as the drought affected areas almost cover the entire rural areas.
Laboratory services are available in one hospital and seven health centers in South Gondar. The laboratories, commonly run routine tests on urine, stool, blood, hemoparasites, sputum, etc. However, two health centers in the drought-affected areas don’t have laboratory services. The lack of microscopes, and shortage of reagents were indicated as outstanding constraints throughout the year. No blood screening for HIV infections is undertaken in the zone.
With regard to prevention and control activities against malaria and HIV/AIDS in general and drought affected areas in particular, health education primarily for HIV/AIDS and the already set strategies for malaria control were underway. With regard to malaria, the trend in September and October 1999 for confirmed cases was 522 and 1120 cases respectively. Shortage of drugs, IV fluids, inadequate insecticide specially for epidemics, shortage of spray pumps and spare parts and shortage of manpower are indicated as sharp problems of malaria control programme. In general malaria disease episode was currently stated as mild.
As to HIV/AIDS, health education in all health facilities, schools, churches and in areas were agricultural extension workers exist is aggressively underway. Committees and clubs are established to coordinate and oversee HIV/AIDS control activities. Condom distribution in towns is satisfactory as it is handled by DKT. However, there is shortage of condoms in health facilities.
In the area of reproductive health it was reported that delivery kits were not available. The availability of oral contraceptive was mentioned as satisfactory, but injectables were inadequate, since the demand was high.
The government policy supports the establishment of two-way functional referral system in the health service in general, but, there is no officially established functional referral system in the zone and logistics for such service by and large is absent. Patients help themselves through self-referral services.
A number of non-government organizations work in South Gondar Zone mainly engaged in the construction of health posts, training of frontline health workers, water and sanitation activities, deworming and distribution of Vit. A. The list of NGOs include:
Name of NGO
Geographical area of Work
Food for the Hungary
Lay Gaint, Tach Gaint, Simada
Amhara Organization for Rehabilitation & Development
Reports of health activities from health facilities are sent to the woreda health offices on weekly (notifiable diseases), monthly (morbidity reports) and quarterly on activities performance. The woreda health office transmits the compiled reports to the zonal health department with comments and measures taken, if any. However, the system of data collection is inadequate as there is lack of trained manpower and support of essential equipment.
In the case of drought affected areas, in the event of epidemic situations, there are a number of channels of reporting. The woreda health office reports to the zonal health department as well as notifies the woreda administrative office. The woreda administrative office reports to the zonal administrative office as well as to the zonal health department. Where communication is difficult to contact the woreda health office, the health facilities directly report to the zonal health department. In addition, there are committees to oversee the situation of drought affected areas at zonal and woreda levels and health is represented and opportunities are there to receive health situation reports about drought hit areas.