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Table of Contents ZIMBABWE – CHOLERA OUTBREAKS TABLE OF CONTENTS 1. EXECUTIVE SUMMARY................................................................................................................. 1 2. INTRODUCTION ............................................................................................................................. 3 3. PLANNING ASSUMPTIONS & OPERATIONAL FIGURES .......................................................... 5 4. PLAN OF ACTION .......................................................................................................................... 6 4.1 OUTBREAK DETECTION .............................................................................................................. 6 4.2 OUTBREAK CONFIRMATION......................................................................................................... 6 4.3 CASE MANAGEMENT .................................................................................................................. 6 4.4 REDUCTION OF MORTALITY ........................................................................................................ 6 4.5 ORGANISATION OF THE RESPONSE ............................................................................................. 7 4.6 LOGISTICS ................................................................................................................................. 8 4.7 SURVEILLANCE AND INFORMATION MANAGEMENT ........................................................................ 8 4.8 COMMUNITY MOBILISATION AND HYGIENE PROMOTION ................................................................ 8 4.9 WATER SUPPLY ......................................................................................................................... 8 4.10 EXCRETA DISPOSAL ................................................................................................................... 9 4.11 SOLID WASTE MANAGEMENT...................................................................................................... 9 4.12 DRAINAGE/SEWAGE ................................................................................................................... 9 4.13 DISINFECTION/VIBRIO CONTROL ................................................................................................. 9 4.14 ASSESSMENT AND MONITORING ................................................................................................. 9 4.15 PARTNERS................................................................................................................................. 9 5. LIST OF PROJECTS COMPRISING THIS PLAN........................................................................ 10 Table I. List of Projects (grouped by cluster), with funding status of each ........................................... 10 Table II. List of Projects (grouped by Appealing Organisation), with funding status of each................. 12 ANNEX 1: DRUGS AND SUPPLIES REQUIRED TO INITIATE A RESPONSE ........................... 13 ANNEX 2: OPERATIONAL STANDARD FOR A CHOLERA TREATMENT CENTRE................ 14 ANNEX 3: COORDINATION OF OUTBREAK INVESTIGATION, RESPONSE, MONITORING AND EVALUATION....................................................................................................... 15 ANNEX 4: CHOLERA RESPONSE GROUP – CONTACT LIST................................................... 18 ANNEX 5: RESPONSIBILITIES AND ACCOUNTABILITIES MATRIX......................................... 19 ANNEX 6: PROTOCOL ON FOOD SUPPORT TO CTCS ............................................................. 21 ANNEX 7: FUEL REQUIREMENTS FOR CHOLERA-AFFECTED DISTRICTS ........................... 22 ANNEX 8: NATIONAL CHOLERA REQUIREMENTS AND GAPS MATRIX ................................ 23 ANNEX 9: INTERNATIONAL FEDERATION OF RED CROSS AND RES CRESCENT SOCIETIES.................................................................................................................... 25 ANNEX 10. DAILY CHOLERA UPDATE 8 JANUARY 2009........................................................... 31 ANNEX 11. ACRONYMS AND ABBREVIATIONS.......................................................................... 37 ii ZIMBABWE – CHOLERA OUTBREAKS 1. EXECUTIVE SUMMARY In 2008, Zimbabwe’s economy suffered a serious decline leading to a rise in social vulnerability. During the protracted election period from March through August 2008, election violence and government restrictions halted most humanitarian field activities. Half a year of critical humanitarian service delivery in support of food security, clean water, health, and education services was lost. A third consecutive failed agricultural season in 2008 has also contributed to further deterioration of livelihoods for already vulnerable groups, and increased requirements for humanitarian assistance. Since August 2008, vulnerable populations in Zimbabwe have also been facing an expanding cholera outbreak and inadequate access to safe drinking water and hygiene. Shortages of medicines, equipment and staff at health facilities throughout the country are threatening the well-being of thousands of Zimbabweans and compounding an already critical humanitarian situation across multiple sectors. As of 8 January 2009, more than 36,600 cases of cholera had been reported, leading to more than 1,800 deaths. Case fatality rates vary by district and reflect issues of access to care, quality of care, and the underlying prevalence of conditions such as HIV/AIDS and malnutrition. Cholera currently affects 55 of Zimbabwe’s 62 districts (88.7%) and all 10 provinces in the country are affected.1 When developing the 2009 Zimbabwe Consolidated Appeal in late 2008, humanitarian partners agreed to step up operational activities in 2009. Planning figures for emergency response and emergency early recovery programs reached a total of US$2 550 million for all sectors, an increase of $235 million from the $315 million initially requested by partners in the 2008 Appeal. An estimated 60% of this total relates to food security. In November and December 2008, as it became clear that the cholera outbreaks in Zimbabwe were of an unprecedented scale, humanitarian partners decided to review response plans developed within the frameworks of the 2008 and 2009 Appeals and establish this joint Health/WASH operational plan to allow for a predictable and coordinated response to the cholera epidemic. With a planning estimate that at least 50% of the population is at risk of contracting cholera, partners planned to respond to 60,000 cases over a period of 12 months from December 2008 to December 2009. The Health and WASH Clusters’ response to these outbreaks, alongside smaller components through other clusters, must be viewed as an emergency measure undertaken within the context of a severely deteriorated health care and civil environment. The response is designed to be multi-sectoral in support of the Ministry of Health and Child Welfare (MoHCW) and implementing agencies, including: IFRC, IOM, OCHA, UNFPA, MSF-Spain/Holland/Luxembourg, UNICEF and World Vision for the Health Cluster; and ACF, GAA, OXFAM, UNICEF, World Vision and others for the WASH Cluster, as well as local non-governmental organisations operating in the field. By indicating the overall amounts required by the Health and WASH clusters to implement the response plans, the operational plan at hand also brings together appeals issued by WHO and UNICEF at the outset of the cholera epidemic. The total requirements for the Health and WASH clusters to respond to the current cholera epidemic amount to $41.3 million. $24.4 million of this amount has already been requested by various agencies through projects in the 2009 CAP for Zimbabwe. The additional resources required to respond to the current cholera outbreaks amount to $16.9 million, bringing the total requested through the 2009 CAP for Zimbabwe to $567 million. NOTE ON FUNDING TO DATE During the peak of the crisis in November and December 2008, donors contributed $40.7 for cholera response. This included bilateral and in-kind contributions, as well as support for UN Agencies, NGOs, ICRC and IFRC. These contributions were in addition to other long-standing donor support for health and water and sanitation activities. 1 For the most updated figures, including epidemiological figures, situation reports, maps, and assessments, see: http://ochaonline.un.org/zimbabwe. 2 All dollar signs in this document denote United States dollars. 1 ZIMBABWE – CHOLERA OUTBREAKS Recipients Amount ($) Bilateral 1,309,382 ICRC/IFRC/Zimbabwe Red Cross 1,684,710 UN organisations 20,890,422 NGOs 6,537,249 Not yet specified (various UN, NGOs, Red Cross) 10,341,066 Total 40,762,829 The specific agencies requesting funds in this document report more than $12 million pledged or contributed to them for cholera action in late 2008. The 2009 requirements of $41.3 million are net of any 2008 funding. For full details of all cash and in-kind contributions and pledges to the immediate cholera response and to on-going health and WASH activities, please consult http://ocha.unog.ch/fts2/pageloader.aspx?page=emerg-emergencyDetails&appealID=789 (2008) and http://ocha.unog.ch/fts2/pageloader.aspx?page=emerg-emergencyDetails&appealID=841 (2009). In addition, the International Federation of Red Cross and Red Crescent Societies issued an appeal on behalf of the Zimbabwe Red Cross Society on 23 December 2008 for 10.2 million Swiss francs ($9.2 million) to respond to the cholera outbreaks (Annex 9). COST ESTIMATE FOR IMPLEMENTATION
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