February 2020

This publication was produced at the request of the United States Agency for International Development. It was
prepared independently by Million S. Tadesse, Eshete Y. Tefera, and Addis K. Mulat.
PUBLIC HEALTH EMERGENCY
MANAGEMENT IN ETHIOPIA
FINAL REPORT

February 2020

USAID Contract No. 7200AA19M00019; Assignment Number: 011

DISCLAIMER

The authors’ views expressed in this publication do not necessarily reflect the views of the United States
Agency for International Development or the United States Government.
This document is available online at the GH-TAMS website at
http://www.ibtci.com/projects-app/global-health-technical-assistance-and-mission-support-project-gh-tam
s. Documents are also made available through the Development Experience Clearinghouse
(http://dec.usaid.gov). Additional information is available from:

Global Health Technical Assistance and Mission Support

1319 F Street NW, Suite 204
Washington, DC 20005
Phone: (1-202) 991-8300
Fax: (1-703) 749-0110
http://www.ibtci.com/projects-app/global-health-technical-ass
istance-and-mission-support-project-gh-tams
This document was submitted by GH-TAMS to the United States Agency for International
Development under USAID Contract No. 7200AA19M00019.
CONTENTS
ACRONYMS v
1. EXECUTIVE SUMMARY 1
2. BACKGROUND AND INTRODUCTION 2
BRIEF OVERVIEW OF PUBLIC HEALTH EMERGENCY MANAGEMENT (PHEM) IN ETHIOPIA 2
INTRODUCTION TO THE PHEM CENTER 2
3. ASSESSMENT PURPOSE AND OBJECTIVES 4
OBJECTIVES 4
4. METHODS 5
5. SUMMARY OF MAJOR CHALLENGES / ISSUES IDENTIFIED 6
6 RECOMMENDED INVESTMENT PRIORITIES FOR USAID’S CONSIDERATION 11
ANNEX I. ORGANIZATIONAL STRUCTURE OF EPHI/PHEM 17
ANNEX II. PHEM REGIONAL STRUCTURES 18
ANNEX III. KEY PHEM PARTNERS 19
A.General 19
B. Key PHEM Partners’ Programs 20
ANNEX IV. DATA COLLECTION TOOL 21
ANNEX V. LIST OF PERSONS INTERVIEWED 25
ACRONYMS
CERF Central Emergency Response Fund
CDCS Country Development Cooperation Strategy
DHIS2 District Health Information System 2
DO Development Objective
DRM Disaster Risk Management
ECHO European Commission for Humanitarian Operations
EHF Ethiopian Humanitarian Fund
ENCU Emergency Nutrition Coordination Unit
EOC Emergency Operation Center
EPHI Ethiopian Public Health Institute
EPRP Emergency Preparedness and Response
EPSA Ethiopian Pharmaceutical Supply Agency
EWARS Early Warning and Alert Response System
EWS Early Warning System
FMOH Federal Ministry of Health
GHSC-PSM USAID Global Health Supply Chain Program – Procurement and Supply Management
HSTP Health Sector Transformation Plan
IHR International Health Regulation
IP Implementing Partners
JEE Joint External Evaluation
NAPHS National Action Plan for Health Security
NDRMC National Disaster Risk Management Commission
OPM Oxford Policy Management
PHE Public health emergency
PHEM Public Health Emergency Management
RAPHS Regional action plan for health security
RHB Regional Health Bureau
UNICEF The United Nations Children's Fund
VRAM Vulnerability and Risk Assessment and Mapping
WBP Woreda Based Planning
1. EXECUTIVE SUMMARY

Public Health Emergency Management (PHEM) has begun receiving the growing attention it deserves,
with the overall PHEM system evolving, albeit slowly, to a stature where it can prevent, detect, and
respond to emergencies more effectively. Initiatives geared towards improving preparedness,
response, and recovery – targeting the major health disaster risks are underway with joint efforts by
the government and key stakeholders.

USAID/Ethiopia commissioned this assessment with the purpose of identifying the challenges facing
the system and the gaps that might require intervention. Principally, it seeks to identify key priorities
to strengthen the health system's resilience to maintain core functions during crisis and to explore
possibilities to enhance the nexus between PHEM and health development endeavors. It contributes
to development objectives one and four of the USAID/Ethiopia’s Country Development Cooperation
Strategy (CDCS).

The assessment reviews and analyzes current challenges for effective public health emergency
management in Ethiopia and presents ways to overcome them. It is a qualitative study based on a
review of relevant documents, key informant interviews (KII), focus group discussions, and field visits.
A one-day consultative workshop was conducted to fill in any additional issues not identified by the
data collection.

The major issues that surfaced include inadequate coordination mechanisms, ambiguous delineation
of roles and responsibilities, absence of a policy and legal framework, inefficient emergency
supply-chain management system, limited attention to preparedness, weak early warning/surveillance
system, poor governance and leadership, and lack of subject matter expertise on specific hazards.
Overall, the humanitarian community focuses almost entirely on response through longstanding
parallel systems undermining the leadership role of EPHI/PHEM, except for few partners that are
directly supporting and building the capacity of PHEM to prevent, detect, and respond to public health
emergencies.

Based on the major issues and challenges summarized above, the team has identified the following
priority intervention areas for the Mission’s consideration. The team has cautiously defined these
recommendations as gaps with utmost care to avoid potential overlaps with existing partners’
programs/activities, including those that are in the pipeline. The team has packaged the recommended
actionable items into the following three groups:

1) Gaps that can be addressed directly through a new investment/activity: These include: developing a
surge roster for human resources tracking, harnessing technology to enhance PHEM coordination
and timely response, woreda capacity building, institutionalization of post-response review, defining
minimum standards for preparedness at all levels of the health system, gender mainstreaming, and
initiating the culture of drills to improve preparedness and response.
2) Gaps that the Mission can consider addressing through existing USAID investments in health.
These include enhancing crisis modifiers, addressing bottlenecks in Public Health Emergency (PHE)
supply systems, domestic resource mobilization for PHEM.

3) Broader issues that USAID can and should contribute to as part of its engagement in the PHEM
landscape via the above two approaches as well as other in-house expertise in collaboration with
partners leading on specific areas of need. These include supporting the development of the PHEM
strategy and the legal framework mentioned above.

2. BACKGROUND AND INTRODUCTION

BRIEF OVERVIEW OF PUBLIC HEALTH EMERGENCY MANAGEMENT (PHEM) IN
ETHIOPIA

Despite decades of humanitarian, resilience-building, and development-oriented investments in health

and other sectors, Ethiopia still suffers from the impacts of recurrent natural and human-made
hazards. Ethiopia still grapples with the impact of several hazards with public health consequences on
its vulnerable populations. The country continues to spend billions of dollars of foreign aid on
humanitarian operations that have successfully averted excess mortality and human suffering.
Unfortunately, it continues to respond to those humanitarian needs with little progress, if any, toward
building a resilient system that can absorb shocks and mitigate their impact— putting development
gains at risk.

The National Disaster Risk Management Commission (NDRMC) is a central governance and
coordination structure that is mandated to coordinate multi-hazard, multi-sectoral disaster risk
preparedness, response, and recovery activities within the context of sustainable development. The
10-year strategic plan that the Commission launched in 2013 has “mainstreaming of disaster risk
management into the development plans and programs of all sectors and implemented at all levels”
as one of its strategic objectives.1

The national disaster risk management (DRM) strategy aspires to establish a comprehensive and
coordinated DRM system, an early warning and disaster assessment information to guide timely and
appropriate responses, and decentralized DRM, along with the mainstreaming into sectoral
institutions; it also seeks to establish a technology-supported DRM information management and
communication system, strengthened implementation capacity, and clearly defined guiding principles
outlining government leadership and utilization of domestic resources, among other things. The
DRM Council, a multi-sectoral body comprising the lead sectors, provides overall leadership, while a
DRM Coordination mechanism designates the respective sectors as leads for their sector-specific
hazards/disasters at all hierarchies of the government structure. The health sector is, thus,
represented by the PHEM Center at the Ethiopian Public Health Institute (EPHI).

INTRODUCTION TO THE PHEM CENTER

The health impacts of disease outbreaks, drought, conflict, floods, and other disasters have
demonstrated the need for strengthening the PHEM systems to better cope with these threats. The
threats are growing in frequency and severity, and so is the need for building resilient public health
systems to strengthen preparedness, response, and recovery. PHEM, as a growing public health field
of practice for effective management of complex health events, has been operational since 2009, first
as a case team, and now as a PHEM Center under the auspices of EPHI.

The Health Sector Transformation Plan (HSTP) identifies public health DRM as one of the primary
strategic objectives of the sector, affirming its commitment to risk assessment, early warning,
forecasting, and preparedness leading up to coordination of response and recovery. The HSTP strives
for a health system that can cope with existing and emerging disease epidemics, acute malnutrition,
and natural disasters of national and international concern.2 The EPHI strategy

1 The Federal Democratic Republic of Ethiopia, National Disaster Risk Management Commission. 2013. National Policy and
Strategy on Disaster Risk Management.

2 The Federal Democratic Republic of Ethiopia, Ministry of Health. HSTP Health Sector Transformation Plan, October 2015
document (2015/2016–2019-2020) also gives due emphasis to PHEM focusing on the full cycle of
DRM preparedness, response, and recovery. 3

Furthermore, EPHI/PHEM is accountable to the International Health Regulation (IHR 2005) that
provides an international legal framework that went into force in 2007 to ensure global public health
security. IHR, as a legally binding instrument, requires countries to implement and maintain the
capacities necessary for detecting and responding to public health threats, including reporting on
those that may constitute a potential public health emergency of international concern.4

In 2017, the IHR Committee conducted a Joint External Evaluation (JEE) on Ethiopia’s capacities to
detect, prevent, and respond to national, regional, and international public health risks, including
threats from infectious diseases, and chemical and radiological incidents. Based on the
recommendations of the JEE, EPHI developed a National Action Plan for Health Security (NAPHS).
NAPHS is a multi-sectoral, multi-year, country-owned planning process that guides evidence-based
priority actions to accelerate the implementation of IHR core capacities. Ethiopia launched its
NAPHS (2019–2023) earlier this year based on the results of the JEE. The plan identifies three
strategic pillars—i) preparedness and coordination, ii) detection capacity and communication, and iii)
response capacity—as its priority objectives to achieve the IHR core capacities.5

The PHEM Center plans to adopt and replicate the JEE to the regional PHEM structures, and it plans
to develop a regional action plan for health security (RAPHS) based on the results of the evaluation.
The RAPHS will, then, be used to tailor and streamline the Center’s capacity building activities.

Structural Arrangements

Housed at EPHI, the PHEM Center has structurally evolved and expanded through time to take its
current shape. It started with two case teams; currently, the Center has five directorates and 22 case
teams under them. (See Annex II for the organizational structure.) The sub-national level structures,
however, are still sub-optimal and vary significantly. Amhara replicates the national structure, with the
regional public health institutes hosting PHEM, while all other regions house PHEM within the
regional health bureaus. The Amhara Public Health Institute/PHEM appears to be the strongest,
well-organized, and well-staffed at regional, woreda, and health facility levels. Intra-regional
differences within Amhara, however, are not uncommon. In Somali Regional Health Bureau (RHB), on
the other hand, PHEM is a directorate with four sub-processes (case teams): Early Warning,
Preparedness and Capacity Building, Response and Recovery, and Emergency Nutrition, with nearly
30 technical staff in total. In general, there appears to be no standardized approach/structure to
organize PHEM at regional and sub-regional levels. Similarly, there are also no minimum structures
defined for health centers and general and tertiary care hospitals. Please refer to Annex II for an
overview of the regional PHEM structures.

The PHEM Center has Emergency Operation Center (EOC), a flexible arrangement for incident
management that gets activated (based on pre-defined threshold criteria) for coordination of
response, including logistics, resource, and information management. The PHEM Center activates an
EOC and assigns an Incident Manager for a confirmed public health emergency that meets the trigger
threshold of the particular hazard. Once activated, EOCs remain operational through the end of the
recovery operations and get de-activated when the situations stabilize. Regions have their own EOCs
that get activated to respond to emergencies within their capacity while liaising with the PHEM
Center for technical and financial support as appropriate.

3 Ethiopian Public Health Institute. The 2ndBSC Based Strategic Management Plan | 2015/2016-2019/2020.

4 https://www.afro.who.int/health-topics/international-health-regulations

5 The Federal Democratic Republic of Ethiopia. National Action Plan for Health Security | 2019-2023.
3. ASSESSMENT PURPOSE AND
OBJECTIVES
USAID/Ethiopia commissioned this assessment with an overall objective of identifying key strategic
and investment priorities for its Health Office to support the management of public health
emergencies. Notably, it seeks to identify key priorities to strengthen the health system's resilience
to maintain core functions during crisis and to ensure linkages with other development endeavors. In
so doing, the Country Development Cooperation Strategy (CDCS), the overall strategic framework
of USAID Ethiopia, guides the assignment. This assessment is expected to contribute to
Development Objectives (DOs) I, II, and IV. (DO1: Risks and impact of disasters reduced; DOII:
Resilience of vulnerable populations to key shocks increased; DOIV: Sustained improvement in
essential service delivery outcomes focused on women and girls.)6

OBJECTIVES

The specific focus of the assessment revolves around the following three broad areas: a) the
effectiveness of PHEM—preparedness, response, and recovery; b) landscape analysis of key
actors; and c) identifying priority areas for support.

Accordingly, it aims to understand the effectiveness of policies, strategies, and implementation

guidance on public health emergency (PHE) preparedness, mitigation, response, and recovery.
Specifically, it looks into the functionality, strengths, gaps, and programmatic challenges related to
Early Warning Systems/Early Warning and Alert Response Systems (EWS/EWARS); health
information systems; service delivery; risk communication; community health systems; and supply
chain management systems.

It also aims to understand who the major players are on the PHEM landscape in the country,
including a description of their strategic/operational focus and investment priorities. In so doing, it
tries to identify and highlight the gaps and critical areas for support on PHEM based on
USAID/Ethiopia Health Office's comparative advantage and linkages with current health
investments.
6 USAID Ethiopia, Ethiopia Strategic Results Framework Paper, 2019
4. METHODS
Qualitative: This assessment was principally qualitative with an element of quantitative study. The
qualitative study component consisted of a preliminary desk review of data sources relevant to PHE
and DRM, including a scoping review of the literature and published papers on the Ethiopian context.
It also included semi-structured key informant interviews and group consultations. We used
purposive sampling to obtain a breadth of views from various stakeholders involved in public health
DRM. The team developed a preliminary list of organizations and respondents as potential key
informants to interview based on their experience and current engagement in emergency
management in Ethiopia. Refer to the list of individuals and organizations consulted in Annex III.
Thirdly, it included site visits to learn from the field—to obtain their perspectives, experiences,
lessons, and challenges in PHEM to be able to see the whole picture.

Participants were contacted by e-mail and telephone with summary information on the objectives of
the assessment. Based on their consent, we set a mutually agreed date, time, and venue for the
consultations/interviews. Consent was obtained to record the discussions, which the assessment
team transcribed for subsequent use. The data was then analyzed using a data-driven inductive
approach of the thematic analysis framework to identify and further explore critical thematic areas.

Consultative workshop: with support from EPHI/PHEM, we conducted a one-day consultative

workshop that intended to deliberate on key issues surrounding public health emergencies in the
country. It was designed to complement the limitations associated with data collection described
below and to gather additional inputs on identifying the major challenges/issues, gaps, and possible
recommendations.

Limitations: Given its specific objectives and defined scope, this exercise does not delve into a
depth of literature review. However, it has covered the critical policy and program documents of the
government and those of the key partners supporting EPHI, such as CDC, WHO, and OPM. The list
of key informant interviews for this assessment could have been broader. We had to prioritize the
critical stakeholders and limit the list to stay within our timeframe. We did, however, try to
compensate through the consultative workshop described above.
5. SUMMARY OF MAJOR CHALLENGES /
ISSUES IDENTIFIED
5.1 Inadequate coordination mechanisms: A fundamental challenge highlighted by PHEM is
the prevailing confusion surrounding the coordination of public health DRM. As the
responsible government body mandated to lead and coordinate PHEs, the PHEM Center
should be in charge or at least aware of all existing platforms and their terms of reference.
Currently, that is not the case. Moreover, there is a limited engagement and access to these
coordination mechanisms. Thus, significant humanitarian community-led coordination
mechanisms are functioning parallel to Government systems. Left unchecked, such
fragmented and disconnected coordination mechanisms could ultimately undermine the
Government’s ownership and leadership role. It can also result in ineffective responses,
duplications, and an uneven distribution of resources in many instances.

5.2 Ambiguous delineation of roles and responsibilities: The discussion on who should
lead emergency nutrition has been around for more than a decade. There are still ambiguities
around roles and responsibilities that have resulted in duplication of efforts.
NDRMC/Emergency Nutrition Coordination Unit (ENCU), Federal Ministry of Health
(FMOH), and EPHI/PHEM Center all have teams working on emergency nutrition. ENCU
(funded by the United Nations Children's Fund [UNICEF]) and the PHEM Center are both
collecting surveillance data, and EPHI/PHEM Center is engaged in the development of an
emergency nutrition guideline, although there is one already in use (though it needs
updating). These ambiguities do have a negative implication on the emergency nutrition
landscape, are causing wastage of limited resources, and in the long run, can hamper the
growth of the system. Emergency nutrition must remain the responsibility and specialty of
one center for all technical, operational, and strategic undertakings involving the management
of acute malnutrition.

5.3 Absence of PHEM Policy and Legal Framework: There is an overarching national
DRM policy developed by NDRMC and a health policy that governs the health sector.
However, EPHI does not have a PHE policy that governs its strategies, resource
mobilization, and program operations. It assumes a mandate of multi-sectoral coordination
pre-, during, and post-emergency operations—without a legal framework that enforces
accountability with clearly defined roles and responsibilities of other sectors. It is done
based on goodwill and mutual understanding, which can falter under duress.

The need for a legal framework also extends to the Center’s interaction with the regions and
sub-regional structures. With the existing arrangement, the PHEM mechanism cannot
enforce the system for effective coordination of preparedness, response, and recovery.
Hence, the critical need for a PHE policy and a clear legal framework with accountability
mechanisms for effective country-wide and multi-sectoral engagement.
5.4 Inefficient PHE supply chain management systems: Public health disaster risk
management, particularly during response, is marred by an inefficient supply chain
management that necessitates a system overhaul.

The USAID Global Health Supply Chain Program-Procurement and Supply Management
(GHSC-PSM) has recently concluded a landscape assessment, including a simulation
 exercise of the emergency supply system. Some of the critical bottlenecks that surfaced
include:

5.4.1 The absence of policy guidance for a flexible system to facilitate emergency
procurement. Hence, emergency procurements must go through a lengthy
procedure meant for routine procurements. On the flip side, this is a reflection of
the weakness of planning and preparedness, which could have otherwise avoided
the need for emergency procurement.

5.4.2 Lack of budget of government source for emergency procurement, often leading
to complete dependence on development partners. Currently, all supplies needed
for emergency nutrition response and supplies for disease outbreaks go through a
parallel procurement via the United Nations and Implementing Partner (IP)
systems.

5.4.3 Lack of ownership and institutionalization of emergency procurement by the

Ethiopian Pharmaceutical Supply Agency (EPSA), which usually remains unengaged in
coordination platforms.

5.4.4 EPSA has limited logistic capacity for the distribution of supplies to remote areas.
During emergencies, IPs on the ground provide logistics support to distribute
supplies.

Given the preceding points, delays in supply are commonly one of the leading causes of
delayed response.

GHSC-PSM is working with EPSA to create an end-to-end supply chain with the
state-of-the-art management information system and overall systems strengthening to
improve the supply chain of emergency health commodities.

5.5 Limited attention to PHE preparedness: The Ethiopia PHE landscape appears to be
characterized by a systemic lack of preparedness. Emergency health resources are almost always
mobilized reactively when a health emergency is declared. The policy instruments and guidelines
emphasize a full-cycle approach (preparedness, response, and recovery) as their guiding
principle. However, those claims and strategies are not backed by resources for pre-disaster
activities. Public financing of emergency preparedness is usually at the low-to-none- at-all levels
of the system, including in areas known to have frequent health-related crises.

Lack of preparedness is affecting the effectiveness and quality of responses, and poor
preparedness compounds negatively on routine service delivery, contributing to the depletion of
resources for primary care. Recent experience of a health center in Tikil Dingai town in Lay
Armacheho woreda of Central Gondar Zone, Amhara region, where the health center used the
entirety of its revenue for the procurement of supplies for internally displaced persons, is an
excellent example of the consequences poor planning and preparedness have on routine service
delivery. The resulting delays in response also caused unnecessary human suffering. Woreda
 Health Office personnel claim that they usually prioritize PHEs and preparedness high during
Woreda Based Planning (WBP), an annual planning and budgeting exercise of the health sector,
but it gets de-prioritized during resource allocation because of various reasons.

On the other hand, the prevailing practice of repetitive short-term funding of humanitarian
donors to support the Community Management of Acute Malnutrition (CMAM) and other health
emergencies through IPs that often last three to six months, for example, does not seem to have
the desired impact on sustainability. Worse still, these short-term grants may even be harming the
system, causing attrition (since agencies usually recruit locally) and dependency as they usually
tend to be in “replacement mode” rather than assisting. The PHEM system and development
partners need to rally behind a strategic shift toward flexible longer-term health system
resilience-building approaches emphasizing preparedness.

5.6 Weak early warning/surveillance and health information systems: The lack of robust
surveillance and information management system has a significant impact on the effectiveness
of PHEM. With 23 immediately and weekly reportable diseases and events of national and
international public health concern, EPHI/PHEM Center has the ultimate responsibility to set
in place a robust EWARS that informs its preparedness and response action plans.

Currently, there are well over 22,000 health facilities engaged in surveillance through a
hierarchically aggregated data flow all the way up to the PHEM Center. With limited-to-no use
of technologies, this system is characterized by delays and worrisome quality issues, or lately,
improved timeliness against a deteriorating level of quality. Poor data analysis, interpretation,
and use, particularly at the regional and sub-regional levels, have been increasingly affecting
timeliness and effectiveness of the response. In the case of data on emergency nutrition, data
can be up to six weeks old by the time it reaches the Center.

Understanding of the concept of early warning as a tool for early action seems to be waning as
we go further down the hierarchy. Emergency nutrition information management still runs
parallel (and duplicated—reported both to the PHEM Center and ENCU) to the national health
information system, District Health Information System 2 (DHIS2). FMOH and UNICEF are
working on the missing emergency nutrition indicators in DHIS2. Once incorporated, DHIS2
relinquishes the need for the existing parallel and duplicate surveillance system.

Having a strong EWS is also a means to forecast and prepare for future emergencies. NDRMC
has an EWS that covers a wide range of data that could be of interest to the PHEM Center. The
Center, on the other hand, has Vulnerability and Risk Assessment and Mapping (VRAM) under its
Preparedness and Capacity Building Directorate. However, there is currently no mechanism to
link and triangulate the two data/early warning systems, which could benefit the PHE
preparedness, risk communication, and response operations.

In summary, weak EWS, poor data quality, lack of knowledge in data analysis and
interpretation, and limited availability of data are all contributing to delays and quality of
responses.
 5.7 Lack of disease and event-specific PHE professionals: Critical shortage of PHE
professionals is a significant constraint for the operations of the PHEM Center and regional
structures. The majority of the existing professionals are field epidemiologists who, as
generalists, do not necessarily have the depth of the knowledge base required for managing or
advising a specific disease or event of public health concern. Having a Human Resources mapping
and tracking system of available expertise in this regard would be an alternative solution for the
Center to fill its gaps. Currently, there is no such mechanism, and EPHI does not have a database
of any sort whatsoever. Existing tradition is to turn to partners for secondment, which, although
serving the immediate needs, does not contribute to long- term system building.

5.8 Poor governance and leadership: While political commitment and leadership is improving,
weaknesses remain at all levels, leaving emergency responses to the humanitarian community.
This pervading tendency of the government, particularly at the lower levels, of systematic
de-prioritizing of emergencies has the serious consequences of aggravating further donor
dependency. It also leads to missing the opportunity to gain efficiency by addressing systemic
issues – putting development gains at risk of being derailed during emergencies. Recent
initiatives of the government to take the lead on financing DRM, as stated in the most recent
Humanitarian Requirements Document, is encouraging, but it is yet to materialize.

In summary, the impact of health emergencies

on the health system, in general, and health
facilities, in particular, has universally been
detrimental. Health facilities and woreda
health offices that experienced public health
emergencies in all the regions visited had their
revenues depleted (and rarely replenished)
affecting health care financing, had their health
workforce deployed leaving primary care
services vacant, community-based health
insurance enrolments dwindling, and depletion
of their supplies affecting routine care. This
was evident in many instances of the woredas
visited where outbreaks weakening the basic care have increased vulnerabilities and exposed the
community to yet another outbreak or crisis. A typical example is a routine immunization program
compromised by emergency response increasing the vulnerability of the under-five population for
outbreaks such as measles. Addressing the major issues and factors identified through this assessment
could play an important role in improving the resilience of the health system in the face of crisis.
 6 RECOMMENDED INVESTMENT PRIORITIES
FOR USAID’S CONSIDERATION

Based on the major issues and challenges summarized above, the team has identified the following priority
intervention areas for the Mission’s consideration. The team has cautiously defined these recommendations as
gaps with utmost care to avoid potential overlaps with existing partners’ programs/activities, including those
that are in the pipeline. The team has packaged the recommended actionable items into the following three
groups: 1) Issues that can be addressed directly through a new investment case/Activity. 2) Issues that the
Mission can consider addressing through existing USAID investments in health. 3) Broader issues that USAID
can and should contribute to as part of its engagement in the PHEM landscape via the above two approaches
or directly via its in-house expertise.

6.1 ISSUES TO BE ADDRESSED THROUGH A NEW ACTIVITY

Below is an outline of important actionable items as our specific recommendations that the
Mission can potentially consider packaging into one activity.

6.1.1 Developing a Surge Roster: Human Resource (HR) is a critical element in any effective
emergency response, and ensuring surge capacity during crises that exceed the limits of the
available workforce is a critical measure to protect basic services from being compromised.
The PHEM system in Ethiopia needs to have a database of its trained personnel that it can
easily track and mobilize during crises. We recommend USAID support the development of
a surge roster with mapping of personnel that can be located, analyzed, and easily updated
in support of the PHEM Center’s effort to establish a pre-disaster HR preparedness system
for responding to potential health emergencies. When developed, this Roster will be
instrumental in mapping the human resources nationally, per region, per city, and expertise.
Further considerations can include making the envisaged Roster interactive allowing health
personnel to self-register and regularly update their availability/status.

6.1.2 Harnessing Technology/Social Media to enhance PHEM coordination: The PHEM

system in Ethiopia has already initiated the use of social media with varying degrees of
engagement at various levels of the government. Anecdotal reports from these experiences
in some areas such as Afar indicate better performance in woredas actively using the
existing telegram group that connects the PHEM Directorate with the 32 woredas in the
region. Success stories from SNNPRS, Halaba zone health department that has used its
 Facebook page for risk communication with the community for an impending flood hazard
are promising initiatives that, if supported, can be harnessed to strengthen emergency
coordination and risk communication at various levels. We recommend USAID’s
engagement in streamlining and strengthening the existing telegram platforms already
established in various parts of the country for effective coordination, reporting, and
information sharing between regional PHEM and sub-regional health offices as well as for
risk communication as appropriate. A potential investment could also consider expanding
on existing platforms for multi-sectoral coordination and coordination between neighboring
regional states.

6.1.3 Woreda capacity building: One of the critical observations of the assessment is the
need for capacity development of woreda health offices (WrHO) across all regions visited.
Transform PHC is playing an important role in creating local capacity to address health
emergencies in a broader sense. It is, however, not sufficient enough to meets the specific
needs of woredas for emergency preparedness. In light of this, investing in woreda capacity
to improve preparedness, response, and recovery with emphasis on surveillance, data
management, data utilization, leadership and management, gender-sensitive response and
recovery as well as on risk communication would contribute to the national effort of
ensuring a resilient health system. The overall objective would be to support the
strengthening of an emergency-ready sub-regional health system that is adaptable to the
changes in their external environment and responsive to the needs and priorities within
their context. USAID can consider implementing this activity in selected woredas affected
by recurrent outbreaks.

6.1.4 Promoting the institutionalization of post-response review: The PHEM system in

Ethiopia needs a rigorous and systematic evaluation of its operational functions
post-response to identify opportunities for improvement and further technical support.
Every outbreak response is a test of preceding preparedness and an opportunity to learn
from and improve in the event of subsequent outbreaks. A systematic approach with a
clearly defined learning framework can help maximize the learning from such an exercise.
USAID can consider supporting the development of a post-response audit/review guideline
to support regions and sub-regional structures to contribute to continuous improvement
and to guide technical support needs.

6.1.5 Need to define minimum standards for preparedness at all levels: The existing
policy instruments, including the NAPHS, emphasize the need to work on the entire
cycle of DRM with pre-, during, and post-disaster action plans. The reality on the ground,
 however, is different. The system still suffers from a lack of preparedness and
pre-positioning of needed supplies and budget— affecting the timeliness and quality of
response. EPRP, in the absence of financial commitments, remains a futile exercise.
As highlighted above, preparedness appears to stand out as one of the major issues calling
the attention of both the government and its partners. Although current actors are all
playing their part in improving preparedness at higher levels, defining a minimum package of
what entails preparedness at various levels of health facilities (HP, HC, primary hospital,
etc.) appears to be a gap the PHEM system has yet to address. USAID can play an
important role in supporting defining the minimum package of what constitutes a ‘well
prepared’ health facility and respective health offices in a given geographic area considering
their respective risk profiles.

6.1.6 Gender mainstreaming: Disasters affect women and children disproportionately with
increased risks of mortality, morbidity, sexual assault, and other forms of gender-based
violence. Reviews of the Guji-Gedeo crisis reveal that there were significant gaps in
ensuring the protection of women and girls from sexual and other forms of violence, and in
providing tailored services for victims. A USAID investment in PHEM could consider
building a core capacity on gender in emergencies. The key recommended focus area
includes incorporating gender mainstreaming in public health disaster risk management to
ensure gender-sensitive risk profiling, gender-sensitive response, as well as
gender-responsive recovery.

6.1.7 Initiate the culture of drills to improve preparedness and response – Simulation
exercise helps to improve readiness by identifying and addressing systemic issues and gaps
before an actual emergency occurs. It is a form of practice or evaluation of response
capabilities involving a hypothetical emergency, to which a hypothetical response is
simulated. According to WHO, simulation exercises play a key role in the validation of core
capacities and gaps in the development and implementation of preparedness and response
measures. USAID could consider and support regular drills, in collaboration with the
government and key stakeholders, to use as a continuous quality improvement tool to
enhance preparedness and to help develop individual capacities as well as to test functional
capabilities of PHEM systems and procedures to manage disaster risks.1

6.2 LEVERAGING EXISTING USAID INVESTMENTS

1
WHO Simulation Exercise Manual. Geneva: World Health Organization; 2017. License: CC BY-NCSA 3.0 IGO.
In addition to addressing the above priorities through direct investment, USAID can leverage its
existing investments in health and make significant contributions in the effort to strengthen public
health emergency management and enhance the nexus between health emergencies and
development.

6.2.1 Enhancing Crisis Modifiers: Humanitarian response in Ethiopia has become the norm
due to the protracted nature of emergencies. These responses, albeit essential, are often
ill-planned and delayed due to protracted short-term grant application and approval
processes. Increasing the practice of multi-year funding, with built-in crisis modifier systems
to allow partners to adapt to changing circumstances without undergoing time-consuming
formal applications for new grants, can bolster flexibility and speed. It is already noticeable
that crisis modifiers embedded in development programs show better timeliness of
responses and more accountability than entirely emergency-focused short-term granting
processes.

The rapid response fund and crisis modifiers instituted into existing USAID investments,
such as the Transform PHC program, are positively contributing to emergency response in
all the regions visited. As part of its overall support system, Transform PHC is also
contributing to preparedness mainly through its capacity building activities. Taking this
commitment a step further and incorporating risk-informed preparedness, including
through building the capacity of local governments to forecast and detect emergency risks,
can play a critical role both in protecting lives and the long term investments themselves.
Not supporting preparedness could be more costly as disasters could derail development
gains, affecting implementation, and jeopardizing on-going activities – as experience from
the Gedeo-Guji crisis revealed. USAID can, thus, consider enhancing its crisis modifier
funds with little or no additional investment by incorporating preparedness. While crisis
modifiers/rapid response funds have already proved beneficial, the inclusion of risk-informed
preparedness through innovative funding mechanisms – such as ‘top-ups’ to existing USAID
health development programs from humanitarian sources such as OFDA – would play a
significant role in strengthening the nexus between health development and emergency
investments. Overlaying emergency response funds on on-going development investments is
a missed opportunity that development partners could capitalize on and counter the
in-effective short-term emergency funding to new IPs. (See section 5.5)

6.2.2 Addressing bottlenecks in PHE supply systems: This is a work in progress. The
PSM landscape assessment, mentioned above, came up with three critical
recommendations based on a global framework for an effective end-to-end emergency
supply system. These are:
 a) Leadership and governance: addresses policy level issues related to
emergency procurement, budget allocations for preparedness
procurement, and higher-level coordination and political
commitment to make the system work.

b) Commodity planning: to maximize the benefits of quality and

quantity through planned procurement, and

c) Logistics, distribution, and waste management: 7 having identified the

issues and priority recommendations, along with a revised system to
address them, GHSC-PSM has submitted their document to the
respective government offices—EPSA and EPHI/PHEM Center—to
implement.

Given the limited capacity in these organizations, USAID can consider playing a role in
supporting the implementation of these recommendations.2

6.2.3 PHEM in DHIS2: Need to continue supporting the PHEM app in DHIS2. The
PHEM Center has managed to incorporate a separate PHEM application in DHIS2 to
address the existing inefficiencies in its surveillance system and in an attempt to
modernize reporting and data management. However, it is going to share the challenges
DHIS2 is facing, namely, poor IT infrastructure, poor internet connectivity, power
interruptions, and capacity issues, among others. Leveraging existing investments such as
the Data Use Partnership (DUP) and Digital Health Activity (DHA) that endeavor to
support the Information Revolution vision with a focus on cultivating an information
culture; digitalization and the scaling-up of priority Health Information Systems (HIS)
including information technology systems and data repository at all levels, and
strengthening HIS governance.

Nonetheless, supporting the system at large, or more specifically, the “PHEM app” and its
use, would go a long way in strengthening public health DRM. The PHEM system as a
whole would benefit from a systemic approach to capacity building in data management
and reporting. It could take the form of conventional training to data managers and clerks,
or instituting a continuous mentoring, coaching, and feedback mechanism through the
retention of qualified personnel in regional PHEM offices.

2
Ethiopia’s Emergency Supply Chain Management Landscape Assessment. EPHI-PHEM and EPSA, Addis Ababa. September 2019
 6.2.4 Minimizing the impact of health emergencies on health care financing: Despite
this critical and huge responsibility of EPHI, the domestic budget allocated to PHEM is
minimal. Such budget shortfalls constrain EPHI from meeting its own needs at the Center
and the needs /requests of the regional PHEM offices. The budget constraint can exacerbate
the prevailing parallel humanitarian financing system in the country. EPHI, with support
from DFID through OPM, is working on identifying mechanisms for mobilizing domestic
resources for health emergencies. The assessment team has observed that the negative
impact of recent emergencies on the achievements of health facility revenue and
community-based health insurance is significant. USAID needs to document, through its
health financing project, the impacts of emergencies on health financing and explore
remedial measures where appropriate. Furthermore, it would be critical to consider the
implementation of the health financing reforms in hot spot and drought-prone areas.

6.3 COLLABORATION WITH KEY STAKEHOLDERS

As a long-term strategic partner of the health sector, as well as its ensuing interest to engage in
the PHEM landscape, USAID can have significant contributions to the development of critical
policy documents that are being funded and supported by other partners.

6.3.1 Support the development of the PHEM strategy: High dependence on technical and
financial support based on cyclic short-term relief funding has been the defining feature of
public health DRM in Ethiopia. In light of the dwindling funding scenario for emergency
response, the need for increased political commitment and allocation of government
resources based on a robust strategy is indispensable. Recognizing the need to formulate a
comprehensive and costed national PHEM strategy, EPHI/PHEM has already embarked on
the development process of the strategy with support from the Oxford Policies
Management (OPM). By their very nature, such processes are widely consultative and do go
through a broader engagement and consultation with all key stakeholders, including the
regional governments. Given its extensive experience and engagement in the national
health policy landscape, USAID is best placed to engage and contribute in a meaningful
manner.

6.3.2 Support the development of a legal framework: The current working arrangement
based on individual and institutional goodwill is an apparent policy vacuum. EPHI needs
policy provisions and a legal framework that empowers the PHEM Center in its effort to
coordinate public health DRM with other sectors and the regional governments. The
current lack of legal provisions and laws concerning the PHEM system as a whole implies an
apparent lack of accountability at all levels.
RESOLVE, an in-coming partner of EPHI/PHEM, is pledging to lead the development of this
missing legal framework for PHEM’s multi-sectoral, cross-boundary, and private sector
engagement, as well as engagement with the regional governments. The process needs to
ensure that the resulting document has the buy-in of all key stakeholders and is substantive
enough to empower EPHI/PHEM to engage at all levels – vertically and horizontally. Given
the critical nature of this assignment, we recommend supporting EPHI, in collaboration with
RESOLVE, to add value to the development of a comprehensive framework.
ANNEX I. ORGANIZATIONAL STRUCTURE OF
EPHI/PHEM
 ANNEX II. PHEM REGIONAL STRUCTURES
REGION3 CURRENT STRUCTURE REMARK
Tigray • PHEM is placed within the Regional Health Bureau (RHB) – There is a Tigray Public Health
as a Case Team within the Disease Prevention and Health Institute (TPHI). TPHI has two staff
Promotion Core Process. working on PHEM – the interaction
• Has two teams (EW and Response, and Capacity Building) with the earlier one is not clear.
with 11 staff members total.
• Working to upgrade it to a Core Process on its own.
• WrHO: one dedicated focal person (PHEM Officer)
Afar • PHEM is placed within the RHB as a Directorate On process to establish a regional
• Has a total of 12 staff members public health institute
• Working to establish a public health institute.
• WrHO: No dedicated focal person
Amhara • PHEM is placed in Amhara Public Health Institute (APHI). APHI is serving as a model for the
APHI was established by proclamation and has direct budget other regions.Visited by Oromia,
support from the regional government as an independent SNNP, and Afar for experience
institution. sharing.
• Has four directorates: EW and Preparedness, Response and
Recovery, Malaria and other vector borne diseases, and
Capacity building.
• Has a total of 35 staff members
• WrHO: one PHEM Officer and separate malaria officer (total
two)
Oromia • PHEM is placed as a Directorate within the RHB. On process to establish a regional
• Working on establishing their version of Oromia Public public health institute
Health Institute (OPHI). PHEM will move to OPHI once
established.
• WrHO: one PHEM Officer
Somali • PHEM is placed as a Directorate (Core Process) within the
RHB. Has four case teams (sub-processes): EW,
Preparedness and capacity building, Response and Recovery,
and Nutrition case teams.
• Has a total of 30 staff members
• WrHO: No dedicated PHEM focal

3
Data covers regions visited only
SNNP • PHEM is placed as a Directorate within the RHB. On process to establish a regional
• It is being upgrade to an institute public health institute
• It has about eight staff and using interns to fill gaps.
• WrHO: one PHEM Officer

ANNEX III. KEY PHEM PARTNERS

A. General
The Ethiopia Humanitarian Fund (EHF) serves as the main source of funding for emergency health. Emergency
nutrition, on the other hand, is largely financed by bilateral donors such as USAID/OFDA and the European
Commission Humanitarian Office (ECHO). It is, however, difficult to draw a clear line as it is not uncommon
for EHF to finance emergency nutrition and the latter on emergency health. The EHF is a Humanitarian
Pooled Fund (HPF), established by the UN and managed by OCHA. It operates through cluster systems such
as the Health and Nutrition Clusters, among others. UNICEF coordinates the Nutrition Cluster and WHO
leads Health. It provides short term grants, usually lasting six months, to implementing partners during crisis.
PHEM’s engagement in this process is very minimal, if at all.

An examination of the composition of OFDA funding in 2018 demonstrates that health was a low priority,
receiving only 4 percent of its disbursement; while nutrition receives a higher proportion of the overall
funding, at 16 percent. Nearly a third of OFDA’s available funding in 2018 was pooled into EHF. OFDA’s
nutrition support goes mainly through WFP and UNICEF for the management of acute malnutrition, both
MAM and SAM activities and commodities.
Source of humanitarian funding in 2018, Nutrition and Health

Source: FTS, 2019.

B. Key PHEM Partners’ Programs

FUNDING IMPLEMENTI ACTIVITY DESCRIPTION REMARK
PARTNER NG PARTNER

CDC(US) EPHI (PHEM) • Lab capacity: on-going support to federal and regional laboratory
services
• Laboratory/microbial surveillance
• Health Emergency Workforce development: supports advanced
Field Epidemiology Training Program (FETP) – Mater’s level
training, and the frontline FETP – a three-month training for
woreda PHEM focal persons
DFID OPM • Development of PHEOC strategy and Resilient Health Systems New project started
(BRE Project) Framework and Strategy recently
• Develop business case for PHEOC and prepare annual EPRP
• Strengthen existing mechanisms for better alignment of external
resources; and explore disaster risk financing within the health
 financing strategy revision process Plans to engage
• Develop processes, structures and tools for EOCs mainly at federal
• Enhance capacity to maintain adequate and quality health care level
surge.
• WHO Leads the Health Emergency Cluster through allocating
WHO EPHI (PHEM) health emergency grants to implementing partners
• Supports early warning & surveillance
• Development of short-term field epidemiological training
• Other direct technical support such as staff secondment
• Containment of outbreaks: cholera, measles, polio, acute
malnutrition, dengue fever, meningococcal...
• Inputs for in-patient care of SAM
UNICEF NDRMC • UNICEF Leads the Emergency Nutrition Coordination Unit
(ENCU): allocating emergency nutrition grants to IPs secured
from EHF (OCHA), coordination of response, inputs for OTP
• Leads on nutrition surveys and rapid assessments
• Working on surveillance of acute malnutrition
• leads on hotspot woreda prioritization in support of
NDRMC/EW Directorate
• Develop, produce and disseminate job aids, treatment guidelines
and protocols, training manuals on SAM, MAM, IYCF in
UNICEF FMOH emergencies, etc. and overall guidance and support for
strengthening the capacity of HEP and community platforms on
Emergency response
• Enhance national capacity on vulnerability risk assessment,
mapping, and response to specific humanitarian events.
• Support building resilience in refugees and host communities in
five identified regions (BG, Gambella, Tigray, Afar and Somali)
USAID Pathfinder • Transform: PHC supports health emergencies through its Rapid
International Response Fund mechanism. Its overall technical support and
capacity strengthening work is contributing to emergency
preparedness

ANNEX IV. DATA COLLECTION TOOL

National and Regional level stakeholders

Semi-structured key-informant interview questions for government agencies

and other stakeholders at national/regional levels

Date of visit
1) Team Introduction

2) Introduction of the Objectives of the assignment

The overall objective of this exercise is to understand the major issues surrounding Public Health
Emergencies Management (PHEM) through the entire spectrum from preparedness to recovery, review
the landscape, and to identify any potential strategic and investment priorities for USAID’s support –
with particular emphasis on the nexus between emergencies and development programming.

3) Verbal Consent

This interview is not a test of your knowledge; it is a tool for learning more about your office’s current
activities that relate to PHEM. In particular, we would like to learn from the knowledge and experience
that you have gained through working in PHEM in the country. We will treat your answers with
confidentiality. The interview will take about 60 minutes, and you are free to opt-out at any time during
the interview. Please let us know when you are ready to proceed.

Name of the ministry, organization, department, or unit:

Respondents:

Name:

Position:

Mobile:

Name:

Position:

Mobile:
Section 1: PHEM Overview and Priorities

1.1 What do you see as the major PHEM issues in Ethiopia? [top level policy, strategy, systems,
and program issues – not specific hazards]
Section 2: PHEM policies and activities

2.1 What are the key policies, strategies, and action plans of importance to PHEM in the country?

(Ask to receive a copy of any policy documents not included in the desk review)

2.2 Do you feel that these identified policies, strategies, and action plans adequately address
the PHEM issues that you mentioned earlier? If no, what do you think is missing?

2.4 What specific PHEM related actions and/or interventions does your agency implement?

Section 3: Budget and Funding

3.1 Is PHEM included in your agency's annual budget? If yes:

3.1.1 If implementing agency, what are the sources of funding for PHEM activities
implemented by your agency?

Main donors to PHEM budget Remark / Types of activities

3.1.2 If a donor agency, who are the main recipients of your funds, and what kind of
PHEM programs or activities do you support?

Main recipients of funds for PHEM Types of activities funded

3.2 Do you feel that there is adequate funding available to tackle the PHEM challenges the
country is facing?

If no, which specific plans or ideas are under-funded?

Section 4: PHEM Coordination System

4.1 Are there any coordination mechanisms (e.g., committees, task force or technical
working groups) that address PHEM at the national level?

4.3 What do you see as the major strengths of the current system for coordinating PHEM activities in
the country?

4.4 What do you see as the major problems/challenges of the coordination of PHEM activities that
should be improved?

4.5 Does your agency also operate at regional and sub-regional levels? If yes, how do you coordinate
activities at regional/sub-regional levels?

4.6 Community health systems at woreda and kebele levels

Section 5: Human resources for PHEM

5.1 What’s the overall strategy for human resources for PHEM? Do current plans reflect
adequate preparedness for surge staff?

5.2 If PHEM services were to be scaled up in the event of a major crisis, what kind of capacities
would be required, and how could those capacities be deployed? [probe to maintain core functions
and attend to the emergency services]

5.3 Do you offer any pieces of training on PHEM? If yes, please provide details (topic, duration,
participants, training material) related to these training programs.

Section 6: PHEM information system

6.1 How does your agency collect and use data relevant to PHEM? Please give us an overview of the
public health emergency surveillance structures.

6.1.1 What types of information and data does your agency collect? PHEM indicators
collected and how often data are collected.

6.1.2 How does your agency use these data? How does the system ensure that the reporting
entities use these data?

6.1.3 Please describe your experience of the Early Warning System (EWS)/Early Warning and
Alert System (EWAS): quality of information generated, use for early action,
coordination, and information exchange with DRMC/MOH.

What’s working well, and what needs to be improved?

6.1.4 Please describe the level of integration and utilization of HIS and EWS information for
preparedness and response
6.2 Please describe the risk communication strategy and structure at the national/regional level in
the event of an emergency. [ Probe for main media outlets used, use of new technologies such
as social media]
 6.2.1 What is working well? Can you share key lessons from the recent crisis?

6.2.2 What’s not working well, and why? How would you improve it?

Section 7: Emergency supply chain management

7.1 Please describe the emergency Supply Chain Management system.

7.2 What’s not working well, and why? How would you improve it?

7. How do you evaluate the current emergency supply system and your recommendation?

Section 8: Concluding questions

8.1 In your opinion, what should this country’s top priority be to manage public health
emergencies effectively?

8.2 Any additional recommendations to improve the efficiency and effectiveness of emergency
responses?
ANNEX V. LIST OF PERSONS INTERVIEWED
S/N Name of Organization Role Email
Participant
1 Daniel Tadesse Global Health Supply Chain Country Director [email protected]
Program (GHSA-PSM) (CD)
2 Tesfaye Seifu “ D/CD [email protected]
3 Elias Geremew “ Learning and
Innovation Mgr
4 Edmealem Ejigu “ HSS Director [email protected]
5 Zelalem Save The Children Health & Nutrition [email protected]
Habtamu International (SCI) (H&N) Director
6 Miraf Solomon ‘’ H&N Specialist [email protected]
7 Adebabay Wale “ Technical Advisor- [email protected]
Newborn & Child
Health
8 Dr. Mengistu USAID Transform: PHC Chief of Party [email protected]
Asnake (COP)
9 Yared Abebe “ Senior Nutrition [email protected]
Advisor
10 Binnyam “ DCOP [email protected]
Fekadu
11 Dr.Yohannes World Vision Ethiopia Head of Health [email protected]
Chanyalew (WVE) Technical Program
12 Samuel Tilahun “ Head of Nutrition & [email protected]
Emergency Affair
Unit
13 Alemshet “ Health & Nutrition [email protected]
Aschalew Grant Projects
Manager
14 Derebe USAID Transform HDR M&E Director [email protected]
Tadesse
15 Murida Kemal “ Program Director [email protected]
15 Yared Abera “ Technical Director [email protected]
17 Koutrey Russow USAID Mission USAID DRM Team [email protected]
Leader
18 Dubale Admasu USAID Mission Resilience Advisor [email protected]
19 Cecile Basquin DRMC Emergency Nutrition Team Leader [email protected]
Coordination Unit (ENCU)
20 Dr. EPHI/PHEM Deputy Director [email protected]
Beyene General (DDG)
Moges
21 Dr. Kassaye OCHA Technical Advisor
22 Muhyedin Somali DPPB/ENCU Head of ENCU [email protected]
Ahmed
23 Abdulfeta Somali DPPB/ EWS Head of EWS
24 Abubakar Somali Regional Health PHEM Core [email protected]
S/N Name of Organization Role Email
Participant
Sh/Adem Bureau- Process Owner
25 Ahmed Ibrahim Somali region USAID T/HDR Manager [email protected]
Transform HDR-Jigjiga
26 Abdi Ali Horafedi Health Post Health Extension
Mohammed Worker (HEW)
27 Moumin Aweberre Health Center Medical Director muuminAhmed@[email protected]
Ahmed (HC)
28 Abdilali Yasin “ OPD [email protected]
29 Malar Ibrahim TogoChallee HC Medical Director [email protected]
Hassan
30 Abdirahman “ [email protected]
Hassen
31 Abdurahman Kologee IDP 2 Center Health Officer
Ali
32 Ahmed UNICEF-Amhara Region Head of Program [email protected]
Abdurahma
n
33 Worku Berhe “ M&E [email protected]
34 Selamawit “ WASH Specialist [email protected]
Zewdu
35 Alamerew Disaster Prevention & Food DRR Expert [email protected]
Minlaregeh Security Program
Coordination (DPFSPCO)
36 Amsalu Belay “ TSF Coordinator [email protected]
37 Birhanu Zewdu “ Early Warning [email protected]
monitoring
38 Ashenafi Amhara Public Health [email protected]
Ayalew Institute (APHI)
PHEM Director
39 Dr Sisay USAID Transform PHC Regional manager [email protected]
Mellese
40 Elalem Abera “ Nutrition Officer [email protected]
41 Getnet Nigatu Lay Armachiho Woreda Head [email protected]
Health Office
42 Aklew Alemye “ V/Head
43 Nega Adamtie T/PHC Gondar Coordinator [email protected]
44 Michael Negus Lay Armachiho Woreda Curative Case Team [email protected]
Health Office
 PART II
GH TAMS-International Business and Technical Assistance (IBTCI)
USAID sponsored Public Health Emergency Management (PHEM) Assessment
PHASE II
S/ Full Name Organizatio Role Email
N n
1 Dr Ayana OPM DFID HEALTH MANAGER [email protected]
Yeneabat
2 William OPM OPM Team Leader [email protected]
Grahaim
3 Haile Bekele International Senior Health Advisor hbekele@internationalmedicalcorps
Medical Corps .org
(IMC)
4 Abebe Alemu IMC Public Health aalemu@inernationalmedicalcorps.
Emergency Specialist org
5 Loko Abrham Ethiopia Director General [email protected]
Pharmaceutica
l Supply
Agency(EPSA)
6 Dr. Meseret Federal Maternal and Child [email protected]
Zelalem Ministry of Health and Nutrition
Health Department
(FMOH) (MCHND)
7 Tegbar Yigzaw JHPIEGO Deouty Chief of [email protected]
Party(DCOP)
8 Numery Mercy Corps Emergency Advisor [email protected]
Abdulhamid
9 Gemechu Oromiya PHEM Director [email protected]
Shume Regional
Health Bureau
(ORHB)
10 Ganta Gamea SNNPR Disaster Risk [email protected]
DRMB Management
Commissioner
11 Solomon USAID Coordinator
Berhane Transform
PHC-SNNPR
12 Tadele Kibrom SNNPR Emergency Nutrition [email protected]
DRMC ENCU Coordinator
13 Asnakech Adola SNNPR SNNPR ENCU [email protected]
DRMC ENCU Nutrition Expert
14 Endashaw SNNPR PHEM Program [email protected]
Shibru Health Bureau Officer
(RHB)
15 Aknaw Kawza SNNP Head
Regional
Health
16 Reita Aemero Save the FOM [email protected]
Children
17 Beyda Mudino SNNPR SNNPR Zone Health [email protected]
Halaba Zone Office; Deputy Head
HO
18 Dakela Darjeba SNNPR SNNPR Zone Health [email protected]
Halaba Zone Office-PHEM
HO Coordinator
19 Nuredin Nwiro Halaba Health SNNPR Head of
Center (HC) Halaba Health Center
(HC
20 Asefa Hafido “ SNNPR Halaba HC [email protected]
MCH Focal Person
21 Zehara Bedna Gedeba SNNPR Halaba Zone,
Health Post Gedeba Health Post
HEW
22 Selamawit Gedeba Halaba Zone, Gedeba
Health Post Health Post HEW
23 Aman Kedir Oromia egion Head, Siraro Woreda [email protected]
Siraro Woreda Health Office
Health Office
24 Ararso Hordofa Siraro Woreda Deputy Head, Siraro [email protected]
Health Office Woreda Health Office
25 Kemal Churiso TransformPH Program Officer [email protected]
C
26 Gemechu Haji TransformPH Program Officer [email protected]
C
27 Berhane Rope Senta Health Extension
Getachew Health Post Worker(HEW)
28 Gete Huffo Rope Senta Health Extension
Health Post Worker(HEW)
29 Tuke Gizaw Ropi Sraro PHCUD
Health Center
30 Aaddis SNNPR Head, DillaZuria
Andualem DillaZuria Woreda HO
Woreda HO
31 Seyoum Gelaple Chuchu Head, Chuchu Health [email protected]
Health Center Center
32 Anezier IOM Head of Dilla IOM Sub [email protected]
Ebrahim Office
33 Kedir Loale Afar Nutrition Specialist [email protected]
DPFSPCO
RENCU
34 Abdella Afar Region RMNCH Regional [email protected]
Mohammed USAID Adviser
Transform-PH
C
35 Anwar Abdu DPFSPCO ENCU IMO [email protected]
36 Mohammed DPFSPCO EWS Case team [email protected]
37 Mahie Ali DPFSPCO ENCU [email protected]
38 Hamedu RHB /AFPHI AFPHI [email protected]
Ahmed
40 Abdu Ali RHB/AFPHI AFPHI [email protected]
41 Dr Mohammed Dubti Hospital CEO [email protected]
Yuusif
42 Solomon Tadele Dubti Hospital PHEM [email protected]
43 Dr yayyib Abdu Dubti Hospital MD
44 Samuel Aregay Tigrai RHB PHEM Officer [email protected]
45 Gidey TRHB PHEM Coordinator [email protected]
G/Libanos
46 Dawit Mulu WHO Data Manager [email protected]
57 Ruth Transform CHD Officer [email protected]
Gebresellasie PHC, Tigray
58 Woldegerima PHEM Tigray PHEM Expert [email protected]
G.Mariam
59 Lijalem Kahsay DRMB EWS & Team Leader [email protected]
Emergency
Resp. Tigray
60 Mcibrahtiu Health PHEM Supervisor
Embakcrsu Center/Tigray
61 Kalseyu Meles Health Center Director
62 Medhin G/Huwt Freweni HP HEW
63 Anessa Meressa Frewni HP HEW
64 Awala Wquar Pathfinder Regional Manager [email protected]
T-PHC/Tigray
65 Mohammed Mekele PHEM AWD
Jemal Hospital Coordinator
69 Kathleen CDC-Ethiopia Program
 Gallagher Director/Global Health
Protection
70 Dr Berhanu CDC-Ethiopia Global Health
Amare Protection team
 For more information, please visit

http://www.ibtci.com/projects-app/global-health-t

echnical-assistance-and-mission-support-project-

gh-tams
 Global Health Technical Assistance and Mission Support
1319 F Street NW, Suite 204
Washington, DC 20005
Phone: (1-202) 991-8300
Fax: (1-703) 749-0110
http://www.ibtci.com/projects-app/global-health-technical-assistance-and-mission-support-project-gh-tams