MULTISECTORIAL EMERGENCY RESPONSE PLAN - CHOLERA Prepared in collaboration between MISAU and Intercluster Date: 6/04/2017
Multisectorial Emergency response plan for cholera in Mozambique - 2017 1. Introduction Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed. The disease is always considered a potentially serious infectious disease and can cause high morbidity and mortality. It has the potential to spread rapidly, depending on the exposure frequency, population exposed and the context. Cholera in Mozambique follows a seasonal pattern with peaks during the rainy season which usually lasts from November to April. According to Ministry of Health s Statistics, 1954 cholera cases and 4 deaths have been reported since 5 th January to 02 nd April 2017 in Maputo, Nampula and Tete provinces. 2. Objective of the plan The purpose of the plan is to reduce morbidity and mortality resulting from acute watery diarrhoea in the communities through timely preparedness for epidemics and early detection of outbreaks in addition to the introduction of appropriate measures to control and contain outbreaks and prevent fatalities. The plan is specifically expected to: Implement coordination mechanism of the response at the national and provincial level Enhance cholera surveillance Ensure proper case management and infection control and prevention during cholera outbreak response Enhance environmental control procedures in response to outbreaks Ensure effective monitoring and evaluation of cholera preparedness and responses 3. component of the plan There are 3 stages of the cholera preparedness and response: pre-epidemic phase, presence of epidemic, post epidemic phase
Stage 1 Time Public health objective Strategic activities Pre epidemic phase When there are no outbreaks Reinforce early detection of cases with acute watery diarrhoea Enhance epidemic preparedness for any acute watery diarrhoea due to Vibrio cholerae Risk assessment Training in rapid reporting process for epidemic prone diseases Mapping high risk or hotspot areas Mapping of human and financial resources Securing stock of strategic reserves of medicines, essential supplies, WaSH items Building local capacity through training and mentoring Setting and dissemination of standards for case definition, reporting tools, case management, infection control and prevention procedures Identifying cholera treatment centers and rehydration corners Securing supplies for laboratories Strengthen information management Stage 2 Time Public health objective Strategic activities Presence of epidemic When lab confirms Vibrio Cholera in stool of suspected cholera case Limit the case fatality rate with adequate case management Reducing the risk of transmission to vulnerable people and to other areas Prevention and containment Coordinating response through national and local committees Enhancing surveillance at health facilities and community levels Active case finding and community engagements in contact tracing Secure safe referral system for suspected cases Opening CTCs and ORT corners for proper case management Reinforce the infection control practice in the CTC and other facilities Identify and coordinate potential partners to be assigned different roles and responsibilities for cholera response interventions Analyse data and produce weekly epidemiologic trends, and disseminate regularly Control of environmental risk elements
Stage 3 Time Public health objective Strategic activities Existstrategy (< 6 months) After the pic cholera to facilitate the end of the outbreak Decrease number of diarrheal diseases and risk of cholera outbreak In Maputo city and suburds (716.000 USD): Feasibility studies and drilling of 6 boreholes + rehabilitation of 22 existtings boreholes (612.000 USD) to connect to waternetwork. Increase awareness on rational use of the water due to water shortage in Maputo (71.000 USD) New main pipeline and connection to borehole (33.000 USD) In Tete city (281.50USD): Support FIPAG with opening of 2 boreholes, elevated tank and extension of waternetwork in most affected barrio Sansao Muthemba (281.500 USD) 4. Assumptions & determination of operational figures In order to find the estimated number of expected cases during an outbreak, we assume that 50% of the population is at risk with an average attack rate of 1%. Once the expected number of cases is determined, the need for medicines will be determined according to the following: - 80% of cases will need only oral rehydration fluid ( each case needs at least 6 litres of fluid) - 20% of cases will need IV fluids( Ringer s lactate) followed by oral rehydration fluid ( each case needs 3000cc of Ringer s lactate) Expected case load in Mozambique = 8.139
5. Plan of action 1.coordination (organization of the response) Activities/outputs Committee for cholera control activated Disseminate the response plan to all partners Establish national and provincial emergency stocks Information flow, feedback and dissemination mechanism Collaborating agencies Health clusterwash cluster Communication actors Activities/outputs Distribution of case management and IPC guidelines and algorithms to assess the severity of dehydration to all health care providers in areas affected by the epidemic Organization of treatment centers in compliance with agreed standards and with full consideration to infection control procedures Collaborating institutions WHO,UNICEF,WHO, MSF 2. case management Mobilize required number and type of personnel to run a cholera centre Training of personnel working in cholera treatment centers on prevention, diagnosis,treatment and control of cholera Oral rehydration therapy corners operational, WHO,MSF Provision of material, drugs, technical guidance and supportive supervision to clinics located in the area of the outbreak Provision of ORS to cases identified during door-to-door visits and encourage referral to the nearby health facility,msf,
3. surveillance and information management Activities/outputs Active case finding in areas where there is laboratory confirmation of vibrio cholera Daily reporting of cases and deaths Geographical analysis with mapping to optimize the targeting of affected areas with chlorination and promotion of sanitation Collection, compilation, analysis and weekly dissemination of epidemiological data Collaborating institutions,who,who,msf WHO 4. Social mobilization & environmental control procedures Activities /outputs Consolidate community sensitization, mobilization using a network of community volunteers to go house to house to provide keys hygiene messages and at least one bottle of certeza Mobilize all potential stakeholders for hygiene promotion campaign Access to sufficient and appropriate water through emergency water supply: water trucking, quick repairs, increase chlorination of water network. Chlorination of water supplies used for drinking at HH level (Certeza) or waternetwork level (FIPAG) Desinfection affected houses, provided hygiene messages and certeza Provide water supply and adequate sanitations facilities of CTCs Collaborating institutions UNICEF, Red Cross,, OXFAM, cluster members WaSH cluster members + Communication partners + MoH,UNICEF, FIPAG, DNAAS, DPOPHRH, cluster Red Cross, DPOPHRH, FIPAG MSF, MoH MSF, FIPAG, WaSH cluster members Water quality monitoring (focusing on chlorine residual) Preposition WaSH items in all provinces to facilitate immediate response. FIPAG, DPOPRH, DNAAS, water providers UNICEF, WaSH cluster members
6. Cost estimate for full implementation of the operational plan Main plan of action 1. Case management, surveillance, information management and coordination Cost (USD) 248,269 USD 2. Incentive for health care personnel in CTCs 450,000 USD 3. IPC (infection prevention and control) equipment and lab supplies 478,440 USD 4. 10 cholera kits prepositioned 120,000 USD 5. Community mobilization 104,246 USD 6. Emergency WASH response and environmental control (for 3 months) TOTAL (3 months emergency budget) 402,919 USD 1,808,974 USD 7. Exit-strategy 6 months 997,500 USD TOTAL (6 months Emergency + exit-strategy) 2,801,374 USD