The outbreak of COVID-19was first reported in December of 2019 in Wuhan in China mainland. The COVID-19 is a contagious disease carried by a virus that immediately infected thousands of people of the globe. The World Health Organization (WHO) considered and recognized this disease as a pandemic on 11 March 2020. The World Health Organization ( WHO) and the Centre for Disease Control (CDC)declared the virus is transmitted by close contact and by small droplets produced during sneezing, coughing even talking. People may also be affected by this virus by touching a contaminated surface and then without washing their hand touching their face. Therefore WHO recommended some preventive measurestaken to suppress the spread of the pandemicwhich includes washing handthrough water and soap often for at-least 20 seconds, avoiding touching the eyes, mouths or nosewith unwashed hands, practicing good respiratory hygiene, staying at home, avoiding crowdedplace, maintaining social distance, covering ones mouth when coughing and sneezing, self-isolated himself if someone suspected himself that he might be affected.

 

COMPLETION REPORT FOR EMERGECNY WASH COVID-19 RESPONSE PROJECT IN AWDAL REGION SOMALILAND

 

 

COMPLETION REPORT FOR EMERGECNY WASH COVID-19 RESPONSE PROJECT IN AWDAL REGION SOMALILAND

 

PROJECT TITLE	EMERGECNY WASH COVID-19 RESPONSE PROJECT IN AWDAL REGION SOMALILAND
FUNDED AGENCY	UNICEF WASH SECTION SOMALILAND OFFICE
MANAGED LINE MINISTRY	MINISTRY OF WATER RESOURCE DEVELOPMENT SOMALILAND
IMPLEMENTED ORGANIZATON	AFRICA YOUTH DEVELOPMENT ASSOCIATION (AYODA)
PROJECT LOCATIONS	15 HEALTH FACILITIES IN 15 TOWNS AND VILLAGES IN AWDAL REGION
PROJECT OUTPUTS	Output 1: Conduct rapid assessment in health facilities & PoE to establish current situation of prevention and WASH requirements. Output 2: Environmental sanitation and waste management. Output 3: Provision of WASH facilities and services in health facilities. Output 4: Training of health staff on hand hygiene, water safety, disinfection and waste disposal protocols and guidelines.
PROJECT PERIOD	FROM 31ST MAY—31ST DECEMBER 2020

1. Introduction.

 

The outbreak of COVID-19was first reported in December of 2019 in Wuhan in China mainland. The COVID-19 is a contagious disease carried by a virus that immediately infected thousands of people of the globe. The World Health Organization (WHO) considered and recognized this disease as a pandemic on 11 March 2020. The World Health Organization ( WHO) and the Centre for Disease Control (CDC)declared the virus is transmitted by close contact and by small droplets produced during sneezing, coughing even talking. People may also be affected by this virus by touching a contaminated surface and then without washing their hand touching their face. Therefore WHO recommended some preventive measurestaken to suppress the spread of the pandemicwhich includes washing handthrough water and soap often for at-least 20 seconds, avoiding touching the eyes, mouths or nosewith unwashed hands, practicing good respiratory hygiene, staying at home, avoiding crowdedplace, maintaining social distance, covering ones mouth when coughing and sneezing, self-isolated himself if someone suspected himself that he might be affected.

 

On March 31 2019, a Coronavirus or COVID-19 Pandemic first two cases confirmed in Somaliland by announcement of the Ministry of Health Development, these two people were among the three suspects who were quarantined by Ministry of Health and had their DNA sent Kenya for testing. As of this writing, the number of detected cases in Somaliland is more than 500 positive cases,26 have died and 84 have recovered after treatment.The Somaliland government has implemented a partial lockdown that largely affects only public offices, including schools and universities.

 

 

Somaliland government collaborating with UN agencies, INGOs and LNGOs has developed

National COVID-19 preparedness and response plan in April 2020. The National Plan was developed following a thorough needs assessment of Somaliland’s current national capacities and in alignment with WHOs' Strategic Preparedness and Response Plan guidelines. It is built on risk assessment findings, known epidemiological information and control measures in addition to the existing capacities for epidemic preparedness and response in Somaliland. The National Plan has been developed to cover a period of nine (9) months, beginning March 2020. It will be reviewed in the course of implementation depending on how COVID-19 evolves globally, regionally and locally in Somaliland.

The goal of the National Plan is to prevent, rapidly detect and effectively respond to COVID-19

Outbreak to reduce morbidity and mortality in the country. The National Plan covers the following key intervention areas with some elements of each area considered as high priority.

 National level coordination, planning & operations

 Risk communications and community engagement

 Surveillance, Rapid Response Teams & Case Investigation

 Points of entry

 National Laboratory for quality and timely diagnostic services

 Case management

 Infection prevention and control

 Logistics and supply management

 Psychosocial support

 

Therefore, UNICEF as a one of the leading UN agencies has been working in Somaliland since 1991 and before that time has responded immediately and took several key above intervention areas including COVID-19 infection prevention and control project in partnership with Ministry of Water Resource Development (MoWRD) and Africa Youth Development Association (AYODA). AYODA cooperating with UNICEF and MoWRD has implemented this project effectively in 15 health facilities in Awdal region from 31^stMay---31^st December 2020, as detailed in this completion report.

2. Executive Summary

The emergency water, sanitation and hygiene named WASH response for COVID-19 project funded by UNICEF, managed & monitored by Somaliland ministry of water resource development (MoWRD) and implemented by Africa Youth Development Association (AYODA) in 15 health facilities in Awdal region, the project consists of four outputs with seven activities, two outputs were under first original project agreement while the other two outputs were developed after successful implementation of those outputs. The first outputs that we implanted in June and July 2020 were- Output 1: Conduct rapid assessment in health facilities and PoE to establish current situation of prevention and WASH requirements which we carried out in June 2020, and Output 4: Training of health staff on hand hygiene, water safety, disinfection and waste disposal protocols and guidelines training that we implemented in July 2020.

While the other two project outputs with five activities that AYODA has implemented during the project period were in the first project amendment which were Output 2: Environmental sanitation and waste management and Output 3: Provision of WASH facilities and services in health facilities. We singed on 30^th July 2020, first amendment of the project and it was planned to start the implementation of the activities under output 2 and output 3 in August 2020, as soon as we receive the project fund and end on September 2020. However, there was fund delay and we received the fund on 11^th September 2020, but we commenced the implementation of the project on 1^stSeptember 2020 and planned to complete the project activities with two months from that date, but due to several reasons including rough roads, less number of experienced manpower for the constructions of incinerators and far distances of targeted health facilities in Awdal region, we completed the project activities on 30^th November 2020. Although the actual project fund is based in two months and fixed on some project activities such provision of water through tracking in 15 health facilities responding to COVID-19 patients, but some of the construction and rehabilitation activities were continued up to end of that month.

3-Implemented project activities per output were as follows:

Output 1: Conduct rapid assessment in health facilities & PoE to establish current situation of prevention and WASH requirements.

Output 2: Environmental sanitation and waste management

2.1- Support solid waste management in 15 health facilities-provision of segregated waste collection/storage bins (coloured differently in 3 red, black, and yellow)

2.2- Support solid waste management in 13 health facilities-construction of incinerators

Output 3: Provision of WASH facilities and services in health facilities

3.1- Construction of 22 new twin latrines in 11 health facilities

3.2- Rehabilitation of 18 existing poor latrines in 6 health facilities

3.3- Provision of water through trucking in 7 health facilities responding to COVID-19 Patients (10 barrels per day for 2 months)

Output 4: Training of health staff on hand hygiene, water safety, disinfection and waste disposal protocols and guidelines.

Based on above project outputs and activities AYODA entered project implementation agreement with Somaliland Ministry of Water Resource Development (MoWRD) on 31^stMay 2020 which is valid from that date to 31^st December 2020. AYODA project staff has planned, managed and implemented all project activities effectively. The first two project outputs for conducted rapid assessment of health facilities and trained health staff were implemented from June to July 2020 by AYODA staff. After successful completion of those outputs the first project amendment consist of output 2 and output 3 was developed and signed it on 31^st July 2020. Due to fund delay we started the implementation of activities under those two outputs from 1^st September –30^thNovember 2020. As detailed below completion report.

 

4-IMPLEMENTED PROJECT ACTIVITES UNDER OUTPUT 2 AND OUTPUT 3

Output 2: Environmental sanitation and waste management

4.1-Constructed 13 Incinerators for 13 health facilities in Awdal region

Based on the outcome of rapid needs assessment conducted in June by AYODA team at targeted 15 health facilities in Awdal region, after several discussions and deep analysis for identified needs of health facilities with UNICEF Wash section officers and AYODA Ed, PM and project staff finally they agreed that 13 health facilities need to construct standardized incinerators, to manage solid wastes of those HFs. AYODA sanitation engineers received stander design with bill of quantities of incinerator from Mohamed Aamin UNICEF Wash officer, our engineers understood it very carefully and applied the construction of incinerators by mobilizing required construction materials engaged local experienced masonries and distributed bids or quotations to them then construction of incinerators continued from 15 September till 25 November 2020. In Borama district 4 new incinerators were constructed in Borama Hospital, Qorgab HF in Borama town, Qunjet village HF & Boon village HF respectively. In Zeila district 5 new incinerators were constructed one per health facility, Zeila hospital, Zeila town HF, Lawyacado HF, Abdulqadir village HF and Xarirad village HF. In Lughay district 3 new incinerators were constructed Lughaya town HF, Garbodadar village HF and Karure HF while in Baki district 1 new incinerator was constructed in Ruqi village health 

facility.

 

Karure HF new incinerator                                         Borama Hospital new incinerator

As shown above pictures those type of new incinerators comprises two story champers or rooms it has fire placewhich all harmful used materials from HFs are burned, this room is located upper part of the incinerator. The new incinerators have also disposal room which is which is the basic floor that burned material is kept temporarily before they are taken to public disposal site of the town. This incinerator also has exit smoke tunnel which is made of GI pipe 2.30 meter tall installed on the top of the incinerator, in order to drive out smoke from burned material to reduce pollution and maintain ventilated environment around HFs. In addition to that there are two small opposite air path on the walls of the second floor intended getting enough airs during burning process for increasing flames and heat. At the moment health workers in those 13 HFs started utilizing constructed new incinerators effectively by managing solid wastes from their health facilities, solid wastes scattered and improperly managed before that might cause health problems to both health workers and people benefiting HFs are now managed properly with best practices of solid waste management protocols and guidelines trained in the beginning of the project implementation period. Furthermore, AYODA senior managers appreciated very useful, durable and touchable incinerators and other project components constructed by AYODA project staff cooperated with UNICEF WASH section officers and MoWRD relevant authorities and contributed the feasibility for the constructed different project components and requested UNICEF WASH section officers to send official logos of project donor so as to pint those completed items.

 

 

 

 

4.2-Supported solid waste management in 15 health facilities-provision of segregated waste collection/storage bins (colored differently in 3 red, black, and yellow).

In October 2020, AYODA project staff has started assessing and purchasing 54 waste collection/storage bins, distributed quotations to various local suppliers who sell garbage storage bins in Borama town, but unfortunately they did not find the needed type of waste collection storage bins in Borama. So they searched other suppliers in Hargeisa city. They got Gamur Factory/company only which is the only company produces required waste collection bins and can supply provision of segregated collection storage bins that colored with 3 deferent and have 100 Liter Capacity, convenience wheels and be opened by automatic leg pressing lever. Therefore due to the project requirement of support Solid waste management in 15 Health Facilities we decided to order 54 pieces of above garbage materials from Gamuur Factory in Hargeisa which became single sourcing suppliers that we got. After the supplier completed bins we began to distribute all 54 bins for their allocated health facilities according to the plan each we provided 3 pieces of different colored for each 14 health facility 14 x 3 = 42 and Borama regional hospital was given 12 storage bins due to the its huge garbage production. In addition to comply with AYODA’s procurement procedure/policy declaring to provide bids/quotations to three or more companies to compete the bid, but in case of circumstances for single sourcing AYODA project staff requested note for record from MoWRD concerned officers to attaché financial report of this item procured and distributed 54 waste collection/storage bins to targeted 15 health facilities in Awdal region.

 

Purchased and distributed 54 segregated waste collection storage/bins

 

 

 

 

 

 

Output 3: Provision of WASH Facilities and Services in Health Facilities

4.3-Constructed 22 new twin latrines in 11 health facilities in 11 targeted villages in Awdal region

AYODA project staff in collaboration with UNICEF Wash officers and Ministry of Water Resource Development regional and national authorities has understood provided designs and bill of quantities for the construction of planned 22 twin latrines of 11 health facilities in Awdal region. After that our project staff has mobilized required construction materials and local manpower in targeted project sites, they started constructions of twin latrines on 17^th September 2020. That continued parallel in all 11 health facilities in the region which are:- Idhanka HF, Qorgab HF and Boon HF in Borama district. Harrirad HF, Abdulkadir HF and Lowya”ado HF in Zeila district. Garbodadar HF, Gargara HF, Lughaya HF and Karure HF in Lughaya district. While in Baki district was Ruqi HF. The construction of 20 twin latrines were completed on 25^th October 2020 for 10 above health facilities except the construction of Gargara HF twin latrine that has disturbed it’s completion by overwhelmed water from the bottom of the dug and very hard rock which our staff and local laborers has struggled to come across but after several discussions and consultations with Lughaya Mayor, health facility team leader and village community committees it was finally agreed to select new site near the HF where dug the twin latrine hole and completing its construction on 20^th December 2020.

In a line with provided and applied twin latrines design, AYODA has constructed suitable and comfortable latrines with hand washing facility for people benefiting above health facilities in Awdal region. The constructed twin latrines consist of 6m2 dug latrine hole outside, two small rooms tiled floor with sitting places, divided wall, metal doors and 28 gauge iron sheets, outside yard fence disposal thrush hole which connects removal plastic pipe, in addition constructed twin latrines has small veranda wall separate it for male and female latrines this indication of male and female usage of the latrines is encouraging females to use the constructed latrines without any shy or fear. Also trained health workers were urged to add their daily community health awareness raising the importance of using constructed latrines and hand washing regularly at health facilities and their homes.

In fact, population catchment for targeted 11 health facilities mainly, those completed 10 HFs has already started using and benefiting constructed twin latrines with hand washing facilities respectively, that playing significant role for improving hygiene promotion of people and contributing prevention and control of COVID-19 pandemic of Awdal region.

 

Constructed new twin latrines Constructed new twin latrines

 

4.4-Rehabilitated of 18 existing poor latrines in 6 health facilities in Awdal region.

Based on initial rapid needs assessment findings conducted in June 2020, there were 18 existing poor latrines in 6 health facilities in Awdal region including 8 latrines in Borama general hospital which needed complete rehabilitations. As a result of that AYODA project staff mobilized required rehabilitation materials and available employees/laborers for targeted HFs. They started rehabilitation of those latrines on 17^thSeptember 2020, and continued parallel work up to on 2^nd October 2020. The rehabilitated latrines are 8 latrines in Borama regional hospital that covering urgent needs of the patients in two different sections of the hospital four of those near male wards while the other four are in front of pediatric ward. The other rehabilitated 10 latrines are Zeila HFs 3, Zeila hospital 2, Lowyacado HF 1, Quljet HF 2 and Idhanka HF 2 latrines respectively.

During rehabilitation activities of these poor latrines, AYODA project engineers were observing and monitored daily how each mason covers the assigned tasks? For instance latrines were badly damaged by excessive uses and careless behavior of the patients, most of them had no doors at all, their walls and roofs were destroyed, therefore we had installed new metal doors and covered new iron sheet in their roof as well as we fixed all other damages. We also demolished previous scratched plastering of the walls of latrines, then walls were fixed with new sand and cement mix, after that crew workers removed all previous cracked floors of the latrines and pasted new plaster and laid tiles at the finishing. In addition repaired latrines had no functioning water pipeline and electricity. Therefore we installed and set up both new electricity and pipe line water systems to all repaired latrines into the 18 latrines.

At the present time all rehabilitated latrines are functioning effectively and people benefiting above health facilities, male patients and parents and care givers of children in the pediatric ward are using properly. Furthermore, we discussed and agreed with Doctors and Nurses working in those two sections in Borama general hospital to give continues awareness raising to patients and their families to keep proper usage of rehabilitated latrines in the hospital and maintain them effectively.

Rehabilitated latrines in Borama regional hospital

 

4.5- Provision of water through trucking in 7 health facilities responding to COVID-19 Patients (10 barrels per day for 2 months)

From 1^st September to 31^stOctober 2020, AYODA project staff has provided water through trucking in 7 health facilities responding to COVID-19 patients (10 barrels per day for 2 months) in Harrirad HF, Zeila HF, Zeila hospital and Lowya”ado HF in Zeila district. Qunjet HF, Boon HF and Idhanka HF in Borama district. As identified in the initial rapid needs assessment those health facilities has been facing water scarcity during COVID-19 outbreak when both health workers and people connecting HFs need urgent water trucking. So under this emergency wash COVID-19 response project was incorporated this intervention, every health facility received 300 barrel of water per month which is equivalent to 60 M^{3 per} month and within the project period we provided each HFs 120 M³ in two months. Provision of water through trucking to those health facility has contributed useful role in prevention and control of COVID-19 by utilizing provided water properly in drinking, hand washing and personal hygiene.

On the other hand during the project period our project staff advocated communities and local authorities to repair and re-connect water supply systems to those health facilities, fortunately community committees and local authorities succeeded to repair and connect water supply six health facilities of above detailed except Idhanka Health facility.

 

 

 

 

 

 

 

 

 

5-Total Number of Population Catchment Reached and Benefiting WASH COVID-19 Response Project Implemented by AYODA Organization in 15 Health Facilities of Awdal region Somaliland

No	Location/Health Facility	Male	Female	Total Population
1	Borama Regional Hospital	3,22848.625	3,91414.375	714,263
2	Qoorgaab HF	30000	36000	66000
3	Idhanka HF	32098	42098	74,196
4	Qunjeet HF	23,295	31,295	54,590
5	Boon HF	20,000	27000	47,000
6	Ruqi HF	10378	11622	22,000
7	Garbodadar HF	6000	8861	14,861
8	Gargaara HF	5324	7242	12,566
9	Lughaya	11563	16703	28,266
10	Karure HF	2900	4120	7,020
11	Hariirad HF	9226	13027	22,253
12	Abdiqadir HF	4000	5018	9,018
13	Zeila Hospital	5000	6994	11,988
14	Zeila HF	5000	6994	11,988
15	Lowyacado	3828	5828	9,656

Source: Awdal Region HIMS office in Borama general hospital

6-The Estimation Number of Population Received Benefit from WASH Covid-19 Response Project as Per the Below 3 Questions

S#	Health Facilities	A-How many people, in rural, small towns & urban centers including schools & health centers, have access to basic & affordable drinking water?	B-How many people, in rural, urban & peri-urban areas, small towns. Schools & health centers, have access to adequate & equitable sanitation & hygiene services & are empowered to end open defecation especially women & girls?	C-How many emergency–affected people are provided with lifesaving WASH interventions, especially women and girls?
1	Borama regional hospital	178,565.75	89,282,875	59,521.91666
2	Qoorgab HF	39600	13200	8250
3	Idhanka HF	18549	10599.4285	7419.6
4	Qunjeet HF	13647.5	7798.571	5459
5	Boon HF	15666.666	7833.33	5222.222
6	Ruqi HF	7333.333	3142.857	2200
7	Garbodadar HF	4953.666	2123	1486.1
8	Gargaara HF	3141.5	1795.1248	1256.6
9	Lughaya HF	7066.5	4038	2826.6
10	Karure HF	1755	1002.857	702
11	Hariirad HF	5563.25	3179	2225.3
12	Abdulqadir HF	2254.5	1288.285	901.8
13	Zeila Hospital	2997	1712.571	1198.8
14	Zeila HF	2997	1712.571	1198.8
15	Lowyacado HF	3218.666	1609.333	965.6

7. Challenges encountered

 

Ø Rough roads from Borama to coastal towns were the main challenges that hinders to mobilize construction materials and local materials to the sites as early as we planned. For instance we purchased construction materials from Borama to build Lowyacado, Zeila MCH s and Zeila hospital we also hired vehicle which took from Boram then unfortunately the truck had not reached the destination due to expecting malfunction of Prius acceleration problems

Ø Availability of construction materials in out rich places were also difficult some places such as Zeila and Lughaya have no construction material suppliers and we had to take materials from big towns like Borama and that brings additional cost.

Ø Very limited skilled workers in the villages where HFs are. Therefore we planned to search and find experienced masons and crew who can build incinerators but this also became challenges

Ø Transportation of local construction materials in coastal areas there are several areas where there is no stones near the selected HFs and other construction material like cement that may result unnecessary delays.

 

 

 

 

8. Achievements

Ø Improved hygiene and sanitation knowledge and awareness of targeted health facilities in Awdal region

Ø Enhanced community and health workers capacity for prevention and control of COVID 19.

Ø Conducted fruitful rapid assessment for hygiene and sanitation situation of targeted 15 health centers in which was designed the second components of the Wash Emergency Covid 19 response project implemented effectively

Ø With guidance and close cooperation with UNICEF Wash section officers and MoWD regional and national level officers AYODA project staff has managed and implemented project activities effectively and ensured attaining project objectives.

Ø 13 planed new incinerator were constructed in Borama regional hospital and Saylac hospital and 11 health facilities in four districts of Awdal region and improved COVID-19 infection prevention and control

Ø 22 new twin pit latrines were constructed in 11 health facilities in Awdal region and enhanced Covid-19 infection and control

Ø 18 existing poor latrines were rehabilitated 8 for Borama regional hospital other in the other targeted hospitals and MCHs which contributed significant Covid-19 infection prevention and control

Ø Safe drinking water was provided targeted 7 health facilities through trucking/water vendors

Ø 54 segregated waste collection storage pins colored different were procured and distributed 15 targeted health facilities in Awdal region and supported waste management of health facilities.

Ø Created employment opportunities for both project staff and local laborers/workers engaged in construction activities in the project period in Awdal region

Ø Contributed improvement of economic activi