WHO Health brief on Southern Africa-July 2002
World Health Organization
Health Brief on
Southern Africa Humanitarian Crisis
August 2002
Department of Emergency and Humanitarian Action
Table of Content
1- Southern Africa: Health dimension of the humanitarian crisis…………... 3
Health Brief and WHO's strategy
2- Regional Appeal activities……………………………………………………….. 7
3- Financial overview of the Country Appeals……………………………… 8
34- Extracts from Country specific appeals: Health situation analysis and WHO projects for:
- Swaziland………………………………………………………… 10
- Lesotho……………………………………………………………. 14
- Malawi……………………………………………………………. 20
- Zimbabwe…………………………………………………………. 33
- Zambia…………………………………………………………….. 50
- Mozambique………………………………………………………. 55
1- Southern Africa: HumanitarianHealth dimension dimensions of the humanitarian crisis
Background
The countries of Southern Africa, mainly Malawi, Zambia, Lesotho, Zimbabwe, Swaziland and Mozambique are currently facing an acute and large-scale humanitarian crisis. Drought, floods, economic degradation, increased poverty and political instability in Zimbabwe combined with a large burden of communicable diseases and outbreaks, faltering health systems, malnutrition and the highest HIV/AIDS loads in Africa, have led to increased mortality and wide suffering among at least 10 million people.
Unusually dry conditions together with erratic rainfalls (sometimes flooding) have led to crop failures and limited production, which combined with poor policies for ensuring adequate stocks, resulted in serious food shortages. Governments in Malawi, Lesotho, Zimbabwe and Zambia have declared national disasters. WFP and FAO estimate that the needs will rise more after the harvests of July and August. Adding to the food shortage, the decreasing government budgets to health, the shortage of drugs, the epidemics of cholera (the worst in Malawi for this year with more than 30,000 cases and 900 deaths), the high burden of malaria, malnutrition, diarrhealdiarrheal diseases and respiratory infections, and with the majority of the population (estimated at 70% in general) living with less than a dollar per day, all these make the ingredients for complicated humanitarian situation.
The past history of drought and famine in the regions especially looking back at the 1992-1993 and the 1995-1996 droughts, reminds us that these are recurring problems, that have deep rooted causes ranging from poverty and cutting across land management and governance issues. The humanitarian community usually responds quickly to such emergencies and has in the past averted many humanitarian crises. However the adequate management of these crises cannot be averted by addressing the food situation alone. As mentioned in a WFP information paper to its executive board in February 2002,
" In many of the large scale life threatening natural disasters…. , it was lack of water, poor sanitation and the risk of epidemics that correspondents highlighted in early dispatches… The nutritional impact of food aid is significantly reduced when other root causes of malnutrition are not addressed, such as inadequate health care and practices, lack of education and poor sanitation and water supplies".
Goal:
In the countries mostly affected by the current humanitarian crisis, WHO will work with the Ministries of Health (MOH) and the partners from the health sectors and from the other sectors, to reduce the avoidable loss of life and the burden of disease in this crisis. To achieve this, WHO through its country offices and the regional inter-country team in Harare will at the regional level and specifically in the countries mostly affected, will work on ensuring a Public Health approach for optimal and immediate impact.
Assessment:
The assessments undertaken by WHO and partners in Malawi and Zimbabwe, the hardest hit countries, demonstrated that the crisis is a humanitarian one not just a food shortage issue. People are dying, and not in the health facilities but in their homes (community survey in Malawi revealed a Crude Mortality Rate CMR, of 1.9/10,000). The assessment in Malawi showed that while the number of deliveries at health facilities have decreased by 7% as a symptom of the deterioration in economic accessibility, maternal mortality rates recorded in these health facilities increased by 71%, due to malnutrition and poor health status, lack of prenatal care and the weak capacity of the health system. Lack of food weakens the population, their immune system, already challenged by endemic diseases, cannot fight infections. This is reflected, in Malawi, by the severity of the cholera epidemic and the increased number of deaths encountered.
The economic degradation, that results from crop failures leads to further weakening of the purchasing power. The number of meals are decreased, the quality of the food eaten becomes questionable. With the lack of water, poor hygienic conditions and sanitation problems abound, setting the stage for diarrheal and other diseases. More so, in health facilities, there are no medicines, and also no food, patients if they can reach a health facility are not admitted, and they go home and die. In Zimbabwe, mortality rates in the assessed districts have increased over the past year among the top ten priority diseases, while outpatient attendance has been going down.
The HIV/AIDS pandemic, which has affected the Southern African countries (for instance Malawi has sero-prevalence rates as high as 3015% and Zimbabwe as high as 34%) has further complicated the situation with its resulting impact on households, and on productivity. This has led to a vicious circle where malnutrition and disease take the centre stage and where the food shortage, poverty, the drug shortage and the weak surveillance system are the driving forces.
Source: UNAIDS Epidemiological Fact sheets 2002
The strategy to respond to the situation in the Southern Africa region should incorporate an integrated approach for response. People are either dying or are sick and suffer from malnutrition. Reports from surveys conducted from Save the Children UK and UNICEF in Malawi report very high incidences of severe malnutrition on exacerbated by a situation of chronic malnutrition. Besides ensuring food or any other form of assistance(rations, food for work, etc.), there is a need to prevent further deaths, follow up on the diseases and outbreaks, and address the health problems of the most vulnerable (young children, pregnant women and mothers, aged persons). WHO will ensure that the quality and the contents of the food basket are according to standards, especially for essential micronutrients. Addressing malnutrition requires an integrated approach to household food security, health and care." Meeting food needs in these situations is essential, but also important is protecting people from illness and ensuring that young children and other vulnerable groups receive good care." (The silent emergency, The State of the World's Children 1998- UNICEF).
Strategy:
WHO's strategy is a two- pronged:
· Build on a regional team that is based in Harare as part of an inter-country support team to support activities in Zimbabwe and in the region and
· Focus intensively on Malawi, which is the hardest hit among the countries of the region.
As a first step, WHO will recruit 2 epidemiologists and 2 nutritionist to reinforce and ensure the quality of surveillance as well as increase capacity through training.
WHO will also increase its advocacy efforts to ensure that the donors give adequate attention and support to the need to invest and support agencies involved in providing health services and interventions.
WHO is coordinating with UNICEF both at regional and at country level regarding the delivery of the key Survival components of the appeal, especially health and nutrition issues (the support needed to nutrition and disease surveillance, monitoring the nutrition situation and assessing impact and progress of interventions, and water sanitation interventions, information sharing and dissemination).
Approach:
1. Strengthen the capacity of WHO to support the Ministries of Health (MOH) and health concerned partners to identify priority health and nutrition related issues and to ensure that they are properly addressed in an integrated primary health care approach that preserves and strengthens the local system.
2. Strengthen health and nutrition surveillance systems (including HIV/AIDS surveillance) to enable monitoring of any changes, early warning of deterioration and immediate life-saving approach through outbreak response and technically sound nutrition interventions.
3. Advocate for the delivery of basic preventive and curative care including essential drugs and vaccines for all, giving priority to the most vulnerable areas
4. Ensure that the lessons learnt in a crisis are used to improve the health sector preparedness for future crises and disaster reduction.
Activities
For this, WHO will be starting in Malawi and in Zimbabwe, and then extending after assessment of needs in the other countries with the following:
1. Recruitment of an epidemiologist to strengthen the Country office and support MOH and partners in surveillance, training and building capacity as well as early warning for epidemics, including HIV/AIDS
2. Recruitement of a nutritionist to support the Country office, the MOH and partners in assessing the problem of malnutrition and devising adequate programs to respond to the needs.
3. Ensure a stock of essential drugs and supplies for responding to outbreaks and also supplies for safe blood transfusion (HIV/AIDS screening)
4. Strengthen and support Reproductive health programs and Integrated management of childhood illnesses (IMCI), which would ensure that diarrheal diseases and Acute respiratory infections, the main causes of infant morbidity and mortality are addressed.
The team in Zimbabwe will support the region for epidemiological surveillance and nutrition issues.
2- REGIONAL ACTIVITIES
WHO is planning to reinforce the inter-country team in Harare in order to support the concerned countries in the Southern African humanitarian crisis for the following :
- epidemiological surveillance, outbreak response and Nutrition surveillance through the collection, analysis, compilation and dissemination of sub-regional epidemiological Health situation
- liaising with the regional information management in Johannesburg and providing a regional picture
- ensuring that complementary approaches between the countries and cross-border activities are coordinated (including surveillance)
- mMonitor Crude Mortality Rates (CMR) and one or two major indicators for Nutrition.(MUAC)
- Pproviding surge and field technical support if needed especially that with the start of the rainy season in November and December, all the ingredients are there for a cholera outbreak.
For these activities WHO will adopt an integrated approach by using the regular budget and the external funds for reducing mortality, morbidity due to humanitarian situation and within a sub-regional framework support the country offices as needed ensuring the link to development. WHO actions will strive to be sustainable and implemented with local human resources.
WHO inter-country team in Harare will support the ongoing collection of information related to epidemic prone diseases and will support any necessary response. WHO and UNICEF will collaborate to ensure ongoing nutritional surveillance in order to monitor the impact and progress of relief assistance.
OCHA is proposing the creation of the Southern Africa Humanitarian Information Management Service (SAHIMS), an inter-agency information and data clearing house, be established within the Regional Support Office (RSO). SAHIMS will liase with and support existing information systems such as FEWS and those of SADC and other technical bodies in the region. UNICEF and WHO will support this facility in order to achieve a more coherent approach to information management and advocacy in their areas of expertise, particularly in the area of nutrition surveillance and health information dissemination.
Summary Table of Funding Requirements for Regional Activities:
Sector/Activity / OCHA / WFP / UNDP / WHO / UNICEF / TotalCoordination / 550,000 / 3,445,153 / 180,000 / 300,000 / 500,000 / 4,975,153
Drugs and vaccines / 1,000,000 / 1,000,000
Information Management / 430,000 / 100,000 / 530,000
Assessments / 250,000 / 250,000
Total / 980,000 / 3,445,153 / 180,000 / 1,650,000 / 500,000 / 6,755,153
3- Financial Overview of the Country Appeals
Country - Swaziland
Population at risk 144,000
Total Appeal Figure US$ 19,028,760
Health, nutrition & Watsan US$ 2,339,939
WHO Appeal US$ 543,939
WHO Projects:
· Preparedness and response to cholera
Country - Lesotho
Population at risk 500,000
Total Appeal Figure US$ 41,033,465
Health,nutrition & Watsan US$ 4,072,000
WHO Appeal US$ 1,272,000
WHO Projects:
· Control of malnutrition and related diseases in under fives US$ 816,200
· Provision of safe water and proper sanitation US$ 455,800
Country - Malawi
Population at risk 3.2 millions
Total Appeal Figure 152,614,060US$ 144,341,111
Health, and nutrition & Watsan US$ 6,037,243
WHO Appeal US$ 2,931,1423
WHO Projects:
· To reduce malnutrition US$ 206,700
· Strengthening disease surveillance US$ 635,152
· Strengthening of cholera epidemic response US$ 605,366
· Reproductive health services US$ 442,263
· Improving response to disease outbreaks US$ 691,862
· Health coordination $US$ 349,800
Country - Zimbabwe
Population at risk 3 millions
Total Appeal Figure US$ 285,112,870
Health, nutrition & Watsan US$ 27,499,625
WHO Appeal US$ 13,208,395[*]
WHO Projects:
· Building health sector partnerships US$ 378,420
· Disease surveillance US$ 593,600
· Strengthening health service delivery US$ 21,200
· Procurement of drugs and supplies US$ 7,763 ,175
· Cholera epidemic response US$ 1,113,000 (UNICEF/WHO joint project)
· Malaria epidemic response US$ 1,855,000 (UNICEF/WHO joint project)
· Reducing maternal mortality US$ 1,484,000
Country - Zambia
Population at risk 2 millions including 400,000 children and 440,000 women
Total Appeal Figure US$ 71,443396,530209
Health and, nutrition & Watsan US$ 5,200,0004,235,000
WHO Appeal US$ 1,805,000
WHO Projects:
· Disease surveillance prevention and control
4- Extracts from country specific appeals: health situation analysis and who projects
Swaziland
Priorities
In this appeal, the most vulnerable and/or socially marginalized groups will be targeted. This population usually bear much of the disease burden in harsh conditions such as those associated with food shortages. They include people with less access to safe water and proper sanitation, pregnant women, children under five years of age, and people living with HIV/AIDS. In this context, priority interventions are: diarrheal diseases (cholera) / water and sanitation, reproductive health, EPI, and HIV/AIDS.
Objectives
To reduce the number of avoidable deaths and the suffering among the affected population through:
->® Cholera prevention and control