Ethiopia

Health response to the drought: May to December 2000


DISCLAIMER
These documents contain the most accurate information available at present. Assessments are on-going and updated information will be posted on a regular basis.

The designations employed and the presentation of material in these documents do not imply the expression of any opinion whatsoever of the World Health Organization concerning the legal status of any country, territory, city or area of its authorities, or concerning the delimitation of its frontiers or boundaries.

I. INTRODUCTION

The Federal Democratic Republic of Ethiopia comprises Nine National Regional States and two Administrative Councils. The size of the country is 1.1 million square kilometer, located in the horn of Africa. Ethiopia has a population of about 61,672,000.

Since the last three years the country is faced with drought due to failure of rains particularly in the two major seasons, namely Meher, and Belg.The regions particularly affected by the drought are five, namely Amhara, Oromia, Somali, Southern Nations, Nationalities and peoples, and Tigray, and the number of people affected is estimated to be over 8 million. (See Annex 1)

In view of the pressing needs for non-food (health services) assistance to the drought affected areas, the UN Agencies mainly WHO, UNICEF, UNFPA and UNEUE in collaboration with the Federal and Regional Government sectors undertook a rapid assessment of non-food requirements in the following Zones:

North and South Gondar, North and South Wollo and Wagherma in Amhara, Borena in Oromia, Gode Liben, Afder, Fike, Korachi, Warder and Deghabur in Somali, Konso and North Omo in SNNPR and West Tigray in Tigray

This document presents first few health indicators of regions affected, second public health activities underway and third a plan of action to minimize health impact of the drought over the next three months through an adequate response.

2. Health situation in affected regions

Health indicators

Amhara
Oromia
SNNPRS
Somali
Tigray
Total Ethiopia
Infant mortality rate( Per 1000 live births)
109/1000
111/1000
121/1000
96/1000
116/1000
110/1000
Under-five mortality Rate (per 1000 live births)
159/1000
163/1000
179/1000
139/1000
171/1000
161/1000
Maternal mortality rate (per 100,000 live births)
N.A
N.A
N.A
N.A
N.A
560-880/1000
Life expectancy
50.9 male
53.5 female
50.5 male
53 female
48.9 male
51 female
56.2 male
52.9 female
49.5 male
52.4female
47-54

Health service coverage

Amhara: 43.6%
Oromia: 56.4%
SNNPRS: 39.32%
Somali: 22.21%
Tigray: 50.93%

Main Health Problems

In drought affected areas, the three main killers are diarrheal diseases, measles and upper respiratory tract infections (see Annex 2). These diseases are more severe on malnourished people.

This situation has been confirmed by the UN Mission which visited recently GODE (SOMALI) (Dr. W. J. Lee, Special Representative of WHO Director General) (see Annex 3).

It should be noted that disturbing living conditions of drought affected people have led to more cases of tuberculosis, malaria, HIV/AIDs and psychological distress. There is a huge burden of disease for people walking long distances in search of food and water distribution points including family disruption. The most vulnerable group are especially affected: women, children, elderly and handicapped (including 150,000 blind people).

Health infrastructures

Amhara: Hospitals 16, HCs 56, HS/HP 877
DPT3 coverage is 36.1% and that of measles is 28.8%.
There are laboratory facilities in two hospitals and nine health centres

Oromia: Hospitals 27, HCs86,HSs/HPs 972

Somali: Hospitals 4, HCs10, HSs/HPs 91

SNNPRS: Hospitals 11, HCs 83, HSs/HPs 773

Tigray: Hospitals 12, HCs 30, H. station/H.posts 262

3. Ongoing public health interventions in affected regions

Currently there is a five-year Health Sector Development Programme (HSDP) in the country which is in its 3rd year of implementation and each of the National Regional States implements its Annual Plan of Action in accordance with the policy and strategy of HSDP. The emergency Health Sector Plan of Action for the year 2000-2001 in the drought-affected areas is in line with HSDP.

a. EPI-Plus & Polio Eradication

The budget for the Polio Eradication in 1999 was about 5.2million USD.

  • Targeted children were 10,500,000 but vaccinated are 11,500,000 Nation wide for both national immunization day (NIDs)
  • Vitamin A supplementation was given for 8, 069,120 6-59 months children Nation wide.
  • WHO-EPI gives support in efforts to build strong and better National Immunization programme using the Polio Eradication Platform in building sustainable immunization activities for the future
  • Type of activities are: Micro-planing and forecasting for logistics need, Training, Operational research, studies, Training Need assessment, Logistics and cold chain supply for routine EPI, Integrated Social Mobilization (routine EPI, Surveillance, NIDs)

Activities in relation to drought affected areas as of July 1999 by WHO-EPI unit
Zones
<5 target population 1999
1st round NID % cov
2nd round NID % Cov
Routine EPI

DPT3 % Cov (target pop=2.6%of total)

West Tigray
150862
102%
103%
90%
N. Gondor
422715
98.6%
107%
62%
S.Gondor
357101
121%
126%
90%
N.Wollo
254522
106.7%
123%
88%
S.Wollo
429,544
102%
104%
90%
Wag Himra
55,580
86.6%
105%
31%
Borena
288790
95.3%
117%
34%
Bale
246,198
96%
104%
60%
North Omo
535,746
95%
89%
33%
Konso
32327
114.6%
107%
66%
Liben
90360
125.9%
126%
2%
Afder
65152
110%
100%
0%
Fik
42889
113%
Not done
2%
Korahe
42828
145%
166%
1%
Warder
57186
93%
95%
9%
Degehabour
52331
180%
174%
4%
Gode
71656
128%
129%
2%
  • Measles supplemental immunisation campaign was done in 9 Zones of whom South Gondar (81%), South Wollo (77%), and North Omo Zones (74%)were included where a total of 2,975,000 children 9-59 months of age are immunized in Amhara, Oromia and Southern Region.


b. Communicable Diseases Surveillance and Response

Surveillance and response

- In October 1999 a national assessment of communicable disease was done encompassing all regions and based on this assessment a five year plan of action to strength the communicable disease was prepared.

- In December 1999 WHO provided support to strengthen the epidemic preparedness and response for meningitis outbreak by providing vaccine and diagnostic kits to MOH and Amhara (Kobo District) and Tigray (Alemata District) Regions Worth 50,000 USD which was used for controlling the current outbreak in the two regions

- Following the current outbreak of dysentery in Somali region training on disease surveillance and epidemic preparedness and response was given to 45 health workers from all zones in the region in February 2000.Additionally order has been place for more vaccine at a cost of 20,00 USD.

In 2000-20001 biennium WHO has allocated 235,000 USD to strengthen the national and regional level communicable disease surveillance and epidemic preparedness and response. Training of regional health workers and support epidemic response are two main activities in the plan

c. Malaria Control

  • In August - September 1999 based on the request of the Ministry and in preparation of the malaria transmission season WHO provided assistance to improve case management and vector control activity in regions by providing drugs laboratory supplies and equipment for vector control activity worth 150,000 USD
  • In 2000-2001 biennium WHO has allocated 415,000 USD for malaria control. The main activities are training of health workers, vector control, case management, promotion of bed nets and social mobilization. The support is aimed at increasing the capacity of MOH and regions in malaria control.


d. Tuberculosis Programme

Worldwide Ethiopia ranks high among those countries worst affected by tuberculosis. The Ministry of Health established National TB Control in the mid 1970s. Currently The M.O.H. implements integrated tuberculosis and leprosy Control countrywide through the National TB & Leprosy Control Programme (NTLCP) and DOTS (Directly Observed Treatment with Short Course Chemotherapy) will expand until the whole country will be covered. This goal is expected to be reached by the year 2001. This Programme receives institutional support from the WHO in collaboration with international donor agencies. The 5 years Project Development Plan covers the period 1996-2001, with a budget of 9 million USD

The WHO supported National TB Control Programme is fully integrated in the general health services and is therefore able to reach even remote communities. The activities are

decentralized to regional, zonal and district (woreda) level, whereby full-time TB coordinators are operational at the Health Bureau's of the region and the zone. The programme is managed by a central office in Addis Ababa, that provides supervision and training input and manages the procurement, distribution and supply of TB drugs and laboratory equipment for the whole country.

Situation in drought areas

Since the early nineties there has been a constant increase in reported cases of TB, for all regions and zones, including the drought affected regions. Case notification figures are high as can be seen from the table:

TB INCIDENCE REGION
year 1998/1999
Number of Woreda's
Total projected population 2000
In area's providing DOTS
Case detection rate of smear-pos PTB per 100,000 pop.
New PTB +
Total new cases
AMHARA 3
106
16,172,942
963
5,685
45
OROMIYA 4
180
21,899,200
7,523
27,563
80
SOMALI 5
44
4,021,358
331
857
9.5 (limited data)
SNNPRG 7
72
12,131,232
5,789
15,644
58
TIGRAY 1
35
3,666,443
1,557
8,800
60
ETHIOPIA: 63 Zones
523
63,460,488
18,855
70,093
62
  1. PLAN OF ACTION FOR THE NEXT THREE MONTHS

IMMUNIZATION

Considering the Lower EPI coverage and the tendency for the measles outbreaks in the drought affected areas:

Rapid assessment of routine EPI and supplemental Polio immunization will be done in the affected areas to minimize wasting measles vaccine where measles epidemic has already immunized the population.

To increase the measles immunization coverage to prevent measles and to maximize the benefit, combining it with Vitamin A supplementation in the affected areas excluding South Gondar and North Omo zones as the activity is already done in December 1999. This will be supported with strengthened surveillance at the Health facilities to see the impact as well.

Estimated Budget

The measles supplemental vaccine and supply requirement for immunizing 2,162,944 children 9-59 months is estimated to be

Item
Estimated Cost USD
1. Vaccine Measles vials (10 doses 24442)
(3,244,416 doses)
422,000
2. Syringes of 2ml +23
G needle (3,244,416)
5ml + 19 G needle (4,671,959)
Syringes 7,916,375
240,000
376,000
Total Safety box needed (792)
1,000
Operational cost
500,000 USD
Total Cost
1,540,000 USD

Vitamin A requirement and cost need discussion with the UNICEF office.

Immediate Technical support will be requested from WHO-AFRO to focus on this activity and budget will be secured for the activity considering the constraint on the WHO-EPI team

Special attention will be given in border areas (200,000USD)

Communicable Diseases Surveillance and Response

In order to better monitor and provide rapid response to epidemic diseases like acute diarrhoeal diseases(cholera, shigellosis etc.) meningitis, other epidemic prone diseases related to drought, WHO assistance will be to strengthen the disease surveillance and response capacity at zonal and regional level in the affected areas. The following priority areas for action have been identified.

Priority areas of Action
Estimated Budget In USD
Strengthening of routine surveillance of communicable diseases at health facility zonal and regional level.
100,000
Capacity building at district and zonal level in data management and analysis.
200,00
Training of health workers in epidemic investigation and response.
50,000
Preparation Guidelines and manuals on epidemic control
50,000
Provision of laboratory products, drugs to better respond to epidemics.
1,000,000
Improve communication between district zone and regional level.
300,000
Total
1,700,000

Provision of Emergency Health Kits

In order to reduce mortality due to major communicable diseases like acute respiratory tract infections, diarrhoeal diseases, measles and other infective and parasitic diseases that are aggravated in drought situations, basic medical services should be strengthened to respond better to the increasing demand that is created (see Annex 4 kits of drugs planned for 10,000 persons for three months). Additionally mothers and children should also be given a particular attention, especially in border areas (200,000 USD)

Based on current estimate of the affected population in each region the following estimate of basic and supplementary health kits are allocated for each region.

Region
Affected Population
Basic Kits
Supplementary kits
Cost in USD
Tigray
1,064,200
107
11
280,000
Amhara
2,783,610
280
28
728,000
Oromia
2,313,000
231
23
598,000
SNNPR
825,258
83
8
208,000
Somali
1,400,00
140
14
346,000
Total
-
-
-
2,160,000

Tuberculosis Control

Famine has a detrimental impact on the control situation of tuberculosis. It affects the nutritional status and consequently the immune system of an individual, who will not only develop rapidly tuberculosis if already infected in the past, but also acquire rapidly new infection. As a result many patients will excrete bacilli and infect other individuals. This increased transmission will further worsen in famine situations, where people will be displaced, will migrate or may be concentrated in camps in order to receive aid. Famine therefore will result in concentration and increased migration of individuals with a lowered immune defence. All these three elements will contribute to an increased transmission of M. tuberculosis and accelerated disease presentation in drought affected areas. In tuberculosis the latency period between infection and disease varies from 2 months to many years. Hence the main impact of famine on the tuberculosis case load will be observed after a time lag of at least 3 months.

The drought affected zones, not yet being covered by the DOTS programme, will be identified and the local capacity will be built up in order to implement DOTS. This activity will include, recruitment of human resources, intensive training in management and subsequently regular supervision and monitoring. Additional required drug supply will be estimated, procured and distributed to the identified zones, not yet covered by the annual plan of action 2000.

An additional budget of 600,000 USD is therefore required for the next three months (with special attention in cross border areas:100,000USD)

Support to Mother and Child Health Protection

Nutrition Surveillance and Monitoring:

Nutritional surveillance and assessment will be part of the regular Antenatal care, Postnatal care and sick childcare in drought affected areas. WHO would carry out community based training in nutritional surveillance and monitoring by peripheral health workers and others involved in emergency works. The following allocated fund will be used for the production of training materials, handouts and preparation of manual for nutrition surveillance and monitoring.

Budget US$ 40,000.

Treatment of common infectious diseases in mothers and children include the issue of essential drug availability and this has been addressed in the appropriate section.

Community Based psychosocial support service:

One serious problem in drought affected area is the emotional problem that people face. WHO has the technology for the training of community level workers on mechanisms that will enable women, children and youth to cope with difficult situations.

Budet required: US$37,000

Technical support on strengthening management Capacity

Strengthening management capacity at the level of Ministry of Health (MOH):

  • by assigning public health specialists with experience in emergency planning and management
  • by establishing an emergency preparedness unit.
  • by developing relevant formats for reporting and monitoring activities

Strengthening management capacity at the level of five Regional Health Bureaux and 20 Zonal Health Departments (including border areas):
  • by assigning 20 National and 5 International public health specialists with experience in emergency planning and management.
  • by strengthening management of emergency operations in Regional Health Bureaux, Zonal Health Departments, Woreda Health Offices and health facilities.
  • by coordinating the distribution of supplies such as drugs, vaccines, medical supplies, other relevant non-food supplies.

The budget allocated for deployment of specialists and the operational cost is US dollars 423,000.

5. SUMMARY OF RESOURCE REQUIREMENT FOR THREE MONTHS

Item
Estimated Cost
a . Basic and Supplementary Emergency Drugs
2,160,000
b. Laboratory Equipment, Kits and drugs to respond to epidemics
1,000,000
c. Vaccines, Supplies and Cold Chain Equipment (EPI)
1,540,000
d. Mother and Child Health Protection
77,000
e. Operational Cost for communicable diseases
700,000
f. Tuberculosis
600,000
g. Technical assistance for management
423,000
Total
6,500,000
DROUGHT AFFECTED AREAS BY REGIONS, ZONES AND DEGREE OF SERITY
Region
Total Population
Need support and followup
Need food assistance and non-food
1. Tigray
1.1. W. Tigray
733,962
77,993
92,200
*1.2. Axum
943,850
114,000
482,000
*1.3. Tigray
873,509
127,000
235,000
*1.4. Adigrat
55,000
255,000
Sub Total
2551321
373,933
1,064,200
2. Amhara
2.1. N.Gondar
2,447,939
1,088,124
709,935
2.2. S.Gondar
2,067,731
1,892,993
504,112
2.3. N.Wollo
1,473,370
1,372,286
533,665
2.4. S.Wollo
2,482,825
2,262,833
920,932
2.5. W.....
322,207
309,564
114,966
Sub total
8,794,072
6,925,800
2,783,610
3. Oromiya
3.1. Bornea
1,423,740
1,600.00
1,600,000
3.2. Bale
1,671,987
713,000
713,000
Sub total
3,095,727
2,313,000
2,313,000
4. SNNPR
4.1. Konso/N
184,224
420,129
*4.2. S.Omo
3,043,096
861,740
405,129
Sub total
3,227,320
861,740
825,258
5. Somali
7 Zones
4,021,358
2,621,504
1,400,000
Total
21,689,798
13,095,977
7,895,069
60%
36%
Note:* Reported by RHBs on 13. IV. 2000

Annex 2

Amhara: The top five causes of out-patient morbidity are malaria, diarrhaeal diseases, intestinal parasites, pneumonia and tuberculosis and the common causes of hospital deaths are malaria, broncho-pneumonia, diarrhoea and scepticaemia. These killing diseases are often associated with malnutrition. There is an increasing trend of infections diseases.

Oromia: In Borena Zone, the health problems are water borne diseases such as diarrhael diseases. Measles outbreak has been reported. The routine EPI coverage is 35% and is attributed to the inadequate logistic support available in the zone. Shortage of EPI cold chain equipment including refrigerator, spare parts, syringes, needles and vaccine carriers. The health facilities have shortage of affordable essential drugs and there is inadequate operational budget.

Somali: The top five causes of morbidity are tuberculosis, measles malaria, diarrhoea, particularly bloody diarrhoea, upper respiratory infection, and malnutrition and these are the common causes of deaths. The DPT3 coverage is 7.2% and that of measles is 8.6%. Laboratory services are available in hospitals and few health centres. Equipment and reagents are in short supply. In general, there is a shortage of essential drugs, laboratory reagents and equipment

SNNPR: In North Omo and Conso the top causes of morbidity are malaria, intestinal parasites, diarrhoeal diseases, tuberculosis, upper respiratory tract infection and malnutrition. The common hospital and health centre deaths are malaria, and diarrhoea often associated with malnutrition. Laboratory facilities are available in hospitals and health centres, however, there is a serious shortage of reagents and medical equipment.

The facilities have shortage of essential drugs, medical supplies and medical equipment and there is an inadequate operational budget.

West Tigray: The health problems reported are waterborne diseases such as (Tigray) diarrhoeal diseases.

Morbidity

Location
Date
ARI
Diarrhoea
Measles
Malnutrition
Total
> 5
000 5
>5
000 5
> 5
000 5
> 5
000 5
1335
East Jluni Jan.2000
Feb.2000
84
31
541
169
203
57
501
118
5
22
1
22
-
-
-
-
419
Feb.2000
March 2000
55
34
117
77
59
81
146
127
55
23
62
29
-
49
-
105
494
525
Danan (Adadle) Jan.2000
Feb. 2000
9
23
34
37
14
26
41
54
8
6
21
16
4
7
25
16
156
189
Hadhad Feb.2000
46
154
12
27
29
30
-
-
298
Besarda Jan. 2000
29
87
10
33
3
-
2
-
164
Qorahey Feb. 2000
March 2000
8
47
23
51
48
51
69
39
2
4
1
2
-
-
-
-
151
194
TOTAL
366
200
561
1155
157
184
62
150
3925
1166
1716
341
212

Annex 3

Mortality

Location
Date
ARI
Diarrhoea
Measles
Malnutrition
Total
Hadhawe Feb.2000
1
3
-
-
13
19
-
-
36
Danan Jan.2000
Feb.2000
March 2000
1
9
17
10
9
33
9
32
22
4
60
47
2
26
6
2
42
20
4
15
-
6
62
-
38
255
145
Bolhajre Feb. 2000
March 2000
6
4
-
-
4
-
-
-
-
-
-
-
7
4
3
3
20
11
Qorahey March 2000
-
-
1
-
-
-
-
1
2
Godey town March 2000
22
12
53
20
62
11
11
8
209
TOTAL:
60
67
121
131
109
94
41
83
716
127
252
203
124

Annex 4

Emergency Drug, Medical Supplies, and Equipment List

S/N
DESCRIPTION
UNIT
1.
Acetysalicylic Acid 300 mg
1000 tabs
2.
Almunium hydroxide 500
1000 tabs
3.
Aminophyline 25mg/ml, 10ml
50 amps
4.
Ampicillin 125 mg/5ml dry powder forsuspension
100 ml
5.
Ampicillin 250 mg
1000 tabs
6.
Atropine 1mg/ml,1ml
50 amps
7.
Bnezathine pencillin 2.4. MIU
50 vial
8.
Benzoic acid 6% salicylic acid 3% oint,500 gm
80 tin
9.
Benzylbenzoate application 25%
1 lt
10.
Butylscopolamine bromide 10mg
1000 tabs
11.
Cetrimide 15% + chlorhexidine de-gluconate
Lt
12.
Chloramphinicol 125 mg/5ml susp
100ml
13.
Chloramphinicol 250 mg
1000 caps
14.
Chlorpromazine 25 mg/ml, 2ml
20 amps
15.
Co-trimoxazol 400mg + 80 mg
1000 tabs
16.
Cotrimoxazol dry powder (200+40)mg/5 ml suspension
100 ml
17.
Dextrose 5%, 500 ml + sets
Bottle
18.
Dextrose 50%, 50 ml
25 vials
19.
Diazepam 5 mg/ml, 2ml
100 amps
20.
Epinepherine 1mg/ml 1ml(=adrenaline)
100amp
21.
Ergometrine malate 0.5 mg/ml, 1ml
100amp
22.
Ferous sulphate 300mg + folic acid 0.25
1000 tabs
23.
Lidocaine hcl 1%, 50 ml
25 vials
24.
Mebendazol 100 mg
500 tabs
25.
Methyl dopa 250mg
500 tabs
26.
Metronidazol 125mg/5ml susp.
100ml
27.
Metronidazol 250mg
1000 caps
28.
Normal saline 0.9% of 1000 ml
Bag
29.
ORS for 1000 ml
50 such
30.
Paractamol 100mg
1000 tabs
31.
Paractamol 100mg/5m syrup1
100ml
32.
Paractamol 500mg
1000 tabs
33.
Phenobarbital 50 mg
1000 tabs
34.
Phenox methylpenicillin 250 mg (pen V)
1000 tabs
35.
Procain penicillin 3 MIU/Benzylpenicillin 1 MIU
50 vial
36.
Promethazine hcl 25mg coated
500 tabs
37.
Promethazine hcl 25mg/ml,2ml
50 amps
38.
PVP iodine 10% solution
200ml
39.
Ringer lactate solution 500ml + sets
Bottle
40.
Tetracycline hcl 250 mg
1000 cap
41.
Tetracycline Hcl eye-oint 1%:5mg
1000 tube
42.
Vitamine A 200 000 IU
1000 cap
43.
Vitamine A 50000 IU
1000 cap
44.
Vitamine C 250 mg (Ascorbic acid)
1000 tabs
45.
Water for inj 10 ml
100 amps
46.
Zinc oide oint 10%, 800gm
Tin
1.
Adhesive tape 2.5 Cm X 5m
Roll
2.
Autoclave tape 50 meter
Roll
3.
Bandage crepe 8cmX4cm
10pcs
4.
Battery for otoscope, alkaline
Pcs
5.
Blades for surgical knives size 22
100 pcs
6.
Bulb for otoscope, mini, heine
Pcs
7.
Catether folly no 14 ballon 5-15ml
5pcs
8.
Cateher folly no 16 ballon 5-15ml
5pcs
9.
Catether folly two ways no 12 ballon 5-15 ml
10pcs
10.
Cotton wool 500gm
10 pcs
11.
Elastic bandage 8 cm X 5m
Roll
12.
Examination gloves latex, medium disposable
100pcs
13.
Examination gloves latex, large disposable
100pcs
14.
Examination gloves latex, small disposable
100pcs
15.
Feeding tube ch.8 disposable
50pcs
16.
Feeding tube ch.5 dispo.40cm luer
20pcs
17.
Gauze commpresses 10 X 10, 12 poly
100pc
18.
Hydrophilic bandage 7.5 X 10m
10roll
19.
Hydrophilic gauze 90cmX90m
Roll
20.
Iv placement unit 20G
Pcs
21.
Iv placement unit 25G
Pcs
22.
Needle luer, 21 GX1.5''(0.8X38mm)
100pcs
23.
Scalp infussion set 21G
100pcs
24.
Scalp vein infussion set 25G
100pcs
25.
Surgical gloves size 7 sterile
50pcs
26.
Surgical gloves size 7.5 sterile
50pcs
27.
Suture vicryl 1/0, 3/8 ct ndl 30mm.
50pcs
28.
Suture vicryl 2/0, 45cm ct needle 18. 30mm
36pcs
29.
Syringe 50 ml luer, disposable
Pcs
30.
Syringe lure, 10ml disposable
100pcs
31.
Syringe lure, 2ml disposable
100pcs
32.
Syringe lure, 5ml disposable
100pcs
33.
Tablet bag reusable 60X80 mm mini g
500pcs
34.
Toungue depresor, wood
100pcs
35.
Urine collection bag 2000 ml
Pcs
1.
Adult scale, Automatic reading with height measurment
Pcs
2.
Clinical thermometer Arm pit type
Pcs
3.
Dish, Kidneys/s 24cm
Pcs
4.
Dressing instrument sets
Pcs
5.
Drum for cotton wool & gauze dia. 15cm ht.15
Pcs
6.
Forceps artery 14.5cm, straight
Pcs
7.
Forceps dissecting 14.5 cm
Pcs
8.
Forceps, artery, pen 14.5cm straight
Pcs
9.
Gallipot s/s without lid 300ml
Pcs
10.
Instrument box with lid s/s 20X10X5cm
Pcs
11.
Instrument tray 30X20X2cm
Pcs
12.
Measuring-tape, flexible
Pcs
13.
Otoscope "mini" with battery handle(complete set)
Pcs
14.
Pretige double-rack 7503phc-sterilizer+access 20 liters
Pcs
15.
Scale, dial type 25kg, 100graduation
Pcs
16.
Scissors surgical bl/bl straight, 14.5cm
Pcs
17.
Spygmomanometer, anaeroid, simple
Pcs
18.
Stethoscope, featal metal (Aluminume type)pcs
19.
Stethoscope, littman type double light
Pcs
20.
Stove kerossine, hypolyto 36 (for 20 lt sterilizer
Pcs
21.
Strecher army type
22.
Tourniquet (arm)
Pcs
1.
Chloroquine 150mg base
1000 tabs
2.
Chloroquine 50 mg base/5ml.dry powder
60ml
3.
Quinine 300mg film coated tablets
1000tabs
4.
Sulphadoxine 500mg+pyrimetamine 25mg
1000 tabs

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