HEALTH CLUSTER

WEEKLY BULLETIN No. 4

29 DECEMBER 2008

OVERVIEW

Woman receiving cholera treatment at CTC (MSF)

o Cholera Situation update o Chinese and Tanzanian governments donate o USAID pledges towards cholera fight o Cholera Command Control Centre update o Health cluster weekly meeting o Health and WASH agree on roles and responsibilities o WHO response team during festive holidays

SITUATION UPDATE AND HEALTH ASSESSMENT The countrywide cholera epidemic in Zimbabwe currently affecting all of the country’s 10 provinces and at least 57 of the 84 rural and urban districts has, as of December 26, caused 1557 deaths with 28492 suspected cases . The case fatality rate (CFR) is 5.5%. The largest number of cases were in (9718 cases and 330 deaths - CFR 3.4%), followed by (3665 cases and 108 deaths - CFR 2.9%), Makonde (2222 cases and 68 deaths - CFR 3.1%) and Urban (1767 cases and 139 deaths - CFR 7.9 %.) For more information, see http://ochaonline.un.org/Default.aspx?alias=ochaonline.un.org/zimbabwe Following reports of a fresh outbreak in Mt Darwin District in Mashonaland Central Provinc e a Rapid Response Team comprising of WHO epidemiologists and environmental health officer , was dispatched on 27/12/08 to make a rapid assessment the cholera epidemic, identify gaps and needs, as well as providing technical support to the health teams in Mazowe District. They found out that Mount Darwin was no longer a serious threat, but Mazowe District. It was suggested that the assessment be done in Mazowe instead of Mt Darwin. All the 8 districts in the province are currently affected by the cholera outbreaks which started in October, 2008.

Zimbabwe Health Cluster Weekly Bulletin No. 20 -29 December 2008 1

DONATIONS AND PLEDGES TOWARDS CHOLERA FIGHT

· The Chinese government donated US$500 000 in cash to the Zimbabwe government to fight the cholera epidemic. · The consignment of medical supplies (Doxixycline, Methylated spirit, Ringer, ORS, Infusion Sets, Ciprofloxacin,Erythromycin, Zinc Oxide, Sodium Chloride, Scalp veins, Canular 18g, Latex gloves) worth US$ 60 000 donated by Tanzania to Zimbabwe to help its fight against cholera arrived in Harare · USAID has pledged US$6,2 million to WASH -related activities in Zimbabwe’s cholera response. · Shipment from WHO Geneva, HQ/HAC - Ringer lactate, 10.000 litres + 10.000 Infusion sets

HEALTH CLUSTER COORDINATION

· The weekly Health Cluster coordination meeting was held o n 23 December. · Social Mobilisation – The Ministry of Health and Child Welfare has endorsed the use of ORS at community level. This will go a long way in reducing the number of community deaths. Cluster members agreed on the need to have a community package composed with water treatment tablets, water containers, ORS, couple with p ublic health education in the form of visits or distribution of pamphlets on cholera awareness, management and hygiene promotion. · Critical activities mainly during the festive season have been summarized in the graph in annex · A WHO Headquarters logistician in Zimbabwe to support NATPHARM to improve the management of the warehouse. · World Vision is supporting food provision to some CTCs including Budiriro, Mudzi, Beitbridge. However it was pointed out that some CTCs do not have facilities to prepare food. The Health Cluster will work with the World Food Programme sort out the issue. · The Cluster will agree on a comprehensive assessment tool with the WHASH cluster to update on the situation in P rovinces and Districts.

World Health Organization · WHO Inter -country Support Team Coordinator Dr O. Walker presented the Cholera Command and Control Centre (C4), Terms of Reference to the Ministry of Health and Child Welfare (MoHCW). It is proposed that the C4 will be co-chaired by the MoHCW and WHO whose major functions will be Surveillance; Case management; Wat er and San itation and Infection Control; Social Mobilisation and Logistics. The C4 will work closely with health, nutrition and Logistic clusters providing technical recommendation for partners to help MoHCW in the implementation. MoHCW is reviewing the document for their approval. · A WHO & MoHCW team responded to an outbreak in Msengezi, Chegutu where number of cases soared from 7 (December 4) to 60 (December 16). They visited Msengezi CTC to assess the situation, provide cholera response material support and onsite training to health personnel at the CTC. · WHO coordinated the cholera daily updates with MoHCW. · WHO set up a response team during festive season comprised an Environmental Health Officer, epidemiologists, data managers from Inter-Coiuntry and WHO Country Office. Daily meetings and updates will continue as usual. UNICEF · UNICEF airlifted supplies for cholera response such as IV fluids, cannulas for both adults and paediatrics, ORS, gloves, cotton wool, adhesive tape and naso g astric tubes for adults and children (in case of vein collapse). · The supplies included drugs, midwifery and obstetric kits for Emergency Obstetric Care. 13,333 boxes (12 units per box) of Ringer Lactate, 24996 adult giving sets and 22632 paediatric giving sets were trucked from South Africa. · An additionanl 48 tents are expected to be flown in on the 29th of December. · UNICEF has continued to respond in the past two weeks to the outbreak through disbursing supplies such as IV fluids, giving sets, blankets, gloves, fuel and cholera kits and WASH supplies through partners such as Concern, City Council, City Council, PSI, MSF Spain, Oxfam, MDM, ACF, GOAL, ICRC, FCTZ, for distribution in CTCs in their areas of operation. Some supplies were also distributed through MOHCW structures such as PMD Manicaland,

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and Hospitals and others sent direct to the Cholera Treatment Centres in Chegutu and Chirundu. · UNICEF is supporting Women’s Action Group (WAG) to provide psychosocial support to the people affected by Cholera in the Chegutu community. GOAL Zimbabwe · Non Food Items (NFI) distribution (soap, Oral Rehydration Salts (ORS), aquatabs and buckets) and health education in Dzivarasekwa and extension, Harare to 5,000 households. · Team sent to Chirundu for general NFI distribution and health education in response to current outbreak reaching 1,500 households. · Goal plans to distribute NFI and provide health education in Hatcliffe and extension, Harare to 8,000 households. PLAN Plan is providing logistical , technical and material support to cholera response teams in , Mutoko and , by seconding two of its Environmental Health Officers to the cholera treatment centres in Mutare and Chipinge districts. · One Plan vehicle has been assigned to cholera control on a full time basis in · In Marange community, Plan is working closely with the MoHCW staff and some leaders of the Johanne Marange Apostolic sect to educate the broader Apostolic followers in the area to seek treatment of any suspected cholera ailment. · A consignment of cholera medical supplies was scheduled to arrive in the country for onward distribution through CTCs in Mutare, Chipinge and Mutoko districts. · Plan to arrange paying a hardship allowanc e to MoHCW staff involved in cholera response beginning last week of December. International Federation of Red Cross and Red Crescent Societies (IFRC) IFRC has transported the following cholera response supplies 4 cholera kits, enough to treat 4,800 people. A further 16 cholera kits are on their way, giving the Zimbabwe Red Cross Society the ability to treat 30,000 people · 552,000 water purification sachets. Each sachet treats 20 litres of water, giving the Red Cross the capacity to provide over 10 million litres of safe water to those most in need · 1,500 ‘life straws’ for Zimbabwe Red Cross volunteers to keep them healthy as they continue with their cholera awareness programmes, and distribution of oral re -hydration salts and water purification tablets · 40,000 pamphlets on the causes of cholera, symptoms and preventative hygiene measures in both English and Shona to further extend cholera awareness programmes. This information is vital to inform and empower at risk communities and contribute towards the reduction of cholera cases and deaths

INTER-CLUSTER COORDINATION · The Health and Water Sanitation Hygiene (WASH) clusters met on 24 December to coordinate cholera response interventions. They agreed that WASH issues in Cholera Treatment centers would be managed by health cluster with support form WASH. Supplies related to WASH as well as technical advice would fall under the health cluster as well. · Expedition of medical supplies and Wash material has been sent from NatPharm to the following Provinces and Districts: Chitungwiza, Chikurubi,Kadoma, Machingu , Mutoko (Hospital), Karoi, Mutare (Province), Muzengezi, (Hospital) and Epworth.

CHALLENGES · Communication system is poor with no reliable communication network in most parts of the country. The Health Cluster has set up a toll free number (0808 9000) for provincial and district officers providing daily cholera data to C4. · Staff motivation, there is a proposal to devise a compensation scheme for health and related field staff working on cholera response to keep Health workers at work mainly in CTCs during the holiday season. The MoHCW country wide policy for salaries will guide partners by January 2009. · There is a lack of cholera response materials both medical and non medical such as containers for hand washing, some ground sheet polythene rolls, antibiotics, body bags and fuel for case investigation especially in some CTCs manned solely by the Ministry of Health workers. · National Pharmaceuticals (National Medical Central Stores) is lacking non medical items like cholera beds, tents, buckets, utensils etc. Zimbabwe Health Cluster Weekly Bulletin No. 20 -29 December 2008 3

· Food for Cholera patients at CTC, has been a challenge with some facilities lacking the supplies and the capacity to provide meals.

NEXT STEPS Way forwards for the Health Cluster interventions · Partners to allocate more resource in areas where there is a lack · The Health Cluster Coordi nator called on the Health Cluster members at the weekly Health Cluster Meeting to prioritize community-based intervention in the cholera fight in Zimbabwe focusing on Surveillance, social Mobilisation, Community ORS distribution and nutrition. He also ur ged a strong mass media campaign to reach all the people with cholera prevention and management messages. (See table below):

Interventions for the cholera response

Intervention Responsible

1- Surveillance & EWAR (investigation - Health & WASH team) & Lab cluster members 2-Social mobilization strategy and plan - MoHCW 3- Guidance Case mgt (training) District 4- WASH activities coordination Coord. & 5- HR: incentives Guidance 6- Logistic support (vehicle, fuel)

1-Staff: incentive - Health Cluster 2- Supplies members CTCs 3-Non medic items -MoHCW Case mgt 4-Guideline (CTC; Case management) 5-Food

1- Package: - Health and WASH - Health & WASH education tools Cluster members Community - Water containers (mainly NGOs) Surv. & EWAR - Water purification tablet -NUT Cluster Soc Mob - Comm- based surv & EWAR -MoHCW Comm-based ORS - ORS at community level Nutrition 2- Media campaign

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Reported cholera cases by district, 19-25 December 2008

Cases above 5000 1001-5000 101-1000 2-100 1 No cases

19 Dec 2008 25 Dec 2008

Case Fatality Ratio by District, 19-25 December 2008

above 5 above 5 1.1 - 5.0 1.1 - 5.0 0 0 no cases/deaths no cases/deaths 19 Dec 2008 25 Dec 2008

For more information, please contact: Dr Custodia Mandlhate, WHO Representative to Zimbabwe Please send contributions for next edition by cob on Tel: +263 4 253 724-30, email: [email protected] each Wednesday to Ms Zora Machekanyanga at Ms Zora Machekanyanga, Communications Officer, WHO Zimbabwe Tel: +263 4 253 724-30 ext 38172, [email protected] email:[email protected] Dr Stephen Maphosa, Emergency and Humanitarian Action, WHO Zimbabwe Tel: +263 4 253 724-30 ext 38158, email: [email protected] Zimbabwe Health Cluster Weekly Bulletin NoDr. 20Michel -29 Yao,December Emergency 2008 and Humanitarian Action (EHA)5 Inter -Country Support Team Tel: +263 4 253 724-30 ext 38028, email: [email protected] Dr S. Midzi, Director, Epidemiology and Disease Control. Tel: +263 4 229032 Mobile: 011878009 e-mail: [email protected]

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