Haiti and the Dominican Republic: Cholera outbreak response and preparedness Emergency appeal n MDR49007 GLIDE n EP-2010-000210-HTI 23 December 2010 This Emergency Appeal seeks 13,741,932 Swiss francs (14,465,191 US dollars or 11,021,751 euro) aiming to assist 500,000 people (100,000 families) in Haiti for up to a year and 150,000 people (30,000 families) in the Dominican Republic for up to six months. This operation will therefore be completed by the end of November 2011. A Final Report will be made available by the end of February 2012. Appeal History: - On 28 October, 78,852 Swiss francs were allocated from the International Federation of Red Cross and Red Crescent Societies (IFRC) Disaster Relief Emergency Fund (DREF) for Patients receive various forms of treatment for cholera at the cholera treatment centre at La Piste camp in Port-au-Prince, home to 50,000 people. Photos by Ben Depp/IFRC. preparedness activities in the Dominican Republic related to the cholera outbreak in Haiti. These DREF funds will now be allocated to this Appeal. Un-earmarked funds to replenish this DREF allocation are encouraged. - A Preliminary Appeal was launched on 3 November for 5,946,897 Swiss francs to support the Haitian Red Cross and the Dominican Red Cross to assist 345,000 beneficiaries (80,000 beneficiary families) in Haiti and 150,000 people (30,000 families) in the Dominican Republic for six months. Summary: The cholera outbreak which started in October 2010 in the Haitian department of Artibonite has extended throughout all ten departments in the country, including areas affected by the January earthquake. As of 17 December, 121,518 cases have been seen, with 63,711 hospitalizations and 2,591 deaths due to cholera, according to the MSPP (Ministère de la Santé Publique et de la Population). The total case fatality ratio stands at 2.1 per cent. The present Appeal aims to support the affected and the vulnerable population following a four-pronged strategy in accordance with the Haitian Red Cross Cholera Response plan of action and with the MSPP directives: Group activity I) water supply, Group activity II) sanitation, Group activity III) preventive health and hygiene promotion and Group activity IV) curative health facilities. The Appeal aims to support the coordinated response of the International Red Cross and Red Crescent Movement to the outbreak, thus increasing the synergy and efficiency of the operation. The proposed activities include the strengthening of the Haitian Red Cross (HRC) volunteer network to improve resilience capacity in their own communities through cascade training and key messages on cholera treatment and prevention. The overall strategy of this Emergency Appeal focuses on the provision of services within the four aforementioned group activities, at three different levels: in the communities, in cholera treatment units and cholera treatment centres.
2 This Appeal also aims to support the Dominican Red Cross efforts to ensure epidemic control and prevention. The DRC s activities place special emphasis on the 5 provinces along the border with Haiti and the three main urban centres in the country. <Click here to view the attached Emergency Appeal Budget; or here to view contact details> The situation In mid-october 2010, the MSPP reported an increase in the number of deaths and cases of acute diarrhoea in the Artibonite region (two hours north from the capital city of Port-au-Prince). Epidemiological studies indicated that the cases of acute diarrhoea were a result of a cholera outbreak. During the following weeks, the epidemic has spread through the country. As of 17 December, the MSPP has reported 2,591 deaths and 63,711 hospitalizations due to the outbreak. The total case fatality ratio is 2.1 per cent nationwide. The cholera situation in Haiti responds to a combination of factors that have exacerbated the epidemic. Firstly, there is a general lack of knowledge about the disease among the population, which delays patients from seeking treatment in a timely manner. Secondly, there is limited capacity from the health system, and thirdly there are difficulties to access some areas. In addition, the poor conditions of the water supply and sanitation infrastructure are a major risk factor for the spread of the epidemic. Given the situation, the UN Secretary General warned that -according to the Pan American Health Organization (PAHO) and the World Health Organization (WHO)- the outbreak could affect up to 650,000 people in the next six months. He urged humanitarian organizations to provide assistance to the Haitian people especially in rural and isolated areas. The increasing rate of cholera patients calls for more sustained action in the form of hygiene and health promotion programmes that will contribute to palliate the current escalation of the disease and to reduce the vulnerability of the Haitian people. Furthermore, treatment response is also needed to prevent further deaths. The MSPP and Department of Civil Protection (DPC) are working in coordination with humanitarian agencies under the Health Cluster to respond to the cholera outbreak providing hygiene and health promotion activities and treatment. Currently, 24 non-governmental organizations (NGOs) are providing health services in Cholera Treatment Centres (CTCs) and Cholera Treatment Units (CTUs). Latest reports by PAHO state that there are 63 CTCs and 123 CTUs currently operating with a bed capacity of 5,479 and 1,860 respectively. However, the Health Cluster is currently reviewing the mapping of the cholera treatment facilities. The coverage of cholera response is still limited in rural parts of the country, especially in the North and South, due to the scarcity in partners presence. The Health Cluster reports that the evolution of the epidemic is showing more clearly that urban and rural areas are unevenly affected. While CTCs and CTUs set up in urban areas are closer to meet the demand for patient care, access to health facilities remains extremely challenging in rural areas. In addition, the majority of actors focused their water and sanitation activities in earthquake affected areas. Since the outbreak, resources have been reallocated to cover non earthquake affected areas. However, there are still large areas in the country where increased presence of humanitarian actors is needed to address water and sanitation needs. Due to post election situations of violence, some humanitarian activities were scaled down. Roadblocks have coincided with sporadic acts of violence, rioting, fires, shooting, and exchanges of gunfire. Despite good respect of the Emblem, access is not always guaranteed. In addition, humanitarian agencies working on cholera response have encountered difficulties due to the lack of acceptance of cholera treatment facilities. The population is sometimes hesitant to allow CTCs and CTUs to be established near their communities for fear of the spread of the disease in the areas where they live. For this reason, the International Red Cross and Red Crescent Movement is working on community mobilization and community work through the network of trained Red Cross volunteers. In the Dominican Republic, a total of 294 cases of cholera have been reported as of 11 December, 32 of which have been confirmed. The following Provinces have confirmed cases of cholera: Santo Domingo (Santo Domingo Norte and Este), Santiago (Navarrete, Janico and Santiago), Elías Piña (Bánica), San Juan
3 (San Juan de la Maguana) and Valverde (Mao). Currently, 63% of cases are men and 37% of cases are women. Coordination and Partnerships The Movement actively participates in all cluster meetings as well as government health coordination meetings such as the Water, Sanitation and Hygiene Cluster, Health Cluster, Logistics and sub-cluster meetings as well as Intercluster fora on a weekly basis. Close coordination is also ongoing with the MSPP, the DPC, PAHO/WHO for all activities related to cholera. In addition, the IFRC is part of the humanitarian country team (HCT) led by the United Nations. At the community level the Movement is actively engaging local authorities, community leaders and health practitioners to coordinate activities. The Dominican Red Cross is ensuring active coordination with the Ministry of Public Health and the National Emergency Operations Centre and also ensures information exchange with the technical humanitarian team lead by the UNDP and the Emergency Operations Centre. In addition, there is close coordination with the Autonomous University of Santo Domingo with respect to the training of trainers. The Ministry of Health has made a number of specific requests to the Dominican Red Cross including support for the testing of water samples, and to ensure the provision of hand washing facilities and sufficient water provision for people crossing over the border at Jimani, as well as the setting up of a model cholera treatment unit at the DRC headquarters. Red Cross and Red Crescent action Click here to view a map of the Partner National Societies response To support the response efforts of the MSPP, the Haitian Red Cross with the support of the IFRC, is contributing to the national cholera response in the four groups of activities: I) Water supply, II) sanitation, III) preventive health and hygiene promotion, and IV) health facilities (See diagram below). To optimize efforts, the IFRC is supporting the Movement s actions around the country by providing logistics support such as procurement, warehousing and transport as well as coordination and information management. At the start of the cholera outbreak, the actions directly implemented by the IFRC were focused on the capital city of Portau-Prince and other earthquake-affected areas. Since early December, the IFRC has scaled-up its response under Group Activity III to all the departments to support the Haitian Red Cross Plan of Action. The IFRC has deployed a cholera coordination support team as part of the scaling-up of capacities in line with the HRC s Plan of Action. The team is composed of both FACT members (from the Canadian and French Red Cross Societies) and senior disaster management staff from the IFRC. This team is embedded in the Country Representation structure and is running a Cholera Operations Centre from the IFRC premises in the base camp. The cholera coordination support team is focusing its support particularly on internal and external coordination, emergency health, water and sanitation, and information management as well as coordinating incoming Emergency Response Units (ERUs) and advanced assessment teams. In order to provide assistance to the most vulnerable population affected by cholera, the active engagement of Red Cross volunteers at the community level is essential. For this reason, hundreds of volunteers from the Haitian Red Cross branches are receiving training on hygiene promotion and are taking part in cholera prevention awareness-raising activities in health facilities, schools, communal areas and markets throughout the country. The IFRC operation aims to provide a base structure to support all activities of the Movement components. Since the beginning of the emergency, the Movement has been active in responding to the outbreak in Haiti. All Movement actors have been active in continuous assessments. The IFRC and Partner National Societies (PNSs) have deployed Basic Health Care ERUs to provide assistance to the vulnerable population. At present Canadian, Finnish, Japanese, Norwegian and Dominican Red Cross Societies teams and the IFRC are conducting assessments in several departments including Nippes, Sud, Sud-Est, Ouest, Nord-Est and Grand Anse to assess needs for further ERUs including Mass Sanitation Module (MSM 20).
4 Partner National Societies in-country are also supporting the cholera response efforts, as summarized below: The American Red Cross (ARC) has deployed 200 promoters to a total of 40 camps in the Port-au-Prince area. Promoters are conveying messages about hygiene promotion and cholera prevention including transmission, symptoms, most at-risk populations, how to prepare ORS and demonstrations on handwashing. Target camps are also receiving information materials, ORS packets, soap and water purification tablets. The ARC is also conducting cholera prevention activities in schools. In Port-au-Prince, a CTU in La Piste run jointly by the British Red Cross, the Finnish Red Cross, and the NGO Partners in Health, has received over 1,000 patients at a rate of 40 patients per day, and is planning to scale up its capacity. Moreover, Oral Rehydration points will be set up in surrounding camps, which will refer serious cases to the CTU La Piste. In Port-à-Piment in the South-West coast area of Haiti, the British Red Cross-Japanese Red Cross Society ERU are supporting the CTU with a 24 bed capacity in collaboration with the local health authorities. This joint ERU has performed assessments and provided training for health staff (doctors and nurses) from the surrounding areas on cholera prevention and treatment, as well as infection control, decontamination and management of dead bodies. Support is being provided to the local clinic in the nearby location of Les Anglais with basic supplies and regular visits from medical staff from the Port-à-Piment CTU. The Canadian Red Cross Japanese Red Cross Society ERU has established a CTC in Carrefour (located at Lamentin 54 which has the highest cholera rate in Carrefour) with a capacity to accommodate 72 in-patients and 35 ORS walk-ins. The Spanish Red Cross is supporting this CTC with the daily water supply. The ERU includes a Community Health Module (CHM). Treated and discharged patients receive through this CHM hygiene promotion and preventive health messages as well as a home kit with water purification tablets, ORS and information pamphlets from the MSPP. The Danish Red Cross, in cooperation with the British Red Cross and the Haitian Red Cross, is planning a community-level prevention project at Les Cayes in the Sud Department, which will include the distribution of posters and brochures with cholera related messages. The Danish Red Cross and HRC Les Cayes branch will provide cholera related information at schools where current programmes take place. As a part of the cholera prevention activities, schools will receive soap. The Norwegian Red Cross and the Finnish Red Cross sent out an advance team of four delegates to support the IFRC Cholera Coordination Team. The advance team is conducting assessments in several departments including Sud, Sud-Est, Ouest and Grand Anse. In Jeremie (Grand Anse department) the advance team coordinated with the German Red Cross. The French Red Cross supports 16 Cholera Treatment Units (CTU), of which 14 are operational and 2 are being set up. In addition, French Red Cross-sponsored hygiene promotion activities continue taking place in schools and camps in Port-au-Prince, Artibonite and Petit Goave. Disinfections of houses, camps and public places in Port-au-Prince and Artibonite are also conducted on a daily basis. Moreover, training is being provided to medical staff, local authorities, teachers, community leaders and members of community associations. The French Red Cross has continued also with the distribution of drums with chlorinated water in the camps and neighbourhoods. To the date, 94 drums have been installed in camps and 31 in neighbourhoods. Water supply is provided to the primary health centres in Desdunes and Grande Saline and two cholera treatment centres. The German Red Cross manages a CTC in Archaie (covering an estimated population of 140,000). It also supports the MSPP activities in the entire commune of Carrefour (population 500,000), including epidemiological data management. More than 800 cases of cholera have been seen and treated in the CTC. The German Red Cross mobile health team is visiting villages where cholera patients come from, to promote hand washing, water disinfection, ORS use and sanitation. The acceptance of this mobile health team has been positive and water treatment tablets are in high demand. The Norwegian Red Cross provides transport services for cholera patients and supports cholera treatment facilities in Petit Goave in cooperation with Médecins du Monde Suisse, Oxfam and Terre des Hommes. The Norwegian Red Cross has also offered a cholera treatment kit to the Grand Goave CTC. Norwegian Red Cross-sponsored hygiene promotion activities have reached 15,765 people in the Petit Goave area. Moreover, Haitian Red Cross volunteers trained by the Norwegian Red Cross are carrying out house-to-
5 house visits giving information talks in Port-au-Prince and providing training at schools in close cooperation with the DPC in Petit Goave. The Netherlands Red Cross, together with the Haitian Red Cross, has been responding with prevention measures to the cholera outbreak in the South East department. In addition, the Netherlands Red Cross and the Haitian Red Cross are intervening with cholera prevention activities in the most affected areas referred by other organizations working on the treatment of cholera cases, such as the St. Michel Hospital in Jacmel, and Doctors Without Borders Spain. Hygiene promotion sessions with specific messages on cholera prevention and treatment have been provided in the most affected areas in the communes of Jacmel, Marigot, Les Cayes and La Vallée in the South East Department. The Netherlands Red Cross is also providing training to volunteers and distributing NFI. The Spanish Red Cross continues working in Artibonite, Port-au-Prince, Léogane and Jacmel. It supports the Cuban Brigade-managed CTC in Artibonite. In L Estere the Spanish Red Cross and Haitian Red Cross water plant provides safe water to the CTC. The Spanish Red Cross also provided latrines and disinfection materials to families in L Estere. This PNS also supports two CTCs run by Médecins Sans Frontières located in Marchand Dessalines and Saint Marc with sprayers, protection materials and buckets. Furthermore, in these two areas disinfection of houses continues to take place jointly with sensitization on cholera transmission, prevention and early treatment and correct hand washing techniques. In Port-au- Prince, the Spanish Red Cross monitors the water in 21 IDP camps to ensure chlorination of tanks and bladders. In addition, the Spanish Red Cross continues supporting the CTC in Bicentennaire with daily water trucking. The Spanish Red Cross jointly carried out the Canadian Red Cross CTC assessment and plans to support it with water, latrines and disinfection materials. The Swiss Red Cross is supporting the IFRC cholera operation with logistics support. In addition, it has provided in-kind items to the IFRC including water buckets and jerry cans. Together with the Norwegian Red Cross, Médecins du Monde-Suisse and other NGOs, it supports a CTC in Grand Goave. The Swiss Red Cross is planning to start a water, sanitation and hygiene promotion programme at Palmiste à Vin with an expected duration of 6 months. Additionally, PNSs are also strengthening the capacity of other organizations by seconding medical staff. An example of this is the partnership between the Swiss Red Cross, the Norwegian Red Cross and Médecins du Monde Suisse who are operating a CTC of 45 beds in Grand-Goave. The International Committee of the Red Cross (ICRC) ensures hygiene measures have been taken in 11 detention facilities. These consist of cleaning and disinfecting cells and latrines, chlorinating water and holding awareness-raising sessions for staff and detainees about hygiene and cholera. The ICRC is also distributing hygiene items such as soap and cleaning materials. On the advice of the medical department of the prison service, over 3,500 detainees in the facilities affected received a preventive dose of doxycycline (an antibiotic). In addition, prison dispensaries are being regularly supplied with medicines, ORS and IV drips. In conjunction with medical staff at the Port-au-Prince Central Prison, the ICRC has set up a CTC within the facility. The centre consists of four observation and treatment stations. In impoverished neighbourhoods, the ICRC is cooperating with the national agency for water supply and treatment, its partners from the Red Cross and Red Crescent Movement, and a number of NGOs. In the neighbourhood of Cité Soleil, the ICRC is scaling up the process of disinfecting the water-supply network. In addition, water-purification tablets are being distributed to people using tap-stands repaired by the ICRC. To expedite the process of taking sick people to hospital, the ICRC is actively supporting the Haitian Red Cross by providing Red Cross staff with vehicles, protective equipment and first-aid material. Furthermore, three times a day 8 radio stations broadcast messages encouraging people to respect the Red Cross emblem. This activity, supported by ICRC, has allowed the continuation of the Haitian Red Cross ambulance services during the election period. In the Dominican Republic: The Regional Representation for the Latin Caribbean based in Santo Domingo is working closely with the Dominican Red Cross, the Pan American Disaster Response Unit (PADRU) and the Federation Zone Office in order to ensure close coordination. The Dominican Red Cross is contributing to national cholera preparedness in close collaboration with the Ministry of Health, the Pan American Health Organization, OCHA and NGOs. The DRC has been assigned
6 by the government to support prevention, preparedness as well as response activities, as appropriate. The Spanish Red Cross is also coordinating closely with the Dominican Red Cross and has arranged for the shipment of oral rehydration solutions. The Regional Representative for the Latin Caribbean is attending coordination meetings organized by the United Nations. The Dominican Red Cross will establish a framework of bilateral cooperation with the Haitian Red Cross for the exchange of information and joint efforts with a view to promoting education and ensuring prevention and control with regard to outbreaks of the disease. The proposed operation The needs Beneficiary selection: As the epidemic spreads through Haiti the entire Hispaniola Island is at risk (approximately 22 million people). Therefore; the need for preparedness and response measures is generalized. The Haitian Red Cross, the IFRC and Partner National Societies continue supporting the vulnerable population affected by the earthquake in January while scaling-up activities to cover all ten departments through the 13 regional branches and 108 local committees; these include both urban and rural areas. The proposed Appeal is in line with the Haitian Red Cross Cholera Response Plan of Action to cover specific activities nationwide such as prevention and promotion, ambulance services and disaster preparedness and response programming with an emphasis on epidemics. It will focus more specifically in assisting up to 500,000 people (100,000 beneficiary families) for 6 to 12 months depending on group activities. Please refer to the expected outcomes per sector for details of group activities. The IFRC will support cholera treatment facilities, reinforce activities in water supply, sanitation, preventive health and hygiene promotion particularly through enhanced provision of clean water, the building of additional latrines, the inclusion of ORS centres, the establishment of hand-washing points and close monitoring of the situation in collaboration with the MSPP and PNS partners. The Plan of Action for cholera preparedness in the Dominican Republic targets some 150,000 people (30,000 families) with particular emphasis on the border region with Haiti and the three largest urban centres in the country. The proposed plan for cholera preparedness and response can be summarized as follows: Immediate needs: In Haiti, immediate needs continue to be: Supply and run cholera treatment facilities and services, including the distribution of ORS. Ensure access to clean water supply to communities and treatment facilities. Provide enhanced sanitation services in the community and treatment centres. Increase community awareness and knowledge about cholera through cholera prevention, hygiene promotion and NFI distribution. In the Dominican Republic, immediate needs relate to preventive health and hygiene promotion through volunteer training on epidemic control and awareness-raising, as well as the distribution of essential relief items. Levels of Intervention The Haitian Red Cross, with the support of the Movement, is implementing its cholera response plan of action in line with the Ministry of Public Health and Population and the Health Cluster strategy aiming to provide a comprehensive response to the vulnerable population. The strategy and group activities can be illustrated as follows:
7 Level 3: CTC Level 2 : CTU Level 1: Community I - Water Supply II Sanitation III Preventive Health and Hygiene Promotion (+NFI) IV Health Facilities (curative) The first level of the strategy corresponds to community and volunteer activities. The second and third levels correspond to activities carried out in treatment facilities and for medical personnel dealing with cholera patients. Level 1: At the community level the operation will continue providing water and sanitation services in the earthquake affected areas increasing the level of residual chlorination to match the current water authorities - Direction Nationale de l Eau Potable et Assainissement (DINEPA) standards. Provision of drinking water will expand to new target areas as defined in the expected outcomes below. Sanitation activities in level 1 will focus on reinforcing latrine management and washing facilities in earthquake-affected areas as well as improving sanitation conditions in new target areas. In addition, to prevent further infections, sanitation services will include disinfection of homes of cholera patients, preventive health and hygiene promotion activities on how to prevent and treat cholera, volunteer training and the supply of non-food relief items such as soap, buckets, jerry cans and water purification tablets. The fourth group activity (health facilities) at the community level includes patient transportation, provision of counselling and ORS at posts. Level 2: Corresponds to cholera treatment units attached to already existing health facilities or stand-alone. Level 3: Corresponds to specialized cholera treatment centres. Under these two levels, efforts in the activity groups of water supply and sanitation will focus on provision of water and adequate sanitation to the cholera treatment facilities, in particular those administered or supported by the Movement for a 6 month period. For preventive health and hygiene promotion, emphasis will be placed on raising awareness among patients treated to prevent further spread of the disease. Water supply Jean Antoine Bassangnol tests water delivered by the Red Cross to make sure it is safe. Bassangnol is one of the people in charge of distributing water delivered by the Red Cross in a Camp in Delmas 89. Photo: IFRC Outcome: The risk of cholera is reduced through the provision of safe water. Output 1: Continue delivering drinking water for up to 220,000 people in camps covered by the HRC/IFRC in Port-au-Prince, makeshift settlements, schools, orphanages, hospitals and surrounding neighbourhoods. Activities planned Drinking water is available at an average of 7.4 litres per person per day for up to 220,000 people living in makeshift camps and surrounding neighbourhood populations supported by the Movement. Safe water will be guaranteed with 0.7 mg residual chlorine. Residual free chlorine will be monitored at water storage and water distribution in at least 132 water distribution points where the IFRC is distributing water. Microbiological tests will be conducted for all Red Cross water sources Water caretakers will be trained in cholera awareness and hygiene promotion.
8 Output 2: Communities in the Grand Anse, Sud and Nord-Est departments (20,000 families) have access to drinking water Through the provision of non-food items under preventive health and hygiene promotion, beneficiary families will receive training in the use of water purification tablets. Existing water supply systems will be appropriately chlorinated. Operators will be trained in chlorination and residual chlorine monitoring 20,000 families will receive household items to store and transport water (2 jerry cans and 1 water bucket). Output 3: Health cholera facilities are supported to meet the water demand (level 2 and 3) in both the earthquake affected area and in the 3 additional geographical areas Output 4: Communities in the five provinces on the Dominican Republic border have access to safe water. *These activities are implemented concurrently with hygiene promotion and sensitization Provide water for up to 6 months with a minimum of 60l/patient treatment for up to 5 CTCs, 5 CTUs and mobile teams Pre-position water and sanitation equipment at the border of the Dominican Republic. The International Red Cross and Red Crescent Movement coordinated efforts to supply water to 345,000 people in Haiti also affected by the January earthquake. The IFRC directly provides water services to 220,000 people and also supports Partner National Societies around the country. A global average of 7.2 litres/person/day of water is distributed to 132 water points in 66 camps in Port-au-Prince. The water has a concentration of residual chlorine of 0.7 milligrams per litre (incremented by 0.2 milligrams from the usual 0.5 milligrams as a preventive measure against cholera). The IFRC has been supporting 4 cholera treatment centres in Archaie, Les Cayes, Grand-Goave and Portau-Prince with water. The French and Spanish Red Cross Societies are also supporting health facilities (including CTCs and CTUs) and the population in the Artibonite region with safe water. The IFRC has supported Haitian water authorities (DINEPA Direction Nationale de l Eau Potable et Assainissement) and Movement partners through the provision of 14 million aquatabs. In the Dominican Republic, a total of 24 water treatment plants have been pre-positioned in Montecristi, Dajabón, Elías Piña, Independencia, Pedernales, Azua, San José de Ocoa, Duarte and the Distrito Nacional as a preparedness measure to ensure potable water supply. The water treatment plants provide coverage of the border area and have been placed in areas with high population density and significant movement of migrants; an additional water treatment plant has been set up in Elías Piña, given the situation in the area of Sabana Cruz de Banica where a number of cholera cases have been detected. In addition, DRC water and sanitation technicians worked with the General Directorate of Environmental Sanitation (DIGESA) and the US Center for Disease Control and Prevention (CDC) to set up a chlorination system for the municipal hospital of Banica. The teams have also carried out tests of water quality in areas which are fed by rivers flowing from Haiti. Sanitation Outcome: The risk of cholera is reduced through the improvement of sanitation conditions. Output 1: Appropriate Activities planned sanitation for up to 85,000 At least 206 existing community sanitation facilities, excreta disposal at people in earthquake affected latrine level and disposal sites will receive specialized treatment because areas, including excreta of the cholera situation. This will be done by adding a high concentration disposal, solid waste disposal of chlorine in latrines to treat the excreta. and drainage is provided in camps, makeshift settlements and surrounding Provide and maintain at least 66 existing hand washing points and 206 existing latrines with soap and water.
9 neighbourhoods. Increase sanitation activities in camps identified with possible cholera cases (spraying of the latrines and disinfection of the pits). This will be done in camps serviced by the Red Cross as well as camps in Red Cross areas supported by health activities. Output 2: Houses of patients are disinfected to prevent further spread of the disease in locations covered by outputs 1 and 2 of the water section Output 3: Sanitation facilities are improved in the three additional geographical areas Output 4: Red Cross treatment centres/units have access to sanitation including excreta disposal, solid waste and drainage Spraying of the houses and training of the beneficiaries in the disinfection of clothes, kitchen utensils. Where sanitation facilities are available, communities will receive training on latrine management including distribution of chlorine/activated lime. Where sanitation facilities are non-existent, support will be provided for the local community in the identification of alternative options and training Provide sanitation facilities, excreta and solid waste disposal to up to 5 CTCs, 5 CTUs and mobile teams (each centre will be provided with latrines, showers, water storage). Currently, the IFRC manages 206 latrines. Thirty-eight clean up kits have been distributed and 175 showers are in place. In addition, the IFRC supports the German Red Cross CTC in Arcahaie. Eight portable latrines have been given to this treatment centre and the IFRC is responsible for the maintenance of these latrines three times a week. The Luxembourg Red Cross was also provided with 2 latrine tanks to support the CTC in Gressier. The Federation is also supporting partners outside the Movement. For example, Partner National Societies supported the CTC of Médecins Sans Frontières (located at Mais Gate on the national road n 1) and the MERLIN CTC with sanitation activities. The vacuum truck operators have been re-trained in the use of personal protective equipment for handling both the chlorine as well as to limit any contact with cholera bacteria. These vacuum truck operators spray the interior of the latrines after emptying them and the area around the latrines. The spraying of 206 latrines is ensured twice a week since mid-november. Preventive health and hygiene promotion Outcome: Cholera-related morbidity and mortality is reduced through a comprehensive approach to preventive health and hygiene promotion while strengthening the National Societies capacity in preparedness and response to cholera outbreaks Output 1: Disease transmission is reduced through increased hygiene awareness of communities and Red Cross volunteers and improved hygiene practices. Activities Planned Continue and increase preventive health and hygiene promotion activities among the population nationwide, with information, education and communication materials. Train staff and volunteers in epidemic control focusing on cholera response, active case finding in households and reporting through cascade training. 15 Trainers of Trainers will be trained at the national level and 2 trainers of volunteers in each of the 108 local committees (216 trainers of volunteers in total). The IFRC will support and coordinate Movement activities for additional training where needed. Carry out training of trainers in the Community Based Health and First Aid (CBHFA) methodology in each of the regional committees. Dissemination of key messages via SMS and radio on cholera
10 prevention and treatment nationwide. Output 2: Preventive health and hygiene promotion activities are reinforced in the 3 geographical areas of implementation of Haitian Red Cross activities Output 3: Prevention and epidemic control activities are integrated into longer-term community based health programming Output 4: In the Dominican Republic, increased awareness and prevention of cholera is ensured through a campaign in 36 branches on the Dominican- Haitian border and the three most populated urban areas: Santo Domingo, Santiago and Puerto Plata. Complement the HRC preventive health and hygiene promotion activities in the 3 geographical areas, through distribution of non-food items and information, education and communication materials, in coordination with Movement partners. Provision of non-food items for up to 20,000 families (soap). This activity is planned for an initial period of 6 months to be implemented concurrently with health promotion and hygiene promotion. Haitian Red Cross and IFRC staff and volunteers implementing activities have increased awareness in epidemiological control and prevention methods. Carry out preventive health and hygiene promotion talks in five border provinces and the three most populated urban areas. Carry out relief activities for 5,000 families supporting distribution of family hygiene kits, kitchen parcels and soap for 30,000 families. Conduct epidemic control workshops for communities and volunteers Provide personal protection equipment for volunteers who are working in affected communities or with cholera patients. Print and distribute public information, education and communication awareness materials such as brochures and posters. Carry out an SMS awareness-raising campaign targeting 1.5 million people. In line with the Haitian Red Cross Cholera Response Plan of Action, preventive health and hygiene promotion is crucial to improve people s quality of life, preparedness and to build resilience in the event of epidemics. This requires a focus on raising awareness of appropriate hygiene practices at community level and amongst Red Cross volunteers. The Haitian Red Cross, jointly working with IFRC and Partner National Societies, will reach the Haitian population with preventive health and hygiene promotion messages as a result of cascade training of volunteers at the branch and community levels. The IFRC standard methodologies on epidemic control for volunteers will be used. Cascade training will allow reproduction of knowledge and a wider dissemination of cholera related knowledge among the vulnerable population both in urban and rural areas. Staff and volunteers will also be trained in epidemic control focusing on cholera response, active case finding in households and activity reporting in coordination with health centres treating cholera patients. HRC branches will thus be strengthened to assist families to better prepare for and respond to future outbreaks. The IFRC is following the WHO s epidemic outbreak communication standards as part of its strategy to reach a wider population. Since the beginning of the operation, key messages are being disseminated via SMS, sound trucks and broadcasted on the radio. These media campaigns started in Artibonite and Port-au-Prince and have now been extended to other locations. The Haitian Red Cross and the Federation, together with Partner National Societies will also provide preventive health and hygiene promotion messages in cholera treatment facilities and supply patients returning home with information, education and communication and hygiene materials. In the Dominican Republic, there is also a strong focus on preventive health and hygiene promotion campaigns and awareness-raising particularly in the border region and in the three most populated urban centres of the country. Personal protection equipment has been provided to volunteers working in disinfection of houses of people affected by cholera as well as those focusing on prevention work.
11 As of 11 December, 208 workshops for cholera prevention and preparedness have been carried out at community level in schools, community centres, DRC branches, universities, sports centres, mothers centres and at neighbourhood gatherings. A total of 6,777 people have benefitted from the talks promoting hygiene, prevention and identification of cholera and measures to follow in the event of positive cases. In addition, awareness-raising campaigns are on-going in schools, universities, businesses, as well as at markets, bus stops and so forth. Messages addressed to the population on cholera prevention and hygiene, with an emphasis on the detection of cholera and appropriate, timely treatment are in line with those issued by the Ministry of Public Health. Health Outcome: Cholera-related morbidity and mortality is reduced through a comprehensive health approach including surveillance, oral rehydration solution (ORS) distribution and case management/treatment. Output 1: Low and moderate cases of dehydration are addressed. (Level 1) in both the earthquake-affected area and in the Grand Anse, Sud and Nord-Est departments. Provision of oral rehydration in communities that are cholera affected concurrently with preventive health and hygiene promotion activities for at least 15,000 people. Training of the Red Cross volunteers dedicated to ORS posts on cholera active case finding and communication with the referral system. Output 2: The health sector is supported to meet the increased needs relating to cholera treatment services (Levels 2 and 3) in both the earthquake-affected area and in the Grand Anse, Sud and Nord-Est departments. Set-up up to 5 Red Cross Cholera Treatment Units to provide case management for the affected population. Set-up up to 5 Red Cross Cholera Treatment Centres to provide case management for the affected population. Mobilize up to 5 mobile teams to support health facilities with a focus on rural areas. Provide medical supplies and equipment to support PNSs and other partners managing Cholera Treatment facilities until 1 January 2011. After this date the IFRC will support Movement partners in the procurement and warehousing of medical supplies (See Logistics output). Provide support to the MSPP with cholera treatment kits until 1 December 2010. Output 3: Management of cholera patients is enhanced. Ensure advocacy in the area of management of cholera patients. Provide support for training of staff from the Ministry of Public Health and agencies working in the management of cholera cases. Adapt the HRC ambulance service first responders training to address cholera specific intervention and correct use of the equipment. Click here to view map of the Cholera Treatment Centres and Cholera Treatment units The health strategy of the IFRC aims to facilitate health services for the population following MSPP guidance. Thus at treatment level 1 the IFRC brings ORS to the community, through Red Cross volunteers. Haitian Red Cross volunteers are receiving training to disseminate messages describing how to prepare oral rehydration solutions and how to care for cholera patients safely at home and when to take them to a health facility. The IFRC is also supporting the Haitian Red Cross ambulance service with training, protective and disinfecting equipment for the staff. Further to that the IFRC will strengthen the nationwide service supporting part of the running cost of the HRC fleet and radio equipment. Movement partners will also seek to strengthen the central dispatch service of HRC ambulances in Port-au-Prince.
12 The second level of the strategy focuses on treatment provided at the Cholera Treatment Units (CTU). These are facilities with up to 20 beds, that can be annexed to existing health facilities or operate independently. The third level focuses on Cholera Treatment Centres (CTC), which are dedicated facilities with a medium capacity for 60 beds. The Red Cross and Red Crescent Movement components are supporting partner institutions running cholera treatment facilities as well as running their own CTCs. The IFRC is facilitating cholera treatment kits, covering the needs for treatment of 1,200 patients, including a treatment module and four volunteer modules. The IFRC aims to support PNS activities in deploying cholera treatment facilities. The coordinated action of the Movement will facilitate assistance to wider areas in the country. The Appeal foresees training of health personnel and advocacy in support of the MSPP and other agencies regarding the management of cholera patients. Disaster Risk Reduction/ Organizational Development The ongoing DP/DRR Surge Project includes capacity building components for the Haitian Red Cross upon which the Cholera Operation can be further built. This project falls under the second pillar of the Earthquake response strategy. This joint project between the IFRC and the Haitian Red Cross is aimed at building capacities within the latter in view of the 2010 hurricane season. The project works on institutional disaster preparedness and community based disaster risk reduction. Within the framework of the DP/DRR Surge Project three main components can be identified that impact the cholera response: 1) As part of the community disaster reduction strategy, volunteers in each Regional Committee will be trained as trainers in the Community Based Health and First Aid (CBHFA) methodology. Each regional Committee today has a DRR Focal Point whose present responsibility is to organize community interventions with this methodology as well as Vulnerability and Capacity Assessment (VCA), Community Education, Preparation and Organization, together with the development of micro projects. In coordination with the IFRC and HRC Health Department these focal points can be key in reaching the community with cholera prevention messages, as well as being an asset to for their branch regarding the mobilization of volunteers. 2) Warehouse capacity and prepositioning of stocks: 12 Regional Committees of the Haitian Red Cross are currently reinforced with additional warehouse capacity. In most of the cases this is achieved with Tropical Mobile Storage Units (TMSU). Even if this space is intended to house hurricane response items, rearrangements can be made to host cholera prevention and hygiene promotion items. This would allow the Regional Branches to have easy access to these materials, enabling them to work more effectively. This initiative has been accompanied with the training of volunteers in logistics in order to manage the stocks stored in each location. This will also allow the regional committees to improve their monitoring capacity regarding the use of emergency stock. 3) Most analyses predict that cholera is likely become endemic in Haiti. The DP/DRR Surge Project has an unexplored component aimed at improving the capacity of the HRC to respond to epidemiological emergencies. In coordination with the IFRC and Haitian Red Cross health departments this component can be used to build a cholera management programme within the Haitian Red Cross health department to successfully face future cholera outbreaks. This would give an additional dimension to the current Emergency Appeal, bringing together capacity building, preparedness and response. A contingency plan for cholera was drawn up by the Dominican Red Cross at the end of October 2010. This contingency plan has been integrated in the Cholera Preparedness Plan of the Ministry of Health which was defined during the first week of November. A specific intervention plan has also been drawn up with all Red Cross partners in coordination with the Ministry of Health. Logistics Outcome: The cholera response operation is supported by ensuring that basic relief supplies are procured, delivered and distributed in a timely, transparent and cost-efficient manner, and that standard logistics procedures are followed. Output 1: Logistics support complements and facilitates the Activities Planned Scale up the current supply chain and control supply movements from
13 activities and assistance planned. the point of entry to final distribution point. Set-up and maintain a warehouse dedicated to storing Red Cross cholera stock. Supply this stock on demand, per request from the cholera programme coordinator. Support the set-up of designated sites as Red Cross cholera treatment centres (CTCs), cholera treatment units (CTUs) including incoming ERUs. Provide logistical and coordination support and supplies for the HRC, and PNSs implementing cholera response activities. Output 2: Logistics supports the HRC ambulance service capacity to respond to the cholera outbreak. Output 3: Logistics is guaranteed through regular monitoring activities. Provide logistics support for the cholera preparedness plan in the Dominican Republic relating to relief supplies and transportation. Increase the HRC ambulance service capacity through the provision of transportation, disinfection equipment, and protective gear. Ensure that logistics activities are implemented, supervised, and monitored by continual assessment of control activities. Only the coordinated action of the Red Cross and Red Crescent actors in Haiti will ensure an adequate and countrywide response. The IFRC aims to provide a framework for the independent but coordinated programmes of Movement components through its logistics department. The logistics team in Haiti, supported by the Secretariat logistics department in the secretariat headquarters and the Panama Regional Logistics Unit, have worked on the plan of action for the response to the cholera outbreak in Haiti and Dominican Republic. For this, a sourcing strategy was defined and implemented. The tendering process was initiated and completed for procuring items such as medicines, oral rehydration salts, medical equipment, water and sanitation equipment, soap, chlorine, jerry cans and buckets. Items requested by the health, water and sanitation sectors are currently in the pipeline. In a second phase, the IFRC s Regional Logistics Unit will work to replenish stock in the warehouses in Haiti and Panama according to the overall stock pre-positioning strategy that is a part of the Haiti earthquake operation (pillar 2). IT and Telecommunications Outcome: The Haitian Red Cross ambulance service s capacity is increased through the provision of IT and Telecom equipment Output 1: The HRC Equip radio room with VHF radio equipment. Ambulance Radio Room is established. Strengthen the central dispatch service of the HRC Ambulance service in Port-au-Prince. Output 2: The HRC ambulance fleet (46 vehicles) is equipped with radios. Output 3: HRC ambulance service operators and volunteers are trained in the use of IT Telecom equipment Equip the ambulance fleet with 46 radios. Train ambulance service team and volunteers on the use of radio equipment. Communications Advocacy and Public information Outcome: The cholera outbreak in Haiti is mitigated by providing information on prevention and treatment to people throughout Haiti