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Ebola Virus Disease (EVD) in DRC: Strengthening Community Prevention, Response, and Recovery

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Ebola Virus Disease (EVD) in DRC: Strengthening Community Prevention, Response, and Recovery USAID OFDA Ebola Virus Disease (EVD) in DRC: Strengthening Community Prevention, Response, and Recovery condomMala Ebola Virus Disease (EVD) in DRC: Strengthening Community Prevention, Response, and Recovery Baseline Report Submitted: 30 January 2020 Revised: 9 March 2020 Prime offeror point of contact: Zaneta Kific Sr. Director, Grants, Contract, and Compliance IMA World Health 1730 M St. NW Suite 1100 Washington, DC, 20036 USA IMA World Health, OFDA funded EBOLA VIRUS DISEASE in North Kivu and Ituri: Strengthening community prevention, response, and recovery in the Democratic Republic of Congo project Award No. 720FDA20CA00003 [email protected] Table of Contents Acronyms ....................................................................................................................................3 Background and Project Overview...............................................................................................4 Baseline Assessment ...................................................................................................................5 Baseline Scope: Population, Locations and Timing ......................................................................8 Methods and Data Sources .........................................................................................................8 Limitations ..................................................................................................................................9 Results and Analysis ....................................................................................................................9 Gender Assessment...................................................................................................................13 Analysis and Data Use ...............................................................................................................14 References ................................................................................................................................14 2 IMA World Health, OFDA funded EBOLA VIRUS DISEASE in DRC: Strengthening community prevention, response, and recovery Award No. 720FDA20CA00003 Acronyms BCZ Health Zone Management Team CHW Community Health Worker DHIS2/SNIS National Health information system DRC Democratic Republic of Congo EVD Ebola Virus Disease IDP Internally Displaced Person IPC Infection Prevention and Control KAP Knowledge, Attitudes, and Practices NGO Non-Governmental Organization SGBV Sexual and Gender-Based Violence WASH Water, Sanitation, and Hygiene WHO World Health Organization 3 IMA World Health, OFDA funded EBOLA VIRUS DISEASE in DRC: Strengthening community prevention, response, and recovery Award No. 720FDA20CA00003 Background and Project Overview The current outbreak of Ebola Virus Disease (EVD) in Eastern DRC is the second largest outbreak of Ebola and has resulted in 3,390 cases and 2,233 deaths (WHO 2020). The outbreak is occurring during widespread insecurity, impeded access to interior health zones, and increasing distrust of international NGO and relief agencies. This environment presents significant challenges in effective surveillance and monitoring of persons exposed to EVD, dissemination of key messages to reduce risk of transmission and stigma and equipping rural health facilities with essential prevention measures such as WASH, waste management, and effective infection prevention and control (IPC) material and protocols. In October 2018, IMA undertook a rapid assessment of 68 strategic key health facilities. Nearly two-thirds of health facilities had IPC materials; yet most consisted merely of chlorine, gloves, and thermometers. Acceptable amenities for water, incineration, and adequate latrines were found in less than one-third of facilities. The sample of 68 was less than a fifth of operational health care facilities (HFs), indicating a significant gap in IPC coverage in frequently visited facilities where most victims first present (and typically visit several centers in the early stages of their disease). In May 2019, IMA assessed facilities in Nyiragongo, Rutshuru, Rwangoma, and Kibirizi. In these facilities, we discovered that the issue of inadequate IPC supplies and WASH infrastructure persists, as well as additional issues including low understanding of protocols for suspect cases, lack of coordination, and staff turnover. These findings are consistent with those of IPC assessments of health centers in other Ebola affected areas (Pathmanathan 2014; Biedron et al. 2019). IMA and its partners’ community outreach and mobilization approach will include deploying nurses and CHWs (relais communautaire) from strategic health areas for community-based messaging and enhanced surveillance. The health facility-based IPC approach will include a rapid survey and gender analysis, provision of IPC material and applied protocols, and a monthly support package and checklist to ensure compliance. Cost-efficient, rapid, and appropriate WASH repairs/renovations will be provided to the EVD isolation units of each of the central health centers and comprise (1) light-touch clean water supply repair (2) latrine rehabilitation and repair (3) solid waste incinerator rehabilitation and (4) set aside areas for triage, isolation, PPE donning and doffing, and ambulance evacuation. Since the onset of the outbreak, communities have eschewed health services at local facilities due to the perceived risk of Ebola. IMA and partners will also work to ensure community demand for and access to quality, safe, and comprehensive health services in 6 selected health facilities in priority health areas as part of a scale-up ‘wrap-around’ component. Additionally, community-based WASH projects will help to improve hygiene, reduce virus transmission, and create positive touchstones to link to Ebola prevention and response actors in the health sector. 4 IMA World Health, OFDA funded EBOLA VIRUS DISEASE in DRC: Strengthening community prevention, response, and recovery Award No. 720FDA20CA00003 The impact of this approach will ensure that high risk and difficult to access health areas and health facilities have the requisite training, financial support, equipment and supplies, and oversight to effectively address the outbreak of EVD while continuing to provide other lifesaving health services; reduce transmission in high risk health-facility areas; provide community-based surveillance and care; ensure contact tracing is appropriately carried out; and reinforce WASH-related and positive behaviors. Curtailment of transmission, reinforced capacity to care, and resilient and engaged communities will help to address the critical gaps in the current EVD outbreak. Baseline Assessment Objective The overall objective of this assessment is to present baseline data on key project indicators against which the project’s results will be monitored. This baseline assessment will enable IMA to measure the project’s contribution to Ebola prevention and response in the targeted areas. The performance indicators for the project include: Table 1: List of Performance Indicators for the Ebola Prevention and Response project Sector Name: Health Objective: Health facilities are improved to adequately and safely respond to the EVD outbreak Sub-Sector Name: Health Systems and Clinical Support Indicator 1: Number of health facilities supported. Indicator 2: Percentage of total weekly surveillance reports submitted on time by health facilities. Indicator 3: Number of outpatient consultations. Indicator 4: Number of health facilities rehabilitated. Indicator 5: Number of health care staff trained. Sub-Sector Name: Communicable Diseases Indicator 1: Number of communicable disease consultations. Indicator 2: Case fatality rates for communicable diseases. Sub-Sector Name: Reproductive Health Indicator 1: Number of pregnant women who have attended at least two comprehensive antenatal clinics. Indicator 2: Number of newborns that received postnatal care within three days of delivery. 5 IMA World Health, OFDA funded EBOLA VIRUS DISEASE in DRC: Strengthening community prevention, response, and recovery Award No. 720FDA20CA00003 Indicator 3: Number of births assisted by a skilled attendant at birth. Indicator 4: Number of cases of sexual violence treated. Indicator 5: Number of women in their third trimester who received a clean delivery kit. Sub-Sector Name: Community Health Indicator 1: Number of Community Health Workers (CHW) supported (total within project area and per 10,000 population). Indicator 2: Number and percentage of CHWs conducting public health surveillance Indicator 3: Number and percentage of community members who can recall target health education messages. Indicator 4: Custom Number of households visited (reached) by a CHW as part of SBC efforts. Indicator 5: Custom Number of community members who received an EVD-associated messaged delivered by a CHW. Indicator 6: Custom Number of church leaders trained and mobilized to champion Ebola prevention messages in their congregations. Indicator 7: Custom Number of Ebola sensitization songs produced in local languages. Indicator 8: Custom Number of persons who received a message from a religious leader. Indicator 9: Custom Number of teachers trained to champion Ebola prevention messages in their schools Indicator 10: Custom Number of children who received an Ebola awareness message in school from teachers Sub-Sector Name: Public Health Emergencies of International Concern and Pandemics Indicator 1: Number of health care staff trained Indicator
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