Final Program Results Report Headquarters Information Field Contact Information Coy Isaacs Bonome Desire Nturo Technical Director, Crisis Response Crisis Response Coordinator, DRC 1825 Connecticut Avenue 44, Av. De l’Auberge, Quartier MUTIRI, Cellule Maghala, Washington, D.C. 20009 Commune de BULENGERA, Ville de BUTEMBO, [email protected] Province du Nord Kivu, DR Congo [email protected] Country/Region of Country: Democratic Republic of the Congo Submission Date: December 18, 2019 Program Title: Rapid Response to the Ebola Outbreak in the Democratic Republic of Congo OFDA Award Number: 720FDA19CA00012 Award Period: March 20, 2019 – Sept 19, 2019 Reporting Period: March 20, 2019 – Sept 19, 20191 Community Leader Sensitization session at Kaniyi Demonstration by the SDB team during Health Center in Masereka Health Zone engagement meeting with cemetery host community 1While this report covers the entire period of the award, please note that many FHI 360 activities as of September 1, 2019 are funded through follow-on Award No. 720FDA19CA00074 and accordingly will be reported under that project. Data presented is from the project start through August 31, 2019 unless otherwise noted. FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Executive Summary This report covers FHI 360’s Rapid Response to the Ebola Outbreak in the Democratic Republic of the Congo (DRC) project. During this project, which took place between March 20 and September 19, 2019 in the eastern regions of the DRC, FHI 360 supported the overall Ebola Virus Disease (EVD) response through Social Mobilization and Community Engagement (SMCE) and Safe and Dignified Burial (SDB) activities. While this project ended on September 19, 2019, activities in this report primarily cover up to August 31, as activities after this time are funded by and thus will be reported on in FHI 360’s follow-on project (Award No. 720FDA19CA00074). At the onset of this project, the epidemic was entering its seventh month. From August 2018 to March 2019, responders had struggled to control the rapidly changing epidemic due to its expansion to new health zones and the unique factors present in the eastern regions of the DRC. At the onset of FHI 360’s project on March 20, 2019, 960 cases had been reported, with 603 proving fatal (fatality ratio of 63%), making this the largest EVD outbreak in the history of the DRC and the second largest recorded in the world behind only the West Africa Outbreak of 2014 -2015. Towards the end of FHI 360’s initial project in August 2019, the total number of reported EVD cases had expanded to 3,036. Of these cases, 2,035 proved fatal (fatality ratio of 67%). While this expansion initially appears shocking, the 59 new cases confirmed over the last week of August was a marked improvement over the height of the outbreak in mid- to late- April, when over 120 new cases were being reported each week. Throughout the initial stage of the outbreak, the World Health Organization (WHO) and other response actors identified SDB and SMCE as two areas that were underrepresented in the overall EVD response. To fill this gap, FHI 360 designed its project to address these shortcomings using proven methods and expertise from the West Africa EVD response. The proposed activities included engaging with local and traditional leadership to create acceptance and promote locally owned and led response activities; the training of Civil Protection teams in SMCE techniques; fully training, equipping, and supporting multiple SDB teams in Ituri and North Kivu Provinces; and working to resolve disputes and improve trust between communities and burial teams, amongst a myriad of other tasks. In the first months of the program (March to April), FHI 360 began SDB and SMCE activities in four Health Zones spread over North Kivu and Ituri Provinces (Bunia, Butembo, Katwa and Komanda). As the Ebola outbreak evolved, FHI 360 continued its planned activities in the original health zones while adapting and expanding its programming to fill critical gaps identified by the FHI 360 Crisis Response team and its partners. For SDB activities, FHI 360 identified new health zones threatened by the outbreak, trained and supported new teams in at-risk communities and took over coffin supply and grave digging activities when the previous actor was unable to continue. As was the case with the SDB activities, FHI 360’s SMCE teams adapted programming to fit new areas and problems, worked to build new relationships with traditional leaders and communities, and expanded efforts to learn from the communities directly affected by the outbreak through dialogue and feedback session. By the end of the project, FHI 360 had worked or was working in a total of 14 Health Zones and had adapted its programming to include the new activities and operations areas discussed above. Throughout the duration of the project, FHI 360 EVD response teams were confronted by a wide set of challenges. Beyond the rapid territorial expansion of the outbreak into hard to reach areas such as the Biakato-Mambasa belt— with high levels of insecurity and deplorable road conditions—and Ariwara—where the use of high-risk commercial planes was a necessity—FHI 360’s teams continuously worked in dangerous regions known for high levels of distrust of international and national actors. Additionally, these regions were home to countless armed groups and community defense forces (Mai Mai). As a result of these difficulties, many SDB and SMCE activities faced roll-out delays and were postponed in order to protect both staff and beneficiaries. Despite these difficulties, FHI 360 met and exceeded many of the project targets. This included involving over 600 traditional leaders and community influencers in the EVD response through SMCE and SDB activities. This involvement of traditional/influential leaders in community engagement activities paved the way for SDB teams to enter previously resistant or closed off areas and meet the ever-changing demands in affected communities and the overall Ebola Response. Later, the FHI 360-supported radio broadcasts strengthened community understanding of the response, supporting the sustainability of gains made. In terms of SDB activities, FHI 360 trained a combined 156 Civil Protection workers in SMCE techniques. Following these trainings, FHI-supported teams were able to successfully resolve community resistance to burial attempts 88% of the time. Finally, and perhaps most importantly when it comes to containing the outbreak, SDB teams were able to bury 672 EVD alerts assigned to them according to FHI 360 SDB protocols (see Annex A for FHI 360’s SDB procedure) they had been trained in. Sector Cumulative Targeted Cumulative Reached Health 949,127; IDPs: N/A 744,843 1 FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Sector: Health Objective: To improve community engagement in Ebola-affected areas and reduce populations’ exposure through safe and dignified burial. Number of Beneficiaries Targeted: 949,127, IDPs targeted: N/A FHI 360’s activities in the Health Sector focused on two sub-commissions of the overall response, Risk Communication, Social Mobilization and Community Engagement (hereafter referred to as SMCE) and SDB. In response to high levels of community resistance to Ebola response activities, FHI 360 proposed a SMCE strategy, presented at both the national and health zone levels of coordination, to: identify and build rapport with traditional, influential, community and special group leaders in at-risk areas; conduct SMCE meetings, follow-ups and feedback sessions in EVD-affected communities; support events-based reporting sessions with leadership; and conduct training sessions with local leaders that empowered them to organize, conduct, and facilitate community level meetings and produce radio call-in shows on EVD-related topics. These activities were aimed at a wide audience across North Kivu and Ituri Provinces and covered a variety of topics, including: EVD messaging on transmission and prevention; the importance of SDB activities in controlling EVD; and discussions with communities on their specific needs beyond the EVD response. FHI 360’s SDB activities, working in conjunction with the overall response coordination/sub-coordination and actors such as Civil Protection, the International Federation of the Red Cross (IFRC), the DRC’s Ministry of Health (MoH), and WHO, were to: identify health zones in need of SDB teams; train, equip and support the identified teams in proper SDB techniques; provide follow-up training; teach SMCE techniques to SDB teams; and integrate local leadership into the Community Death Alert System. Sub-Sector 1.1: Public Health Emergencies of International Concern and Pandemics 1.1.1: Engage with multiple tiers of community-based leadership structures to build ownership and acceptance of the EVD response. At onset of the project, FHI 360 Crisis Response leaders met with and presented the project strategy at various levels of the EVD Response, including the national, health zone and sub-coordination levels. As the project progressed, FHI 360’s staff continued to meet with partners and EVD coordination at all levels, working to ensure the efficacy and efficiency of the project and react to the growing geographic and thematic needs of the response. At both the coordination and sub- coordination levels, these meetings were held based on need. When EVD alerts were at high levels, coordination meetings were held on a daily basis. As the levels of outbreak decreased, the frequency of the meetings would subside accordingly. These meetings had the added value of ensuring that FHI 360’s activities did not overlap with other actors and important lessons learned, best practices, and relevant up-to-date information was shared throughout the response. During these meetings, coordination and sub-coordination leaders discussed the current trends of the outbreak, strengths and weaknesses of the response and identified evolving areas of need.