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Yemen National COVID-19 Preparedness and Response Plan

10 April 2020 (Revision # 10)

This document jointly brings together the requests/needs, capacities and actions identified by both authorities in Sana’a and Aden.

The purpose of the Plan is to ensure Yemen is able to detect, test, isolate and treat any

individual that could become infected by the novel coronavirus (COVID-19).

The Plan provides guidance on a set of targeted actions, organized under eight pillars. It complements existing and forthcoming WHO guidance on the wider implications of

COVID‑19 for health systems and Cross-sector strategies for responding to the risks of COVID‑19 outbreak.

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Table of Contents

Executive Summary .................................................................................................................... 3

Introduction ............................................................................................................................... 5 Background information ................................................................................................................................. 5 Section I: Catastrophic effect of COVID-19 in Yemen .................................................................................... 5 Section II: Risk factors and vulnerability of Yemen to introduction of COVID-19 ........................................ 7

Section III: Strategic components of the Preparedness and Response Plan (Core pillars) .............. 8

Section IV: Assumptions to operationalize the Preparedness and Response Plan ......................... 9

Section V: Core Pillar Objectives, Expected outcomes and current level of preparedness and response capacity ..................................................................................................................... 11

Pillar 1: Country-Level coordination, planning and monitoring .................................................................. 11 Pillar 2: Risk Communication and Community Engagement ....................................................................... 13 Pillar 3: Surveillance, rapid response teams, and case investigation .......................................................... 14 Pillar 4: Points of Entry ................................................................................................................................. 16 Pillar 5: National laboratories ....................................................................................................................... 17 Pillar 6: Infection, Prevention and Control ................................................................................................... 18 Pillar 7: Case management and continuity of services ................................................................................ 20 Pillar 8: Operational support and logistics ................................................................................................... 23

Section VI: Monitoring and Evaluation of the Plan Implementation ........................................... 24

Section VII: Estimated funding requirements............................................................................. 24

Section VIII: Sequencing out the priority actions by Pillar .......................................................... 26

Section IX: Risk Management ................................................................................................... 27

Annexes ................................................................................................................................... 30 Annex 1: List of 12 informal land crossing points from northern to southern governorates ........................ 30 Annnex 2: Worldwide distribution of COVID-19 cases in affected countries, including the Eastern Mediterranean Region ................................................................................................................................... 30 Annex 3: Suppressive measures put in place by authorities in Sana’a and Aden as part of the Yemen COVID-19 Preparedness and Response Plan ............................................................................................................. 30 Annex 4: Distribution of sentinel reporting sites throughout the country .................................................... 30 Annex 5: List of Formal Points of Entry in Yemen .......................................................................................... 30 Annex 6: Stock of PPE available and anticipated needs for the first 6 months ............................................ 30 Annex 7: List of healthcare facilities identified for use as isolation units ...................................................... 30 Annex 8: List of facilities identified to serve as quarantine areas ................................................................. 30 Annex 9 : Estimate quantities of supplies for an initial period of 3 months.................................................. 30 Annex 10: Current ICU bed capacity and availability of ventilators .............................................................. 30 Annex 11: WHO warehouse capacity for Yemen operations and Supply Routes ......................................... 30 Annex 12: Yemen COVID-19 Preparedness and Response Plan M&E Framework ........................................ 30 Annex 13: Key Performance Indicators, Planned outcomes and Products ................................................... 30 Annex 14: Information Management Support for COVID-19 Preparedness and Response .......................... 30

Glossary of Terms and Key operational abbreviations ............................................................... 31

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Executive Summary

The Yemen National COVID-19 Preparedness and Response Plan is a strategic document prepared by both authorities in Sana’a and Aden, with the support of WHO, other United Nations Agencies, Funds and Programmes and partners working in Yemen with inputs from donors. It provides guidance on a set of actions to be taken to ensure that the country is able (1) to detect, test, isolate and treat individuals that become infected by the coronavirus as well as (2) to slow down and contain the spread of the virus in the community. The first section of the plan provides an overview of the catastrophic effect that COVID-19 could have in Yemen considering the already existing vulnerability in the country, in combination with the fact the health system is working at 50 percent of its capacity at most. The second section highlights the risk factors and vulnerability of Yemen to introduction of COVID-19 with regard to Points of Entry (POEs), including internal land crossing points and the suppressive measures that have been put in place in both geographical parts of the country to reduce the transmission and spread of the disease. The third section outlines the WHO global 8 core pillars around which the national plan is based which are: (1) Country-level Coordination, planning and monitoring; (2) Risk communication and community engagement; (3) Surveillance and rapid-response teams and case investigation; (4) Points of entry; (5) National Laboratories; (6) Infection, Prevention and Control (IPC); (7) Case management; and (8) Operational Support and Logistics. The fourth section lists key assumptions to operationalize the preparedness and response plan. These include: (1) the imperative coordination between central and local levels; (2) the role of governorate Emergency Operational Cells (EOC) in the operationalisation of the plan; (3) the need to base the plan on evidence-based preparedness and response, including the need to take into consideration the disease severity based on models proposed by several researchers including Imperial College of London; (4) respect of humanitarian and ethics principles of care for suspected and confirmed cases; (5) the need to maintain essential health services during COVID-19 outbreak and (6) the need to minimizing the negative socio-economic impact of Impact on communities. The fifth and main section of the plan establishes, for each one of the 8 core pillars, the main objectives, the expected outcomes as well as the current level of readiness and response capacity, including target performance indicators. These objectives and expected outcomes aim at ensuring that:

There is a well-coordinated response to COVID-19 outbreak and a well-informed health care

workforce, communities, donors, health partners and Humanitarian Country Team (HCT)

members about the disease, its effect and well engaged in reducing its negative impact.

The Yemeni Community is well informed, engaged and participatory in containment and

response efforts.

In less than 24 hours all rumours, alerts and suspected cases are investigated and verified,

including contact tracing (index case).

Surveillance is instated at POEs and risk of COVID-19 cases being introduced in Yemen reduced

and that travellers are well informed about COVID-19 and are able to protect themselves and

their communities.

All suspect cases that meet WHO case definition, all contacts of confirmed cases and patients

identified as suffering from respiratory diseases are timey laboratory tested for COVID-19 and

all results (negative and positive) timely released.

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Infection Prevention and Control (IPC) strategies are systematically applied to prevent or limit

COVID-19 transmission in health settings and other settings, including households, schools,

mosques and during mass gatherings

Healthcare facilities identified to serve as isolation units are prepared to receive an increase in

COVID-19 cases and are able to provide appropriate case management, particularly to patients

at higher risk

An efficient response to COVID-19 pandemic is in place to ensure timely and uninterrupted

supply chain as well as identification of and support to critical functions (i.e. water and

sanitation, fuel, energy, food, telecommunications/internet, financial resources,

transportation, essential workforce, procurement)

The plan also addresses COVID-19 cross cutting services that will be provided to already vulnerable groups of populations such as IDPs, refugees and migrants, people suffering from different levels of malnutrition, individuals with other underlying causes which make them most vulnerable to COVID-19, including patients with chronic health conditions, compromised immunity, as well as individuals who are likely to need mental health and psycho-social support services. The plan explores how those groups can be protected and get access to services they may need while creating conditions for their protection in a dignified fashion. The sixth section provides a framework for monitoring and evaluation of the implementation of the plan based on a set of key performance indicators as well as a number of datasets and products that will be regularly developed and widely shared with different actors including donors, health and non-health partners. Finally, the plan addresses the challenges linked to the risk management through a review of operational and risk factors that can impact the effectiveness of the preparedness and response plan implementation by health and non-health partners that will be involved in different aspects of COVID-19 pandemic response in Yemen.

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Introduction Background information

On 31 December 2019, WHO was alerted to several cases of pneumonia in Wuhan City, Hubei Province of China. One week later, on 7 January 2020, Chinese authorities confirmed that they had identified COVID-19 as the cause of the pneumonia.

Since the first cases were reported, WHO and its partners have been working with Chinese authorities and global experts to learn more about the virus, including how it is transmitted, the populations most at risk, the spectrum of clinical symptoms, and the most effective ways to detect, interrupt, and contain transmission. Epidemiological evidence shows that COVID-19 can be transmitted from one individual to another.

During previous outbreaks due to other coronaviruses, including Middle-East respiratory syndrome (MERS-CoV) and the Severe Acute Respiratory Syndrome (SARS), human-to-human transmission most commonly occurred through droplets, personal contact, and contaminated objects. The modes of transmission of COVID-19 are likely to be similar. The precise origin of the COVID-19 is still uncertain.

The virus has been identified in environmental samples from a live animal market in Wuhan, and some human cases have been epidemiologically linked to this market. Other coronaviruses, such as SARS and MERS, are zoonotic and can be transmitted from animals to humans. On 30 January 2020, the Director-General of WHO declared the COVID-19 outbreak a public health emergency of international concern (PHEIC) under the International Health Regulations (2005), following advice from the Emergency Committee.

Section I: Catastrophic effect of COVID-19 in Yemen The introduction of this virus in the current situation and environment of Yemen will be catastrophic for two main reasons: (1) the already exiting vulnerability in country, in combination with the fact (2) the health system is working at 50 percent of its capacity at most. Severity of suffering and unmet health needs for vulnerable populations, are shocking: Health needs assessment conducted as part of the Humanitarian Needs Overview (HNO) based on the results of HeRAMS Assessment estimates that:

19.7 million people (out of the total population of 30 million) are in need of health care services and 14 million people are in desperate need.

Two-thirds of districts (203 of the total 333 country districts) are in most severe health needs due to poor access to health services and these affected districts are distributed in all 22 governorates but with contrasting severity rating amongst governorates.

There are also about a total of 1.5 million of displaced populations, including 1.28 million of IDPs, 0.27 million of refugees and asylum-seekers who are likely to be victims of stigma on the top of already vulnerable situations.

Almost 50% of health facilities impacted by the ongoing conflict with reduced operational capacity: HeRAMS Assessment has shown that 2,477 health facilities (or 49 % out of a total of 5,056 health facilities across the country) were not functional or only partially functioning due to damages, staff shortages, lack of medicines and medical supplies or limited access due prevailing security environment. Most of the hospitals in Yemen do not have onsite healthcare waste disposal systems, therefore identification of final waste disposal sites with safe transportation need to be put in place.

Severe food insecurity and malnutrition: A total of 15.9 million people (53% of the population) are severely food insecure, despite ongoing humanitarian food assistance. Of greatest concern are the

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additional 63,500 people facing catastrophic levels of food insecurity1. Population of children of less than five years is about 5.3 million and Global acute malnutrition rate is 11.6%%, based on SMART survey from 2016 to 2019. Considering WHO thresholds, this prevalence is high and is of public health concern. Severe acute malnutrition (SAM) prevalence is 2-3% and the prevalence of moderate acute malnutrition (MAM) is 11.4 % Malnutrition contributes to reduced immunity and renders the child immune-compromised and more likely to develop severe form of infectious diseases with 9 to 12 times more chance to die from. In addition, considering the high level of severe acute malnutrition among underfive children and the need to provide them a special health and nutrition treatment in line with WHO guidance. All children underfive years nutritional status will be assessed and they will be appropriately treated. Using the combined GAM2 rate (13,7%) to estimate the caseload,the number of children expected to have acute malnutrition in 2020 is over 1.9 million and those with severe acute malnutrition are over 325,000. Severe acute malnutrition with medical complications affect about 32, 520 children under five year of age. High burden of communicable and non-communicable diseases: Evidence circulated globally indicates that patients with diabetes, hypertension and immuno-compromised witness higher morbidity rates from COVID-19, making this category at higher risk and more susceptible. In the current situation of Yemen, unability to respond adequately to COVID-19 outbreak could lead to millions of people dying from complications of existing high prevalence of underlying medical conditions and caseloads of preventable diseases/illnesses, including communicable diseases such as cholera, measles, dengue and diphtheria as well as NCDs as the health system is too weak to cope with the high burden of these diseases. Since 2014, the country continues to experience waves of outbreaks, including diphtheria which has

re-emerged for the first time in Yemen since 1982, with 5,500 probable cases since August 2017 till 1 March 2020 with 333 associated deaths.

Immunization coverage has also decreased by at least 30% since the conflict started. Measles

infections jumped sharply in 2017 and 2018 reaching 29,234 cases by end of 2018. For 2019 and 2020 (1 March) the total number reached 11,210 suspected cases and 55 associated deaths. The measles ad diphtheria outbreaks are a clear indication of declined coverage of the national programme on immunization.

Dengue fever also spiked in June 2019, with incidence of more than 76,000 suspected cases and 283

associated deaths by the end of December2019. Cholera outbreaks in 2017 and 2018 lead to 1,393,762 suspected cases while in 2019 and 2020 (1 March) the total cumulative number of suspected cases for this period reached 930,522 with death 1,044 associated deaths.

Although there no recent studies available on burden of NCDs, data emerging from the

implementation of different programmes supported by WHO reveal that in 2018, NCD were responsible for 57% of all deaths in the country, excluding deaths directly caused by armed confict. The most prevalent NCD are cardiac diseases, hypertension, cancers, chronic kidney failure and

1 IPC analysis, from December 2018 to January 2019. Additional analysis conducted by the Yemen IPC Technical Working Group (TWG) to estimate the severity and magnitude of food insecurity excluding the mitigating effects of the HFA delivered, shows that 20.1 million people (67% of the total population) would be in need of urgent action (IPC Phase 3 and above), including 238,000 people in IPC Phase 5 (Catastrophe) had HFA not been delivered 2 The combined GAM rate is use only for the calculation of the caseload but not to describe the situation.

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diabetis. To date, WHO has provided medical treatment to cover several life threatening conditions, including 4,000 cancer patients under active treatment and over 32,000 patients in need of dyalisis sessions.

Similary, the burden of mental health disorders associated to a hight number of crisis affected populations requiring mental health psychosocio support (MHPSS) services is estimated to be significantly high, owing the impact of ongoing and precedent conflicts of recent years.

Limited number of skilled health workforce that is vulnerable: There are no doctors in 18% of districts across the country and most health personnel have not received salaries for at least two years. This is in addition to the insufficient number of nurses and midwifes coupled with a weakened medical health education, unable to fill the deficit in human resources for health, compounded also by the brain drain which has led to loss of many of the most skilled health professionals who have been constrained to leave the country for better opportunities abroad . Based on the existing knowledge of the healthcare workforce structure in place, medical and paramedical staff lack training on case management, IPC and use of PPE in the context of COVID-19. Section II: Risk factors and vulnerability of Yemen to introduction of COVID-19 At present, there are a total of 30 formal/official points of entry (PoEs) out of which 4 have been closed as a result of war and 26 are functional. These include 5 by air 13 by sea and 8 by land to Yemen which could be all considered as potential points for introduction of COVID-19 cases in the country. There are also 28 informal land crossing points from northern to southern governorates which will apply similar procedures for travellers using these crossing points (Annex 1). At the time of developing the present plan (18 March 2020), no COVID-19 case has yet been reported in Yemen. However, the risk of having a COVID-19 case introduced anytime in the country, through existing POE is real. It has been assessed that land cross-points represent a considerable risk, as crossing points lead to neighbouring Kingdom of Saudi Arabia and the Sultanate of Oman which are already COVID-19 affected countries with local transmission. The vulnerability of land crossing points should be also considered in the wider context of the Eastern Mediterranean Region where an increasing number of countries are already faced with a COVID-19 ongoing transmission which appears to be amplifying, resulting in exportation of cases to other countries. Annex 2 shows worldwide distribution of COVID-19 cases (as of 25 March 2020) in affected countries, including in the Eastern Mediterannean Region based on the most recent update released by the WHO Regional Office for the Eastern Mediterranean (EMRO) and WHO/Headquarters. With regard to POEs by air, Aden and Sayoun international airports represent the highest risk as these are the main airports where travellers might arrive from countries affected by COVID-19. With regard to seaports, the risk is relatively low as most of them do not have activities involving contact with other countries, with exception of POEs that are reported to be used time to time by migrants, using Yemen as a stagging point to reach other gulf countries with better opportunities. In addition to the official POEs, the country has also informal points of entry used by migrants mainly from the Horn of Africa. Data collected by the International Organization for Migration’s (IOM) Displacement Tracking Matrix (DTM) shows that over 138,000 people crossed the Gulf of Aden to Yemen last year (in 2019). Nearly 90 per cent of those who arrived in Yemen in 2019 intended to proceed to the Kingdom of Saudi Arabia (KSA). In addition to the number of migrants and asylum seekers, approximately 1.2 million have been displaced across the country as result of the last one year of escalation of violence and movement of the frontlines. Illegal migrants do not go through medical

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screening and have very limited access to healthcare assistance. In case COVID-19 cases are confirmed among refugees and asylum seekers, who are already vulnerable groups will be likely to be victims of stigma, being accused to have brought the COVID-19 virus in the country. As a precaution, schools have been closed nationwide, and passenger flights have been suspended. Authorities have applied suppressive measures to other public places, including restaurants and mass gatherings. Land entry points for travellers have been closed, and strict measures at informal crossings are being applied. Cargo imports are continuing with health checks. Domestic movements of goods and people are experiencing some delays as authorities finalize regulations to minimize risks. The suppressive measures taken throughtout the country, have been coordinated for the northern and southern governorates, through decrees and ministerial circulars as shown in Annex 3 which provides a comparative summary of different suppressive measures taken in both geographical parts of the country. As the spread of COVID-19 virus does not respect borders and crossing lines, the need for all the governorate health offices across the country to fully collaborate in the figth to contain the spread of the virus and reduce transmission is extremely important and will be part of the collaborative approach that will be applied, taking advantage of lessons from cholera vaccination campaign in 2017 during which days of tranquillity were secured to ensure that there are no regions/areas left behind. Section III: Strategic components of the Preparedness and Response Plan (Core pillars) The present plan has been developed using the 8 core pillars defined in WHO guidelines published on 12 February 2020 titled “COVID-19 Strategic Preparedness and Response Plan: Operation Planning Guidelines to Support Country Preparedness and Response” which can be accessed through WHO COVID-19 website (https://www.who.int/docs/default-source/coronaviruse/srp-04022020.pdf?sfvrsn=7ff55ec0_4&download=true). The plan outlines the priority steps and actions to be included accross the 8 major areas (core pillars) of public health preparedness and response plan which are:

1. Country-level Coordination, planning and monitoring; 2. Risk communication and community engagement; 3. Surveillance and rapid-response teams and case investigation; 4. Points of entry; 5. National Laboratories; 6. Infection, Prevention and Control (IPC); 7. Case management; and 8. Operational support and logistics

Given the particular circumstance of Yemen which hosts a substantial number of displaced population

comprising of about (1) a total of 3.34 million of IDPs of which over 1 million people are living in precarious conditions in IDP camps across the country and (2) about 270,000 refugees and asylum-seekers, mainly from the horn of Africa, both groups will require specific and targeted support in the context of COVID-19. A section on IDPs, migrants and refugees has been included in the plan under core pillars 3, 6 and 7 mentioned above. The plan has been developed based on agreed strategic actions, resulting from consultative discussions between the national authorities, both in Sana’a and Aden, and key technical and operational partners, including WHO, UNICEF and other health partners. Strategic actions already taken or under preparation are described in each pillar.

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Section IV: Assumptions to operationalize the Preparedness and Response Plan To implement the Preparedness and Response Plan, the national health authorities, in coordination with WHO and other sector partners, have identifed the following assumptions. These assumptions can be subject to change and can change depending on how the situation evolves; the below list will be updated according.

Coordination between central and local levels: The present plan identifies the areas of work that require integrated and concerted response from health and non-health partners. The scale of the COVID19 crisis is unprecedented and requires clear lines of coordination among national authorities. The lines of command among ministries are discussed and agreed within the inter-ministerial emergency COVID-19 Response Committee. International and National Organizations, as well as civil society organizations, can extend their support to the COVID19 preparedness and response by following the high level directions agreed at the Committee level.

Operationalisation of the COVID-19 Health Preparedness and Response Plan: COVID-19 represents a threat to the safety and wellbeing of all communities, across Yemen. The operationalisation of the plan entails strategic and operational coordination. Both types of coordination require all parties to work together under the directions defined in the plan – this applies to health and non-health actors. The MOPHP will be coordinating the implementation of the present plan with the support from the COVID-19 Task Force. Detailed sectoral and governorate operational plans will be developed based on key actions highlighted in the present national plan. Each EOC at the governorate level will be responsible to operationalise the plan in accordance to the general conditions of coordination established by the inter-ministerial emergency COVID-19 Response Committee.

Evidence-based preparedness and response, including modelling to forecast COVID-19 outbreak within Yemen: The existing models from other countries heavily impacted by COVID19 (i.e. China, Italy, Iran, etc..) are not applicable to the case of Yemen as the health system and public health determinants are different. The existing models developed for other countries are not ‘one size fits all’. The World Health Organization is extending its support to the national health authorities to develop models that can help understand the severity of the potential spread. WHO is coordinating with different international institutions to develop the models of transmission, defining predictable caseload. One model that is closely being followed with interest, out of a dozen of models being developed based on Yemen context, is the Imperial College model3. These models are useful from the planning perspective as they define predictable caseloads for best and worst case scenarios. With the assumptions that the initial number of cases is 10, that the outbreak lasts 11 weeks, and that testing strategy is targeted as opposed instead of testing all suspected cases, the model predicts that in the worst case scenario, there will be a total number of 2,097,151 cases out of which 1,677,721 will be mild, 314,573 severe and 104, 858 critical. The estimated maximum number of in-patients at any one time would be 20,878 out of which 20,381 will occupy severe beds and 497 ICU beds. It is also estimated that the doubling time of cases will be every 4 days and the number of deaths could vary from 35,000 to 49,000. It is evident that the current health system of Yemen will not be able to stand or handle such caseload. Support from UN agencies and other partners will be needed.

Plan Implementation performance validation from the Third Party Monitoring: Building on the lessons learned from the cholera preparedness and response, WHO will extend its support to

3 The Global Impact of COVID-19 and Strategies for Mitigation and Suppression, 26 March 2020, Imperial College COVID-19 Response Team.

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activate TPM monitoring (remote and on the site, depending on the specific conditions of access) to ensure protocols of case management and other conditions (i.e. IPC) are in place.

Respect for humanitarian principles and ethics principles of care for suspected and confirmed: The Plan foresees the activation of Points of Entry, quarantine and isolation units. The health authorities, with the support of other ministries and sector partners, restate their commitment to ensure that all cases (suspected and confirmed) receive dignified medical assistance and are protected from stigmatization. This applies to Yemen communities, as well as to other groups already exposed to other forms of vulnerability (i.e. displaced populations, migrants). In this regard, the Plan puts emphasis on the importance to have two-way communication in place to reach out communities, as well as mechanisms of support from the other clusters (i.e. Protection).

Maintaining essential health services during COVID-19 outbreak: While the focus will be put on COVID-19 outbreak, all efforts will be exerted to ensure that ongoing life saving programmes are not interrupted despite competing demands. The “COVID-19: Operational guidance for mainaining essential health services during an outreak” published on 25 March 2020 which can be access at https://www.who.int/publications-detail/covid-19-operational-guidance-for-maintaining-essential-health-services-during-an-outbreak is beeing used to prioritize the types of services that must remain available during COVID-19 outbreak. Strategic shifts will be made to establish effective patient flow, including screening, triage, and targeted referral of COVID-19 and non-COVID-19 cases at all levels of the health care systems in the country. Priority will be given to preventing communicable diseases, averting maternatl and child morbidity and mortality, maintaining treatment regimens to existing chronic conditions and managing emergency conditions that require time-sensitive interventions. Protection of non-COVID-19 facilities will also need be ensured in order to allow no-COVID-19 patients to continue receiving the health care services they need, particularly those with underying causes such as cancer, kidney failure, diabetics, cardiovascular diseases.

Minimizing the negative socio-economic impact of COVID-19 outbreak on communities: There is a strong fear that COVID-19 context will expose further the country to disruptions of the supply chains owing the heavy reliance on imports which will lead to loss of income in a context of already limited purchasing power of individuals and communities with high risk of shortages and inevitable increase of prices of essential items of wide consumption. This will be also compounded by the fact that COVID 19 response will pull scarce resources from other lifesaving health responses including cholera, dengue and other communicable and no communicable diseases at a time when these other lifesaving health programmes must be maintained as indicated above. Financial and technical support from all partners will be needed to minimize the socio-economic impact of COVID-19 on Yemeni population.

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Section V: Core Pillar Objectives, Expected outcomes and current level of preparedness and response capacity Pillar 1: Country-Level coordination, planning and monitoring

Objective Outcome

Ensure information sharing in real time between health and no health sectors fora and ensure adherence to a common plan for COVID-19 by all actors.

A well coordinated response to COVID-19 outbreak and a well informed health care workforce, communities, donors, health partners and Humanitarian Country Team (HCT) members about the disease, its effect and well engaged in reducing its negative impact.

Pillar 1 Readiness & Response Capacity

1 integrated, multi-sectoral coordination system activated for central and governorate response

25 Existing Emergency Operations Centers (EOC) + 1 under activation (Socotra) 2 Central EOCs.

An inter-ministerial emergency COVID-19 Response Committee has been established in Sana’a and in Aden and is headed by the respective authority Deputy Prime Minister. The Response Committee is responsible for strategic decisions, going beyond the health sector- decisions that entail safety and security of all communities across Yemen, as well as regional coordination. The present Plan helps the inter-ministerial Response Committee have a framework of action related to the preparedness and response from the health sector. A COVID-19 National Emergency Task Force has also been activated under the leadership of the Ministry of Public Health and Population (MOPHP) in Aden and Sanaa. The Task Force focuses on implementing preventive measures and ensuring that country preparedness activities are coordinated through a multi-sector approach. Other members of the Task Force include WHO, the Ministry of Foreign Affairs, the Ministry of Education and Higher Education, the Ministry of Public Works and Transport, the Ministry of Interior and Municipalities and the Ministry of Information. Within the National Task Force, the MOPHP acts as secretariat. The Task Force meets on a weekly basis in addition to ad-hoc meetings organised as needed. The Task Force provides to the Prime Minister’s Emergency Committee advise on the support needed to move forward the preparedness and readiness efforts which, at this stage where no case has been reported, focus mainly on improving control at points of entry, providing training to human resources required for accelerated response and mitigation capacity. To operationalize Pillar 1, the National Task Force and its partners will continue using the existing network of 2 central and 25 governorate based EOCs. As part of the COVID19 Plan, WHO will support the health counterparts to activate the EOC in Socotra. In total, in the next three months, Yemen will count on 28 EOCs (2 central and 26 governorate-based). The network of EOCs provide access to real-time data for about 130 implementing partners. Under Pillar 1, EOCs will continue promoting operational coordination and ensuring the information sharing protocols are correctly applied by all partners (health and non-health). The expected outcome is to have well informed health care work force, well informed communities, donors, HCT with the evolution of this crises and rumors, cases and capacities. Each EOC will be required to regularly track a number of variables to assess whether the system is effective. The EOC will update the list of variables already being monitored and will include the

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additional indicators, namely: number of rumours and alerts checked, number of persons scanned at relevant PoE, number of tests performed, number of ICU beds occupancy. Coordination within UN and other patners in support to authorities: The RC/HC has established a Crisis Management Team chaired by the COVID-19 Outbreak Coordinator. The Team is responsible for effective coordination of COVID-19 preparedness and response, including liaison with authorities. A UNCT Preparedness and Response Plan outlines standard operating procedures to ensure preparedness, response protocols and business continuity. As no COVID-19 cases have yet been reported, current work focuses on preparedness and community outreach.4 WHO and UNICEF are working together to define points of convergence and integration as related to health response, risk communication and community engagement, WASH, Nutrition and mental health psychosocio support (MHPSS). A Taskforce, focussing on incorporating MHPSS considerations into the COVID-19 response, is in place and WHO will technically support the work of the Taskfoce. IOM and UNCHR are working together to finalize the plan and mapping of available health services, including referral for migrants, refugees and asylum seekers. Once ready, the mapping will be used by the health authorities and WHO to validate the plans related to distribution of available supplies and equipment like PPE, ventilators as well as in supporting the government to ensure that these already vulnerable population groups are protected against any stigma. As of 25 March 2020, based on the most recent agreement reached by all parties, quarantine units will be coordinated by the national couterparts with the direct support of the UN Protection Cluster, to address the needs as related to assistance to people in quarantine in terms of protection (i.e. food and cash assistance provision). From the health sector side, the national health authorities and WHO will coordinate the provision of medical supplies and equipment to the units, as well as guidance to healthcare workers deployed to the units. WHO and WFP have revised the shipment plans to prioritize the delivery of COVID-19-related supplies using the points of entry which remain open to commercial and humanitarian shipments. The existing Inter-Agency coordination mechanisms contribute to the work of the inter-ministerial emergency COVID-19 Response Committee and COVID-19 National Task Force. The coordination between the COVID-19 Task Force and NGOs will be done through respective relevant clusters in respect to each pillar. Partners will be provided with capacity building in the areas of detection and surveillance, including referral mechanisms. NGOs will be provided with all the necessary COVID-19 technical guidance/guidelines and community awareness materials. As of mid-March 2020, the Health Cluster - in coordination with the national health authorities – has organized orientation sessions informing the Health Cluster partners that COVID-19 preparedness and response cannot be considered equal to cholera preparedness and response model, given the complexity of the nature of the disease itself. The Health Cluster has indicated to its members that COVID-19 will be responded to by the national health authorities, with technical and funding support of WHO, in coordination with other UN Agencies dedicated to other sectors, namely: UNICEF (Risk Communication at the community level), Wash Cluster (IPC-related issues) and IOM and UNHCR (IDPs, migrants/refugees).

4 Source: United Nations Coordinated Appeal, Global Humanitarian Response Plan for COVID19, March 2020.

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Pillar 2: Risk Communication and Community Engagement

Objective Outcome

Engage the community, to dispel any rumor and ensure average individual understands the evolution of the disease and how to protect themselves.

An informed Yemeni Community, well engaged and participatory in containment and response efforts.

Pillar 2 Readiness & Response Capacity

1 risk communication plan in place for Sanaa and Aden as two-way channels for community and public information sharing and for correcting misinformation and rumors. The comprehensive, multi-sector strategy being developed.

2 hotlines (toll free number) already activated in Aden and Sanaa. Ad-hoc Health Cluster meetings and coordination mechanisms put in place to provide

health partners with technical guidance.

As stressed in the operational planning guidelines, it is critical to listen to the public’s concerns and perceptions, and communicate to them what is known and unknown about COVID-19,what is being done to limit or stop community transmission of the virus, how those affected will be cared for, as well as other actions being taken on a regular basis. Strategic actions implemented are based on guidance contained in the “Risk Communication and Community Engagement (RCCE) Action Plan Guidance: COVID-19 Preparedness & Response” which was jointly developed in March 2020 by WHO, UNICEF and IFRC https://www.who.int/publications-detail/risk-communication-and-community-engagement-(rcce)-action-plan-guidance) The WHO myth buster website is being used as a source of reliable information on COVID-19 and risk for the communities (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters). WHO Yemen, regional and global resources, along with partner collaborations, serve as a system to detect and rapidly respond to and counter misinformation. All information is available in English, Arabic and other languages. At the local level, social media, TV, radio, mosques, local influencers including community leaders, imams, celebrities, as well as community volunteers and local networks are already being used throughout the country to engage the community. For messages and actions for COVID-19 prevention and control, priority is being given to health facilities/hospitals, households, schools, mosques and to locations/settings that traditionally involve mass gatherings or that are trusted community institutions. Particular attention will be paid to ensuring compliance with basic Infection, Prevention and Control (IPC) principles at these facilities and in the first point of care which will be mainly in primary health care settings in the remote areas. IPC guidance for home and community care providers will be disseminated and training packages to address skill and performance gaps will be developed and rolled out.

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Pillar 3: Surveillance, rapid response teams, and case investigation

Objective Outcome

Ensure that in less than 24 hours all rumors, alerts and suspected cases are investigated.

All cases investigated including contact tracing (index case) and all rumours verified.

Pillar 3 Readiness & Response Capacity

333 District Rapid Response Teams (DRRTs), 5 people/team) in place 2 Central RRTs (Aden and Sanaa, 3 people/team) activated 1,991 sentinel sites reporting through Electronic Integrated Disease Early Warning System

(eIDEWS) 23 Governorate Rapid Response Teams (GRRTs) to be activated with a total of 45 staff 666 DRTTs targeted for scale-up (2 people/team) as ramp-up measure.

Strategic surveillance and case investigation actions that are planned under this pillar are based on different technical guidance and guidelines recently produced by WHO in the context of COVID-19 including the 16 March Interim guidance on “Critical preparedness, readiness and response actions for COVID-19” (https://www.who.int/publications-detail/critical-preparedness-readiness-and-response-actions-for-covid-19). In the context of COVID-19 preparedness and response ongoing planning, focus is currently put on reinforcing the surveillance and the capacity of all RRTs, particularly those operating in areas bordering other countries. The aim is to ensure that suspected cases will be investigated, isolated or treated right away to prevent cross-border spread. Under Pillar 3, the existing 333 DRRTs will be deployed for investigation of suspected 2019‑nCoV cases and initial treatment where appropriate. This will require the preparation and dissemination of case investigation protocols (as per WHO guidance) and supplies, establishment of a system for contact tracing and monitoring, and the implementation of a community-based surveillance mechanism. All 333 districts in Yemen have functional rapid response teams comprising of 5 members /team with a total number of 1,665 members that are responsible for investigation and response to outbreaks. The Central RRTs coordinate the response of the DRRTs. Plans have been developed to train and equip RRTs so that they are able to investigate cases and clusters early in the outbreak and conduct contact tracing within 24 hours. Ongoing coordination is taking place to ramp up the number of RRTs, from 333 to 999. This factors in the lessons learnt from the cholera response, as well as the need to increase the capacity to timely detect and investigate rumors in a much larger number of districts and intra-district locations. Effective from 1st April 2020, the Governorate Rapid Response Teams (GRRTs) will be deployed. WHO is coordinating with ministry authorities to finalize the list of GRRTs staff. The GRRTs will have an overall technical supervision of the DRRTs; they are responsible for verification and validation of the data collected and reported by DRRTs. They will be fully repurposed to the cholera program once the COVID-19 response is over. Similarly, the case definition has been revised. The updated case definition, along with case reporting, specimen collection and laboratory request forms, will be shared with surveillance focal points and IHR 2005 national focal points. The same tools will be made available with the POEs as part of the activation plan of the Points of Entry.

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Pillar 3 response will build on existing disease surveillance system which was developed in the course of the last 2 years to deal with frequent disease outbreaks experienced in the recent years, including cholera. Across Yemen, there are currently 1,991 active sentinel sites that are detecting and electronically reporting on 28 different highly pathogenic diseases such as cholera, dengue, viral haemorrhagic fever, measles, pertussis and acute flaccid paralysis. Severe Acute Respiratory Illness and influenza like illnesses are part of the eiDEWS reportable diseases. Sentinel sites are reporting using a centralised electronic reporting mechanism called Electronic Integrated Disease Early Warning System (eiDEWS) which has been recently successfully revamped and expanded. In 2019, a total of 83,609 true alerts were received through the eDEWS system that were verified and investigated by the eiDEWS coordinators and DRRTs to early detect and contain any potential outbreak. Annex 4 shows the distribution of sentinel sites throughout the country. The above described COVID-19 surveillance approach will be also supported through four hotlines (toll-free numbers) already established and tested which are currently operating at the central EOCs in Aden and Sanaa (two per EOC).5 Coordination is ongoing with national health counterparts to address technical improvements of the service.

With regard to COVID-19 lab testing, triggers are intergrated into existing surveillance of other influenza infections such as severe acute respiratory infections, upper and lower respiratory infections and influenza like illnesses. These infections are monitored on weekly basis; a team goes to the health facility reporting increased number of cases to look into registry books. Patients who fit the case definition will be tested. In addition to information obtained at facility level, the hotline team will assess the case either through direct phone calls with a suspected patient, or by obtaining additional information/clarification from the caller. In the latter, a RRT team will be deployed for further investigation and lab specimen taking for lab testing where considered needed. The hotlines will also address multiple needs currently endured by individuals, communities and the health system itself (chart below).

Chart I: Services that can be linked to hotlines for the benefit of individuals and communities

5 EOC Sana’a numbers: 02 358 259, 02 358 260. EOC Aden numbers: 01 255 942; 01 255 952

Provide referrals as needed for those reporting

potential or suspect cases

Prevent mis-information and rumors and combat

myths

Provide a centralized location to access vetted, trusted information about

COVID-19

Provide public health advice about where people should can seek treatment

and protect themselves from the disease and

prevent community spread

Provide customized information tailored, based

on operational feasibility

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With the support from UNICEF, in close coordination with WHO, a network of over 18,000 of community volunteers and religious leaders will conduct community based surveillance and report through the hotlines any suspected case that meets the definition so that RRTs can be deployed for further investifation. These community volunteers will also support the process of contact tracing. To this effect, SOPs to guide and inform their work are under development. Depending on issues reported through the hotlines and based on actual epidemiologic scenario (i.e. zero case, sporadic transmission, cluster cases or full blown transmission), RRTs will be deployed for further investigation, including lab sample taking, advising on referrals. A sufficient stock of PPEs will be made available to RRTs and an appropriate training on the use and disposal of different types of PPEs will be conducted. Pillar 4: Points of Entry

Objective Outcome

Ensure that each POE is well equipped and has the necessary resources to support COVID-19 surveillance (steps for quarantine and isolation if necessary) and risk communication. Linked to this, contribute to prevent the introduction of new imported cases while raising awareness among travellers about the risk posed by COVID-19.

Surveillance instated at POEs and risk of COVID-19 cases being introduced in Yemen reduced. Travellers are well informed about COVID-19 and are able to protect themselves and their communities.

Pillar 4 Readiness & Response Capacity

26 formal functional PoEs which are open to be activated and equipped (5 airports, 13 seaports and 8 land crossing points).

In Yemen, there are 30 formal Points of Entry comprising of 5 airports, 13 seaports and 12 land crossing points out of which 4 have been closed as a consequence of war (See table shown as Annex 5). Under Pillar 4, the Plan focuses to equip and train POE entry staff in appropriate actions for disease surveillance as well as to manage ill passengers, including having updated information SOPs for referring ill passengers to identified isolation facilities. WHO has global standard guidelines on POE activation, both in terms of case management and types of essential supplies required at each POE. The Plan refers to the existing standard procedures agreed at the global level (https://www.who.int/publications-detail/management-of-ill-travellers-at-points-of-entry-international-airports-seaports-and-ground-crossings-in-the-context-of-covid--19-outbreak). The POEs are also meant to be used as information point. They can provide the latest information about COVID-19 and actions needed by passengers to protect themselves and reduce risk of disease further transmission. In addition to the communication, it is critical to enforce the transportation control measures applied in other countries- travellers must fill identification and travel history cards. At the POE, staff will screen all people passing through the entry point with thermo-infrared devices and will fill out the questionnaire about the previous 2 weeks movements and possible contacts. If one person is defined as a possible “suspect case” s/he will be sent to the isolation facility by ambulance for testing. If other persons are not “suspect” but as decided in some entry points, they will be sent to quarantine location for 2 weeks before being able to move – or sent home for self-quarantine. It is critical to ensure health officials screen travellers in a safe and dignified way, away from other travellers. Any probable or confirmed case will be reported by the MOPHP to WHO in line with the International Health Regulations (2005) and the WHO’s interim guidance “Considerations for

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quarantine of individuals in the context of containment for coronavirus disease (COVID-19)” released on 19 March 2020 (https://www.who.int/publications-detail/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19). Health care workers who will be supporting the provisison of health services at POEs when needed will be also trained on Psychological First Aid (PFA) as an integral part of the response. WHO is working closely with MOPHP to prepare for the rapid detection and response to cases or clusters, at the main PoEs to Yemen. Preparedness measures have started with the establishment of temperature monitoring systems at the airports of Aden, Seyoun, Mukalla, Sana’a and Socotra; at some of the seaports in Aden, Hadramout, Hodeidah, Mukalla, Shabwa, Socotra and Taz and the road entry points to/from the Sultanate of Oman and to/from the Kingdom of Saudi Arabia. Most of the entry points are already implementing the use of traveller information cards “identification forms”, which enable public health officials to know the travel history of passengers and keep track of individuals entering the country. This will facilitate also the contact tracing once there are suspected cases. With exception of 4 POEs that are currently closed due to war impact, all others are equipped with temperature screening capacity. Pillar 5: National laboratories

Objective Outcome

Ensure that laboratories network identified for lab testing for COVID-19 have the appropriate capacity and readiness to timely manage large-scale testing in term of skilled personnel, equipment and lab supplies.

All suspect cases that meet WHO case definition, all contacts of confirmed cases and patients identified as suffering from respiratory diseases are timey tested for COVID-19 and all results (negative and positive) timely released.

Pillar 5 Readiness & Response Capacity

6 Central Public Health Laboratories (CPHLs) in place (Sana’a, Aden, Mukala’a, Taiz; Hodeida and Ibb) out of which 2 CPHL with PCR capacity (Aden and Sanaa)

2 additional CPHLs planned for activation6.

Planned actions to strengthen the testing laboratory capacity haved been prioritized based on WHO Interim guidance published on 19 March 2020: “Laboratory testing for coronavirus disease (COVID-19) in suspected human cases” (https://www.who.int/publications-detail/laboratory-testing-for-2019-novel-coronavirus-in-suspected-human-cases-20200117) and the WHO Interim guidance of 12 February 2020: “Laboratory biosafety guidance related to coronavirus 2019 (COVID-19).” (https://apps.who.int/iris/bitstream/handle/10665/331138/WHO-WPE-GIH-2020.1-eng.pdf). The public health laboratory network identified to support lab testing for COVID-19 includes 6 CPHLs

(Sana’a, Aden, Mukala’a, Taiz; Hodeida and Ibb). Two out of six labs (Sana’a and Aden) have the capacity for testing for COVID-19 virus using Real Time Polymerase Chain Reaction (RT-PCR) technology. The CPHLs in Sana’a and Aden are considered as reference laboratories and have been equipped with level 2 biosafety capacity to diagnose COVID-19 with RT-PCR methods. The two CPHLs have been provided with sufficient PCR based kits to be able to confirm COVID-19 suspected cases. The upgrade of the CPHLs in Hodeida, Al-Mukalla, Taizz and Ibb is part of the present plan as immediate step. As other four CPHLs become equipped with PCR, plans for on-the-job training and technical

6 The 2 additional CPHLs planned for activation are Saada and Seyoun after the required infrastructure improvement

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assistance will be rolled out and WHO will facilitate availability of testing kits and other essential supplies to CPHLs while continuously assessing technical procedures and validating the application of standard operating procedures and biosafety regulations. It should be noted that the CPHL in Ibb will require substantive infrastructure improvement before it can be used as a COVID-19 testing laboratory. Plans to establish 2 additional CPHLs (in Saada and in Seyoun ) to scale up the testing capacity are under implementation. In term of total number of tests that can be performed, an initial stock of 500 PCR reactions was made available (200 for CPHL in Sana’a and 300 for CPHL in Aden). Recently, additional 6,000 reactions have been provided by WHO and 200 more secured. This stock is going to be increased by 1,700 additional reactions sourced from Jordan which are to be delivered with the first available aircargo to Yemen. This will make a total of 6,700 reactions (3,500 for Sana’a and 3,200 for Aden) available at present. Efforts are being coordinated by WHO, in support to health authorities, to scale up the testing capacity with more reactions as well as laboratory staff training. WHO has provided the CPHLs with SoPs for all procedures related to collecting, transporting, receiving and testing COVID-19 lab samples. WHO will also facilitate the safe triple packaging and shipment of any specimen to WHO designated reference laboratories abroad, in case there is a need for validation, reconfirmation or further analysis. A series of capacity building/training activities have already started and will continue to be rolled out to cover a wide range of lab components and will include topics such as:

Laboratory testing guiding principles for patients who meet the suspect case definition safe specimen collection and shipment; Techniques for laboratory testing for COVID-19 virus, including techniques based on Nucleic

acid amplification tests such as PCR and serological testing. Where necessary, viral sequencing and viral culture technologies will be also introduced

Reporting of cases and notification of test results to WHO based on the provisions of IHR 2005 Pillar 6: Infection, Prevention and Control

Objective Outcome

Infection Prevention and Control (IPC) strategies systematically applied to prevent or limit COVID-19 virus transmission in health settings as well as in other settings, including hospitals, households, schools, mosques and during mass gatherings.

Transmission of COVID-19 virus to health care workers, patients/visitors and communities prevented or reduced to the possible extent, through systematic application of IPC practices relevant to specific settings.

Pillar 6 Readiness & Response Capacity

37 Isolation Units, 26 POEs and 42 quarantine units to be equipped with protection supplies and WASH services to ensure adherence to IPC protocols and standards

147 DTCs targeted for increased WASH support given the risk of co-morbidity.

Strategies and actions planned for IPC throughout the country are based on WHO Interim guidance published in March 2019on “Infection prevention and control during health care when COVID-19 is suspected” (https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125). Also for health care facilities with COVID-19, they will be requested to apply the procedures and recommendations of the Interim guidance for “Risk Assessment and management of exposure of health care workers in the context of COVID-19” (https://apps.who.int/iris/bitstream/handle/10665/331496/WHO-2019-nCov-

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HCW_risk_assessment-2020.2-eng.pdf) which is an assessment tool for health care facilities with COVID-19 patients. Pillar 6 interventions are cross-cutting and relevant to all other Pillars of the plan. Under Pillar 6, partners will focus on four main areas of work: First, undertake a risk assessment of IPC capacity at all levels of the healthcare system (includes availability of triage and appropriately ventilated isolation rooms). On the basis of this assessment, define a referral pathway in collaboration with case management capacity (Pillar 7). Particular attention will be given to ensuring IPC compliance with basic IPC principles at the designated Isolation Units, POEs , laboratories and planned facilities for quarantine (Pillar 1 and 4). Second, ensure availability of WASH (safe water provision) and IPC supplies needed to implement the recommended IPC protocols (e.g., hand hygiene resources, personal protective equipment, environmental cleaning, and waste management). Provision of WASH and IPC supplies needs to factor-in the worldwide demand for same type of supplies and apparent scarcity of supplies. Under this component of Pillar 6, partners will also scale-up the IPC measures in the existing Diarrhoea Treatment Centres (DTCs) given the increased risk for cholera patients in terms of co-morbidity. Third, provide WASH services in healthcare facilities that are critical for quality care and prevention of hospital acquired diseases (i.e. nosocomial infections), particularly through human to human transmission. Applying WASH, waste management and IPC practices will be crucial at this point given their relevance to COVID-19. Environmental cleaning and safe excreta management (faeces and urine) are being prioritised, along with hand hygiene services, availability of disinfectants, and safe waste management. As part of the safe healthcare waste management system, hardware components, waste segregation, collection and disposal are essential, and this is an area where huge efforts to improve this sector will be needed.

Fourth, in coordination with the organizations specialized in risk communication and the Health ad WASH Cluster, help the dissemination and application of IPC guidelines in the target facilities, particularly facilities identified for isolation and treatment of COVID 19 patient. This is primarily to prevent onward transmission to staff, fellow patients and visitors. Training and capacity building activities have also been initiated as part of actions being taken to ensure that health staff working in isolation facilities and quarantine areas are familiar with IPC protocols and requirements. So far a total of 85 health professionals have been trained and this activity is being rapidly scaled up to reach a target of 925 staff to be trained in short period of 2 to 3 months to support not only IPC activities but also the clinical management of COVID-19 patients. To support the process of triage, referral pathways, an initial stock of PPEs has been made available. Annex 6 shows the stock of PPEs already distributed across the country and estimated needs for 6 months period. Additional PPE are being procured. Similalry, part of ambulance fleet recently made available to the MOPHP, with the support of WHO, is being re-purposed so support the referral pathway. Support from other UN organisations such as OIM, UNHCR and UNICEF has been requested to support the preparation of adequate space for triage using tents. These organisations will work closely with WHO for technical guidance on IPC, triage and referral protocols. It is important to note that IPC measures will help save lives not only for COVID-19 patients but also will assit in reducing deaths from secondary infections/causes, including reducing nosocomial infections.

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Pillar 7: Case management and continuity of services

Objective Outcome

Ensure that healthcare facilities in Yemen are prepared to receive an increase in number of suspected cases of COVID-19. Ensure that health personnel are well trained and familiar with COVID-19 case definition and management, and are able to deliver appropriate care to patients according to COVID19 protocols, particularly patients at higher risk (older adults and people with underlying medical conditions).

Better case management, including increased survival rate, among patients. High rate of patients recovering from COVID-19 with low case fatality rate (CFR) . Increased protection of health personnel and health facilities through the provision of supplies needed for COVID-19 treatment and IPC.

Pillar 7 Readiness & Response Capacity

26 healthcare facilities to be activated as isolation units 314 points of assistance for IDPs and migrants to be activated

Actions included in the plan for clinical management of COVID-19 impacted patients are based on a number of WHO guidance and guidelines such as “Clinical management of sever acute respiratory infection (SARI) when COVID-19 disease is suspected” (https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected); “Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts” (https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts); “Mental Health and Psychosocial Considerations During COVID-19 Outbreak” (https://www.who.int/publications-detail/mental-health-and-psychosocial-considerations-during-the-covid-19-outbreak) and “Management of ill travellers at Points of Entry –in the context of COVID-19 outbreak” (https://www.who.int/publications-detail/management-of-ill-travellers-at-points-of-entry-international-airports-seaports-and-ground-crossings-in-the-context-of-covid--19-outbreak). Planned actions aim at ensuring that resources needed for clinical management are in place:

Identification of health facilities with isolation and or Intensive Care Unit capacities and setting up protocols for triage and screening areas at these facilities

Assessing and mapping the size of groups of populations having underlying causes who are likely to be at higher risk should them be affected by COVID-19

Establishing dedicated and equipped teams and ambulances to transport suspected and confirmed cases and referral mechanisms for severe cases with other underlying conditions (co-morbidity)

Identification of those presenting with mild illness and isolate them in non-traditional facilities, such as re-purposed hotels, stadiums or gymnasiums where they can remain until their symptoms resolve and laboratory tests for COVID-19 are negative. Alternatively, asymptomatic cases and patients with mild diseases and no risk factors can be managed at home, with strict adherence to IPC measures and precautions regarding when to seek care.

In case of cases managed at home, ensuring availability of guidance for the self-care of patients with mild COVID-19 symptoms, including guidance on when referral to health care facilities is recommended;

Ensuring availability of trained health personnel to provide comprehensive medical, nutritional and mental health and psycho-social support care for those with COVID-19, including referral services.

Rolling out training on detection and referral of persons requiring MHPSS services

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Updating and disseminating regularly information and protocols on the management of severe acute respiratory infections and COVID-19 specific protocols based on international standards and WHO clinical guidance.

Annex 7 shows the list of 37 healthcare facilities that will be used as isolation units should suspected and confirmed cases occur. These facilities have been selected to be used as isolation units in each governorate and these are linked to Emergency Operations Cells. Annex 8 shows also the list of 42 centres that have been identified to serve as quarantine areas, including at Points of Entry. Considering the anticipated increased number of those who will present mild symptoms, health authorities have started to identify some hotels, in Sana’a and other major urban areas, which can be re-purposed to serve as non-traditional facilities where those patients will remain until their symptoms resolve and laboratory test results for COVID-19 are negative. The aim is to contain the spread of the disease while at the same time allowing the healthcare facilities to deal only with severe cases instead of the health system being overwhelmed by patients with mild illnesses. At present, efforts focus on increasing the number of beds, ICU and ensuring there are sufficient supplies including ventilators. Nevertheless, preparedness and response under this Pillar need to take into account the ongoing worldwide shortage of supplies, including medicines for respiratory related illnesses. Estimate quantities of supplies needed for an initial period of 6 months is shown as Annex 9. MOPHP and other line ministries, including the ministry of transport, ministry of foreign affairs have been communicating to WHO and other international organisations, new lists of requirements. Additional lists will continue to be submitted as needs become clearer. These lists are regularly subject to review, in terms of technical specifications as well as in term of relevance to the needs and value of money. At present, a total of 195 ventilators are already in the country and additional 430 are under procurement. For ICU bed capacity, there are 720 beds in the country which will be delivered upon completion of assessment of identified isolation units. Additional 800 ICU beds have been ordered and are in procurement process. For details please see Annex 10. The plan is to have isolation units with an average of 20 beds for moderate to critical cases for which ventilators might not be needed and then 5 additional ICU beds for severe cases requiring the use of ventilators. An estimated number of 3,500 health care workers of different categories are available in the country to support various aspects of the management of communicable diseases. With potential COVID-19 outbreak expected in the country, some of them will have to be repurposed and most of them require specific training on how to manage COVID-19 patients while protecting themselves. As of March 2020, a total of 85 health workers out of a target of 925, have been trained on IPC and case management from 6 governorates. Plans to scale up the training of the remaining 840 healthcare workers (925-85) are currently being rolled out, with the support of WHO and other Health Cluster member organisations. Lessons learnt from other countries already affected by the pandemic show that about 80% of patients will experience mild symptoms and will eventually recover. Recent studies have shown that highest case fatality rates (CFR) occur among population groups with underlying chronic health conditions such as heart diseases, diabetes, cancers, kidney failure, patients with immunity compromised system, etc. Given the high prevalence of these underlying conditions within Yemen population, preparations are ongoing to maximise the ability of selected health care facilities to prepare for and respond to large increases in the number of COVID-19 cases. Sectoral plans to provide support to vulnerable groups will also be developed, including population affected by different forms of malnutrion, lactating women and populations that could need mental health and psychosocial support services in the context of COVID-19.

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Other vulnerable groups that are likely to require specific support are IDPs, migrants and refugees that could be victims of stigma if no concerted action is taken for their protection. In this regard, the Plan foresees integrated coordination among UN partners to support local authorities and provide assistance to vulnerable groups through the existing platforms of humanitarian assistance. The UN inter-agency is a concerted effort co-shared by WHO, UNICEF, UNHCR and IOM.

Current IDPs total caseload in Yemen is estimated is over 3 .34 million. The majority of them are living in host communities (70 %) and the remaining are living in 1,616 IDP sites (approximately over 1 million) and this group in IDP sites is the most vulnerable. Recent studies on vulnerability and availability of services in these IDPs sites show that: - 83% of sites across the country have elderly population presence - 78% of sites contain people with chronic disease - 91% of sites have pregnant and lactating women - 54% of sites report as infectious disease as the main threat in the site - 38% of sites report the second most common threat being water contamination With regard to migrants and refugees, local authorities will work closely with UN agencies to reduce the risk of stigma as these populations might be perceived as potential risk of introducting COVID-19 virus in the country. The health system in Yemen remains fragile. Demand generated by the COVID‑19 preparedness and response will increase pressure on the existing health system capacity. When health systems are overwhelmed, both direct mortality from an outbreak and indirect mortality from vaccine-preventable and treatable conditions increase dramatically. Health facilities can become also a “dissemination” factor if not well prepared. Analyses from the 2014-2015 Ebola outbreak suggest that the increased number of deaths caused by measles, malaria, HIV/AIDS, and tuberculosis attributable to health system failures exceeded deaths from Ebola.7 Access to reproductive, maternal and newborn health will be also seriously affected by COVID-19 pandemic and there is an urgent need to ensure the continuation of these services so as to prevent further deterioration of the maternal and newborn health in Yemen which is already the lowest in the Arab region. To continue preserving the health system functionality and avoid disruption of non-COVID related services, the present plan will prioritize the following categories:

• Essential prevention for communicable diseases, particularly vaccination; • Services related to reproductive, maternal and newborn health, including care during pregnancy; • Care of vulnerable populations, such as young infants and older adults; • Provision of medications and supplies for the ongoing management of chronic diseases, including mental health conditions; • Continuity of critical inpatient therapies; • Management of emergency health conditions and common acute presentations that require time-sensitive intervention; • Auxiliary services, such as basic diagnostic imaging, laboratory services, and blood bank services.

The key actions to support the non-COVID19 services include:

7 Quoting original source: WHO, COVID19-Strategic Planning and Operational Guidance for maintaining essential health services during an outbreak (draft, as of 20 March 2020) available at

https://www.who.int/publications-detail/covid-19-operational-guidance-for-maintaining-essential-health-services-during-an-outbreak.

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Identify core services and locations/facilities that will be prioritized in their efforts to maintain continuity of service delivery

Map core services list to resource requirements Revise the existing patient referral pathways Re-distribute health workforce capacity, including by re‑assignment.

Pillar 8: Operational support and logistics

Objective Outcome

Provide appropriate support to all other pillars and ensure that resources and supply systems in health and other sectors are functional.

Efficient response to COVID-19 pandemic with timely and unterrupted supply chain and critical functions identified and supported (i.e. water and sanitation, fuel, energy, food, telecommunications/internet, financial resources, transportation, essential workforce, procurement)

Pillar 8 Readiness & Response Capacity

Shipment plans coordinated with the support from WHO and WFP using WHO Supply Chain Management System (SCMS).

Up to $ 12M worth supplies to be procured to secure preparedness and response capacity under all relevant Pillars.

This pillar is the backbone of the preparedness and response as it provides support to all other pillars. However, it is also recognized by all stakeholders expected to get involved in COVID-19 response as the most challenging, considering the ongoing conflict in the country, , global disruption to travel and scarcity of supply chain. Planned actions and activities being already implemented aim at:

Mapping available resources and supply systems to update current stocks and pipelines across sectors and making estimates of disease commodity package (DCP) and COVID-19 patient kits that will be needed for use and for contingency stock.

Putting in place coordinated systems and processes that will facilitate smooth goods importation and distribution, including permits to move materials and supplies where these are most needed.

The MOPHP, supported by WHO, has started to review available emergency supplies and in pipeline which were procured as part of the response to the ongoing conflict, in order to identify relevant supplies that can be mobilized should COVID-19 cases be confirmed. The MOPHP in Sana’a and Aden is taking the lead to ensure that fast tracking mechanisms for importation and customs clearance approvals are in place. This requires agreements with other line ministries as well as with authorities responsible for security. WHO, UNICEF and other health partners members of the Health cluster have expressed their readiness to support national authorities in its ongoing efforts to develop COVID-19 preparedness and response plan. WHO, in particular, has started to mobilise resources that will be needed to support MOPHP. In this regard, WHO will be gradually increasing its staff surge capacity. The organisation has also requested the local authorities to establish mechanisms that could fast track issuance of regular and residency visas.

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WHO, in collaboration with WFP, has started to mobilise its logistic resources and assets, to support the country in responding to COVID-19 should a case occurs.WHO will leverage on the current warehousing capacity estimated at about 34,400 square meters with 5 warehouses in different locations (Aden, Sana’a, Dubai, Djibouti and Salalah). Annex 11 is a map showing WHO warehousing capacity as well as the supply routes currently used by WFP, in its support to WHO operations. Section VI: Monitoring and Evaluation of the Plan Implementation A framework for monitoring and evaluation of the COVID-19 plan implementation has been developed with key performance indicators (see Annex 12). These will be used at national and governorate level. Details of the COVID-19 Preparedness and Response Plan M&E Framework are shown as Annex 13. With the aim to increase the accountability towards affected communities, independent monitoring mechanisms will be put in place, with WHO’s support, through the activation of Third Party Monitoring (TPM) both through on the site and remote modality. During the implementation of the plan, at central and at governorate levels, WHO, will support the MOPHP, to collect regularly data related to key variables and performance indicators, and will also assist in making available, including facilitating their dissemination, a number of products that could include briefings, electronic dashboard, situation reports, infrographics, reports to WHO specific COVID-19 donors who might have provided funds to WHO to support health authorities in addressing COVID-19 outbreak. Some of these datasets and products are listed in the matrix shown as Annex 14.

Section VII: Estimated funding requirements The following section outlines the estimated resources required to be mobilized to implement priority public health measures in support of the plan. The estimated resource requirements are for overall planning purposes and will be adjusted as the situation evolves. Funding requirements build on the following assumptions and pre-conditions (see Table 1 below). Table 1: Assumptions and Considerations for estimation of budget requirements for Yemen COVID-19 Preparedness and Response Plan

General assumptions Yemen-specific pre-conditions

Resource estimates are inclusive of essential supplies, as outlined in the standard 2019-nCoV Disease Commodity Packages, and critical staffing, technical, and operational support costs, including training and incentives for national workforces.

Health sector funding gaps, particularly relevant to the incentives and per-diem payment for the retention of the healthcare workers.

Support is to be provided on a no regrets basis resulting in receiving support to manage imported cases; manage localized transmission and manage community transmission.

Socio-economic erosion and already stretched health system and capacity. Access to medical supplies and equipment remains dependent on international aid, with increased costs for preparedness and response.

Since the start of the COVID-19 outbreak, prices have surged. Surgical masks have seen a six fold increase, N95 respirators have tripled and gowns have doubled.

25

The estimate budget requirements for 7 months period are outlined in the table 2 below. The budget is organised by pillar. Detailed activities to be implemented unde each pillar will be part of the operational sectoral plans. Table 2: Estimate of Budget required for 7 months for Implementation of Yemen COVID-19 Plan

Pillar Resource projections ($US) Programmatic variables and assumptions

Pillar 1: Country-Level coordination, planning and monitoring

2,700,000

Sustain the existing EOCs and support the activation of new EOCs as required.

Pillar 2: Risk Communication and Community Engagement

5,178,000

Large scale outreach using existing community and health-facility based platforms.

Pillar 3: Surveillance, rapid response teams, and case investigation

15,469,000

Scale-up the surveillance capacity, including activation of GRRT and increase in the number of DRRTs.

Pillar 4: Points of Entry 12,500,000 Activation and running costs for all target POE.

Pillar 5: National laboratories 4,252,000 Sustain and expand the CPHL capacity to max 13 labs.

Pillar 6: Infection, Prevention and Control

11,701,000 Based on the target locations to be prioritized under Pillar 6.

Pillar 7: Case management and continuity of services

13,860,000

It factors in the need to support the non-COVID facilities and maintain in place independent monitoring over target COVID-19 facilities established under Pillars 4 and 7.

Pillar 8: Operational support and logistics

10,900,000

It factors in the expansion of the logistics requirements in new locations (border and POE).

Total 76,560,000

26

The Gantt Chart below shows the timeline for implementing priority actions within a period of 7 months, should sufficient funds become available

Section VIII: Sequencing out the priority actions by Pillar 8

Pillar Action Mar-20 Apr-20 May-20 Jun-20 Jul-20 Aug-20 Sept-20

1 Maintain in place the existing EOCs

Activate Socotra EOC

2 Finalize and launch the risk communication plan

Have the hotlines operational

3 Maintain in place and support existing 335 RRTs (district and central)

Activate and maintain the 23 GRRTs

Scale up the DRRTs (666 DRRTs)9

4 Activate and equip 26 PoE

Have in place PoE monitoring (remote and on the site)

5 Complete the activation of the PCR at the 3 CPHL with PCR capacity10

Procure and monitor the stock of supplies for all 6 existing CPHL

Retain lab staff at the 6 CPHL (incentives and on-the-job site support)

Activate 7 additional CPHL

6 Complete the procurement and equip isolation and quarantine units

Have in place monitoring (remote and on the site)

Increase support in the area of IPC to existing DTCs

7 Activate and equip 26 isolation units

Have in place PoE monitoring (remote and on the site)

Finalize and implement the COVID19 plan for migrants, refugees

Prepare and implement the plan for non-COVID facilities and services

8 Sustain the SCM including its monitoring (upstream and downstream)

8 This is not a timeframe. It is meant to visualize the interventions to be prioritized under each pillar and help decision making in the next months for all partners implementing the present plan. 9 Contingent to availability of resources/funding allowing the payment of incentives to the teams. 10 Mukalla, Hodeida and Taiz.

27

Section IX: Risk Management The Plan considers operational and context risk that can impact health and non-health partners to be effective at the preparedness and response stage. The health authorities, in coordination with WHO and other sector partners, will revise and update the risks as the situation evolves and more evidence is generated, including the modelling and scenario-based response. Risk review will refer to the types of risks as well as threshold of risk.

Risk Likelihood Impact Risk management activated under the COVI-19 Plan

The COVID19 Preparedness and Response Plan follows a vertical approach instead of promoting active coordination with other sectors and actors.

Possible Major The Plan comprises 8 Pillars and each of them will be operationalized by both health and non-health sector partners, based on areas of expertise and required support. The health authorities are part of the COVID19 Inter-Ministerial Response Committee. Strategic decisions will be taken at the inter-ministerial level with the technical support of the ad-hoc COVID19 TaskForce.

Partners use non-harmonized scale of incentives and for needs not related to the COVID19 Preparedness Plan.

Possible Major Incentives for COVID19 will be time-bound and limited to the essential healthcare workers needed in critical functions (case management, surveillance). Independent monitoring mechanisms (TPM) will be put in place to track the allocation of resources; the health authorities will continue coordinating with WHO to validate the list of payees /health workers assigned to COVID19 preparedness and response.

COVID19 supplies and equipment (i.e. PPE) are delivered to facilities that are not in the list of target locations.

Possible Major The health authorities have identified the locations where screening, isolation and case management will take place; and already started coordinating with WHO for the delivery of the existing supplies, while waiting for more equipment to reach the country.

28

Risk Likelihood Impact Risk management activated under the COVI-19 Plan

The distribution plan will be revised with partners on regular basis. The health authorities will conduct supervision visits (independent and joint with other technical partners) and facilitate access to TPM.

Trucks transporting COVID19 supplies and equipment (i.e. PPE) are denied access to reach target locations.

Likely Major The COVID-19 Task Force will detect possible cases of access denial and coordinate with the inter-ministerial emergency COVID-19 Response Committee to prevent obstruction and interference.

COVID19 preparednes and response is operationalized at the local level without integrated coordination.

Possible Moderate The Governorate Health Offices (GHOs) will support the implementation of the COVID-19 plans based on the agreed-upon plan signed by the central authorities and in coordination with the correspondent administrative units of other ministries at the governorate level (i.e. WASH). GHOs will support NGOs re-purporsing their resources to support communication and community engagement, facilitating the update of their sub-agreements as per existing conditions agreed with GHOs and UN Country Team.

The most at-risk patients do not receive adequate support during the preparedness and response phase.

Unlikely Major The health authorities are working to maintain in place and functional specialized treatment centers- these units will not be used for COVID-19 response. IPCs measures will be strengthened at critical facilities treating vulnerable patients like SAM children- the central health authorities are coordinating with WHO and other health sector partners to ensure IPC support is increased according.

Healthcare workers are not protected during duty of care.

Possible Severe Support plan from WHO and other partners is in place to equip healthcare workers with PPEs and train them on IPC and correct use of PPEs.

29

Risk Likelihood Impact Risk management activated under the COVI-19 Plan

The health authorities will facilitate access to TPM to monitor the availability and correct use of PPEs.

The existing surveillance system is unable to respond to the possible outbreak of COVID19.

Possible Major During the current phase (preparedness), the main focus remains to equip all CPHLs with additional supplies and full capacity to run PCRs. In the interim period, the health authorities will work together with WHO to activate additional CPHLs. As for the RRTs, the health authorities will coordinate with UN Agencies, primarily WHO, to expand the number of RRTs on interim and time-bound basis for impact response in the next 7 months.

30

Annexes Annex 1: List of 12 informal land crossing points from northern to southern governorates Annnex 2: Worldwide distribution of COVID-19 cases in affected countries, including the Eastern Mediterranean Region Annex 3: Suppressive measures put in place by authorities in Sana’a and Aden as part of the Yemen COVID-19 Preparedness and Response Plan Annex 4: Distribution of sentinel reporting sites throughout the country Annex 5: List of Formal Points of Entry in Yemen Annex 6: Stock of PPE available and anticipated needs for the first 6 months

Annex 7: List of healthcare facilities identified for use as isolation units Annex 8: List of facilities identified to serve as quarantine areas Annex 9 : Estimate quantities of supplies for an initial period of 3 months Annex 10: Current ICU bed capacity and availability of ventilators Annex 11: WHO warehouse capacity for Yemen operations and Supply Routes Annex 12: Yemen COVID-19 Preparedness and Response Plan M&E Framework Annex 13: Key Performance Indicators, Planned outcomes and Products Annex 14: Information Management Support for COVID-19 Preparedness and Response

31

Glossary of Terms and Key operational abbreviations

Contact Tracing: The process of identifying, assessing, and managing people who have been exposed to a contagious disease to prevent onward transmission. Community transmission: Infections identified in a given geographic area without a history of travel elsewhere and no connection to a known case. Confirmed case: A person with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. Contact (Definition of a): A contact is a person who experienced any one of the following exposures during the 2 days before and the 14 days after the onset of symptoms of a probable or confirmed case:

1. Face-to-face contact with a probable or confirmed case within 1 meter and for more than 15 minutes;

2. Direct physical contact with a probable or confirmed case; 3. Direct care for a patient with probable or confirmed COVID-19 disease without using proper

personal protective equipment; OR 4. Other situations as indicated by local risk assessments.

eIDEWS: Electronic Integrated Disease Early Warning System GRRT: Governorate Rapid Response Team HeRAMS: Health Resources Availability Monitoring System Index Case: The first identified and confirmed case in a group of related cases of a communicable disease Influenza-Like Illness (ILI): Also known as flu-like syndrome/symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. Possible COVID-19. Isolation: Separating sick pick who may have COVID-19 from those who do not. This can take place in various settings; clinical and home. Isolation Centre: A location to treat mild-moderately affected patients and take them out of circulation to prevent further disease spread. Isolation Unit: A specialized unit which has the capacity to treat severe or critical patients. Probable case:

A. A suspect case for whom testing for the COVID-19 virus is inconclusive. a. Inconclusive being the result of the test reported by the laboratory. OR

B. A suspect case for whom testing could not be performed for any reason. Quarantine: Separating and restricting the movement of people exposed (or potentially exposed) to a contagious disease. RCCE: Risk Communication and Community Engagement

32

RRT: Rapid Response Team Severe acute respiratory infection (SARI): Sudden respiratory infection that requires hospitalization Self-Quarantine: Staying home and away from other people to avoid exposure and minimise spread. Social Distancing: Measures taken to reduce person-to-person contact in a given community, with a goal to stop or slow down the spread of a contagious disease. Measures can include working from home, closing offices and schools, cancelling events, and avoiding public transportation. Suspect case A:

A. A patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND a history of travel to or residence in a location reporting community transmission of COVID-19 disease during the 14 days prior to symptom onset. OR

B. A patient with any acute respiratory illness AND having been in contact with a confirmed or probable COVID-19 case (see definition of contact) in the last 14 days prior to symptom onset;OR

C. A patient with severe acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath; AND requiring hospitalization) AND in the absence of an alternative diagnosis that fully explains the clinical presentation.

Transmission pattern (Definition of categories for):

1. Category 1: No cases – Country/territory/area with no cases 2. Category 2: Sporadic cases - Country/territory/area with one or more cqses, imported or

locally detected 3. Clusters of cases – Country/territory/area experiencing cases, clustered in time, geographic

location and /or by comp, exposures 4. Community transmission – Country/territory/area experiencing larger outbreaks od local

transmission defined through an assessment of factors including, but not limited to: o Large numbers of cases not linkable to transmission chains o Large numbers of cases from sentinel lab surveillance o Multiple unrelated clusters in several areas of the country/territory/area

Triage: The assignment of degrees of urgency to illnesses to decide the order of treatment of a large number of patients.

Annex 1: List of Internal land crossing check Points as of 29 March 2020

List of Internal Points of Entry (Land Crossing check points) Availability of Screening

Capacity (Yes or No)

S/N Governorate Name of Land Crossing Point

1 Al Bayda Afar Entry point Yes

2 Al Bayda Thaina’an Entry point Yes

3 Al Bayda Rada'a Checkpoint Yes

4 Al Bayda Albaala- ouween -Alsawoumah Yes

5 Taiz Hayfan- Tour Al Baha Yes

6 Taiz Maqbanah-Al Mukha Yes

7 Taiz Mawiyah-Al Mosaymeer Yes

8 Taiz Almesrakh – Demonah Yes

9 Taiz Samae- Demonaah Yes

10 Taiz Alrahedah – Alqabetah Yes

11 Taiz AlMosaymeer- Alazareq Yes

12 Taiz AlRamadah- Barashah Yes

13 Taiz Alayar Yes

14 Ibb Shiban Al-Saiany Yes

15 Ibb Al Zahar- Kahza Yes

16 Ibb Al Amira Yes

17 Ibb Al Salba Yes

18 Ibb Hayran Yes

19 Ibb Al Kaida Yes

20 Ibb Al Ajlab Yes

21 Ibb Al Asameen Yes

22 Amran Abla Yes

23 Al Hudaydah Almareer Yes

24 Al Hudaydah Al Khamees Yes

25 Al Hudaydah Al Khawba Yes

26 Al Hudaydah Alluhaya Yes

27 Al Hudaydah Bab alnaka Yes

28 Al Hudaydah Al Saleef Yes

Annex 2: Worldwide distribution of COVID-19 cases in affected countries, including the Eastern Mediterranean Region- as of 25 March 2020

Page 1 of 3

Annex 3: Suppressive measures put in place by Sana’a and Aden authorities as part of the Yemen National COVID-19 Preparedness and Response Plan

S/N Type of measures Decree or ministerial instructions Reference

Measures put in place by Authorities in

Sana’a as of 14 March 2020

(Yes or No)

Decree or ministerial instructions Reference)

Measures put in place by Authorities in Aden (Yes or No)

Remarks (i.e. decree issuance date)

1 Closure of Schools Decree Higher committee of 14 March 2020

Yes Yes

2 Closure of Restaurants Idem Yes No

3 Closure of Mosques Idem No Ministerial instruction (Ministry of Endowments and Guidance)

Yes

4 Interdiction of Mass gatherings Idem Yes Ministerial instruction (MoPHP)

Yes

5 Closure of all land entries Idem Yes Ministerial instruction reference to Decree from Vice PM*

Yes

6 Closure of Sana’a airport/ Aden Idem Yes Ministerial instruction reference to Decree from Vice PM

Yes As 17 March 2020

7 All arrivals from countries with circulation of the virus to self-quarantine for 14 days

Idem Yes Yes

8 Stopped issuing of entry visa No Ministerial instruction reference to Decree from Vice PM

Yes As of 17 March 2020

9 Cancelation of all trainings and workshops organized with International organizations**

Yes Ministerial instruction reference to Decree from Vice PM

Yes As of 20 March 2020

Page 2 of 3

10 Instruction to international and national organizations to apply measures to reduce mass gathering during celebrations

No Ministerial instruction reference to Decree from Vice PM

Yes As of 17 March 2020

11 Closure of hotels, parks, wedding halls, and qat markets for two weeks

No (except qat) Instruction by STC Security belt forces

Yes As of 23 March 2020

12 Curfew starting from 10:00 pm to 6:00 am

No Instruction by STC Security belt forces

Yes As of 26 March 2020

13 Restrict closure of all ports of entries

No Instruction by HE Minister of Health to HE PM

Yes As of 29 March 2020. This is advisory as information that some government authorities are planning to return Yemeni nationals to their country.

14 Restrict closure of Al Sahen and Sarfit Omani border

No Instruction from Al Mahra Governorate to security forces at the POEs

Yes As of 29 March 2020

15 Extension of closure of all POEs land crossing, air and Sea port of another two week starting from 01 April 2020.

Yes Decree by PM and Higher National committee for Emergency and control of COVID-19

Yes As of 30 March 2020

16 Prevention of illegal immigration in all points of entry, including land crossing points***

Part of 17 measures adopted by the Parliament in its session of 4 April in Sana’a

Yes

17 Disinfection of public places and ensuring collection of solid waste from streets

Idem Yes

Page 3 of 3

18 Ensuring health education messaging addressed to communities

Idem Yes

19 New arrivals through check points to be quarantined but ensure those are not mixed with old caseloads of previous arrivals

Idem Yes

20 Ensuring availability of sufficient number of ambulances ready to transport confirmed and suspected cases to isolation centres

Idem Yes

21 Protocols for case management put in place

Idem Yes

22 Activation of the recruitment of volunteers to support COVID-19 response

Idem Yes

23 Applying lessons learned from other already COVID-19 hard hit countries

Idem Yes

24 Commitment to draw on all available resources to combat COVID-19

Idem Yes

24 Appeal to international organisations to support COVID-19 response plan

Idem Yes

Notes:

*Including seaports, with exception of humanitarian goods and commercial goods.

**With exception of activities organised in relation to COVID-19 preparedness and response activities

*** From #16 to # 24, there are some suppressive measures formally adopted by Sana’a authorities might have been also adopted by authorities in Aden.

Annex 4: Distribution of sentinel sites reporting into the electronic disease early warning system (eIDEWS)*

*eIDEWS is an electronic based reporting platform used by sentinel sites across Yemen to report on 28 highly pathogenic diseases such as cholera, dengue, viral hemorrhagic fever, measles, pertussis diphtheria and acute flaccid paralysis and others. Today, there are 1,991 active sentinel sites that are actively engaged in reporting through eIDEWS.

Annex 5: List of Points of Entry in Yemen (N = 26 operational as of 25 March 2020)

Page 1 of 1 Monday, April 6, 2020

S/N Name of Point of Entry (PoE) Location

Type of PoE Screening Capacity Status

(Yes or No) Governorate District

1 Hudaydah sea port

Hudaydah

Al-Maina Sea port Yes

2 Hudaydah Fishing port Al-Hwak Sea port Yes

3 Khwakh sea port Khwakh Sea port Yes

4 Al-Salif sea port Al-Salif Sea port Yes

5 Mukalla sea port Hadramout

Al-Mukalla Sea port Yes

6 Alsheher seaport Al-Sheher Sea port Yes

7 Socotra sea port Socotra Hadaibw Sea port Yes

8 Neshtoon sea port Al-Maharah Neshtoon Sea port Yes

9 Al-Mu'ala sea port

Aden

Al-Mu'ala Sea port Yes

10 Al-Twahi sea port Al-Twahi Sea port Yes

11 Al-Bouraiqa sea port (oil port-Mina Al-zait)

Al-Boriqa Sea port Yes

12 Mukha sea port Taiz Mukha Sea port Yes

13 Shabwa Sea port Shabwa Bairali Sea port Yes

14 Sana'a Airport (international only for humanitarian actors)

Sana’a (Amanat Al-Asimah) Bani Al-Harith Airport Yes

15 Aden Airport (International) Aden Khwer Maxer Airport Yes

16 Al-Rayan Airport (domestic) Hadramout Al-Mukalla Airport Yes

17

Sayoun airport (International) Hadramout Sayoun Airport Yes

18 Socotra Airport Socotra Socotra Airport Yes

19 Al-Wadeah Land crossing point (KSA)

Hadramout Sayoun Land Crossing

Yes

20 Shahan Land crossing point (Oman)

Al-Maharah

Shahan Land Crossing

Yes

21 Sarfeet Land crossing point (Oman)

Sarfeet Land Crossing

Yes

22 Al-Boka’a Land crossing point (KSA)

Sa’ada

Al-Boka’a Land Crossing

CLOSED

23 Al-Thabat Land crossing (KSA) Al-Thabat Land Crossing

Yes

24 Alraqw Land crossing (KSA) Alraqw Land Crossing

Yes

25 Alb Land crossing (KSA) Alb Land Crossing

CLOSED

26 Algour Land crossing (KSA) Land Crossing

Yes

27 Sarah Alqahar Land crossing (KSA) Land Crossing

Yes

28 Tair hamdan Land crossing (KSA) Land Crossing

Yes

29 Miaddi Land crossing Hajjah Miaddi Land Crossing

CLOSED

30 Harrad land crossing Hajjah Harrad Land Crossing

CLOSED

Item Description UOM Quantity Location in Warehouses and DP area

Glove examination, nitrile, pf, size l, ext. cuff min. 28 cm, box-100 Box of 100 8,320 Aden

Gloves protection, nitrile, pf, ambidext., disposable, size l, box-100 Box of 100 4,598 Sana'a

Gloves, surgical, latex, s.u., sterile, pair, size 7 & 8, pkt-50 Pack of 50 72 Aden

Gloves, surgical, latex, s.u., sterile, pair Box of 50 120 40%Sana'a- 60%Aden

Goggles protective, wraparound, soft frame, indirect vent., unit Unit 200 Aden

Gown, aami level 3, non sterile, disp., size l Unit 2,400 Aden

Gown, non-sterile, aami level 4, size xl, disp., unit Unit 5,565 40%Sana'a- 60%Aden

Mask surgical, type iir, level 2, s.u, non sterile, ear loop, size l, Box of 50 250 40%Sana'a- 60%Aden

Mask surgical, type iir, level 2, s.u, non sterile, ear loop, size s, Box of 50 125 Aden

Respirator, mask, n95 (safety ware 3280), s.u., duckbill, Box of 20 503 40%Sana'a- 60%Aden

Respirator, mask, n95 (safety ware 3280), s.u., duckbill, Box of 20 158 Aden

Set, tunic + trousers surgical, woven, reusable, green, size m Unit 3,700 40%Sana'a- 60%Aden

Item description Unit of measure

PPE for

PoE &

Quaranti

PPE for RRTsPPE for

Lab

PPE for ISOLAT

(triage-IPD-IPC-

OPD-

hygienists)

PPE for

triage

and

other

facilities

PPE buffer

Estimate for 6

months in unit

of measure

Apron protection, plastic, disposable, thick. 20 um, pack-100 Pack of 100 360 960 680 2,000

Apron protection, polyester, reusable, 300g/m2, white, pack-10 Pack of 10 1,080 420 1,500

Boots, rubber, pair Unit 480 520 1,000

Face shield, clear plastic, disp., box-200 Box of 200 440 500 1,060 2,000

Gloves protection, heavy duty, nitrile, green, cat iii Pack of 12 2,880 1,120 4,000

Gloves, examination, nitrile Box of 100 2,160 36,110 3,200 10,840 5,000 10,960 30,000

Gloves, surgical, latex, s.u., sterile, pair Box of 50 300 200 500

Goggles protective, wraparound, soft frame, indirect vent., box-100 Box of 100 10 50 10 50 10 30 100

Gown, aami level 3, non sterile, disp. Unit 97,200 120,600 40,000 518,400 50,000 391,600 1,000,000

Mask surgical, non sterile, disp., 3 ply, pack-50 Pack of 50 2,052 6,000 18,720 5,000 6,280 30,000

Mask surgical, type iir, level 2, s.u, non sterile, earloop, size m, box-120 Box of 120 1,250 2,500 660 5,400 1,000 22,940 30,000

Respirator, mask, n95 (safetyware 3280), s.u., duckbill, box-100 Box of 100 100 100 1,000 1,440 500 2,060 5,000

Set, tunic + trousers surgical, woven, reusable, green Unit 400 2,500 100 3,000

Annex 6: Stock of PPE distributed in Country and in pipeline (warehouses)

Annex 6: Stock of PPE available and anticipated needs for 6 months

Page 1 of 2

Annex 7: List of health facilities identified to serve as COVID-19 Isolation Units

S/N Isolation unit name Current # of

beds

Location

(District name)

Name of

Governorate

Functional

(Yes, No)

Triage capability

(Yes, No)

1 Sheikh Zaied Maternity Hospital Bani Al- Harith Amanat Al-

Asimah

No

2 Al Kuwait Hospital Amanat Al-

Asimah

No

3 Al Jamhouri Authority Hospital Amanat Al-

Asimah

No

4 Mathna Hospital Sana’a No

5 Jehanah Hospital Jahanah No

6 Al-Wahdah (Ma'aber) Hospital Jahran Dhamar No

7 Dhamar Authority Hospital Dhamar Dhamar No

8 Al Thawrah Authority Hospital Ibb No

9 Jeblah Hospital Ibb No

10 22 May Hospital Amran City Amran No

11 Al Tholaia Hospital Raymah No

12 Al-Hwabany Hospital Hudeidah City

Hudaydah

No

13 Al-Salakhanah Hospital Al-Salakhanah No

14 Al Waharah Centre Al Khokha No

15 Al Jamhouri Hospital Hajjah No

16 Al Salam Hospital Sa’ada No

17 Al Talh Hospital Sa’ada No

Page 2 of 2

18 Al Hawban Hospital Taiz

No

19 Al-Rahidah Hospital Al-Rahidah No

20 Al-Dhabab hospital Dhabab No

21 Al Hazm Hospital Al-Hazm Al-Jawf No

22 Al-Naqa’a hospital Al-Malajm Marib No

23 New University Al Rodah No

24 Al-Naser hospital Al-Dhala city Al-Dhalae No

25 Al Somah Hospital

Al Baytha

No

26 Al Thawrah Hospital Thi Na'am No

27 Radaa Hospital Radaa No

28 Al-Jamhouri Hospital Al-Mahwit No

29 Al-Omoma Center Socotra No

30 Ibn Sina hospital (Infectious diseases Center)

Mukalla Hadramot Al-

mukalla

No

31 Sayoun hospital Sayoun Hadramot

Sayoun

No

32 Al-Qaidah hospital Al-Mahrah No

33 Al Jamhouri Teaching Hospital Aden

No

34 Al-Amal Center No

35 Al Mahad Alsehi Abyan No

36 Ateq hospital Ateq Shabwa No

37 Al-Anad hospital Tubin Lahj No

Annex 8: List of Facilities selected for use as COVID-19 Quarantine areas (N= 42 as of 25 March 2020)

S/N Name of quarantine center District name Governorate name Functional (Yes or No)

1 Quarantine Building in Sana'a Airport Bani Al-Harith Amanat Al-Asimah

2 Gader Health Center Bani Al-Harith Amanat Al-Asimah

3 Al-Sinainah Health Center Maian District Amanat Al-Asimah

4 Gabar Ban Haian Health Center Sha'awb Amanat Al-Asimah

5 AL-Fwars Health Center Sha'awb Amanat Al-Asimah

6 Vocational Commercial Institute Al-Dhaher Ibb

7 Community College (Quhazah) Sanhan Sana’a

8 Sanhan Bait Bous Health Centre Sana’a

9 Vocational Training Centre Manakhah Sana’a

10 Vocational Training Centre Dhamar City Dhamar

11 Governor's residence Amran City Amran

12 Al-Shahid Al-Samad Complex Al-Jabeen Raymah

13 Al-Salif Port Hudaydah City Hudaydah

14 Al-Luheyah Fishing Port Al-Luheyah District Hudaydah

15 Al-Dar Hotel in the port Street Al-Maina Hudaydah

16 Al-Asdiad (Fishing) port Al-Maina Hudaydah

17 Al-Rahadi Center at the Vocational Institute 2nd & 3rd Floor

Hajjah City Hajjah

18 Vocational Training institute Abs Hajjah

19 Vocational Training Al Mahabishah Hajjah

20 Gouhazah Center Sa’ada Sa’ada

21 IDPs accommodation city Al-Hzm Al-Jawf

22 Al-Watoiya Quarantine Center Al-Malajm Mareb

23 Rada'a Hospital Rada’a Al-Baydha

24 Al-Raiady Park Al-Madinah Al-Mahwit

25 Sport Auditorium Al-Madinah Al-Mahwit

26 22 May Hospital Hadibo Socotra

27 Socotra airport Hadibo Socotra

28 Socotra seaport Hadibo Socotra

29 Al-Ryan airport Mukalla Hadramoat Al-Mukalla

30 Mukalla seaport Mukalla Hadramoat Al-Mukalla

31 As-Sheher seaport Al-Sheher

Hadramoat Al-Mukalla

32 Sayoun airport Sayoun Hadramoat Sayoun

33 Al-Wadeah land port Al-Abr Hadramoat Sayoun

34 Shahan land port Shahan Al-Mahrah

35 Sarfeet land port Sarfeet Al-Mahrah

36 Neshtoon seaport Neshtoon Al-Mahrah

37 Haifan Hospital Hifan Taiz

38 Al-Wahshei Hotel Damt Ad-Dhalee

39 TBD Aden

40 TBD Abyan

41 TBD Shabwa

42 TBD Lahj

# Item dscriptionUnit of measure

(UOM) Quantity in UOM

1 Autoclave 80 to 100 ltr Capacity Unit 25

2 HTH Hypochlorite (70%) for decontamination Kg 15,000

3 Detergents-70 % disinfection strength (for surface and floor cleaning) liters 15,000

4 Antiseptic soap (72 grm) Unit 25,000

5 Hand sanitizers alcohol based solution (70%) with holder - 100 ml bottle Unit 50,000

6 Protective clothing( Aprons) for sanitary workers Unit 1,000

7 Soiled linen trolleys Unit 50

8 General waste collection bins with two wheel 110 liter Unit 100

9 Needle cutters and safety boxes 5 liters Unit 40,000

10 Segregation bins red and yellow hospitals Unit 400

11 Trolleys for transportation of waste hospitals Unit 100

12 Multipurpose trolleys Unit 100

13 Hand washing stations Unit 250

14 Floor mop with the enclosure Unit 1,000

15 Broom washing floors Unit 1,000

16 Sweepers with a stick Unit 1,000

17 Plastic Bags ,black and red /yellow color( Large size)100l - Roll (1kg) Unit 1,000

18 Plastic Bags, black and red /yellow color (20L &30L) - Roll (1kg) Unit 1,000

19 Plastic Bags, black and red/yellow (50l) - Roll (1kg) Unit 1,000

20 Calcium Hypochlorite Powder drums of 45 kg; Unit 100

21 ICU bed  Unit 125

22 Excellent leather mattress thikness of 15 cm for ICU bed Unit 125

23 Cotton Bed sheet Unit 250

24 Pillow with cotton cover Unit 250

25 Disposable bed sheet Unit 2,500

26 Irrigator Stand (Drip Stand), stainless steel, adjustable height, with castors (for ICU beds) Unit 125

27 Module drugs, general cargo (kit COVID-19 - 100 patients/20 sever) Kit 390

28 Module drugs, cold chain (kit COVID-19 - 100 patients / 20 sever) Kit 390

29 Module drugs, controlled drugs (kit COVID-19 - 100 patients/20 sever) Kit 390

30 Supplies for medicine administration (kit COVID-19 - 100 patients/20 sever) Kit 390

31 Monitor patient , NIBP, w/o ECG (Dinamap Carescape V100), battery, trolley, +acc. Unit 395

32 Cuff Adult M, navy 23-33cm 002203(monitor Procare B40/Dinamap) Unit 395

33 Cuff adult L, wine 31-40cm 002207 (monitor Procare B40/Dinamap) Unit 395

34 Cuff child, green 12-19cm 002201 (monitor Procare B40/Dinamap) Unit 395

35 Cuff neon., orange 8-13cm 002200(monitor Procare B40/Dinamap) Unit 395

36 Tubing NIBP adult/child 107363 (monitor Dinamap) Unit 395

37 (monitor Procare B40/Dinamap) SENSOR SPO2 adult Nellcor DS100A Unit 395

38 (monitor Dinamap) SENSOR SPO2, ped/inf. + adh.wrap OXI-P/I Unit 395

39 OXYMETER, PULSE, finger tip model, SpO2/PR, 2xAAA batt. Unit 395

40 CONCENTRATOR O2 (New Life Intensity) 10L, 230V, 50 Hz + acc. Unit 260

41 (conc. NL Intensity 10L) OUTLET CONNECTOR, FITTING O2 F0025-1 Unit 130

42 (conc. NL Intensity 10L) OXYGEN OUTLET F0007-3 Unit 130

43 CPAP 10 machine, w/twin flowmeters (DIAMEDICA BABY) Unit 51

44 Nasal cannula kit w/prongs, baby bonnet, velcro fixing and chin strap; size 0-1. Unit 260

45 Nasal cannula kit w/prongs, baby bonnet, velcro fixing and chin strap; size 2-3. Unit 260

46 Nasal cannula kit w/prongs, baby bonnet, velcro fixing and chin strap; size 4-5. Unit 260

47 Nasal cannula kit w/prongs, baby bonnet, velcro fixing and chin strap; size 6-7. Unit 260

48 Humidifier Unit 260

49 Bubble bottle Unit 260

50 CPAP unit w/nasal tubing and mask for adult Unit 52

51 ELECTRONIC DROP COUNTER (Dripassist), IV fluids infu. gravity monitor, alarm, batt.AA Unit 265

52 VENTILATOR PATIENT (Dräger Savina 300 Select), adu/paed/neon., w/acc. Unit 130

53 (drager savina 300) BREATHING CIRCUIT, adult (tub./balloon/valv./mask), s.u. Unit 2,600

54 (drager savina 300) BREATHING CIRCUIT, paediatr. (tub./balloon/valv./mask), s.u. Unit 520

55 (drager savina 300) BREATHING CIRCUIT, neonat. (tub./balloon/valv./mask), s.u. Unit 260

56 High Flow Nasal Cannula (HFNC) (Fisher&Paykel AIRVO 2) Unit 130

57 Optiflow + Nasal Cannula, small, pack of 20 Pack of 20 130

58 Optiflow + Nasal Cannula, medium, pack of 20 Pack of 20 260

59 Optiflow + Nasal Cannula, large, pack of 20 Pack of 20 130

60 Disinfection kit Each 520

61 Cleaning Sponge Stick, pack of 20 Pack of 20 26

62 Disinfection filter, pack of 2 Pack of 2 260

63 Suction pump, electrical (medela vario 18), 100-230v,50-60hz Unit 130

64 Collection bottle, 1l, autoclavable Unit 260

65 Lid w/connector and overflow device Unit 260

66 Bacteria filter, unit Unit 520

67 Infusion pump (agilia vp z019510) Unit 130

68 Infusion line vlst00 (inf. pump agilia) Unit 260

69 Defibrillator, mobile, semi-auto.(beneheartd3), multi-paramet,ac/dc, w/acc+trolley Unit 26

70 Defibrillator beneheartd3 lithium battery Unit 26

71 Defibrillator beneheartd3 electrode pads, adult, adhesive, disp. Unit 520

72 Defibrillator beneheartd3 electrode pads, paediat., adhesive, disp. Unit 52

73 Electrocardiograph (schiller at-1 g2), portable, 3 ch+acc Unit 26

74 Patient cable 10 leads, 2.400070 (ecg schiller at-1/g2) Unit 26

75 Set electrodes, paediat., 6 bulbs and 4 clips (ecg schiller at-1/g2) Unit 26

Annex 9: Estimated Quantity of COVID-19 Supplies for 6 months (excluding PPEs)

based on prior global estimate of COVID-19 Transmissibility

76 Electrodes clip, limb, set 4pcs/colors (ecg schiller at-1/g2) Unit 26

77 Suction electrode, adult, 4mm, set of 6 (ecg schiller at-1/g2) Unit 26

78 Recording paper, pack, 2.157044 (ecg schiller at-1 g2) Pack of 2 26

79 Ultrasound system mobile (sonosite m-turbo), transducer, trolley, 220v, w/ acc. Unit 26

80 Linear transducer 5.0-7.5 mhz. (ultrasound sonosite m-t) Unit 26

81 Phased array cardiac transducer 5.0-7.5 mhz. (ultrasound sonosite m-t) Unit 26

82 Ultrasound, system, mobile (mindray m7), transducer, trolley, 220v, w/ acc. Unit 26

83 Linear transducer 5.0-7.5 mhz. (ultrasound mindray m7) Unit 26

84 Phased array cardiac transducer 5.0-7.5 mhz. (ultrasound mindray m7) Unit 26

85 Table, resuscitation, neonate Unit 26

86 INFANT/BABY SCALE, electronic, portable, 20kg-10g, remov. baby tray, AA batt.x4 Unit 112

87 SCALE, mechanical, adult 0-150 kg, grad. 500 g Unit 120

88 MODULES CENTRAL STERILIZATION, TBM 90L Unit 37

89 Beds for isolation units Unit 300

90 Heating Block Unit 8

91 Multi-channel pipettor Unit 8

92 Multi-channel pipettor Unit 8

93 Multi-channel pipettor Unit 8

94 Microcentrifuge - Refrigerated Unit 8

95 Laboratory timer Unit 12

96 Pippete Aid - Electronic Unit 12

97 Realtime PCR Thermocycler Unit 8

98 Wall Mounted Clock Unit 12

99 Pipette Stand Unit 12

100 Emergency Eye Wash Station Unit 12

101 Single Channel Pippette Unit 8

102 Single Channel Pippette Unit 8

103 Laboratory Refrigerator Unit 8

104 Laboratory freezer Unit 8

105 Purified Biological safety cabinet level II Unit 8

106 rRT-PCR primer/probe sets for COVID-19 complete kit Unit 10,000

107 Positive template control Unit 400

108 TaqPath™ 1-Step RT-qPCR Master Mix, CG (ThermoFisher; cat # A15299 or A15300) Unit 1,000

109 Molecular grade water, nuclease-free Unit 200

110 P2/P10, P200, and P1000 aerosol barrier tips - for each tips of pipettor Unit 12,000

111 Sterile, nuclease-free 1.5 mL microcentrifuge tubes Unit 60,000

112 0.2 mL PCR reaction tube strips or 96-well real-time PCR optical 8-cap strips (box of 300 strips) Unit 200

113 Laboratory marking pen Unit 100

114 Cooler racks for 1.5 microcentrifuge tubes and 96-well 0.2 mL PCR reaction tubes Unit 200

115 Racks for 1.5 ml microcentrifuge tubes Unit 200

116 Micropipettes (2 or 10 µl, 200 µl and 1000 µl) Unit 32

117 Multichannel micropipettes (5-50 µl) Unit 18

118 2 x 96-well cold blocks Unit 18

119 DNAZapTM (Life Technologies, cat. #AM9890) Unit 24

120 RNAse AwayTM (Fisher Scientific; cat. #21-236-21 Unit 24

121 Realtime PCR Diagnostic Kit fo Pan (Screening Test) Unit 20,000

122 Realtime PCR Diagnostic Kit for COVID-19 Unit 10,000

123 Positive template control - COVID-19 Synthetic Unit 1,200

124 TaqPath™ 1-Step RT-qPCR Master Mix, CG (ThermoFisher; cat # A15299 or A15300) Unit 1,000

125 Molecular grade water, nuclease-free Unit 200

126 RNA Isolation kit (Qiangen) Kit of 50 1,000

127 Thermometer Infrared (gun) Unit 140

128 Thermo Scanner Unit 10

129 Chairs for waiting Room Unit 72

130 Beds for Quarantine Centers Unit 600

131 Bed sheet of cotton 150cm x 260 cm Unit 1,500

132 Excellent leather matress thikness of 15 cm, Unit 600

133 Pillows with cotton cover Unit 1,500

134 Disposable bed sheet Unit 6,000

135 Blanket Unit 600

136 Receptacle waste Unit 600

137 Thermometer Infrared (gun) Unit 60

138 Alcohol-based hand rub, solution, 100 ml, bottle Unit 40,200

139 Liquid soap, bottle, 100 ml Unit 40,200

140 Sprayer insecticide (hudsonxp93793),pump cylinder, stainless steel, chem.resist.,8.5l Unit 335

141 Sodium hypochlorite, solution, 0.5%, 5 l, can Unit 40,200

142 Thermometer, infrared, no contact, handheld Unit 670

Annex 10: Yemen COVID-19 Isolation Units: ICU Beds and Ventilators Availability

Page 1 of 1

Item description Quantity Delivered

Quantity Ordered Total Remarks

Beds in Isolation units 720 800 1,520

Of the 720 beds in the country, 540 are still undergoing customs clearance process as of 25 March 2015

ICU Ventilators

195 430 625

Of the total 195 ICU ventilators available in the country, 19 are in hospitals supported through Emergency Health and Nutrition Programme (EHNP), 76 under Diphtheria Program; 39 are provided by UNFPA and 60 in Therapeutic Feeding Centers (TFCs).

Note: Each one of the facilities selected for use as COVID-19 isolation units is expected to have 20 admission beds and 5

ICU beds

Annex 11: WHO Concept of Operations in Yemen: Warehousing Capacity and Supply Routes (With WFP Support)

Aden

Salalah

Dubai

Sana’a

Hodeidah

Inbound from the suppliers

WHO/BSP supply routes

Non-preferred supply routes

North/South approximate delimitation

Transshipment point

Air supply route

Maritime supply route

Land supply route

Legend

Djibouti

S/N Warehouse Nameand Location

Capacity(in square

meter)

1 Dubai Warehouse(WHO/EMRO)

18,000

2 Salalah Warehouse(WFP/BSP SLA)

3,600

3 Djibouti Warehouse(WFP/BSP SLA)

4,000

4 Sana’a Warehouse 2,800

5 Aden Warehouse 6,000

Project title

Project goal

Outcome indicator description Baseline Target Sources of verification Implementing partner

Outcome 1: Well informed health care workforce,

communities, donors and health partners and HCT

members

Outcome indicator 1.1

% of Governorate EOC submitted report on 24 hr to national EOC 0 90% EOC report; Supervision and

monitoring visit report

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 1.1.1 Number and proportion of assessments/monitoring/supervision

conducted on established isolation centers, PoE, and other

supported areas

0 TBD and 100% Assessment, supervision and

monitoring visit report

WHO and MoPH

Output indicator 1.1.2 # of COVID-19 taskforce meeting conducted 0 TBD Meeting minutes; attendance

sheet

WHO and MoPH

Activities

Activity 1.1.1

Activity 1.1.2

Activity 1.1.3

Activity 1.1.4

Activity 1.1.5

Activity 1.1.6

Activity 1.1.7

Activity 1.1.8

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 1.2.1 # number of EOC established and functional 0 28 EOC report; Supervision and

monitoring visit report

WHO and MoPH

Output indicator 1.2.2 # of health and non-health partners received real time information 0 130 EOC report; Supervision and

monitoring visit report

WHO and MoPH

Activities

Activity 1.2.1

Activity 1.2.2

Activity 1.2.3

Activity 1.2.4

Annex 12: M&E Logical framework Yemen-COVID-19 Preparedness & Response Plan

Yemen National COVID-19 Preparedness and Response Plan

Reduce occurrence and to minimize morbidity and mortality of COVID 19

Pillar 1: Country-Level coordination, planning and monitoring

Output 1.1: Strengthened capacity of the country

preparedness and response activities

Activate multi-sectorial, multi-partner coordination mechanisms to support preparedness and response

Engage with national authorities and key partners to develop a country-specific operational plan with estimated resource requirements for COVID‑19 preparedness and response

Monitor implementation of national plan based on key performance indicators

Supportive supervisions to monitor the activities of the surveillance teams, PoEs, EOC, isolation unit, lab and other areas

Conduct assessments in identified health facilities and POEs regarding establishment of isolation centers/quarantine areas and triage.

Established COVID 19 task force and conduct meeting regularly

Conduct regular operational reviews to assess implementation success and epidemiological situation, and adjust operational plans as necessary

Identify MoH website for sharing updates and make all materials available and accessible to public

Output 1.2:National and governorate EOCs are

functional including Scotra EOC

Established EOC at Scotra governorate

Provide support(furutuire, equipment's, operational cost, etc.) for all EOC across the country

Provide training for EOC staff

Provide incentive payment for EOC staff

Outcome Indicator Outcome indicator description Baseline Target Sources of verification Implementing partner

Outcome 2.1 % of vulnerable population received adequate risk information

about COVID-19

0 80% Reports WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 2.1.1# of people trainned on RCCE

0 TBD Attendance sheet; training

report; M&E report

WHO and MoPH

Output indicator 2.1.2 % of issues/questions raised on hotline get answered with heath

professionals

0 100% EOC report WHO and MoPH

Output indicator 2.1.3 % of people using the hotline as result of the community and/or

social media outreach

0 TBD Report WHO and MoPH

Output indicator 2.1.4 Number of Isolation unit, PoE and Quarantine equipped with IEC

materials

0 37, 26 formal and 28

informal and TBD

Reports; Supervision and

monitoring visit report

WHO and MoPH

Activities

Activity 2.1.1

Activity 2.1.2

Activity 2.1.3

Activity 2.1.4

Activity 2.1.5

Activity 2.1.6

Outcome Indicator Outcome indicator description Baseline Target Sources of verification Implementing partner

Outcome 3.1 % of contact tracing conducted on person who contacted with

cases

0 90% RRT reports WHO and MoPH

Outcome 3.2 # of suspected cases identified through surveillance 0 TBD RRT reports WHO and MoPH

Outcome 3.3 # confirmed case 0 TBD RRT reports; Lab report WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 3.1.1

# of district and governorate RRTs members deployed

333 RRT 999 RRT RRT,FETP and data entry

report; M&E report

WHO and MoPH

Output indicator 3.1.2 # of RRT trained 0 3000 Attendance sheet; training

report

WHO and MoPH

Output indicator 3.1.3 # of sentinel site(eDEWS) reported in weekly basis 1991 1991 eDEWS report WHO and MoPH

Output indicator 3.1.4 % of samples transported in 48 hr 0 80% RRT reports; CPHL report WHO and MoPH

Output indicator 3.1.5 % of rumors and alert investigated in 48 hrs 0 90% RRT reports; CPHL report WHO and MoPH

Activities

Activity 3.1.1

Activity 3.1.2

Activity 3.1.3

Activity 3.1.4

Activity 3.1.5

Activity 3.1.6

Activity 3.1.7

Activity 3.1.8

Pillar 2: Risk Communication and Community Engagement

Outcome 2:An informed Yemeni community, well

engaged and participatory in containment and

response effort

Output 2.1: Improve knowledge of affected

communities on COVID-19

Ensure community have access to the right information on COVID-19

Support hotline to answer issues raised with public

Print and distribute IEC material (short awareness videos, frequent awareness messages on TVs, travelers' brochures, hand hygiene brochures, awareness puppet shows, etc.).

Engage community to transfer message through several platforms and social media, TV, radio, mosque, local influencer such as community leader, celebrities, community volunteer

Pillar 3: Surveillance, rapid response teams and case investigation

Outcome 3:All case investigated including contact

tracing

Identify the rumors and way to correct them

Ensure CHW/Vs training on various IEC materials related to COVID - 19 to reach community with the right information on COVID- 19

Output 3.1: Preparedness and response of Rapid

Response Teams is reinforced.

Maintain line of contact and ensure active tracing by RRT

Strengthened eDEWS to provide real-time information for monitoring disease

Support active case finding at point of entry, health facilities and in communities

Develop and endorse the COVID-19 surveillance guideline

Mobilize and train RRT and surveillance team on early detection

Ensure screening at PoE

Train RRT(governorates and district) surveillance and IHR focal points on case definition

Ensure RRT are equipped with appropriate resources and materials

Outcome Description Baseline Target

Outcome 4: Risk of COVID-1 9 cases being introduced

in Yemen reduced and travelers are well informed about

COVID-19 and are able to protect themselves and their

communities

Outcome 4.1 Number and proportion of arrivals in POEs are monitored and

screened

0 TBD and 100% M&E and supervision report;

PoE records

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 4.1.1 Number and proportion of POEs established and functional 0% 26 Formal and 28 Informal PoE records; Supervision and

monitoring visit report;

WHO and MoPH

Output indicator 4.1.2 Number and proportion of POEs with quarantine areas set-up and

functional

0 26 Formal and 28 Informal

and 100 %

PoE records; Supervision and

monitoring visit report;

WHO and MoPH

Output indicator 4.1.3 Number and proportion of formal POEs where thermal scanners

installed and functional

0 12 and 41% PoE records; Supervision and

monitoring visit report;

WHO and MoPH

Activities

Activity 4.1.1

Activity 4.1.2

Activity 4.1.3

Activity 4.1.4

Activity 4.1.5

Activity 4.1.6

Activity 4.1.7

Activity 4.1.8

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 4.2.1 Number and proportion of suspected cases arriving in POEs

transferred to Isolation Unit

0 TBD and 100% PoE records; Supervision and

monitoring visit report;

WHO and MoPH

Activities

Activity 4.2.1

Activity 4.2.2

Activity 4.2.3

Pillar 4-Point of Entry

Sources of verification

Output 4.1: Points of entries are fully equipped, and

with functional quarantine areas Procurement and installation of thermal scanners in selected POEs

Ensure availability of ambulances (with trained personnel/RRT) to transfer any suspected case to isolation center

Set-up of quarantine area in all POEs

Provision of advanced PPEs and IPC materials and supplies

Ensure training for the RRTs and personnel in the PoEs on early definition/ detection, management of suspected cases and reporting

Increase capacity for contact tracing

Identify list of point of entry in the country(formal and informal)

Procurement and distribution of handheld thermometers among HCWs in all POEs

Output 4.2: Points of entries are adequately staffed

Recruitment of at least 4 HCWS at each POE

Ensure training for the RRTs and personnel in the PoEs on early definition/ detection, management of suspected cases and reporting

Provision of incentives for HCWs in POEs

Outcome Description Baseline Target

Outcome 5: All suspect cases that meet WHO case

definition, all contacts of confirmed cases and patients

identified as suffering from respiratory diseases are

timey tested for COVID-19 and results timely released.

Outcome 5.1 # of laboratory test conducted on proportion of test requested 72

hrs time response

0 100% Laboratory report; Supervision

and monitoring visit report;

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 5.1.1 % of laboratory tests request performed and reported within TAT

of 24 hours (turn-around-time being time from receiving samples

to releasing results)

0 90% Lab report; Supervision and

monitoring visit report

WHO and MoPH

Output indicator 5.1.2 % of laboratories with sufficient resources such as diagnostics,

reagents, consumables, and human resources required to meet

the testing needs of the country.

25% 100% Lab report; Supervision and

monitoring visit report

WHO and MoPH

Output indicator 5.1.3 # & % of laboratories results that are validated and quality

reviewed by a technical person

0 TBD Lab report; Supervision and

monitoring visit report

WHO and MoPH

Output indicator 5.1.4# of laboratories that have conducted adequate biosafety risk

assessment for planning and for better infection prevention

2 8 Lab report; Supervision and

monitoring visit report

WHO and MoPH

Output indicator 5.1.5# & % of lab worker who have received training on bio-safety,

technical procedures and reporting formats.

0 TBD Attendance sheet; training

report

WHO and MoPH

Output indicator 5.1.6 Number of laboratories that have adequate PPE, antiseptics,

running tap water, and other infection prevention and control

measures

2 8 Lab report; Supervision and

monitoring visit report

WHO and MoPH

Activities

Activity 5.1.1

Activity 5.1.2

Activity 5.1.3

Activity 5.1.4

Activity 5.1.5

Activity 5.1.6

Activity 5.1.7

Pillar 5- National Laboratories

Sources of verification

Output 5.1: National referral laboratory capacity is

upgraded

Provide incentive payments for laboratory personnel

Translate guidelines and SOPs for collecting clinical samples and testing suspected cases.

Support the transportation of samples from health facilities to the testing laboratories.

Establishment of a direct communication between the laboratories and the central level for test results

Rapid assessment for lab capacity and ensure lab testing capacity especially in the designated facilities

Procurement of additional lab equipment and supplies including PCR thermocyclers.

Training of laboratory staff on biosafety, safe handling of samples, and safe disposal of lab waste

Outcome Description Baseline Target Sources of verification Implementing Partners

Outcome 6:Transmission of COVID-19 virus to

health care workers, patients/visitors and

communities prevented or reduced to the possible

extend, through systematic application of IPC

practices relevant to specific settings.

Outcome 6.1 % of health workers infected with COVID-19 0 0% Lab report; M&E and

supervision report; health

facilities records

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 6.1.1 % of isolation center, PoE and quarantine areas who are well

versed with IPC measures and SOPs

0 80% Supervision and monitoring visit

report

WHO and MoPH

Output indicator 6.1.2 % of treatment centers where water, sanitation and infectious

diseases control systems applied as per SOP

0 100% Supervision and monitoring visit

report

WHO and MoPH

Output indicator 6.1.3# of health worker trained on infection prevention

0 925 Attendance sheet; training

report

WHO and MoPH

Output indicator 6.1.4 % of isolation center, triage, inpatient and outpatient, laboratory

and sanitary workers provided with PPEs

0 100% Distribution plan; waybill; M&E

report

WHO and MoPH

Activities

Activity 6.1.1

Activity 6.1.2

Activity 6.1.3

Activity 6.1.4

Activity 6.1.5

Activity 6.1.6

Activity 6.1.7

Activity 6.1.8

Activity 6.1.9

Activity 6.1.10

Activity 6.1.11

Activity 6.1.12

Activity 6.1.13

Activity 6.1.14

Activity 6.1.15

Pillar 6- Infection Prevention and Control

Output 6.1: Infection Prevention and Control measures

are reinforced.

Training of trainers for health care workers on IPC in health care setting

Roll out of IPC training through workshops organized at health facility level  

Recruitment of national infection prevention and control expert as consultant to MOPHP

Equipment, hand tools and other supplies (waste bins of different sizes, brooms etc.) needed for the collection, transport and safe disposal of healthcare waste will be provided.

Personal protective gears (clothes, gloves, boots, aprons, etc.) will be supplied to sanitary workers.

Conduct healthcare hygiene promotion and awareness raising trainings in each health facility, for senior medical staff, nurses and sanitary worker, with focus on infection control.

Provision of hygiene and healthcare infection control education materials (messages, pamphlets, brochures etc.).

Adequate detailed information regarding the hazardous nature of waste material to persons responsible for its handling, transport, treatment, storage or disposal will be provided.

Hazardous wastes handling staff will be provided with appropriate safety devices such as safety masks, goggles, hand gloves, and boots.

Procurement of contingency stock of IPC supplies and PPE 

Establish a triage system with a temporary isolation unit in health facilities

Improve water quality and quantity and sanitation facilities addressing specially needs of women (keeping privacy).

Health facility sanitation services of critical units of the health facility (isolation units) will be improved, with repair of existing latrines where necessary, with female health workers and patients access to

Provision/repair of hand-washing facilities in critical units of the health facility, where needed.

Provision of soaps, detergents and other health facility disinfectant chemicals, to improve overall hygienic conditions and infection control mechanisms of the critical units of the health facility.

Outcome Indicator Outcome indicator description Baseline Target Sources of verification Implementing partner

Outcome 7.1 % of death among reported case 0 < 4% HF record; eDEWS;M&E and

supervision report

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 7.1.1 % of PPE distribution among medical/ambulatory teams 0 100% Distribution plan; waybills;

Supervision and monitoring visit

report

WHO and MoPH

Output indicator 7.1.2 # of training(s)/person conducted for medical/ambulatory teams 0 TBD Attendance sheet; training

report

WHO and MoPH

Output indicator 7.1.3 %of suspected cases who have access to Isolation Unit 0 100% Report; M&E and supervision

report

WHO and MoPH

Activities

Activity 7.1.1

Activity 7.1.2

Activity 7.1.3

Activity 7.1.4

Activity 7.1.5

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 7.2.1 % of governorate coverage with at least one (1) isolation unit 0 100% M&E and supervision report WHO and MoPH

Output indicator 7.2.2# person trainned on case managemnt

0 675 Attendance sheet; training

report

WHO and MoPH

Output indicator 7.2.3 % of ICU equipped with at least 3 vital monitors & ventilators 0 at least 80% M&E and supervision report WHO and MoPH

Output indicator 7.2.4

# of Admission(New and Total)

0 TBD Health facility record;

eDEWS;M&E and supervision

report;

WHO and MoPH

Output indicator 7.2.5# of Referral(New and Total)

0 TBD Health facility record;

eDEWS;M&E and supervision

report;

WHO and MoPH

Output indicator 7.2.6# of Isolation center supported with PPE

0 37 Distribution plan; waybill; M&E

report

WHO and MoPH

Output indicator 7.2.7 % treatment center who has designated ARI/COVID-19 Triage

area

0 100% M&E and supervision report WHO and MoPH

Output indicator 7.2.8 # of non-covid health facilities supported in order to continue

provide health services

0 TBD M&E and supervision report WHO and MoPH

Activities

Activity 7.2.1

Activity 7.2.2

Activity 7.2.3

Activity 7.2.4

Activity 7.2.5

Activity 7.2.6

Activity 7.2.7

Activity 7.2.8

Pillar 7: Case Management

Outcome 7: Increased survival rate among patients

with increased number of those recovering from

COVID-19 and reduced case fatality rate (CFR) with

number of patients recovering with long term COVID-

19 induced long term impact.

Output 7.1: Safe transport of suspected cases/patients

is ensured

Procurement and distribute PPE

Disseminate regularly updated information, train, and refresh medical/ambulatory teams in the management of severe acute respiratory infections and COVID‑19-specific protocols based on international

standards and WHO clinical guidance;

Set up triage and screening areas at selected healthcare facilities

Establish dedicated and equipped teams and ambulances to transport suspected and confirmed cases, and referral mechanisms for severe cases

Provide trainings for case management team

Output 7.2:Case management and continuity of

essential services reinforced.

Establish at least one isolation facility in each governorate

Provide incentives payment for case management team members

Provision of critical supplies and equipment for the isolation ward/center

Provide case management training for SARI, hypoxemic respiratory failure, ARDS, septic shock

Ensure comprehensive medical, nutritional, and psycho-social care for those with COVID‑19

Ensure that guidance is made available for the self-care of patients with mild COVID‑19 symptoms, including guidance on when referral to healthcare facilities is recommended

Provide support for non-COVID health facilities in order to ensure continuities of health services

Map vulnerable populations and public and private health facilities (including traditional healers, pharmacies and other providers)

Outcome Indicator Outcome indicator description Baseline Target Sources of verification Implementing partner

Outcome 8.1

% of zero stock-outs of supplies in identified isolation units and

quarantine AREAS0 0%

WHO and MoPH

Output indicators Description Baseline Target Sources of verification Implementing partner

Output indicator 8.1.1 # of Quarantine unit supported with medical supplies and

equipment's

0 42 Distribution plan;

waybill;M&eEreport

WHO and MoPH

Output indicator 8.1.2 # of Isolation unit supported with medical supplies and

equipment's

0 37 Distribution plan;

waybill;M&eEreport

WHO and MoPH

Output indicator 8.1.3# of PoE supported with medical supplies and equipment's

0 26 Formal and 28 Informal

PoE

Distribution plan;

waybill;M&eEreport

WHO and MoPH

Output indicator 8.1.4# of CPHL supported with medical supplies and equipment's

0 14 Distribution plan;

waybill;M&eEreport

WHO and MoPH

Output indicator 8.1.5 number of local suppliers identified and contracted to increase the

availabilkity of supplies

0 TBD Procurment report WHO and MoPH

Activities

Activity 8.1.1

Activity 8.1.2

Activity 8.1.3

Activity 8.1.4

Pillar 8: Operational support and logistics (with support from WFP/BSP)Outcome 8:Efficient response to COVID-19

pandemic with interrupted chain supply and critical

functions identified and supported (i.e. water and

sanitation, fuel, energy, food,

telecommunications/internet, financial resources,

transportation, essential workforce, procurement,

etc..)

Output 8.1: Operational support and logistics is

provided for preparedness and response activities

Map available resources and supply systems in health and other sectors;

Assess the capacity of local market to meet increased demand for medical and other essential supplies, and coordinate international request of supplies through regional and global procurement mechanisms

Procurement of equipment and supplies needed for PoE, CPHL, quarantaine unit and issolation unit

Importation and distribution of equipment and supplies received

Pillar Objective Outcome Output Indicators Baseline Target Means of verification Responsible Person Frequency Type of indicators

% of Governorate EOC submitted report on 24 hr to

national EOC 0 90% EOC report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

Taskforce

Weekly Outcome

Number and proportion of

assessments/monitoring/supervision conducted on

established isolation centers, PoE, and other supported

areas

0 100% Assessment, supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# of COVID-19 taskforce meeting conducted 0 TBD Meeting minutes; attendance sheet MoPH; WHO; COVID-19

TaskforceWeekly Output

# number of EOC established and reported 0 28 EOC report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# of health and non-health partners received real time

information0 130 EOC report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceWeekly Output

% of vulnerable population received adequate risk

information about COVID-19 0 80% Reports MoPH; WHO; COVID-19

TaskforceMonthly Output

% of issues/questions raised on hotline get answered

with heath professionals0 100% EOC Reports; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceWeekly Output

Number of Issolation unit, PoE and Quarantine equpied

with IEC materials0 37, 26 formal and 28 informal and TBD Reports; Supervision and monitoring

visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

% of people using the hotline as result of the community

and/or social media outreach0 TBD Report MoPH; WHO; COVID-19

TaskforceMonthly Output

# of people trainned on RCCE 0 TBD Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceMonthly Output

% of contact tracing conducted on person who contacted

with cases0 90% RRT reports MoPH; WHO; COVID-19

TaskforceDaily Outcome

# of suspected cases identified through surveillance 0 TBD RRT report MoPH; WHO; COVID-19

TaskforceDaily Outcome

# confirmed case 0 TBD RRT report MoPH; WHO; COVID-19

TaskforceDaily Outcome

# of district and governorate RRTs members deployed 333 RRT 999 RRT reports; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# of RRT trainned 0 3000 Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceWeekly Output

# of sentinel site(eDEWS) reported in weekly basis 0 TBD RRT reports; CPHL report; M&E report MoPH; WHO; COVID-19

TaskforceWeekly Output

% of samples transported in 48 hr 1991 1991 eDEWS report MoPH; WHO; COVID-19

TaskforceWeekly Output

Number and proportion of rumors and alert investigated

in 48 hrs0 TBD and 90% RRT reports; CPHL report MoPH; WHO; COVID-19

TaskforceDaily Output

Pillar 3: Surveillance, rapid

response teams and case

investigation

Ensure that in less than 24

hours all rumors, alerts

and suspected cases are

investigated

All cases investigated

including contact

tracing (index case)

Preparedness and response of

Rapid Response Teams is

reinforced.

Improve knowledge of affected

communities on COVID-19

Annex 13: Key Performance Indicators, Planned Outcomes and Products for Yemen National COVID-19 Preparedness and Response Plan

Pillar 1: Country-Level

coordination, planning and

monitoring

Ensure information

sharing in real time

between health and no

health sectors fori and

ensure adherence to a

common plan for COVID-

19 by all actors

Well informed health

care workforce,

communities, donors

and health partners

and HCT members

National and governorate EOCs

are functional including Scotra

EOC

Strengthened capacity of the

country preparedness and

response activities

Pillar 2: Risk

Communication and

Community Engagement

Engage the community, to

dispel any rumor and

ensure average individual

understands the evolution

of the disease and how to

protect themselves.

An informed Yemeni

Community, well

engaged and

participatory in

containment and

response efforts.

Number and proportion of arrivals in POEs are monitored

and screened0 TBD and 100% PoE records; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceDaily Outcome

Number and proportion of POEs established and

functional0 26 Formal and 28 Informal PoE records; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceMonthly Output

Number and proportion of POEs with quarantine areas

set-up and functional0 26 Formal and 28 Informal and 100 % PoE records; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceMonthly Output

Number and proportion of POEs where thermal scanners

installed 0 12 and 41% PoE records; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceMonthly Output

Points of entries are adequately staffedNumber and proportion of suspected cases arriving in

POEs transferred to Isolation Unit0 TBD and 100% PoE records; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceDaily Output

# of laboratory test conducted on proportion of test

requested 72 hrs time response0 100% Laboratory report; Supervision and

monitoring visit report;

MoPH; WHO; COVID-19

TaskforceDaily Outcome

% of laboratory tests request performed and reported

within TAT of 24 hours (turn-around-time being time from

receiving samples to releasing results)

90% Lab report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

% of laboratories with sufficient resources such as

diagnostics, reagents, consumables, and human

resources required to meet the testing needs of the

country.

25% 100% Lab report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# & % of laboratories results that are validated and quality

reviewed by a technical person 0 TBD Lab report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# of laboratories that have conducted adequate biosafety

risk assessment for planning and for better infection

prevention

2 8 Lab report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# & % of lab worker who have received training on bio-

safety, technical procedures and reproting formats.0 TBD Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceMonthly Output

Number of laboratories that have addequate PPE,

antiseptics, running tap water, and other infection

prevention and control measures

2 8 Lab report; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

% of health workers infected with COVID-19

0 0%

Health facility records; Supervision

and monitoring visit report

MoPH; WHO; COVID-19

TaskforceDaily Outcome

% of isolation center, PoE and quarantine areas who are

well versed with IPC measures and SOPs

0 80%

Supervision and monitoring visit report MoPH; WHO; COVID-19

TaskforceMonthly

Output% of treatment centers where water, sanitation and

infectious diseases control systems applied as per SOP

0 100%

Supervision and monitoring visit report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of health worker trainned on infection prevention

0 925

Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceMonthly

Output% of isolation center, triage, inpatient and outpatient,

laboratory and sanitary workers provided with PPEs

0 100%

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

Output

Ensure that laboratories

network identified for lab

testing for COVID-19 have

the appropriate capacity

and readiness to timely

manage large-scale

testing in term of skilled

personnel, equipment and

lab supplies.

All suspect cases that

meet WHO case

definition, all contacts

of confirmed cases

and patients identified

as suffering from

respiratory diseases

are timey tested for

COVID-19 and results

timely released.

Pillar 4-Point of Entry

Ensure that each POE is

well equipped and has the

necessary resources to

support COVID-19

surveillance and risk

communication and hence

contribute to prevent

introduction of new

imported cases while at

the same time raising

awareness of travelers

about the risk posed by

COVID-19.

Risk of COVID-19

cases being

introduced in Yemen

reduced and travelers

are well informed

about COVID-19 and

are able to protect

themselves and their

communities

Points of entries are fully

equipped, and with functional

quarantine areas

National referral laboratory

capacity is upgraded

Pillar 5- National

Laboratories

Pillar 6- Infection

Prevention and Control

Infection Prevention and

Control (IPC) strategies

systematically applied to

prevent or limit COVID-19

virus transmission in

health settings as well as

in other settings, including

hospitals, households,

schools, mosques and

during mass gatherings.

Transmission of

COVID-19 virus to

health care workers,

patients/visitors and

communities

prevented or reduced

to the possible

extend, through

systematic application

of IPC practices

relevant to specific

settings. Infection Prevention and Control

measures are reinforced.

% of death among reported case

0 Less than 4%

Health facility record; Supervision and

monitoring visit report

MoPH; WHO; COVID-19

TaskforceDaily Outcome

% of PPE distribution among medical/ambulatory teams

0 100%

Distribution plan; waybills; Supervision

and monitoring visit report

MoPH; WHO; COVID-19

TaskforceMonthly Output

# of training(s)/person conducted for medical/ambulatory

teams

0 TBD

Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceMonthly Output

%of suspected cases who have access to Isolation Unit

0 100%

Report; M&E and supervision report MoPH; WHO; COVID-19

TaskforceMonthly Output

% of governorate coverage with at least one (1) isolation

unit

0 100%

M&E and supervision report MoPH; WHO; COVID-19

TaskforceMonthly

Output# person trainned on case managemnt

0 675

Attendance sheet; training report MoPH; WHO; COVID-19

TaskforceMonthly

Output% of ICU equipped with at least 3 vital monitors &

ventilators

0 at least 80%

M&E and supervision report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of Isolation center supported with PPE

0 37

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of Admission(New and Total)

0 TBD

Health facility record; eDEWS;M&E

and supervision report;

MoPH; WHO; COVID-19

TaskforceDaily

Output# of Referral(New and Total)

0 TBD

Health facility record; eDEWSM&E

and supervision report;

MoPH; WHO; COVID-19

TaskforceDaily

Output% treatment center who has designated ARI/COVID-19

Triage area

0 100%

M&E and supervision report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of non-covid health facilities supported in order to

continue provide health services

0 TBD

M&E and supervision report MoPH; WHO; COVID-19

TaskforceMonthly

Output% of zero stock-outs of supplies in identified isolation

units, PoE and quarantine areas

0 0%

Facility stock report; M&E and

supervision report

MoPH; WHO; COVID-19

TaskforceMonthly

Outcome# of Quarantine unit supported with medical supplies and

equipment's

0 42

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of Isolation unit supported with medical supplies and

equipment's

0 37

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of PoE supported with medical supplies and

equipment's

0 26 Formal and 28 Informal PoE

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

Output# of CPHL supported with medical supplies and

equipment's

0 14

Distribution plan; waybill; M&E report MoPH; WHO; COVID-19

TaskforceMonthly

OutputNumber of local suppliers identified and contracted to

increase the availabilkity of supplies

0 TBD Procurment report

MoPH; WHO; COVID-19

Taskforce

Monthly Output

Operational support and logistics

is provided for preparedness and

response activities

Efficient response to

COVID-19 pandemic

with interrupted chain

supply and critical

functions identified

and supported (i.e.

water and sanitation,

fuel, energy, food,

telecommunications/i

nternet, financial

resources,

transportation,

essential workforce,

procurement, etc..)

Provide appropriate

support to all other pillars

and ensure that resources

and supply systems in

health and other sectors

are functional

Pillar 8: Operational

support and logistics (with

support from WFP/BSP)

Pillar 7: Case

Management

Ensure that healthcare

facilities in Yemen are

prepared to receive

unexpected huge increase

in number of suspected

cases of COVID-19 and

that health personnel are

well trained and familiar

with COVID-19 case

definition and able to

deliver appropriate care to

patients, particularly those

with, or at high risk of,

severe illnesses and those

that might be vulnerable

such as elderly, patients

with chronic conditions,

pregnant and lactating

women and children,

including ensuring that no

one is dying for secondary

causes

Increased survival

rate among patients

with increased

number of those

recovering from

COVID-19 and

reduced case fatality

rate (CFR) with

number of patients

recovering with long

term COVID-19

induced long term

impact.

Case management and continuity

of essential services reinforced.

Safe transport of suspected

cases/patients is ensured

Annex 14: Yemen Information Management Support Planning for COVID-19 Preparedness

Page 1 of 2

Data source/ Point

Formulae / Denominator

Data collection tool

Product Type Visualization/ Variables/Attributes

Frequency Audience

Pillar 1 Information Management & Monitoring and Evaluation

Number of governorates across the country

M&E tools DHIS2

KPI Dashboard National Key Performance Indicators

COVID-19 KPI’s Weekly -MoPHP -All pillar leads -M&E

Risk Coms Pillar 2

Number of governorates reached

Absolute numbers

Absolute numbers # of COVID19 posters distributed at PoE # of media messages # of people reached through different channels

Weekly -MOPHP -WR briefing -Incident manager

EOCs National and governorate level Pillar 3

Number of EOC sites

Absolute Numbers

RRT & EOC Daily Activity Matrix

# of rumors, daily alerts that are screened and calls answered related to Covid-19 # of RRTs deployed

Daily -MOPHP - WR Briefing -MoPHP -Incident Manager -Comms

eDEWS Pillar 3

Total suspected cases

Line list Contact line list

National Epidemiological update Time series case mapping

# of suspected cases # of cases investigated # of contacts traced -Weekly Epi curve

Daily -MOPHP -WR Briefing -Epidemiological team -Pillar lead

Quarantines and at PoE sites Pillar 4

Total number of quarantine facilities

Absolute Numbers

Absolute numbers # of people screened who fit case definition # of PoE with screening capacity

Daily -MOPHP - WR Briefing -Incident Manager -Pillar lead -HCT

Annex 14: Yemen Information Management Support Planning for COVID-19 Preparedness

Page 2 of 2

Notes:

- In addition to the list of product type mentioned above, a series of other products for wide dissemination, including situation reports,

Infographics, reports to donors, will be produced in relation to overall COVID-18 response activities.

- The processes matrix outlined above follow the regular IIMU strategy document and SOPs from data acquisition, cleaning and production.

Product Clearance and Dissemination Mechanism

All products will first be cleared internally by the IM COVID-19 Focal person and by the IMsT Pillar leads

Cleared products will be shared by Comms to disseminate

Laboratory test at CPHLs Pillar 5

Number of tests performed

Line list for labs

Lab test sitrep

# of daily lab tests performed # of reactions # of positive vs negative # of new tests / total tests # tests available #of PCR machines

Daily/ Automated

-MOPHP - WR Briefing -Incident Manager -Pillar lead -HCT

IPC Pillar 6

Number of health facilities

Absolute numbers

Activities # of training # of IPC materials distributed # of isolation units established # of triage established # of isolation units and triage provided with WASH services and IPC material/PPEs

Weekly -MOPHP -WR Briefing -Pillar lead

Isolation Facilities Pillar 7

Total number of Isolation facilities

Absolute numbers

Isolation facility profile

# of suspected cases by Isolation facility; # of deaths by sites # of ICU beds # of discharge

Daily - MOPHP - WR Briefing -Incident Manager -Pillar lead -HCT

OSL Pillar 8

Number of health facilities under COVID-19 response

Absolute numbers

Yemen Preparedness Dashboard

# of items in pipeline, stocked and delivered

Weekly -MOPH -Pillar Leads -WHO Staff -WR Updates