health services may have compromised the case management of patients. Flooding has caused significant damage to health infrastructure therefore reducing access to health services for populations living in affected areas. It is one of the consequences of internal displacement of populations (IDPs) combined with infrastructural damage and poor access to health centres that would lead to the potential exacerbation of major infections like TB and HIV. Whilst there is no direct causal relationship, the potential for disruption of health services linked with increased vulnerability of affected populations to malnutrition that lead to compromised immunity may accelerate infection rates for TB and accelerate the progression of HIV infection to clinical AIDS. Thus the impact on the health system is the major common factor that maybe associated with an increase in incidence of major communicable diseases including the increase in drug resistance and treatment failure as a result of poor adherence to treatment from disrupted services due to El Niño. Similarly the closure of health facilities due to lack of water supplies has probably affected ART access and reversed the gains made in PMTCT, which was already less than 90 per cent in Lesotho, Madagascar, Malawi Zambia and Zimbabwe before the El-Niño event. El Niño may also have caused a decrease in service utilization and adherence to ART and TB treatment with lack of food being one of the reasons for people to stop taking their medication since one of the side effects of the medication is increased feeling of hunger. Uninterrupted access to treatment is crucial to ensure drug adherence and avoid later multi-drug resistant TB (MDR-TB). RECOMMENDATIONS (HEALTH AND COMMUNICABLE DISEASES & HIV/AIDS AND TB CO-INFECTION) • Invest in staff capacity to ensure that case management protocols, prevention and treatment guidelines are adhered to, including severe acute malnutrition (SAM); as well as ensuring uninterrupted availability of lifesaving essential medical supplies, particularly those needed to manage disease outbreaks • Strengthen routine immunization services to maintain high coverage of all antigens by reaching every child, including through outreach, and as necessary, through multi-antigen catch-up campaigns. • Ensure provision of emergency water and sanitation services in health facilities through rehabilitation of water schemes and sanitation in selected health facilities and/or new water schemes where needed. • Engage and invest in strengthened community health systems and platforms to execute effective case finding, assessment, case-management and referral to the next level of care as appropriate. including social mobilisation to create timely health seeking behaviour and reinforce positive health promotive and disease preventive action. • In addition to the above, development programmes should accelerate focus on strengthening information management systems for generation, analysis and use of age, sex and genderdisaggregated data in order to get a clear view of the direct and indirect impacts (of the drought on children, women and families; and fine-tune responses to address emerging issues and trends. Increased transactional sex and violence due to the deteriorating socio-economic conditions following such shocks can also influence HIV transmission in endemic areas • Using the best available data of El Niño impacts and projections to advocate for resources, (human, financial) to enable community and health systems to effectively respond. and Poor feeding practices resulting from lack of food will also further compromise people’s immune system and increase the risk of infection due to drinking water scarcity as well as increases in vector borne diseases. Ultimately, the drugs are less effective in virus suppression if not taken with food. • Capacitate country-led coordination platforms to sharpen national and local response plans. and effectively oversee and monitor El Niño response, including the differential impacts on women, girls and boys, and vulnerable households. 17