COVID-19 OUTBREAK Country plan for Zambia Red Ross Society Date 21th May 2020 1. SITUATION ANALYSIS 1.1 Description of the Situation Since its maiden outbreak late December 2019, in Wuhan City in China, Corona Virus Disease (COVID-19) has moved like a wave hitting various regions around the globe affecting more than 4.3 million people and recording about 295,101 fatalities as at 15th May 2020. COVID-19 was declared a global pandemic on 11th March 2020 by the World Health Organization (WHO) and the global impact has already been significant, and it represents the most serious global health threat resulting from a respiratory virus since the 1918 Influenza pandemic. Zambia, like many other countries in the African region, has not been spared from this pandemic with the number of confirmed COVID-19 cases as at 17th May, 2020 standing at 735 with 7 deaths since the confirmation of its first cases on 18th March 2020. According to the Ministry of Health, over 17,354 tests have since been administered across the country so far to keep track of the evolution of the pandemic and to curb its spread through early identification, quarantine and treatment of those infected. The pandemic has affected Lusaka, Central, Copperbelt Muchinga and North-western provinces As more countries are being affected, through cross border traffic, Zambia has imposed stringent measures to limit the spread of the virus in the country. These measures include closing of schools, universities, colleges, churches, bars, cinemas, gyms and prohibited gatherings of any kind. Organizations and institutions have been advised to put their staff on paid leave and essential workers to work remotely (from their homes). A few essential service providers have been allowed to operate on rotation basis, allowing the public to access, basic needs if required. According to the risk analysis conducted by Disaster Management and Mitigation Unit (DMMU) in collaboration with Ministry of Health, COVID-19 has the potential to affect 7,616,108 people in the latent hotspots in the ten provinces of the country. The national Contingency Plan highlights 48 districts spread out across the country as hotspots representing areas with major highways and transport corridors, densely populated areas, and those districts with an international Figure1: Districts at high risk of COVID-19 (Source Zambia COVID-19 National Contingency and Response airport. These risk areas are mostly Plan 2020) 1 concentrated in areas where the country shares a boarder with Congo DR, Tanzania, Mozambique, and Zimbabwe which are some of the most highly affected countries in sub- Sahara Africa.Districts covered currently by ZRCS are Livingstone , Sesheke, Chirundu, Kafue, Lusaka, Chipata, Kabwe Kapiri Mposhi, Ndola, Kitwe, Chingola, Chililabombwe, Solwezi and Mpulungu. Under this appeal, ZRCS endeavors to scale up interventions to 5 more districts bringing the total to 18 districts. Additional districts will include Nakonde, Katete, Mansa, Mufulira and Mpika. Zambia Red Cross will focus their interventions in urban areas of the targeted districts border posts and surrounding communities 1.2 Potential Impact of COVID-19 in Zambia The pandemic will have health and non-health related effects on Zambian communities and the economy at large. The following are some of the expected impacts of the pandemic in Zambia: 1.2.1 Potential Health Impacts a) Decreased access to outpatient and inpatient services due to closure of health facilities, repurposing of health workforce and stock-outs of medicines and other supplies; b) Diversion of resources from routine services to response to COVID-19; c) Stretched health services including isolation facilities, intensive care units, laboratory and other diagnostic services and ambulances; and d) Increased morbidity and mortality due to COVID-19 and other diseases that receive less attention. e) Increased disease burden like malnutrition due to poor dietary intake emanated from compromised livelihood support 1.2.2 Potential Non-Health Impacts The major non-health impacts of the pandemic would include: a) Poor performance of the economy due to business closures, social distancing, restriction of travel and movements of goods and services, and diversion of resources from other sectors to health; b) Closure of schools, religious and social places due to social distancing and public anxiety; c) Transport and travel restrictions, both local and international; d) Xenophobia to foreign nationals; e) Stigmatization of the affected and survivors; f) Mass migration of people from localities deemed to be high risk; and g) Escalating civil misconduct, crime, Sexual and Gender Based Violence; h) Diversion of resources from routine services to response to COVID-19; i) Desertion of duty and increased industrial action; j) Reduced economic activity leading to reduced revenue collection for government; k) Reduced revenue generation for Small and Medium Enterprises (SMEs); l) Reduced tourist visits to national parks in the affected areas due to suspended flights; m) Reduced forex due to low earnings from non- traditional exports; n) Disruption in the provision of socio- economic services 1.3 National Vulnerabilities and need assessment The COVID-19 pandemic is a relatively new kind of outbreak that rapidly propagates affecting vast areas and huge numbers in a short time space. This poses an unprecedented level of risk for any country regardless of how robust their health and response systems have been. For a country like Zambia, with no experience in responding to outbreaks of respiratory diseases and 2 an inadequately prepared health care system, the situation could quickly spiral out of control overwhelming local health care facilities and other response agents. Zambia has the following vulnerabilities on its preparedness to respond to COVID-19. 1.3.1 National Vulnerabilities a) Long and porous border: Zambia is a land locked country with long porous borders shared with 8 neighbouring countries (Tanzania, Mozambique, Malawi, Botswana, Angola, DRC, Namibia and Zimbabwe). The country has 16 designated and 24 authorized Point of Entries (POEs) that include 4 international airports. This makes the country vulnerable to the spread of COVID-19 from people travelling to and from Zambia; b) Dependence on imports: weak local value chains leading to dependence on imports. This constrains the provision of essential goods and services in the event of shutdowns in trading partner countries; This affects the country’s economy as well as livelihoods of the people of Zambia. c) Weak health system: Inadequate health facilities including Intensive Care Units (ICUs), isolation facilities, ambulances and laboratories, among others. Additionally, inadequate frontline medical personnel including, doctors, nurses and paramedics (doctor to patient ratio 1 to 12,000), according to WHO, 2020; In case of increased number of cases of COVID 19, the Health system can easily be overwhelmed and get out of hand. d) Inadequate water and sanitation infrastructure: Effective response to COVID-19 requires access to clean and safe water and sanitation facilities as a way of preventing further spread of the disease. However, only 60 percent of Zambians have access to clean and safe water while 26 percent have access to good sanitation facilities (Global Waters, 2019). This will compromise the efforts on COVID 19 prevention if not taken into consideration in the response. e) Fragile economy: Ease of response to COVID-19 is aided by strong and stable economic fundamentals. However, Zambia has weak economic fundamentals with high debt burden (external debt US$11.2 Billion, domestic debt K80.2 Billion), 1.2 months of import cover and high inflation (14 percent). This will affect the small business enterprises which will increase the household poverty levels that usually result into compromised health status of the majority of Zambians f) Inadequate ICT infrastructure: A well-developed ICT infrastructure eases the response to COVID-19 through the facilitation of information dissemination, provision of essential goods and services through e-commerce and enables the population to work from home in light of social distancing measures. It also makes it possible for students to continue learning from home. However, Zambia has an underdeveloped ICT infrastructure with internet penetration rates at 58.4 percent1 making it difficult for the whole population to use e-platforms. g) High poverty levels: Effective response to COVID-19 is compromised by high poverty levels. Given that 54 percent2 of the population live on less than US$2 a day, adherence to measures to respond to COVID-19 may be compromised. 1.3.2 Needs assessment 1 Zambia National COVID-19 Contingency and Response plan, 2020) 2 Zambia National COVID-19 Contingency and Response plan, 2020) 3 Geographically, 48 districts have been identified to be affected most as mentioned above. Currently the pandemic has affected Lusaka, Central, Copperbelt, Muchinga and Northwestern provinces. ZRCS will focus on 18 districts in the aforementioned provinces for its response activities. Nonetheless, operations would be extended to the other districts where the Figure 2:Provinces affected by COVID-19 (as at 13th May 2020) (MoH National Society has 2020) presence if more resources are mobilized. As observed from the pandemic in other countries, people likely to be affected most include externally and internally displaced persons, women, elderly, people living with disabilities as well as pre-existing conditions,