ZIMBABWE HEALTH CLUSTER WEEKLY BULLETIN No. 4 29 DECEMBER 2008 OVERVIEW Cholera Situation update o o Donations received from the Chinese and Tanzanian Governments 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 © MSF. Woman receiving cholera treatment at CTC. holidays SITUATION UPDATE AND HEALTH ASSESSMENT • As of 26 December, the cholera epidemic currently affecting the country’s 10 provinces and at least 57 of the 84 rural and urban districts has caused 1557 deaths with 28 492 suspected cases. The case fatality rate (CFR) is 5.5%. The largest number of cases were reported in Harare (9718 cases and 330 deaths - CFR 3.4%), followed by Beitbridge (3665/108 - CFR 2.9%), Makonde (2222/68 - CFR 3.1%) and Chegutu Urban (1767/139 - CFR 7.9 %.) For more information, see http://ochaonline.un.org/Default.aspx?alias=ochaonline.un.org/zimbabwe • In Mashonaland Central Province, a rapid response team including WHO epidemiologists and an environmental health officer was dispatched on 27 December to assess the outbreak, identify gaps and needs as well as provide technical support to Mazowe District health teams. All eight districts in the province have reported simultaneous outbreaks whose characteristics have never been experienced before. This has resulted in overstretching of resources. DONATIONS AND PLEDGES TOWARDS CHOLERA FIGHT • The Government of China donated US$ 500 000 in cash to the Government of Zimbabwe to fight the cholera epidemic. • A consignment of medical supplies (doxixycline, methylated spirit, Ringer lactate, oral rehydration salts, infusion sets, ciprofloxacin, erythromycin, zinc oxide, sodium chloride, scalp veins, cannulas, latex gloves) worth US$ 60 000 donated by the Government of Tanzania arrived in Harare. • USAID has pledged US$ 6.2 million for WASH-related activities. • WHO/HAC in Geneva shipped 10 000 litres of Ringer lactate and 10 000 infusion sets. HEALTH CLUSTER COORDINATION • The weekly Health Cluster coordination meeting was held on 23 December. • Social Mobilization – The Ministry of Health and Child Welfare (MoHCW) endorsed the use of oral rehydration salts (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, including water treatment tablets, water containers, ORS, coupled with public health education activities, such as of visits or distribution of pamphlets on cholera awareness, management and hygiene promotion. • Critical activities mainly during the festive season are summarized in the graph in annex. • A WHO headquarters logistician is in Zimbabwe help the National Pharmaceutical Company of Zimbabwe (NATPHARM) improve the management of their warehouse. • World Vision is supporting food provision to some cholera treatment centres (CTCs) in Budiriro, Mudzi and Beitbridge. The Health Cluster and WFP are working together to sort out the lack of cooking facilities in some CTCs. • The Health and WHASH Clusters will agree on a comprehensive assessment tool to update on the situation in provinces and districts. World Health Organization • The WHO Inter-country Support Team Coordinator presented the Cholera Command and Control Centre’s (C4) terms of reference to the MoHCW, who would co-chair the C4 with WHO. WHO’s major functions will be surveillance, case management, water and sanitation and infection control, social mobilization and logistics. The C4 will work closely with the Health, Nutrition and Logistic Clusters and provide technical recommendations to partners helping the MoHCW implement response activities. The MoHCW is reviewing the document for approval. • in Mashonaland West, a WHO and MoHCW team responded to an outbreak in Msengezi, Chegutu, where the number of cases soared from 7 on 4 December to 60 on 16 December. They visited the CTC in Msengezi to assess the situation, provide cholera response equipment and onsite training to health personnel. • WHO coordinated the cholera daily updates with the MoHCW. • WHO set up a response team during the festive season which includes an Environmental Health Officer, epidemiologists and data managers from the Inter-Country Team and the WHO Country Office. Daily meetings and updates continue as usual. UNICEF • UNICEF airlifted supplies such as IV fluids, cannulas for both adults and children, ORS, gloves, cotton wool, adhesive tape and nasogastric tubes for adults and children. • The supplies also included drugs, midwifery and obstetric kits for emergency obstetric care. In addition, 13 333 boxes (12 units per box) of Ringer lactate, 24 996 adult giving sets and 22632 paediatric giving sets were trucked from South Africa. • An additional 48 tents are expected on 29 December. • UNICEF is distributing supplies, such as IV fluids, giving sets, blankets, gloves, fuel and cholera kits and WASH supplies, to partners such as Concern, Bulawayo City Council, Chitungwiza 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 the MoHCW structures such as the Provincial Medical Directors of Manicaland, Mutoko and Marondera Hospitals and others were sent direct to the CTCs 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 • GOAL distributed soap, ORS, aquatabs and buckets and provided health education to: − 5000 households in Dzivarasekwa and Dzivaresekwa Extension, Harare. − 1500 households in Chirundu. • Goal plans to extends its distribution to 8000 households in Hatcliffe and Hatcliffe Extension, Harare. PLAN • Plan seconded two Environmental Health Officers to the CTCs in Mutare and Chipinge districts to provide logistical, technical and material support to response teams in Mutare, Mutoko and Chipinge. Zimbabwe Health Cluster Weekly Bulletin No. 4 – 29 December 2008 • One Plan vehicle was assigned to cholera control on a full time basis in Mutare District. • 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 for 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 is to arrange paying a hardship allowance to MoHCW staff involved in cholera response beginning last week of December. International Federation of Red Cross and Red Crescent Societies (IFRC) • IFRC transported the following cholera response supplies: − 4 cholera kits, enough to treat 4800 people. A further 16 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, or over 10 million litres. − 1500 ‘life straws’ for Zimbabwe Red Cross volunteers to keep them healthy as they provide cholera awareness programmes and distribute ORS and water purification tablets. − 40 000 pamphlets on the causes and symptoms of cholera and on preventive hygiene measures in both English and Shona to strengthen awareness programmes. INTER-CLUSTER COORDINATION • The Health and WASH Clusters met on 24 December to coordinate cholera response interventions. They agreed that WASH issues in CTCs would be managed by the Health Cluster with support form WASH. Supplies related to WASH as well as technical advice would fall under the Health Cluster as well. • Medical supplies and WASH material were sent from NATPHARM to the following provinces and districts: Chitungwiza, Chikurubi, Kadoma, Machingu, Mutoko (Hospital), Karoi, Mutare (Province), Muzengezi, Rusape(Hospital) and Epworth. CHALLENGES • The communication system is poor with no reliable 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 is low. There is a proposal to devise a compensation scheme for health and related field staff working on cholera response to keep health workers in CTCs during the holiday season. The MoHCW countrywide policy for salaries will guide partners by January 2009. • Medical and non medical equipment such as containers for hand washing, groundsheet polythene rolls, antibiotics, body bags and fuel for case investigation is lacking, especially in some CTCs manned solely by the MoHCW workers. • NATPHARM is lacking non medical items like cholera beds, tents, buckets, utensils etc. • The provision of food to cholera patients in CTCs 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 Coordinator called on members at the weekly meeting to prioritize community- based intervention focusing on surveillance, social mobilization, community ORS distribution and nutrition. He also urged a strong media campaign on cholera prevention and management to reach all the people (See table below). Zimbabwe Health Cluster Weekly Bulletin No. 4 – 29 December 2008 Interventions for the cholera response Intervention Responsible 1- Surveillance &