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Reaching the most vulnerable during COVID-19

Fecha publicación: 21/12/2021

Lessons learnt from WASH First COVID-19 Response Project in Ethiopia

The WASH First COVID-19 Response Project is an intervention aimed at preventing and controlling the anticipated catastrophic effects of the pandemic. Funded by the Ministry of Foreign Affairs of The Government of the Netherlands (DGIS), this 14-month project has the goal of reaching half a million people in Shashamane and Negelle Arsi districts through increasing access to water supply, increasing awareness, prevention, and control of COVID-19, and increasing access to Infection Prevention and Control (IPC), Non-Food Items (NFI) and Personal Protective Equipment (PPE).

Located in the Lake Shala belt, characterised by acute shortages of drinking water for human and livestock consumption and food insecurity, Shashamane and Negelle Arsi districts are high-risk areas. Shashamane town is especially vulnerable as it is the epicentre of a local market ushering in thousands of people a day, a condition that favours the spread of COVID-19.

To realize its goals, the project has focused on increasing access to water supply at community and institutional settings (prioritizing quarantine and treatment centres), increasing awareness of COVID-19 prevention and control, and increasing access to IPC, NFI, and PPE including handwashing systems and waste bins in health care facilities and households in collaboration with private and public institutions. The most vulnerable groups were given special priorities during both the design and implementation phases of the project.

This blog focuses on distribution in both districts through direct field observation and interviews with beneficiaries, local government, and Amref field project staff.

IPC and PPE Institutional and Household Provision

The project provided PPE, NFI, and IPC for both institutions and community members in the intervention areas. So far, the project provided 34,000 PPE and NFI items for each intervention district, mainly focusing on the most susceptible households.

Apart from community level distribution, a total of 36,185 different types of PPE and IPC items were distributed to health and education offices in Negelle Arsi town. For the Shashamane districts, a total of 37,264 IPC and PPE were distributed to district health and education offices, with a separate 51,116 distributed to Shashamane town institutions including health, education, and prisons.

Process and learning from PPE Distribution to the Most Vulnerable Households

While the awareness creation activities targeted the entire community in the intervention districts, the NFI and PPE distribution was intended for the most susceptible target groups due to their ill medical condition, age, and poor socio-economic status. A total of 8,000 households were reached with the essential packages for prevention of COVID-19 in both intervention districts. The package for households included 10 laundry and body soaps, a bucket, five washable face masks, and a jerrican for drinking water storage.

IRC WASH attended the PPE distribution program in three rural kebeles and interviewed beneficiaries. The beneficiaries were happy with the level of concern that Amref showed in terms of protecting them from the pandemic. Some also expressed the need for food support considering their poor socioeconomic status and famine in the area because of delay the seasonal rain.

Coordination and Collaboration with Local Government: The screening of beneficiaries was conducted through collaboration and coordination with community leaders, the beneficiary screening committee, and partners from the Health and Disaster Risk Management Office (DRM). Health Extension Workers (HEWs) played a significant role in selecting the right beneficiaries as they are based at community level.

A community leader in Edo Jigessa Kebele interviewed at the time of PPE and NFI provision, confirmed that he and his team has been actively involved from the very beginning in the screening of the most vulnerable target group. He indicated they prioritized the most at risk, mainly focusing on households with people with disability, bed ridden members, or who are economically destitute, mainly focusing on women headed households and elderlies, especially those who have a comorbid condition.

Samuel Girma, the Area Manager for Amref Health Africa Shashamane field office, confirmed post screening verifications were conducted on a sample of randomly selected households to make sure that eligible households were targeted.

The distribution program was collaboratively organized by Amref and kebele administrations in the kebele administration compounds and attended by HEWs, DRM offices, District Finance Offices, Women and Children Affairs Offices, kebele leaders, and other admirative members.

Verification of Screened Households: To minimize screening of ineligible households or individuals, the Amref field team conducted a verification survey on randomly selected households in selected kebeles.

Alima is one of the selected beneficiaries who was interviewed during the PPE and NFI distributions. She is a mother of seven children and her husband is bedridden. He used to be a farmer and the breadwinner for the household. Out of the seven children, five died and she is currently living with the younger two. The survival of the family is challenged as she is not able to earn a living from daily labour due to low business activities caused by the COVID-19 pandemic and high inflation, reducing her purchasing power.

Other beneficiaries interviewed shared similar stories, but due to the small quota provided to the kebeles, there were eligible and susceptible households who were left out of the distribution. This resulted in grievances among some community members who were present during the PPE distribution. According to them, the quota given to their kebeles were negligible resulting in exclusion of the most deserving households.

Fatuma is a pregnant mother with two children. Her husband has been laid off from his daily labour due to slow business activity in the area related to COVID-19. She said, “I am expecting to give birth in the coming two to three weeks. I am worried because we do not have food. I do not have something to eat in our house to care for myself and my children. I came here assuming there is some food items provision.”

Geographic Equity: The distribution of PPE was made in prioritized kebeles in both intervention districts. The distribution was also made in proportion to the population size of each kebele. On average, 100 households were targeted in each kebele, and kebeles with higher populations were given higher proportions, the maximum being 150 households. According to the leader of Edo Tatessa Kebele, one of the most remote interventions kebeles, despite efforts to include the most vulnerable target group, there were grievances and complaints from most of the community members. He indicated that the area is arid and often food insecure due to recurrent drought. Children are exposed to malnutrition and were physically emaciated at the time of the field visit. A crowd of mothers with their children were in a long queue during the visit waiting for Plumpy’nut for their children. The majority of the households in the community were generally vulnerable, so prioritizing only 135 households was the most daunting task for the screening committee.

Mothers in line to receive plumpynut for their children

Mothers in a queue to receive Plumpy'nut for their children in Ido Tatessa Kebele

Essential Package of Services: Though not able to address all the needs of the beneficiaries, especially those in food insecure geographic areas, the project team has thoughtfully packaged the PPE and NFI to comprehensively address the households hygienic needs, providing households a range of PPE and NFI including washable face masks, laundry and body soaps, a transparent jerrican for drinking water storage, and also a bucket to help households store water for handwashing and other cleaning purposes.

Despite clear communication during the screening process on the objective of NFI and PPE distribution, the majority of the beneficiaries objected that food items were not part of the package, especially in areas where there is food insecurity and extended drought.

“Most of the people you see here are not able to meet their daily subsistence, let alone buy COVID-19 protective items. I want to have a face mask while going outside every time, but I must prioritize the purchase of other food items for my children. I do appreciate Amref provided reusable masks which we can wash and use for long time,” said a mother of five children in Jido Tatessa Kebele.

Another young mother in her early twenties appreciated the fact that packages were thoughtfully put together including a transparent and white jerrycan.

High level of sensitivity to gender equality and social inclusion: The screening process was thoughtful in terms of addressing gender equity and social inclusion. From the total list of 4,000 households in both districts, almost half of them (1,911) were females. The screening committee also gave high priority for the female headed households and households with people with disabilities. The majority of the beneficiaries during the PPE and NFI distribution were observed to be mothers and elderlies.

Post-Distribution Follow up: Following the distribution, the Amref Shashamane field office team has conducted a follow up assessment using a household survey, focus group discussion, and key informant interview methodology. The purpose of the assessment was to see the households’ COVID-19 prevention practices, utilisation of PPE provided to them, and their overall level of satisfaction or experience. Data was collected by the field office team and was under synthesis at the time of writing this blog. The result of the assessment will help to provide an insight on the selection and distribution process and also household’s attitude and practice towards COVID-19, mainly in relation to the provided PPE and NFI.

Way Forward

The provision of PPE and NFI, especially for institutions and households, is important in terms creating an enabling environment for community members to easily practice and adhere to COVID-19 prevention protocols. But other considerations need to be considered while doing so. These include the following: 

Demonstration of PPE Usage During Distribution: During the distribution of PPE and NFI in the 18 kebeles of Shashamane and Negele Arsi districts, the Amref team did provide a brief orientation on activities undertaken by Amref Health Africa and key messages on COVID-19 prevention. But, due to the tight travel schedules, there was no time to demonstrate to community members how to properly wash their hands with soap and how to use the reusable face mask, including frequency of washing and how to handle them within large households. The district partners reported demonstrating the items in some neighbourhoods where the number of beneficiaries were manageable to handle, but they were often overwhelmed during the distribution and unable to provide sufficient guidance.

Additionally, during the distribution almost all the community members were not wearing face masks and also not practicing social distancing which casts doubt on their proper utilisation the PPE items of provided to them.

Creating Mechanisms for Dealing with Community Grievances: Two major grievances were expressed and observed during the PPE and NFI distribution. One is related to quota given to each kebele as most of the interviewed households objected to the size of the screened households from the total population as inadequate. The second point for grievance was the lack of food items.

Rahamat expressed her grievances saying, “There is no way that these selected households are more deserving than me. I am pregnant and my husband is not working any longer. I beg you to let the government know that we are having hidden famine in this community. We have nothing to eat.”

Consider Project Design on Livelihood and Resilience: Despite budget limitations, emergency aid needs to build in elements, which support sustainable livelihoods and resilience. This means humanitarian relief organizations should collaborate with and seek support from development organizations with experience in strengthening resilient systems. 

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