In September 2016, Ethiopia’s Federal Ministry of Health (FMOH) began assessing the prevalence of neglected tropical diseases (NTDs) in all refugee camps in Gambella and Beneshangul-Gumuz regional states. According to United Nations High Commission on Refugees (UNHCR), the significant majority of refugees in Beneshangul-Gumuz and Gambella regions are from the Republic of South Sudan. Less than 2% in Beneshangul-Gumuz are from Burundi, the Democratic Republic of Congo, and Rwanda.
Recently, I spoke with two experts leading this effort, Biruck Kebede Negash, FMOH NTD team leader, and Scott McPherson, Chief of Party for the USAID-supported ENVISION Project, led by RTI International. We discussed health delivery structures in the camps, coordinated mapping, and Ethiopia’s efforts to ensure equitable and quality health services.
Biruck will be presenting on NTD mapping in Ethiopia’s refugee camps during the Terrorism, Conflict, Epidemics and Acts of God: The Impact of the Unpredictable on NTD Programs symposium – November 14 from 4 - 5:45 PM.
Q. Can you give us a picture of the refugee camps in Gambella and Beneshangul-Gumuz?
Scott: I was struck by the variation between camps. The camps in Beneshangul-Gumuz are more settled, less transient, and some have been in place for more than 10 years. In some cases, it was difficult to tell them apart from any other community. Other camps, particularly those in Gambella, were created within the last two years and are facing a large influx of new arrivals, while transitioning from tents to more permanent housing. Having lived in South Sudan for a number of years, some communities were so similar to the communities where I worked back then that I felt nostalgic.
Biruck: I was surprised to find that the camps are very well-organized with camp health leaders, zonal health leaders, block leaders, and community health workers. In many ways, it is a copy of the Ethiopian health extension worker program. I recognize the amazing work that the Administration for Refugee and Returnee Affairs (ARRA) and UNHCR have done in accomplishing this, and I’m proud of the health access provided to our refugee guests. This has also made the entire NTD mapping process easier.
Q. How will addressing refugee health support Ethiopia’s plans to reach global 2020 goals for NTD control and elimination?
Biruck: During the recent review of Ethiopia’s Health Sector Development Plan in 2014, one of the biggest challenges identified was that the health sector was not reaching all communities even though a nationwide health extension program was being implemented. One of these unreached communities identified was the growing refugee camps along Ethiopia’s borders. During development of the Health Sector Transformation Plan (2015-2020), one of the four transformation agendas was ensuring equitable and quality services to ALL population groups.
This includes NTDs. I want to address any population that may be affected by NTDs with a holistic and integrated approach.
Scott: Aside from the question of equity and fairness, which we agree is incredibly important, there is also the epidemiological imperative to ensure that transmission of NTDs are controlled or eliminated among populations at risk. Otherwise, achieving 2020 elimination goals will be impossible.
Q. Though the mapping process has been completed, and the results are still being analyzed – but what do you expect to find?
Biruck: Our general impression is that border areas along Ethiopia, South Sudan, and Sudan will have the same endemicity on both sides given porous borders, similar ecological factors, same ethnic groups, etc. Some countries, such as South Sudan, have incomplete NTD mapping data. However, the areas that have been mapped, particularly within states bordering Ethiopia, suggest NTD disease transmission on some level. Unfortunately, treatment data of these populations is difficult to verify especially when populations from several different locations from a neighboring country intermingle.
Scott: We are also working together with ARRA and UNHCR to compare data, which we hope will give us a strong idea of how long mapping participants have been in the camps and where their general point of origin was. When compiled, we hope this will provide insight into the NTD landscape within the origin communities of the participants.
Q. What have you learned thus far from mapping efforts in refugee camps?
Biruck: Coordinated mapping is a good approach for refugee camps since the communities are well-organized and tightly-structured. Coordinated mapping teams can move easily from cluster to cluster and have logistic support nearby. For communities outside of the camps, however, the logistical and organizational requirements of coordinated teams might outweigh the benefits. Therefore, coordinated mapping within other communities of Ethiopia, at least for the simultaneous mapping of all five NTDs at once, may not be feasible or advisable.
Q. In 2015, 65.3 million individuals were forcibly displaced worldwide as a result of persecution, conflict, generalized violence, or human rights violations – a record high number. Many national health programs are faced with challenges brought about by mass displacement. What lessons from Ethiopia can you share?
Biruck: The global community needs to be as open and welcoming to refugees as Ethiopia. It is only by welcoming refugees as our guests that we can build the trust necessary to understand and address diseases that are a threat to everyone and which will not respect borders.
Biruck Kebede Negash is the current FMOH NTD team leader. He received his Bachelor of Science in Public Health from Jimma University in 2008 and was awarded an Irish Aid scholarship for a Masters in International Public Health at the University College Dublin (UCD). Biruck previously served the FMOH as a coordinator for the National Tuberculosis Prevention and Control Program, and spent one year in the Somali region leading an FMOH health system strengthening team.
Scott McPherson is the current Chief of Party for RTI’s NTD programs in Ethiopia. He received his Masters in Public Health from Johns Hopkins Bloomberg School of Public Health and is currently a PhD candidate at the London School of Hygiene and Tropical Medicine. Before joining RTI, Scott lived in South Sudan for three years as a technical advisor for the Guinea Worm eradication and trachoma control programs of The Carter Center.