Technical Financial Proposal

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					                                                  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       W ATER SUPPLY ......................................................................................................................... 8
     4.10      EXCRETA DISPOSAL ................................................................................................................... 9
     4.11      SOLID W ASTE 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




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                                             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
         1
affected.

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
                                                            2
emergency early recovery programs reached a total of US$ 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.




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                                 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 OF OPERATIONAL PLAN

                           Requirements and
                                                                                     Total requirements
                             project code of                Additional
    Response Area                                                                   relevant to this plan
                           relevant CAP 2009             Requirements ($)
                                                                                             ($)
                               project ($)
 A. Surveillance,
 information                         1,552,000                       2,248,000
 management and           (ZIM-09/H/21864/122)         (increased requirement)
 coordination
 B. Equipment and                                                                              4,148,000
 supplies to strengthen                                                348,000
 outbreak
                                               -            (new component of
 investigation,
 monitoring and                                                existing project)
 evaluation capacity
 C. Stockpiling and
 responding to cholera                 929,999                      10,304,001
                                                                                             11,234,000
 and other health         (ZIM-09/H/20937/122)         (increased requirement)
 emergencies
                                                                                              15,382,000
 SUBTOTAL HEALTH                      2,481,999                     12,900,000
                                                                                           (37% of total)
 D. Water, sanitation,                                               3,987,500
                                      21,931,780
 hygiene and infection                                    (Additional project to
                            (Includes all WASH                                                25,919,280
 control (including in                                 support WASH activities
 health facilities)       projects in 2009 CAP)
                                                            in health facilities)
                                                                                              25,919,280
 SUBTOTAL WASH                       21,931,780                       3,987,500
                                                                                           (63% of total)

 TOTAL                               24,413,779                     16,887,501                41,301,280




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                               ZIMBABWE – CHOLERA OUTBREAKS


2.             INTRODUCTION
Zimbabwe has experienced cholera annually since 1998, but previous outbreaks have never reached
the scale of the epidemic facing the country since August 2008. As of 8 January 2009, over 36,600
cases had been reported, leading to more than 1,800 deaths across the country.




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                                            ZIMBABWE – CHOLERA OUTBREAKS


There is a high risk that the outbreak could expand further. It already has a subregional dimension
with cases spilling over to neighboring countries. The risks are particularly high in populations already
                                                  3
weakened by poverty and poor nutritional status.

The outbreaks are clearly due to the lack of safe drinking water, the inadequacy of sanitation, and the
declining health care infrastructure within an already overburdened health care system. The long-term
crisis in the country has resulted in shortages of treatment materials, scarcity of health care providers
and overall poor access to care. In addition, the mobility of the population has been identified as a
critical factor in the spread of the outbreaks. Cross-border areas are at an elevated risk of cholera
outbreaks because of high population movement, commercial and trade activities. Mobile and
vulnerable populations are particularly high-risk groups for disease outbreaks of this nature, since they
often reside in overcrowded informal settlements characterized by inadequate water and sanitation
facilities, poor access to health facilities and high population mobility.

The Zimbabwe Health and WASH Clusters have developed this operational plan in order to mount a
predictable and coordinated response to this unprecedented outbreak of cholera.

The main objectives of the Health Cluster response are to control the cholera outbreak in
Zimbabwe by:
 Strengthening coordination of the national response;
 Reducing the spread of the epidemic by:
        Strengthening epidemiological and laboratory surveillance;
        Ensuring access to safe water and sanitation and safe isolation and infection control
          practices in health care facilities;
        Strengthening community mobilisation activities.

    Decreasing mortality by:
          Ensuring early case detection;
          Ensuring easy access to health care, including availability of oral rehydration solutions
            (ORS) at community/ household level;
          Ensuring appropriate case management and feeding practices for cholera patients.

The main objectives of the WASH Cluster response are to prevent and control transmissions of
cholera in Zimbabwe by:
 Strengthening coordination of the national response;
 Ensuring/providing sufficient clean, safe water as both preventive and curative measures;
 Ensuring/providing sufficient and safe excreta disposal facilities as both preventive and curative
    measures;
 Ensuring/providing adequate solid waste management as both preventive and curative measures;
 Ensuring that men, women and children are mobilised and enabled to take actions to
    prevent/mitigate cholera outbreak risks by adhering to safe hygiene practices;
 Preventing contaminations linked with sewage overflow as preventive measures.

While this operational plan focuses mainly on cholera, the framework may also be used to address
other outbreaks, such as anthrax, which is suspected to affect a few districts.




3 According to the sentinel sites survey of July 2008, the prevalence of acute malnutrition is 5%. Micronutrient deficiencies such as
pellagra are increasing in Matabeleland prisons and hospital. Combined case fatality rates for hospital and community treatment of severe
malnutrition stand at 17.7%, well above international standards. The treatment coverage is low. Food insecurity is widespread and
already in December 2008 some 5 million people were in need of food aid.


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                                 ZIMBABWE – CHOLERA OUTBREAKS


3.              PLANNING ASSUMPTIONS & OPERATIONAL FIGURES
In order to guide the planning process, the following assumptions were made to estimate the potential
evolution of the outbreak:

     Assuming at least 50% of the population (estimated at about 12 million for the purpose of this
      plan) is at risk of contracting cholera, and estimating a cholera attack rate of 1% (not a
      conservative estimate, given the prevalence of risk factors for cholera transmission including
      lack of safe water supply, poor sanitation conditions and the rainy season), the estimated
      number of cases would be 60,000 (12,000,000 x 50% x 1%). Of course, the effectiveness of
      the control measures put in place will influence this estimated figure.

     In most cholera outbreaks, approximately 10-20% of symptomatic cases of cholera develop a
      severe form of the disease which requires vigorous rehydration. Therefore, approximately
      12,000 cases would require admission for intensive treatment including antibiotics.

     In order to facilitate the initiation of response and mobilisation of adequate personnel, drugs and
      material resources, a consensus has been reached to standardise the holding capacity of a
      cholera treatment centre (CTC), and also the required personnel, kits and finances to operate a
      treatment centre and implement community and household activities aimed at limiting
      transmission (Annex 2).

     Accordingly, the agreed holding capacity of a cholera treatment centre for the purpose of this
      plan is 50 beds. The human resources and material and logistical requirements have been
      estimated based on this operational figure and are further detailed in Annex 2.

     For each CTC to be established, a cholera kit for 100 people could be used to initiate the
      response. Additional materials shall be made available as per the request of the responsible
      CTC coordinator, but kits should no longer be used to run operating cholera treatment centres
      and cholera treatment units.

     From the WASH perspective the above scenario implies a caseload of six million people (one
      million households), i.e. those at risk of contracting cholera who need to be targeted for
      preventive measures. WASH actions will need to be prioritised and strongly informed by health
      data, and will focus primarily on high-density urban and sub-urban populations where the attack
      rate is difficult to slow down once the disease establishes itself.

     Particular attention should be paid to cross-border areas and to mobile and vulnerable
      populations (MVP) as high-risk groups for disease outbreak and the spread of cholera.

     All humanitarian organisations involved in cholera response are expected to contribute to the
      emergency stock and subscribe to this WASH and Health cluster operational plan.




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                                           ZIMBABWE – CHOLERA OUTBREAKS


4.                   PLAN OF ACTION
4.1       Outbreak Detection
Health:
A functional early warning system should be established as soon as possible. Within that system,
alerts and immediate preliminary assessments should be conducted in accordance with a specific
format by Inter-Agency Rapid Assessment Teams (IARAT) made of medical doctors, engineers,
microbiologists, hygiene promotion experts, and epidemiologists, supported by MoHCW which should
provide timely information. A database of alerts, assessments and feedback should be developed and
maintained. This would be conducted in collaboration with all Health Cluster partners and
humanitarian agencies with the support of the MoHCW. IARAT will be receiving logistical and
financial support.


4.2       Outbreak Confirmation
Health:
A mapping of the capacities of district and provincial laboratories will be conducted and alternative
(external) reference laboratories identified for additional testing. The central reference laboratory will
be supported, after and following the recommendations of an assessment mission. Five laboratory
technologists will be identified to be on standby for rapid deployment and carry out the tests and will
use sets of portable laboratory kits (n=10).


4.3       Case Management
Health
                                   4
Cholera treatment centres / units (CTC/Us): materials for cholera treatment should be available
within 24 hours of confirmation of outbreaks and decision to set up a CTC/U based on assessment.
The number and type of personnel required to run a cholera centre (holding capacity of 50) should be
mobilised within 48 hours of decision to set up a CTC/U (Annex 3). The overall organisation of
treatment centres should comply with agreed standards and with full consideration to infection control
procedures. At least 90% of all personnel working in CTCs should have been trained in patient
management or their corresponding activities within three days of opening the centre for service. All
treatment protocols and other standard operation procedures should be available and visible in
various units of the CTC/U and the rational use of antibiotics for cholera patients and rigorous patient
monitoring should be particularly enforced. Number of admissions (plan B and C), cure and deaths in
the CTCs should be monitored and reported on a daily basis.

Regular Clinics: materials, drugs, technical guidance and supportive supervision will be provided to
clinics located in the area of the outbreak. Morbidity, referral and mortality data will be collected,
compiled and reported daily from the clinics or other secondary cholera treatment units. Inter-cluster
monitoring of all elements of the cholera response and weekly reporting to WHO (and the inter-cluster
task force on cholera) by all partners will be encouraged.

Food
A major concern at the CTC/Us is the risk of cross-contamination arising from relatives of patients that
are preparing food just outside the premises. The major food aid partners have been working in close
consultation with the Health and WASH Cluster partners on a food support protocol to guide the
requested food assistance to patients and health staff at the CTC/Us (Annex 6). The agencies are
currently working out the operational details, including identification of partners operating at the
CTC/Us that will be instrumental in preparing the food on site in a safe manner. The food protocol
abides by the medical criteria and has mapped out geographical areas of responsibility among the
food aid partners.


4.4       Reduction of Mortality



4
 Cholera treatment centres (CTCs) are set up specifically to manage cholera cases. Cholera treatment units (CTUs) are usually smaller,
separate case management units set up in hospitals to treat cholera patients.


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                                  ZIMBABWE – CHOLERA OUTBREAKS

Health
In collaboration with district and provincial medical officers, the number, availability and experience of
technical personnel for immediate deployment when needed will be documented. A training campaign
to all health personnel in districts affected by the outbreak on prevention, diagnosis, treatment and
control of cholera will be organized and implemented in coordination with all partners and MoHCW.
To improve staff work attendance, an incentive/allowance payment schedule applicable in all contexts
by all partners will be developed and implemented. Community sensitization, mobilisation and active
case finding will be consolidated using a network of community volunteers. In particular, provision of
ORS (10 sachets/volunteer/day) for immediate treatment of cases identified during door-to-door visits
will be ensured, and referral of the most severe cases to the nearby health facility will be encouraged.

The official prevalence of HIV/AIDS is estimated to be 15.6% of the adult population in Zimbabwe
(MoHCW). People Living With AIDS (PLWA) are more vulnerable to opportunistic infections, and it is
expected that cholera infection rates among them would be much higher than in the general
population, although this has not been scientifically proven. Particular attention needs to be paid to
this group.


4.5     Organisation of the Response
Health:
Procedures are detailed in Annex 3. A minimum „start up kit‟ with basic treatment and hygiene
supplies will be developed to help IARAT initiate responses (see Annex 1). Similarly, national and
provincial emergency stocks of medical and WASH supplies will be established to allow for a quicker
response, as well as emergency reserve funds to facilitate the deployment of personnel. A
standardised bed capacity, personnel, kits, supplies and logistics for a 50 bed CTC has been
developed (see Annex 2), including estimated budget needs. Humanitarian agencies dedicated to
support CTC/Us will be asked to comply with information management procedures, including daily
reporting of activities. Information flow, feedback and dissemination mechanisms as well as inter-
cluster monitoring and evaluation will also be organized and share among partners.

It has been established that the highest case fatality rate in a cholera outbreak occurs during the first
three days of the outbreak. This is due to a delay in relaying information from the outbreak areas up
to district, provincial and national levels. An early warning system has been set up to contact all towns
and vulnerable districts on a daily basis to get updates on the situation in these areas. It is envisaged
that response will be implemented within 24 hours from the start of the cholera outbreak through this
Early Warning System.

Cholera Command and Control Centre (C4) in Zimbabwe: the C4 has a mandate to coordinate the
support to the National Health Service of Zimbabwe and other health providers to implement activities
related to the Cholera Preparedness and Response Operational Plan in order to bring the epidemic
under control as soon as possible. The command centre will focus on providing technical guidance
mainly in the areas of surveillance, laboratory and operational research, management of media
relations, case management, WASH, social mobilisation and logistics. The C4 will provide technical
recommendations to the Health, WASH and other clusters for onward implementation. The C4 will
also decentralize the support to the provincial level. Clusters will work closely with the command
centre. Finally, the C4 budget is reflected in the overall cholera response requirements.

WASH:
Addressing the weaknesses identified will include a series of mapping so as to identify potential gaps
and overlaps. For example the existing, ordered and needed stocks/supplies will be tracked while a
3W matrix („who does what where‟) will be developed and disseminated. Contextualised and agreed
cholera response (including monitoring and evaluation) guiding framework and standards will be
developed by the sector. In order to improve inter-cluster partnership, collaboration and coordination,
a clear sharing of roles and responsibilities between the WASH and Health Cluster will be established.
Eventually advocacy efforts will be intensified for quality response delivery as well as for a clear
humanitarian space.




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                                 ZIMBABWE – CHOLERA OUTBREAKS


4.6     Logistics
Health:
WHO will purchase all WASH-related items through UNICEF. However, medical supplies and other
commodities will be purchased through the normal WHO purchasing procedures. Storage will be at
the National Pharmaceutical Company of Zimbabwe (NatPharm) facility in Harare. Transportation of
supplies will be provided for by WFP on a cost recovery basis following the service level agreement
signed between WHO and WFP. Supplies will be transported from national level down to CTC level.

WASH:
As a Cluster Lead and based on proven capacities to deal with procurement (purchase, clearance,
delivery and storage), UNICEF is ready to receive funds for and procure all supplies required for the
sector. Nevertheless this should not prevent individual cluster members from requesting WASH
Cluster funds received if they would like to do their own procurement. Apart from the procurement,
each member of the Cluster will deal with its own logistics, such as vehicles and communication,
although support can be provided by the Cluster Lead where feasible.


4.7     Surveillance and Information Management
Health:
Humanitarian organisations involved in cholera response will be asked to provide daily updates of their
activities to MoHCW and to WHO. Based on the data received, WHO will compile and analyse the
epidemiological data and verify/compare with information gathered through the regular MoHCW
Health Information System and humanitarian reports. It is acknowledged that improvements in the
overall cholera surveillance (involving community structures making for easy contact tracing, etc) will
strengthen the overall WASH and Health Cluster response in terms of strategies and priorities. WHO
will provide daily statistical information to OCHA for dissemination to all other humanitarian agencies.
Weekly Health Cluster meeting to discuss on situation, response, gaps and action plan will be
organized. Twice weekly Inter-Cluster Task Force meeting will also be organized to update partners
on the situation, mobilise resources and coordinate response. The C4 will be established. A weekly
epidemiological bulletin will be produced by WHO to update all partners and OCHA on the
epidemiological situation. An inventory and report on available medical stocks and supplies (national
stock, provincial stock and cholera centres) will be made and updated every week. Support will be
provided to the MoHCW to handle medical logistics in collaboration with WFP.

WASH:
To address the current weaknesses, the cluster will recruit an information management officer who will
work closely with colleagues from OCHA and the Health Cluster. With the contextualised and agreed
cholera response (including monitoring and evaluation) and the guiding framework and standards, it is
expected that overall reporting will improve.


4.8     Community Mobilisation and Hygiene Promotion
WASH:
On-going activities will improve by feeding back the lessons learnt up until now into the current
response – in particular, establishing agreed guidance frameworks and standards, and inter-cluster
working groups or task forces which will bring together the health authorities, members from the C4,
the Health and WASH Clusters. Among the issues that will be urgently discussed are the
establishment of a common working group/task force, the revision and harmonization of incentives for
volunteers, and the availability of and access to enabling resources (non-food items, water points,
latrines) by the households in the affected areas. Strong advocacy by donors for involvement of all
individual stakeholders in the coordination mechanisms is strongly appealed for.


4.9     Water Supply
WASH:
The water supply authorities do not have the ability to meet the needs of at-risk and affected
communities. Rehabilitating the infrastructure in a timely manner goes beyond the operational and
financial capacities of most WASH Cluster members. Therefore alternative strategies will need to be
sought to address safe water shortages in at-risk and affected areas. Short-term emergency



                                                    8
                                  ZIMBABWE – CHOLERA OUTBREAKS


strategies will include water trucking and mass water distribution systems. Alternatives to trucking
(including drilling and rehabilitation of boreholes, support to the Zimbabwe National Water Authority
[ZINWA] when feasible and cost-effective, rain water harvesting, etc.) will be actively pursued to allow
an exit from expensive trucking operations. There is also a lack of containers at household level
preventing proper implementation of water treatment best practices (boiling or chlorination).


4.10    Excreta Disposal
WASH:
To increase coverage the WASH cluster strategy will look at supporting national/local NGOs and
community structures. Advocacy and donor support for inclusion of excreta disposal components in
WASH projects is strongly appealed for.


4.11    Solid Waste Management
WASH:
In the rainy season solid waste constitutes a high risk factor for cholera. The amount of action needed
in solid waste management is overwhelming and beyond the capacities and resources of almost all
members of the WASH Cluster. So far only the WASH Cluster Lead has been able to get engaged at
a significant level with such activities. Therefore, the strategy will be to support the city councils with
resources (materials, equipment, funds), to actively mainstream waste management into hygiene
promotion and NFI activities, and to support communities with clean-up campaigns.


4.12    Drainage/Sewage
WASH:
Contamination of alternative water sources (i.e. aside from ZINWA water supply) by the sewage
system has been one of the triggers for the cholera epidemic. Similarly to the water supply system,
the scale of the problem may go beyond the capacities of most individual members of the WASH
Cluster. So far the strategies being explored include supporting ZINWA with sewage rods, protective
clothing for staff and treating open sewage with chloride of lime. The funding gap is included under
sanitation.


4.13    Disinfection/Vibrio Control
WASH:
Improved contact tracing will inform this activity. Coverage will be increased through support to and
coordination with health authorities, involvement of community volunteers and disinfection campaigns.


4.14    Assessment and Monitoring
WASH:
Improvement in these activities will happen as the result of the establishment and enforcement of
agreed guiding framework and standards for overall WASH cholera response. Furthermore, the
WASH Cluster is discussing the need of having a joint monitoring team for the overall cholera
response as a way of systematising and increasing the monitoring scope and activities within the
sector.


4.15    Partners
HEALTH AND WASH:
Humanitarian and development agencies will mobilise funds committed to emergency interventions,
while the C4 will establish reserve funds to fill gaps for operational support. It is expected that
humanitarian organisations will make an inventory of available human resource and logistic capacity
that may be mobilised for emergency response, and notify the Health and WASH Cluster Leads and
the IASC of their capacity and geographical coverage in order to enable mapping of capacities and
appointment of provincial and district focal points. Humanitarian and development organisations



                                                     9
                                                              ZIMBABWE – CHOLERA OUTBREAKS


working in the Health and WASH Clusters commit to participate in assessment, investigation of
outbreaks, and initiation of response, monitoring and evaluation anywhere in the country.


5.                            LIST OF PROJECTS COMPRISING THIS PLAN



                                     Table I: Cholera Response Projects in Consolidated Appeal for Zimbabwe 2009
                                                          List of Projects (grouped by cluster), with funding status of each
                                                                                as of 9 January 2009
                                                                                   http://www.reliefweb.int/fts


                                               Compiled by OCHA on the basis of information provided by donors and appealing organisations.                                            Page 1 of 2


Project Code:                                                             Appealing          Original     Revised                 Funding           %            Unmet           Uncommitted
Project Title                                                            Organisation      Requirements Requirements                              Covered     Requirements         Pledges

Values in US$




HEALTH

ZIM-09/H/20937/122:
Strengthen response and management of cholera, other diarrhoeal        WHO                         929,999        11,234,000                  -        0%          11,234,000           357,654
disease and emerging infectious diseases


ZIM-09/H/21864/122:
Health Cluster Coordination, disease surveillance and health           WHO                       1,552,000         4,148,000                  -        0%           4,148,000                    -
information management in the Health Sector



Subtotal for HEALTH                                                                              2,481,999        15,382,000                  -        0%          15,382,000           357,654




The list of projects and the figures for their funding requirements in this document are a snapshot a s of 9 January 2009. For continuously updated information on projects, funding
requirements, and contributions to date, visit the Financial Tracking Service (www.reliefweb.int/fts).



Table I.                      List of Projects (grouped by cluster), with funding status of each




                                                                                               10
                                                               ZIMBABWE – CHOLERA OUTBREAKS




                                     Table I: Cholera Response Projects in Consolidated Appeal for Zimbabwe 2009
                                                         List of Projects (grouped by cluster), with funding status of each
                                                                               as of 9 January 2009
                                                                                   http://www.reliefweb.int/fts


                                               Compiled by OCHA on the basis of information provided by donors and appealing organisations.                                           Page 2 of 2


Project Code:                                                             Appealing          Original     Revised                 Funding            %          Unmet          Uncommitted
Project Title                                                            Organisation      Requirements Requirements                               Covered   Requirements        Pledges

Values in US$




WATER AND SANITATION

ZIM-09/WS/20548/124:
Emergency safe water supply, sanitation facilities and hygiene          UNICEF                   9,000,000         9,000,000                  -        0%          9,000,000                    -
promotion to affected vulnerable populations in urban and rural
areas of Zimbabwe.

ZIM-09/WS/20868/124:
PREPARDENESS, MITIGATION AND RESPONSE TO WASH                           UNICEF                   4,000,000         4,000,000                  -        0%          4,000,000                    -
RELATED EPIDEMICS IN ZIMBABWE (DISASTER RISK
REDUCTION)

ZIM-09/WS/20868/5120:
PREPARDENESS, MITIGATION AND RESPONSE TO WASH                           OXFAM GB                 5,250,000         5,250,000                  -        0%          5,250,000                    -
RELATED EPIDEMICS IN ZIMBABWE (DISASTER RISK
REDUCTION)

ZIM-09/WS/20868/5186:
PREPARDENESS, MITIGATION AND RESPONSE TO WASH                           ACF                        762,000             762,000                -        0%            762,000                    -
RELATED EPIDEMICS IN ZIMBABWE (DISASTER RISK
REDUCTION)

ZIM-09/WS/21193/8502:
Bulawayo Emergency Water and Sanitation Project                         WVI                      1,000,000         1,000,000                  -        0%          1,000,000                    -



ZIM-09/WS/21268/5162:
Prevention and treatment of water-borne diseases in Buhera,             Mercy Corps                350,000             350,000                -        0%            350,000                    -
Chipinge and Chiredzi Districts

ZIM-09/WS/21682/6708:
Provision of safe water and sanitation facilities and promotion of PA (formerly                    470,000             470,000                -        0%            470,000                    -
hygiene education in the vulnerable Peri Urban areas of Harare and ITDG)
Kadoma

ZIM-09/WS/21685/8818:
Hygiene & Rural Water Supply Rehabilitation Programme                   DT                         250,000             250,000                -        0%            250,000                    -



ZIM-09/WS/21694/7975:
Reducing the incidence of severe diarrhoea, and cholera in              Linkage Trust              255,000             255,000                -        0%            255,000                    -
vulnerable rural families.

ZIM-09/WS/21708/6310:
Hygiene Promotion and Home-Based Water Treatment for diarrhoea PSI                                 594,780             594,780                -        0%            594,780                    -
epidemic prevention and emergency response in Zimbabwe.


ZIM-09/WS/23888/122:
Water, Sanitation, Hygiene and Infection Control in Health Facilities   WHO                                -       3,987,500                  -        0%          3,987,500                    -



Subtotal for WATER AND SANITATION                                                              21,931,780         25,919,280                  -        0%        25,919,280                     -




Grand Total                                                                                    24,413,779         41,301,280                  -        -%        41,301,280            357,654


NOTE: "Funding" means Contributions + Commitments + Carry-over

Pledge:             a non-binding announcement of an intended contribution or allocation by the donor. ("Uncommitted pledge" on these tables indicates the balance of original pledges not
                    yet committed).

Commitment:         creation of a legal, contractual obligation between the donor and recipient entity, specifying the amount to be contributed.

Contribution:       the actual payment of funds or transfer of in-kind goods from the donor to the recipient entity.




The list of projects and the figures for their funding requirements in this document are a snapshot as of 9 January 2009. For continuously updated information on projects, funding
requirements, and contributions to date, visit the Financial Tracking Service (www.reliefweb.int/fts).




                                                                                                11
                                                                   ZIMBABWE – CHOLERA OUTBREAKS


         Table II. List of Projects (grouped by Appealing Organisation), with funding status of each

                                   Table II: Cholera Response Projects in Consolidated Appeal for Zimbabwe 2009
                                                      Table II: Consolidated Appeal for Zimbabwe 2009
                                                   List of Projects (grouped by Appealing Organisation), with funding status of each
                                                                                       as of 9 January 2009
                                                                                      http://www.reliefweb.int/fts


Appealing           Project code          Sector         Project title                                             Original         Revised       Funding     %          Unmet        Uncommitted
Organisation                                                                                                     Requirements     Requirements              Covered   Requirements      Pledges
                                                                                                                     USD              USD          USD                    USD             USD


NGOs
ACF                 ZIM-09/WS/20868/5186 WATER AND       Prepardeness, mitigation and response to WASH                 762,000         762,000        -          0%        762,000            -
                                         SANITATION      related epidemics in Zimbabwe (disaster risk
                                                         reduction)

DT                  ZIM-09/WS/21685/8818 WATER AND       Hygiene & Rural Water Supply Rehabilitation                   250,000         250,000        -          0%        250,000            -
                                         SANITATION      Programme


Linkage Trust       ZIM-09/WS/21694/7975 WATER AND       Reducing the incidence of severe diarrhoea, and               255,000         255,000        -          0%        255,000            -
                                         SANITATION      cholera in vulnerable rural families.


Mercy Corps         ZIM-09/WS/21268/5162 WATER AND       Prevention and treatment of water-borne diseases              350,000         350,000        -          0%        350,000            -
                                         SANITATION      in Buhera, Chipinge and Chiredzi Districts


OXFAM GB            ZIM-09/WS/20868/5120 WATER AND       Prepardeness, mitigation and response to WASH                5,250,000       5,250,000       -          0%       5,250,000           -
                                         SANITATION      related epidemics in Zimbabwe (disaster risk
                                                         reduction)

PA (formerly ITDG) ZIM-09/WS/21682/6708 WATER AND        Provision of safe water and sanitation facilities and         470,000         470,000        -          0%        470,000            -
                                        SANITATION       promotion of hygiene education in the vulnerable
                                                         Peri Urban areas of Harare and Kadoma

PSI                 ZIM-09/WS/21708/6310 WATER AND       Hygiene Promotion and Home-Based Water                        594,780         594,780        -          0%        594,780            -
                                         SANITATION      Treatment for diarrhoea epidemic prevention and
                                                         emergency response in Zimbabwe.

WVI                 ZIM-09/WS/21193/8502 WATER AND       Bulawayo Emergency Water and Sanitation Project              1,000,000       1,000,000       -          0%       1,000,000           -
                                         SANITATION


Subtotal for NGOs                                                                                                     8,931,780       8,931,780       -          0%       8,931,780           -



UNICEF
UNICEF              ZIM-09/WS/20548/124   WATER AND      Emergency safe water supply, sanitation facilities           9,000,000       9,000,000       -          0%       9,000,000           -
                                          SANITATION     and hygiene promotion to affected vulnerable
                                                         populations in urban and rural areas of Zimbabwe.

UNICEF              ZIM-09/WS/20868/124   WATER AND      Prepardeness, mitigation and response to WASH                4,000,000       4,000,000       -          0%       4,000,000           -
                                          SANITATION     related epidemics in Zimbabwe (disaster risk
                                                         reduction)


Subtotal for UNICEF                                                                                                  13,000,000      13,000,000       -          0%      13,000,000           -



WHO
WHO                 ZIM-09/H/20937/122    HEALTH         Strengthen response and management of cholera,                929,999       11,234,000       -          0%      11,234,000       357,654
                                                         other diarrhoeal disease and emerging infectious
                                                         diseases

WHO                 ZIM-09/H/21864/122    HEALTH         Health Cluster Coordination, disease surveillance            1,552,000       4,148,000       -          0%       4,148,000           -
                                                         and health information management in the Health
                                                         Sector
WHO                 ZIM-09/WS/23888/122   WATER AND      Water, Sanitation, Hygiene and Infection Control in                -         3,987,500       -          0%       3,987,500           -
                                          SANITATION     Health Facilities


Subtotal for WHO                                                                                                      2,481,999      19,369,500       -          0%      19,369,500       357,654




Grand Total                                                                                                          24,413,779      41,301,280       -          0%      41,301,280       357,654




                                                                                                   12
                                  ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 1:        DRUGS AND SUPPLIES REQUIRED TO INITIATE A RESPONSE
(Based on the estimated minimum supplies needed to treat 100 patients during a cholera outbreak -
WHO, 1994)

Rehydration supplies
650 packets ORS (for 1 litre each)
120 bags Ringer's lactate solution, 1 litre, with giving sets
10 scalp-vein sets
3 nasogastric tubes, 5.3 mm OD, 3.5 ID, (16 French), 50 cm long for adults
3 nasogastric tubes, 2.7 mm OD, 1.5 ID, (8 French), 38 cm long for children

Antibiotics
For adults:
Cyproflaxacin 500 mg

For Pregnant women and children under 12 years:
400 tablets Erythromycin, 500 mg (1 tablet four times daily for five days for adults) and children @
6.25-12.5mg/kg

Other treatment supplies
2 large water dispensers with tap (marked at 5- and 10-litre levels) for making ORS solution in bulk
20 bottles (1 litre) for ORS solution (e.g. empty IV bottles)
20 bottles (0.5 litres) for ORS solution
40 tumblers, 200 ml
20 teaspoons
5 kg cotton wool
2 reels adhesive tape

Other remarks
     The amount of supplies listed allows enough intravenous fluid followed by ORS for 20 severely
      dehydrated patients, and the exclusive use of ORS for the other 80 patients.
     If Ringer's lactate solution is not available, substitute normal saline.




                                                    13
                                  ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 2:       OPERATIONAL STANDARD FOR                        A CHOLERA TREATMENT
               CENTRE
                                         Capacity = 50 patients


   Cholera Treatment Centre                Community interventions         Transport & logistics

1) CTC Coordinator = 1                   1) Environmental health           1) Vehicles (2)
                                            technicians=2
2) Doctors = 2 (1 per 12 hour shift)     2) Active Case Finding            2) 4X4 Pick Up
                                            Team=10
3) Nurses = 30 (10 per 8 hour shift)     3) Hygiene Promoters = 10         3) Motor Cycle (2)

4) Support staff (at a ratio of 1 to 3   4) (1hygiene promoter per 50      4) Fuel as per
   nurses) =10                              households)                       estimated travel
                                                                              distance and
5) Record keeping = 3 (one per 8         (Note: The number can be             consumption
   hour shift)                           increased depending of the area
6) Environmental Health                  and size of community to be       5) (Start up
   Technicians = 3 (one per 12 hour      reached)                             volume=500 liters)
   shift)                                                                  6) For food supplies-
7) Logisticians=2                                                             see annex 7
8) Data entry personnel=2
9) Miscellaneous support staff=12
   (3 per 8 hour shift)




             Total: 67                             Total: 27




                                                  14
                                                      ZIMBABWE – CHOLERA OUTBREAKS



ANNEX 3:     COORDINATION OF OUTBREAK INVESTIGATION, RESPONSE, MONITORING AND EVALUATION

1) Alerts, assessment, initial response and outbreak investigation




                                                                     15
                                  ZIMBABWE – CHOLERA OUTBREAKS



2) Organisation of the response




                                               16
                                             ZIMBABWE – CHOLERA OUTBREAKS




3) Surveillance and information management




                                                          17
                             ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 4:      CHOLERA RESPONSE GROUP – CONTACT LIST

1. Alerts, assessment and response (medical logistics):
      1.1 Mr Alex Chimbaru , chimbarua@zw.afro.who.int, 0912241591
      1.2 Mr Stephen Maphosa, maphosas@zw,afro.who.int, 0912279259


2. Case management and surveillance:
      2.1 Dr Lincoln Charimari, charimaril@zw.afro.who.int, 011406427
      2.2 Dr Thomas Aisu, aisut@zw.afro.who.int , 0912490712
      2.3 Dr Stanley Midzi, Director , Epidemiology & Disease Control, MoHCW


3. Data and information management:
      3.1 Mr Donald Shambare, shambared@zw.afro.who.int
      3.2 Mr Regis Katsande, katsander@zw.afro.who.int, 011865559
      3.3 Mr Chakauya Jethro, chakawyaj@zw.afro.who.int, 0912765828

4. Health Promotion (Information, Education and Communication)
      4.1 Ms Dorothy Mtemeli; mtemelid@zw.afro.who.int
      4.2 Ms Wendy Julias; juliasw@zw.afro.who.int


5. Overall team support and coordination
      5.1 Dr Yilma R. Gari, gariy@zw.afro.who.int, 0912546430


6. WHO Country Representative and Team Leader
     6.1 Dr Custodia Mandlhate, mandlhatec@zw.afro.who.int


7. UNICEF Country Representative a.i. / WASH Cluster Lead
      7.1 Mr Roeland Monasch, rmonasch@unicef.org, 0912266172


8. WASH Cluster Lead Coordinator - UNICEF
     8.1 Mr Souleymane Sow, ssow@unicef.org


9. WASH Cluster Co-Lead Coordinator - OXFAM
     9.1 Ms Penninah Mathenge, pmathenge@oxfam.org.uk, 0912437566


10. OCHA Head of Office / Inter-Cluster Coordination
     10.1 Dr Georges Tadonki, tadonki@un.org, +263 11 617 734 / +27 82 908 1324


11. Cholera Control Command Centre
     11.1 E:mail cholera_taskforce@zw.afro.who.int; International: +47 241 38234;
     Local: 0808 9000 or 04 253 724 -30




                                            18
                                   ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 5:          RESPONSIBILITIES AND ACCOUNTABILITIES MATRIX
This matrix defines the responsibilities and accountabilities of the Health and WASH Clusters during
the response to cholera in Zimbabwe in areas of potential overlap. The below matrix is an adaptation
of a matrix developed by the Global WASH Cluster with a broad consultation of the Health and
Nutrition Clusters. The adaptation of the matrix was jointly done by both clusters during the Health –
WASH Cluster meeting in Harare on 24 December 2008. The below matrix will be used with flexibility
and revised as needed.

Objectives
    Clarify responsibilities and accountabilities among the two clusters, especially as they relate to
     the prevention and control of cholera.
    Improve coordination and collaboration among Health and WASH Cluster partner field staff
     during emergency operations.

Please note that:
    Responsibility means ensuring that the job gets done, not necessarily doing it.

    AREA OF                                                             RESPONSIBILITY
                            SPECIFIC
   POTENTIAL
                            ACTIVITY                 HEALTH CLUSTER                     WASH CLUSTER
    OVERLAP
   Assessment        Conduct WASH               In health facilities              Outside health facilities
                     assessments
    Monitoring       Monitor and share          Disease status and WASH           WASH indicators (more
                     WASH related               indicators in health facilities   perception based) outside
                     information with other                                       health facilities
                     clusters
      WASH           Develop and monitor IM     Gather, analyze and               Gather WASH information
   Information       system                     disseminate evidence based        and share with other clusters.
   Management                                   health information (health
       (IM)                                     facilities). Share with other
                                                clusters
      WASH           Disseminate, promote       In health facilities              Outside health facilities
    Standards        and monitor application
                     Agree indicators           Provide input                     Responsible for coordinating
                                                                                  agreement
  Water Quality      Identify country testing                                     Fully responsible
   & Quantity        capacity and facilities
                     Ensures testing capacity   In health facilities: WASH to     Outside health facilities – in
                                                support upon request              collaboration with national
                                                                                  authorities. Provide support
                                                                                  to Health Cluster as
                                                                                  requested.
                     Testing                    In health facilities: WASH to     Outside health facilities - in
                                                support upon request              collaboration with national
                                                                                  authorities (includes source,
                                                                                  storage & distribution)
                                                                                  Provide training to other
                                                                                  clusters as requested
                     Monitoring                 In health facilities: WASH to     Outside health facilities – in
                                                support on request                collaboration with national
                                                                                  authorities
                     Provide quantity                                             Fully responsible
  Water facilities   Improve access                                               Fully responsible
      Water          Procurement of             Responsible for health            For other areas
   Treatment         chemicals                  facilities: WASH to support on
                                                request
                     Design systems                                               Fully responsible
     Hygiene         Promote and improve        In health facilities              To coordinate common
                     hygiene                                                      messages between clusters;
                                                                                  and to conduct health
                                                                                  promotion outside health
                                                                                  facilities
     Excreta         Improve access             In health facilities: with        Outside health facilities
     disposal                                   support from WASH on
                                                request


                                                      19
                               ZIMBABWE – CHOLERA OUTBREAKS



  AREA OF                                                           RESPONSIBILITY
                        SPECIFIC
POTENTIAL
                        ACTIVITY                  HEALTH CLUSTER                   WASH CLUSTER
 OVERLAP
 Improving       Improve environment         In health facilities: with      Outside health facilities
  Sanitary                                   support from WASH on
Environment                                  request
   Disease       Assessment,                 Fully responsible for overall   Participate in assessment and
  Outbreak       Surveillance and            coordination (with input from   Support as requested
                 monitoring (& contact       other clusters)
                 tracing),
                 Outbreak control,
                 Communication
  Waste          Maintain, construct and     In health facilities            Outside health facilities
Management       renovate                                                    Provide support to Health
                                                                             Clusters as requested
    WASH         Prioritise facilities for                                   Fully Responsible
Infrastructure   renovation and
                 construction. Implement
                 projects
WASH-related     Procure and share           Material used in health         Population based material
 Stockpiles      information about           facilities. WASH cluster        (Bed nets, water treatment
                 stockpiles between          support supports as required    chemicals (e.g. chlorine),
                 clusters.                                                   water testing equipment,
                                                                             soap)
Disinfection     Disinfection of             Responsible; with support
                 household, health           from WASH as requested
                 facilities




                                                   20
                                  ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 6:        PROTOCOL ON FOOD SUPPORT TO CTCs
Within the context of the cholera outbreak and the setting up of cholera treatment centres or units
(CTC/CTU), the food aid working group lead, as a cross-contamination mitigation strategy, is looking
into the provision of food to CTC's for on site-preparation for staff on shift and to patients recuperated
before discharge (and possibly care-takers).

C-SAFE and WFP, as the two main food pipelines in country, agree for the need to come up with a
commonly agreed upon model for food assistance to CTC/CTU.

Proposed model for food assistance protocol to CTC/CTU
    objective of the food assistance is to reduce the vectors for cross-contamination
    modality is hence on-site food preparation only for on-site feeding
    ratio to be used for food assistance is one patient to one “other” (all inclusive of staff, care-
     takers, on-site cooks) across the board
    threshold for planning a food support to a CTC/CTU is set at 10 patients per month in rural
     settings and 50 per month in urban
    dispatch plan for a daily average of (patients + 1) for a month to a given CTU/CTC: patients’
     average stay varies from 4 (urban) to 7 days (rural), hence feeding days from 3-6. Some 70%
     of patients present eat on average on any given day, but 100% of “other” category making up
     for the longer stays
    rations to be used (grams/person/day) may vary depending on available basket, as per below –
     averaging a minimum of 1,900 kcal per person per day:

         Ration A                                    Ration B
         400 gr CER (mml, mz or wheat)               400 gr CSB
         100 gr PUL                                   60 gr PUL
          20 gr VOIL                                  20 gr VOIL

Related issues
     the specific identification of the food operator suitable for food preparation on site in any CTC/U
      may be problematic – particular attention needs to be given to adherence to minimum hygiene
      and sanitation standards;
     safe water supply needs for food preparation should be considered: the WASH Cluster has
      confirmed on the Inter-Cluster Task Force meeting of 9 December that these are considered
      into their protocol for safe water provision to CTC/Us (as per Sphere standards);
     basic kitchen and cooking utensils also need to be considered: WHO has confirmed in on the
      Inter-Cluster meeting of 9 December that such equipment will be added into the “cholera kit”




                                                   21
                            ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 7:     FUEL REQUIREMENTS FOR CHOLERA-AFFECTED DISTRICTS



                         # Affected         Amount per District         Total per Province
      Province
                          Districts
                                            Diesel          Petrol      Diesel     Petrol
Mashonaland East                      8              2000       1000      16000       8000
Mashonaland West                      6              2000       1000      12000       6000
Mashonaland Central                   8              2000       1000      16000       8000
Midlands                              5              2000       1000      10000       5000
Masvingo                              7              2000       1000      14000       7000
Manicaland                            6              2000       1000      12000       6000
Matabeland South                      3              2000       1000       6000       3000
Chitungwiza Urban                     1              2000       1000       2000       1000
Harare Urban                          2              1000       1000       2000       2000
Kadoma Urban                          1              1000       1000       1000       1000
Kwekwe Urban                          1              1000        500       1000        500
Gweru Urban                           1              1000        500       1000        500
Chegutu Urban                         1              1000        500       1000        500
Mutare Urban                          1              1000        500       1000        500
TOTAL                                                                     95000     49000

NB:   The calculation is based on an average of three vehicles per district using an average
      of 160L per week for 4 weeks




                                            22
                                   ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 8:        NATIONAL CHOLERA REQUIREMENTS AND GAPS MATRIX
                                                           Quantity                 Total
                    Item                       # CTCs                 Available                  Gap
                                                           per CTC                required
*Erythromycin tablets (250mg x1000 tin)             150           1         180         150           -30
*Ertythromycin syrup (125mg x100ml bottle)          150         150          82      22500         22418
*Ciprofloxacillin tablets (250mg x 1000 tin)        150          12          18        1800          1782
10 men tents with sides                             150           5           0         750           750
20 men tents with sides                             150           2           0         300           300
4 men tents with sides                              150           4           0         600           600
Ground sheets polythene rolls                       150           4           0         600           600
20-25 litre water containers with tap               150           7           0        1050          1050
20-25 litre water containers without taps           150           7           0        1050          1050
100 litre bins with taps                            150           2           0         300           300
100 litre bins without taps                         150           5           0         750           750
*Chloride of lime 25 kgs                            150          15           0        2250          2250
*HTH 1 kgs bottles                                  150           8           0        1200          1200
*Sodium hypochlorite 25 litres                      150           8           0        1200          1200
*Aquatabs boxes 14000 tablets                       150          10           0        1500          1500
20-25 litre buckets (for cholera beds)              150          40           0        6000          6000
Cholera beds                                        150          40           0        6000          6000
Spray pumps 10-15 litres(Hudson)                    150          10           0        1500          1500
Plastic Aprons heavy duty                           150         100                  15000         15000
Work suits S                                        150          50           0        7500          7500
Work suits M                                        150          50           0        7500          7500
Work suits L                                        150          50           0        7500          7500
6mm twine camp demarcation (100m rolls)             150           4           0         600           600
Bactericidal liquid soap boxes ( 20 litres)         150           4           0         600      600
Pots 10 litres                                      150          20           0        3000          3000
Pots 20 litres                                      150          20           0        3000          3000
Plates                                              150          50           0        7500          7500
Pans                                                150          50           0        7500          7500
Dishing Spoons                                      150          50           0        7500          7500
Tea spoons                                          150          50           0        7500          7500
Gumbboots                                           150         100           0      15000         15000
Heavy duty gas stoves                               150          10           0        1500          1500
19 kgs gas cylinders                                150          10           0        1500          1500
*Batteries                                          150         150           0      22500         22500
Fuel                                                                                                    0
Diesel                                               80       3000                  189000    189000
Petrol                                               80       2000                  126000    126000
Laboratory Reagents and materials
Cholera antisera                               Districts                                                 0
Polyvalent – 01 2mls/vial                             62         2                     124             124
Serotype Inaba 2 mls/vial                             62         1                      62              62
Serotype Ogawa 2mls/vial                              62         1                      62              62
Serogroup -0139 2mls/vial                             62         2                     124             124

Media                                                                                    0               0
TCBS 500g                                            62          1                      62              62
Muller Hinton 500g                                   62          3                     186             186
Kliger Iron Agar 500g                                62          1                      62              62
Heart Infusion 500g                                  62          1                      62              62
MaConkey Agar 500g                                   62          2                     124             124
XLD Agar 500g                                        62          2                     124             124
Cary Blair 500g                                      62          1                      62              62
Peptone Water 500g                                   62          1                      62              62
Sodium Chloride 500g                                 62          1                      62              62
Rapid API 20E Kit 50 strips                          62                                  0               0

Reagents                                                                                 0               0
Oxidase Vial                                         62          5                     310             310
0.5% Sodium Deoxycholate 500g                        62          1                      62              62
Mcfaland Turbidity Standard Vial                     62          2                     124             124
Sodium Hypochloride 5L                               62          2                     124             124



                                                     23
                           ZIMBABWE – CHOLERA OUTBREAKS

                                             Quantity                 Total
                    Item           # CTCs               Available                Gap
                                             per CTC                required
Other Materials                                                              0        0
Petri dishes                            62         2                      124       124
Swabs                                   62         2                      124       124
Slides                                  62         2                      124       124
Cotton Wool                             62        50                     3100      3100
Soap                                    62       100                     6200      6200
Liquid Soap L                           62        10                      620       620
Cooler Box                              62         3                      186       186
Stool Containers                        62      1000                   62000      62000
QC organisms                            62         1                        62       62
Gloves                                  62       100                     6200      6200
Lab Coats/Gowns                         62        10                      620       620
Disposable Aprons                       62       100                     6200      6200
Sensitivity Disc                        62                                   0        0
Cotrimoxazole                           62          2                     124       124
Tetracycline                            62          2                     124       124
Chloramphenicol                         62          2                     124       124
Ciprofloxacin                           62          2                     124       124
Furazolidone                            62          2                     124       124
Nalidixic acid                          62          2                     124       124




                                        24
                                ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 9:       INTERNATIONAL FEDERATION OF RED CROSS AND RES
               CRESCENT SOCIETIES




                                                               Emergency appeal n° MDRZW004
 Zimbabwe: Cholera                                               GLIDE n° EP-2008-000218-ZWE


 This Emergency Appeal seeks
 10,170,233 (USD 9.2m or EUR
 6.6m) in cash, kind, or services
 to support the Zimbabwe Red
 Cross Society (ZRCS) to assist
 1.5 million beneficiaries. This
 seven-month operation will be
 completed by end-July 2009.

 A total of CHF 403,302 (USD
 359,372 or EUR 269,456) was
 allocated        from       the
 Federation’s Disaster Relief
 Emergency Fund (DREF) to
 support this operation.
      CHF      203,302    (USD
       177,556 or EUR 139,248)
       allocated on 11 November,
       2008.
      CHF      200,000    (USD      Mr. Zuze works for the Ministry of Environment and Health in
       181,818 or EUR 130,208)       Kadoma. Normally he is responsible for running the home-based visit
       allocated      on      12     to prevent epidemics such as malaria and cholera, including clearing
       December, 2008.               ponds to avoid mosquito breeding. Since the establishment of a CTC
                                     in mid-November, Zuze and his team have been helping with clearing
 Summary: This Emergency             the surrounding environment and off-loading equipment for the CTCs.
 Appeal responds to a request        “Cholera is not new to us, but this year, lack of nurses and medicines
 from the Zimbabwe Red Cross         in the hospital caused the spread of the disease. In the past, cholera
 Society (ZRCS) to respond to a      is something we could put down within the hospital. The Red Cross
 quickly evolving cholera crisis     brought the big change. Patients are now sleeping on beds. The
 in the country, and focuses on      assistance from Japanese Red Cross is excellent” said Zuze
 supporting      the    National
 Society to deliver appropriate and timely action in providing assistance and relief in the water
 and sanitation (WatSan), health, and hygiene promotion sectors . A vital component of the
 operation are the Federation’s Emergency Response Units (ERUs) as follows: three Basic
 Health Care (BHC) ERUs from the Finnish, Japanese and Norwegian Red Cross, two Mass
 Sanitation ERUs from the British and Spanish Red Cross, and two Water Supply ERUs from
 the German/Austrian and French Red Cross.

COORDINATION AND PARTNERSHIPS
Coordination mechanisms currently exist to varying degrees in each of the provinces, with the
MoHCW, the provincial Civil Protection Units, the cluster system, UN agencies and other non-
governmental organizations. Coordination is crucial for this intervention and the ZRCS‟s presence in
all provinces and districts will ensure that the Red Cross is represented and participates in all
coordinating forums. On the national level, coordination will continue with the MoHCW, the UN and



                                                 25
                                   ZIMBABWE – CHOLERA OUTBREAKS


other key partners. This will ensure cooperation and coordination and avoid duplication of activities
with other actors on the ground.

The Federation‟s Country Representative Office in Zimbabwe is coordinating activities with the Zone
Office, Geneva Secretariat, Partner National Societies and the ICRC. The Federation‟s Country Office
will continue to support the ZRCS in the implementation of this operation with a view to strengthening
the capacity of the National Society to face future emergencies, especially in health related
emergencies. The Federation‟s Southern Africa Zone Office (SAZO) will continue to support the
operation by making support and specialist available as needed in the areas of disaster management,
health and care, water and sanitation, logistics, finance, reporting, monitoring and evaluation.

RED CROSS AND RED CRESCENT ACTION
The International Federation‟s Disaster Relief Emergency Fund (DREF) has provided vital support to
this operation, with CHF 203,302 to assist with the initial cholera response targeting 20,000
households (100,000 people) in the form of providing materials from existing disaster stocks including
cholera kits, household water treatment chemicals, sanitary platforms (SanPlats), soap, jerry cans and
blankets. A second DREF of CHF 200,000 was released on 12 December to scale-up the operation.
From 11 to 25 November 2008, the ZRCS reached over 11,000 people with health and hygiene
awareness messages in seven provinces. The ZRCS produced 40,000 cholera information pamphlets
in English and Shona (vernaculars), which are being distributed alerting vulnerable communities to the
risk of cholera and the precaution they need to take to prevent infection as well as the treatment
required. The ZRCS also distribute 500,000 sachets of water purification chemicals, two cholera kits,
and the following support in the provinces and districts:
 Mashonaland Central (covering Budiriro, Chitungwiza and Shamva districts) – the ZRCS
     distributed two cholera kits for 300 patients each, 60,000 water purification sachets to purify a
     total of 1.2 million litres of water, 500 bars of soap (0.5 kg), 500 jerry cans (20 Litres), 500 bottles
     of household bleach.
 In Midlands (covering Gweru, Mberengwa, Zvishavane, Shurugwi districts) - the National
     Society seconded volunteers to the cholera treatment centres (CTCs) managed by the MoHCW
     and provided 500 pairs of latex gloves, 200 disposable masks, 500 water purification sachets
     (enough to treat 10,000 litres), ten (20 litre) jerry cans, 20 buckets and 680 IEC materials.
 In Matebeleland South covering Beitbridge and Gwanda district – the National Society is
     conducting health and hygiene promotion, home disinfection particularly where cholera related
     deaths were reported, distribution of IEC materials and has supplied 1,000 latex gloves, and
     bottles of bleach to the CTCs.
 In Masvingo, Manicaland, and Mashonaland West Provinces – the ZRCS is conducting health
     and hygiene promotion using house to house visits, distribution information, education and
     communication (IEC) materials and spreading messages in community gatherings and funerals.

With the support of the DREF, ZRCS conducted a rapid assessment in two of the most affected
provinces (Mashonaland Central and Mashonaland East). Major gaps were identified in curative
health, social mobilisation, prevention, clean water supply and sanitation facilities, to which high
morbidity and mortality rates are attributed to. The results of the assessment tallied the gaps identified
by the MoHCW and the health cluster.

In order to cover the identified gaps, Emergency Response Units (ERUs) were deployed in areas
allocated by the MoHCW and CPU. The ERU assets include three Basic Health Care (BHC) ERUs
from the Finnish, Japanese and Norwegian Red Cross, operating as Cholera Treatment Centres and
acting as hubs for volunteer activities; two Mass Sanitation ERUs from the British and Spanish Red
Cross facilitating sanitation and hygiene promotion activities and two Water Supply ERUs from the
German/Austrian and French Red Cross providing clean water for up to 55,000 people. The Canadian
and Australian Red Cross are also contributing with staff to support the ERU deployment. The ERUs
are working in close coordination with the local ZRCS branches and the communities they serve, and
have been deployed in-country as follows:

           Location                                           ERU
     Harare                    German/Austrian Water and Sanitation
     Manicaland                Finnish, German/Austrian Basic Health Care and Mass Sanitation
     Mashonaland West          Japanese and Spanish Basis Health Care and Mass Sanitation
     Midlands                  British, Norwegian Basic Health Care and Mass Sanitation
     Midlands                  Germany/Austrian Water and Sanitation


                                                     26
                                  ZIMBABWE – CHOLERA OUTBREAKS


THE NEEDS
The joint Federation / ZRCS assessment confirmed the gaps identified by the MoHCW and the UN
health cluster, and identified the following immediate needs:

Immediate needs:
 Improving case management and strengthening disease surveillance and monitoring;
 Ensuring coordination among health partners;
 Increasing the availability of oral rehydration solution at community level;
 Intensifying social mobilization and community awareness ahead of the holiday period and the
   possible increase in population movements.

Longer-term needs:
 Provision of safe drinking water and sanitation facilities for at least 46 percent (six million people)
   of the population across the country in both rural and urban areas;
 Sustained community health and hygiene promotion;
 Training of volunteers in cholera prevention, mitigation and infection control.

THE PROPOSED OPERATION
The ZRCS cholera operation will focus on a comprehensive approach to cholera epidemic management
including surveillance and active case finding, provision of ORS and cholera kits at the community level,
case management, health and hygiene promotion, safe water supply, and sanitation facilities.

Volunteers will be a major force in achieving the needed link between health facilities and the
community. By implementing a strong community outreach component into the operation, Red Cross
volunteers will provide individuals and communities with the capacity to address the current epidemic
and enhance resilience to face future outbreaks. This will happen by enabling volunteers to conduct
active surveillance, find and refer cases, disseminate health and hygiene messages, distribute water
treatment chemicals and hygiene items and provide ORS within communities. ZRCS will intensify
volunteer training in order to empower them for active participation throughout the operation. The
National Society will also make use of the IFRC disaster management tools and facilities in enhancing
the capacity of volunteers.

To achieve the above, Emergency Response Units (ERUs) have been deployed by the Federation and
Partner National Societies. The initial areas of deployment have been agreed with the Ministry of
Health and the Civil Protection Unit. They are working in close coordination with ZRCS branches and
the communities that they serve. The ERU assets include three Basic Health Care (BHC) ERUs from
the Finnish, Japanese and Norwegian Red Cross, operating as Cholera Treatment Centres and acting
as hubs for volunteer activities; two Mass Sanitation ERUs from the British and Spanish Red Cross
facilitating sanitation and hygiene promotion activities and two Water Supply ERUs from the
German/Austrian and French Red Cross providing clean water for up to 55,000 people. The Canadian
and Australian Red Cross are also contributing with staff to support the ERU deployment.

Water supply
 Objective: To improve access to safe and adequate water in four provinces reaching at least
 280,000 people by the end of the appeal timeframe.
                            Activities planned:
                             Provision of clean drinking water for 55,000 affected people to
 Expected result: Access        supply CTCs and local communities through two water and
 to safe water is improved      sanitation ERUs (M40 and M15).
 for 280,000 households  Distribution of 1 million water purification sachets and promotion of
 through     treatment   of     correct use to 100,000 people.
 household and community  Distribution of 40,000 jerry cans and buckets for storage and
 level water supplies.          transport of water at household‟s level (Jan – Feb 2009).
                             Rehabilitation of 200 water points in 4 provinces to benefit 100,000
                                persons (February – April 2009).
                             Facilitate water treatment for CTCs and health centres which are
                                near water source or untreated municipal water supply pipeline.
                             Drilling of 50 boreholes, equipped with hand pumps or pressure
                                hand pumps to serve the needs of 25,000 people.
                             Support local municipalities with water pumps spare parts and
                                diesel/petrol.


                                                   27
                                 ZIMBABWE – CHOLERA OUTBREAKS



Progress: The German/Austrian ERU conducted rapid assessments in Gweru of Midlands Province
and in Harare. With the findings, the German/Austrian ERU has deployed M40 equipment to support
the Zimbabwe National Water Authorities (ZINWA) at the city water reticulation centre 20 km outside
of town. The water treatment facility has not been working due to broken pumps, lack of chemicals for
flocculation and dysfunctional sand filtration. The ERU team will provide tanks for chlorination and
enhancing storage capacity. The British Red Cross mass sanitation ERU is also operating in Gweru
supporting the Norwegian Red Cross BHC.

The Japanese Red Cross BHC and Spanish Red Cross and Mass Sanitation ERU conducted a joint
rapid assessment in Karoi and Chirundu in Mashonaland West Province. Basic health and sanitation
equipment have been stationed in Karoi to support the CTCs and hospitals. The French Red Cross
WatSan ERU has handed over two bladders and tap stands to complement Spanish Red Cross Mass
Sanitation ERU in response to the water needs at Karoi Hospital. However, the bladder tanks will be
used at the CTCs since UNICEF has already delivered bladder/tanks at the hospital.

Another assessment was conducted in Kadoma (Chidamoyo district) during which were identified are
the needs for sanitation activities, upgrade of the water supply system at CTCs and hygiene
promotion; activities will be carried out by Spanish Red Cross ERU team. The French Red Cross
WatSan ERU will complement the efforts by providing some bladder tanks and tap stands. In addition,
British and Finnish ERU conducted assessments in Mutare, Manicaland Province and plans to
establish a service centre are underway. French Red Cross ERU made four assessment trips to
Mutare, Gweru district, Musengezi (Chegutu), Karoi and Chirundu (with Japanese RC). The team has
yet to identify an appropriate location for its water treatment units.

Sanitation and hygiene promotion
Objective: Improved hygiene awareness and sanitation for 1,500,000 people (300,000
households) in 8 cholera affected provinces, and increased access to latrines in health
centres and schools.
                                         Activities planned:
                                              Provision of hygiene promotion activities to
Expected result:                               1,500,000 people through training and activating
     Appropriate sanitation, including        volunteers at the community level.
      excreta disposal, solid waste           Distribution of hygiene kits to 20,000 vulnerable
      disposal    and    drainage,    is       households in cholera affected areas. Hygiene kits
      provided to affected households          are designed for this operation and include soap
      over the next seven months.              and other items.
     Disease transmission is reduced         Provision of Sanitation facilities, excreta and solid
      through raised awareness of              waste disposal for CTCs and communities. These
      communities      and    improved         activities will be supported by the two Mass
      hygiene behaviour.                       Sanitation ERU‟s which can reach 20,000 people
     The scope and quality of the             each.
      Zimbabwe Red Cross Society              Training     of staff and volunteers on cholera
      water, sanitation and hygiene            response, reporting, and household water
      promotion services are improved.         purification
                                              Production and distribution of IEC materials in local
                                               languages.

Progress: British Red Cross Mass sanitation ERU and Norwegian Red Cross BHC ERU have been
deployed in Midlands province and their equipment and teams are focused on hygiene promotion and
sanitation. In Manicaland Province, Finnish Red Cross BHC is supported by a German Red Cross
ERU team (Canadian and Austrian team members) who have conducted a joint assessment focusing
on sanitation and hygiene promotion needs in medical institutions, CTC and in rural areas.

Spanish Red Cross Sanitation ERU is covering Mashonaland West province, providing support to the
Japanese BHC ERU. The operation base is in Karoi, which is close to various CTCs with strong Red
Cross branch and active volunteers, of which the majority are trained in community mobilization.
Further assessments will be carried out in other parts of the province to establish the needs and
possible support to the CTCs. The planned hygiene promotion campaign at community level is at an
advanced stage while training of volunteers in underway. Spanish Red Cross ERU also has plans to
distribute hygiene kits tailormade for this operation to cover 20,000 families throughout the country.

                                                 28
                                  ZIMBABWE – CHOLERA OUTBREAKS



Health and care
 Objective: To reduce cholera-related morbidity and mortality through a comprehensive health
 approach including surveillance, case finding, health promotion, ORS distribution and case
 management and to improve Zimbabwe Red Cross capacity and the resilience of
 communities.
                                      Activities planned:
                                           Provision of 40 volunteer modules of the cholera kits,
 Expected result:                           to support with community based activities at cholera
     Health services are supported         treatment centres and in the community under the
      to meet the health needs of the       Ministry of Health and Child Welfare.
      population.                          Mitigate the effects of cholera by developing the
     The     resilience    of    the       capacity of eight provincial Red Cross Offices in active
      community is improved through         case finding correct preparation, use and distribution
      better    health    awareness,        of Oral Rehydration Solution (ORS) and in
      knowledge and behaviour.              surveillance.
                                           Training of volunteers in target branches in
                                            Community Based Health and First Aid (CBHFA) and
                                            on Epidemic Control for Volunteers training package.
                                           Orientation of 800 volunteers and staff on the correct
                                            use and preparation of ORS.
                                           Orientation and reorientation of 30 staff members
                                            directly responsible for project implementation.
                                           Develop a first response plan at provincial Red Cross
                                            branches, through the establishment of ORS
                                            distribution outlets at community level.
                                           Distribution of 80,000 ORS sachets through
                                            community level outlets.
                                           Establishing 3 Cholera Treatment Centres (CTCs)
                                            using Basic Health Care ERUs with cholera treatment
                                            kits that will provide case management for affected
                                            population functioning in health facilities and using
                                            additional capacity from local health professionals.
                                            Those CTCs will also serve as centres for community-
                                            based activities performed by ZRCS volunteers.

Progress: With the increase of cholera cases in Kadoma town, Mashonaland West Province, part of
the Japanese Red Cross ERU supported Spanish Red Cross counterparts in supporting the CTC
(distributing tents, beds, blankets, jerry cans, buckets, water purifiers and ORS). As one of the first
deployments at the onset of an outbreak, this provided an opportunity to assess the effectiveness of
IFRC systems in emergency situation. In Kadoma, the Red Cross in close collaboration with MSF
Spain and MSF Holland are working through the office of the provincial medical director (PMD) and
the local ZRCS branch. All cholera cases are referred to the CTC and according to the
Germany/Austrian M40 visit to the CTC in Chisangano area near Kadoma, the centre is in need of
waste disposal facilities, construction of latrines, installation of additional water pints, improvement on
the drainage system, provision of body bags, food, bedding for patients, detergents and protective
clothing. The Red Cross volunteers are assisting with hygiene promotion during burial proceedings,
which is a potential source for the spread of the disease.




                                                    29
                               ZIMBABWE – CHOLERA OUTBREAKS



How we work
All International Federation assistance seeks to adhere to the Code of Conduct for the
International Red Cross and Red Crescent Movement and Non-Governmental
Organizations (NGO's) in Disaster Relief and is committed to the Humanitarian Charter and
Minimum Standards in Disaster Response (Sphere) in delivering assistance to the most
vulnerable.

The International Federation‟s     Global Agenda Goals:
activities are aligned with its
Global Agenda, which sets out          Reduce the numbers of deaths, injuries and impact from
four broad goals to meet the            disasters.
Federation's      mission     to       Reduce the number of deaths, illnesses and impact from
"improve the lives of vulnerable        diseases and public health emergencies.
people by mobilizing the power         Increase local community, civil society and Red Cross Red
of humanity".                           Crescent capacity to address the most urgent situations of
                                        vulnerability.
                                       Reduce intolerance, discrimination and social exclusion
                                        and promote respect for diversity and human dignity.
Contact information
For further information specifically related to this operation please contact:
     In Zimbabwe: Emma Kundishora, Secretary General Email zrcs@ecoweb.co.zw;
      ekundishora@comone.co.zw , Phone: Tel: +263.4.332638; +263.4.332197; Fax
      +263.4.335490
     In Zimbabwe: Farid Abdulkadir ;Acting Head of Operations, Zimbabwe, Harare; Email
      Farid.Aiywar @ifrc.org .Phone: Tel: +263.4.705166; +263.4.720315, Fax +263.4.708784
     In Southern Africa Zone: Françoise Le Goff, Head of Zone Office, Johannesburg; Email
      francoise.legoff@ifrc.org;  Phone:     Tel:   +27.11.303.9700;   +27.11.303.9711;   Fax:
      +27.11.884.3809; +27.11.884.0230
     In Geneva: John Roche, Operations Coordinator for Africa, Email: john.roche@ifrc.org;
      Phone: +41.22.730.4400, Fax: +41.22.733.03.95




                                               30
                                       ZIMBABWE – CHOLERA OUTBREAKS



ANNEX 10. DAILY CHOLERA UPDATE 8 JANUARY 2009




                                                    31
ZIMBABWE – CHOLERA OUTBREAKS




             32
ZIMBABWE – CHOLERA OUTBREAKS




             33
ZIMBABWE – CHOLERA OUTBREAKS




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ZIMBABWE – CHOLERA OUTBREAKS




             35
ZIMBABWE – CHOLERA OUTBREAKS




             36
                        ZIMBABWE – CHOLERA OUTBREAKS


ANNEX 11. ACRONYMS AND ABBREVIATIONS

ACF       Action Contre la Faim

CFR       case fatality rate
CTC       cholera treatment centre
CTU       cholera treatment unit
C4        cholera command and control centre

GAA       German Agro-Action

IARAT     Inter-Agency Rapid Assessment Teams
IFRC      International Federation of the Red Cross and Red Crescent Societies
IOM       International Organization for Migration

MoHCW     Ministry of Health and Child Welfare
MSF       Médécins Sans Frontières
MVP       mobile and vulnerable populations

NFI       non-food item
NGO       non-government organisation

OCHA      Office for the Coordination of Humanitarian Affairs
ORS       oral rehydration solution

PLWA      People Living With HIV/AIDS

UNFPA     United Nations Population Fund
UNICEF    United Nations Children‟s Fund

WASH      water, sanitation and hygiene
WFP       World Food Programme
WHO       World Health Organization

ZINWA     Zimbabwe National Water Authority




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