Democratic Republic of the Congo. July 2005

Transcription

1 World Health Organization Project Proposal Strengthening Disease and Nutritional Surveillance in Eastern DRC Democratic Republic of the Congo OVERVIEW Target country: Democratic Republic of the Congo Beneficiary population: Implementation period: 12 months Amount: 1,500,000 USD Starting date : 1/7/2005 Ending date: 30/6/2006 Applicant organization: WHO Country contact: Dr Leonard Tapsoba, WR Organisation Mondiale de la Santé, DRC Tel : Mobile : Fax : GPN tapsobal@cd.afro.who.int omskin@cd.afro.who.int Contact HQ: Ms Marianne Muller Donor Relations Unit Health Action in Crises Tel: Fax : mullerm@who.int Bank: UBS AG Case Postale 2600,1211 Genève 2 World Health Organization Genève Swift code: UBSWCHZH12A Bank account US$: Swift Code UBSW CH 12A US dollar account number CO Bank account Euro: No.: 240-C IBAN: CH C PROBLEM ADDRESSED Weak disease and nutritional surveillance in the eastern Democratic Republic of the Congo. PROJECT SUMMARY In order to reduce morbidity and mortality resulting from diseases and malnutrition, WHO intends to increase its support to the MOH to expand the weekly surveillance at sentinel sites; improve the diagnosis capacity and to monitor and manage the nutritional status of vulnerable population.

2 I. CONTEXT AND BACKGROUND The installation of the transitional national government in June 2003, following the peace agreement of December 2002, formally ended seven years of civil conflict. The international community is cautiously optimistic, and has recently launched major reconstruction programmes. There are concerns that the peace in the east of the country is not stable and there is expectation for further consolidation of the peace process and the holding of elections, which are scheduled for. Most important outbreaks are cholera, measles, but include pertussis and re-emerging pathogens such as Marburg, Ebola, trypanosomiasis and plague. Humanitarian needs are likely to continue to exist while the capacity of agencies to deliver humanitarian services is often inadequate to meet all the needs, mostly due to the size and inaccessibility of many parts of the country, aggravated by continuing insecurity and instability in the east of the country. In addition, natural disasters including volcano eruptions in the East, droughts in the South, and flooding of the Congo River further add to the vulnerability of the population. II. PROJECT RATIONALE 1 DRC has a population of about 58 million, of which 28 million live in the eastern provinces of South and North Kivu, Maniema and Oriental. Conflict has caused some three million internally displaced persons (IDP). Security and logistic constraints limit access to large parts of eastern DRC. Mortality rates in eastern DRC continue to be above emergency thresholds; in the last years millions of people have died in excess to normal baseline mortality rates for sub-saharan countries. Maternal mortality in the DRC is estimated to be 1,289 per 100,000 live births.in eastern DRC, surveys suggest a maternal mortality of 3,000 per 100,000 live births. Childhood mortality is at least double the normal rate, indicating that the severity of the crisis is still in emergency conditions. Most of these excess deaths are attributable to malaria and other common diseases, rather then directly due to violence. Control of epidemics is one of the highest priorities in DRC, as the country faces numerous and severe disease outbreaks. Most important are cholera, measles and meningitis, but include pertussis and (re)emerging diseases such as Trypanosomiasis, Viral Hemorragic Fever and plague and a drastic increasing of many other endemic diseases (Onchocerciasis) which affect severely the living conditions of the population as well as the economic grow. The principal public health concerns in the DRC are communicable diseases such as malaria, tuberculosis, HIV/AIDS and diarrhoeal diseases (including cholera). Malaria accounts for 45% of childhood death. Acute respiratory infections (ARI), diarrhoea and measles are other important causes of morbidity and mortality among children. Coverage of the Expanded Programme of Immunization (EPI) is low. For instance only 50% of children are vaccinated against measles. Environmental health conditions such as lack of sanitation, indoor air pollution, inadequate hygiene and insufficient water supplies increase the potential for ill health. High levels of malnutrition heighten susceptibility to disease, particularly aggravating the health predicament of children under five. Conflict-related injuries are on the increase, particularly after recent surge in violence. Genderbased violence in conflict areas, although mostly undocumented, remains the greatest threat to women's reproductive/sexual health and their emotional well-being. The poor health status can further be attributed to high levels of poverty, displacement and limited access to adequate minimum health services. Regarding the health situation of the 600,000 people living in Shabunda Health zone, South Kivu, for example, practically nothing is known. A UNICEF 1 Based on the assessment done by Michael and Von Schreeb in May Strengthening Disease and Nutritional Surveillance in Eastern DRC 2

3 survey from 2001 (MICS 2) suggests an under-five mortality rate of 231 in the eastern provinces (range ). Malnutrition is cited by the MOH as an underlying cause in 48% of cases of infant mortality in the DRC and the prevalence of acute global malnutrition is given as 16.1%, though other source report that it is on the decrease. The same source estimates the prevalence of chronic malnutrition as more than 70% in North-Kivu. Childhood diseases such as measles are an important contributor to malnutrition. World Vision conducted a small nutritional and mortality survey (for the last six months of 2003) in northern part of North Kivu and found under-five crude mortality rate (CMR) between 0,8-2,5/10 000/day suggesting that some areas had mortality levels above emergency threshold. WHO has been supporting the Ministry of Health in establishing an integrated disease surveillance, building on the polio eradication initiative network. However there is a great need in strengthening the system, mainly by training health staff in the health zones (health districts). This project will contribute in having a more integrated and more sustainable surveillance system especially in the eastern part of the country. III. GENERAL OBJECTIVE To reduce morbidity and mortality resulting from diseases and malnutrition in Eastern DRC. Specific objectives 1. To strengthen the disease and nutritional surveillance system in Eastern DRC; 2. To upgrade the preparedness and response capacity towards disease outbreak and to provide limited nutritional support. IV. EXPECTED OUTPUTS Disease and nutritional surveillance system strengthened; Completeness and timeliness of surveillance reports improved; Analysis of data on disease occurrence collected done at the health zone level; Standardized monthly disease surveillance/nutritional status reports produced and disseminated; Medical supplies pre-positioned at provincial level to respond within shortest possible period to likely emergencies (emergency and cholera kits to be provided through a different funding source). Minimum laboratory technology available for priority diseases; Provincial surveillance units able to confirm any outbreak within 72 hours; Improved awareness of community on preparedness, and prevention; Nutritional status of vulnerable groups among refugees, IDPs, returnees and resident population regularly assessed and findings addressed in a coordinated manner. Indicators Reduction in the time to detect and to respond to epidemics; Availability of trained and equipped teams in Eastern DRC; Improvement of completeness and timeliness of surveillance reports; Number of laboratories equipped to diagnose priority diseases; Reduction of case fatality rates in outbreaks and epidemics; Trend of malnutrition monitored and addressed. Strengthening Disease and Nutritional Surveillance in Eastern DRC 3

4 V. ACTIVITIES 1. To support the Ministry of Health in expanding the weekly surveillance through early warning systems at sentinel sits, in both NGO and public sectors, to prevent and control epidemics, through the following process: Training of provincial and health zones teams in integrated disease surveillance. Consolidation of provincial taskforces for outbreaks to coordinate efforts for preventing and controlling the disease. Establishment of Rapid Response teams in the eastern provinces to carry out epidemic investigation and control in the event of outbreak. Preposition of emergency medical supplies for quick delivery to affected areas. (Emergency and cholera kits will be provided through a different funding source). Strengthen of provincial reference laboratories through training of staff and provision of minimum equipment and reagents to enable them to detect and determine the nature of diseases and proper treatment. Preparation and implementation of emergency mopping-up vaccination campaigns to prevent and control vaccine-preventable epidemics. 2. To support the Ministry of Health in assessing the nutritional status of vulnerable groups among the refugees, IDPs, returnees and resident population regularly and to address the situation in a coordinated manner, through the following: Periodic rapid nutrition surveys (every 4 to 6 months) within the vulnerable groups of the refugees, IDPs, returnees and resident population. Consolidation and dissemination of reports from supplementary and therapeutic feeding centres and health clinics. Capacity building and technical support aimed at strengthening the medical component in the existing therapeutic and supplementary feeding centres. Standardization and consolidation of on-going efforts in the area of training in managing malnutrition. At least two workshops will be organized with this purpose targeting MOH and NGOs staff. Consolidation of existing provincial emergency coordination mechanisms, raising community awareness on environmental sanitation and diseases. VI. IMPLEMENTATION ARRANGEMENTS Through the Three Year Plan to strengthen WHO country offices capacity for Health Action in Crises, WHO will hire an expatriate specialist in emergency and humanitarian action who will be based in the WHO sub-office in Goma. He/she will lead the project and work closely with the rest of the WHO team already in place and in conjunction with the EPI surveillance network. Under the leadership of the WHO Emergency Health Coordinator for Eastern DRC based in Goma and under the supervision of the WHO Representative/DRC the project team will also comprise one international epidemiologist and one international nutritionist. WHO and MOH will oversee the operation. WHO will provide technical assistance to other UN Agencies and NGOs with experience in providing health and nutrition in these provinces. WHO and MOH will ensure close supervision of the project activities through regular site visits and evaluation. Reports will be regularly sent (monthly and quarterly consolidated) to the WR and shared with AFRO, HQ and other stakeholders. The security situation, especially in the Eastern part of the country, continues to be of concern. The run up to the elections scheduled for can add tension to the already fragile situation. South and North Kivu, Maniema and Oriental provinces suffer sporadic fighting. Communication facilities and travelling are still challenging in the area. Many areas remain inaccessible or are difficult to access all year around. Strengthening Disease and Nutritional Surveillance in Eastern DRC 4

5 II. BUDGET BREAKDOWN Item Unit Cost (USD) Cost (GBP) 1. Staff Public health officer 1 To be funded by ECHO/TYP International Nutritionist 1 80,000 43,011 International Epidemiologist 1 80,000 43,011 Secretary 1 9,000 4,839 Driver 5 35,000 18,817 Sub total 204, , Supply and equipment Computer kit (desktop/ Printer/UPS) 3 10,500 5,645 Laptop for the Epidemiologist and the Nutritionist 2 4,000 2,151 Colour Printer Laptop for MoH provincial focal points 4 8,000 4,301 Office equipment kit (desk/chairs, etc.) 3 9,000 4,839 Car with UHF radio communication system (CODAN) 5 125,000 67,204 Air-freighting the cars to the respective provinces 5 15,000 8,065 VHF Radio Communication set (Motorola) Satellite phone with accessories (Thuraya) + RBGAN 1 3,500 1,882 Cellular mobile phone Radio communication system for remote health centres , ,968 Solar power with converters and batteries ,700 62,204 Stationery and other office running cost -- 8,000 4,301 Communication costs (mobile and satellite while on mission) 5,500 2,957 Laboratory equipment/reagents/breeding grounds (purchase/freight/transport) 320, ,043 Various Antibiotics (Oily Chloramphenicol, Nalixidic Acid) 15,000 8,065 Fuel -- 15,000 8,065 Cars maintenance -- 25,000 13,441 Subtotal 2 906, , Activities Training health centres staff in integrated disease surveillance 55,000 29,570 Workshop on nutritional surveillance and malnutrition management 25,000 13,441 Strengthening Disease and Nutritional Surveillance in Eastern DRC 5

6 Refresh training of provincial reference labs staff 20,000 10,753 Support to quick nutritional surveys (transport/per diem) 15,000 8,065 Field missions for investigations (transport/per diem) 30,000 16,129 Support to shipment of specimens to laboratories 10,000 5,376 Contingency 21,450 11,532 Project management, monitoring and reporting 128,645 69,164 Sub total 3 305, ,030 PSC 6% 84,905 45,648 Grand Total 1,500, ,452 Note: 1 USD for 1.86 GBP. VIII. BUDGET JUSTIFICATION Cost of staff The cost of the international staff takes into account the following items: salaries (P4 grade), Rest and Recuperation, Hazard Pay and estimated cost of travel from country of residence to the duty station and back. Supply and equipment There is office space for the new staff but there is need for office equipment (desk, chairs, etc.) for the two officers and the secretary. Five cars have to be purchased: one for the team based in Goma and one for the rapid response team in the four provinces. These vehicules will be managed following WHO rules and drivers will be recruited. Four laptops have to be provided to the MoH provincial focal points, because WHO has already granted the provincial disease surveillance units (in all provinces) with desktops. The laptops can be carried on while on mission in the field. To strengthen the laboratories capacities a total amount of 80,000 USD by province is planned to equip and provide reagents, feeding grounds, etc. to the provincial reference laboratories and equip also some health centres lab with a minimum basic equipment. To improve the transmission of data from health centres to Central Bureau of Health Zones and from Health Zones to provincial level, there is a need to equip some health centres and some Central Bureau of Health Zones with UHF radio communication system. We plan to equip at least 40 of them. The estimated cost (4,500 USD) includes the purchase cost, freight and installation at the site). In some areas lacking of electricity there is need to install solar panels. Except the vehicules, the radio communication system, laboratory equipment and drugs, which have to be ordered outside DRC through WHO procurement service, all other items can be purchased locally. The fuel cost has been calculated by allocating the amount of 4,000 USD by vehicule for the year. For the maintenance of the cars, 5,000 USD has been allocated by car for the year. Strengthening Disease and Nutritional Surveillance in Eastern DRC 6

7 Activities Training in integrated disease surveillance: Only three provinces will be targeted (Oriental, North and South Kivu) because the training has been already conducted in Maniema Province. Thirty staff will be involved in each province and the training last one week. Modules and training material are already available. In collaboration with MoH and NGOs working in the nutritional recuperation centres, two workshops will be organised to strengthen capacities in nutritional surveillance and dealing with malnutrition. Strengthening Disease and Nutritional Surveillance in Eastern DRC 7