Emergency Plan of Action (EPoA) Angola / Region: Yellow Fever Outbreak

Transcription

1 Emergency Plan of Action (EPoA) Angola / Region: Yellow Fever Outbreak DREF n MDRAO006 Date of issue: 05 July 206 Glide n EP AGO Expected timeframe: 6 months Expected end date: End December 206 DREF allocated: CHF 73,653 in 3 allocations (CHF 50,672; CHF 9,790; CHF 3,9) Appeal budget: CHF,443,96 Total number of people affected: 2-23,000,000 (i.e. potentially all of Angola) Number of people to be assisted: 9 million people (4 million directly and a further 5 million through social mobilization) Host National Society presence: The Cruz Vermelha de Angola (CVA) is organized into 8 branches: in each provincial capital, with the HQ located in the capital of Luanda. 66 nurses are employed at health posts. The CVA has 5000 volunteers, 3668 of which are active (73%) and one hundred and twenty (20) staff. Red Cross Red Crescent Movement partners actively involved in the operation: IFRC, Norwegian Red Cross, Australian Red Cross, Sao Tome Red Cross Other partner organizations actively involved in the operation: World Health Organisation (WHO), UNICEF, Center for Disease Control (CDC), Ministry of Health (MoH) of Angola A. Situation analysis Description of the disaster Yellow Fever (YF) is a viral disease endemic to tropical regions of Africa and the Americas. The disease principally affects humans and non-human primates and is transmitted via the bite of infected mosquitoes. The agent of Yellow Fever Virus (YFV), can cause devastating epidemics of potentially fatal, haemorrhagic disease with mortality rates as high as 50% for severe cases. Surveillance of the disease is difficult, with ongoing endemic transmission needing to be differentiated from potential epidemic urban transmission. A big challenge to surveillance system is that up to 80% of people infected can experience mild or limited symptoms that go undiagnosed; however, they are still able to transmit the virus. For these reasons, it is estimated that YF is significantly underreported. Historically, YF has caused devastating epidemics. Since the creation of the vaccine in 939, the world has relied on mass vaccination campaigns to prevent and control these outbreaks. However, the risk of major YF epidemics, especially in densely populated, poor, urban settings, both in Africa and South America, has greatly increased due to: () Increased density of the mosquito vector of YF, Aedes aegypti, especially in urban areas(2) Rapid urbanization, particularly in parts of Africa, with populations shifting from rural to predominantly urban settings(3) Declining immunization coverage at high risk areas. These risk factors are also exacerbated by a limited supply of vaccine and the time-consuming procedures involved in producing YF vaccine. The technology for the vaccine has not changed since its initial development in 939. To support rapid outbreak response, a global stockpile of YF vaccine is maintained by the International Coordination Group (ICG). The largest outbreak of YF in 30 years in Angola is currently ongoing. The outbreak was detected in Luanda, Angola in late December 205, with the first cases being lab confirmed on the 9 January 206. An immediate response was launched by the Angolan Ministry of Health and its partners. Despite initial efforts, the outbreak rapidly increased in size and scale, spread across the country and resulted in exportation of 4 of cases to other countries. This exportation has resulted in confirmed local transmission in Democratic Republic of Congo (DRC), including the capital city of Kinshasa. The response to the YF outbreak in Angola is complicated by both the limited vaccine supply and the

2 P a g e 2 ongoing DRC outbreak and a concurrent but separate outbreak in Uganda. The risk for further cross boarder transmission, extension of the outbreak in Angola and DRC, as well as the potential spread of YF to other countries increases the complexity and urgency of the response to the outbreak in Angola and the surrounding countries. Angola As of 3 June 206, Angola reported 3,37 suspected cases of Yellow Fever with 345 deaths with a Case Fatality Rate (CFR) of %. Among those cases, 847 have been laboratory confirmed. Despite extensive vaccination campaigns in several provinces, circulation of the virus persists and continues to spread. WHO have implemented the Incident Management (IM) system and is coordinating multi-agency teams in responding to the epidemic. Since the beginning of the outbreak all 8 provinces of Angola have reported suspected cases, placing all provinces at risk. Recent epidemiological investigation of rural areas indicates extensive spread of the virus that had previously gone undetected, indicating that surveillance may be limited, especially in provisional areas, the scale and spread of the virus could be much more extensive than is currently being reported. The capital of Angola, Luanda, has reported the majority of cases, with 489 laboratory confirmed cases (58%) of local transmission. Currently, of the 8 provinces have confirmed local transmission. Based on the census data for these districts the current population identified for vaccination is 3,309,786. Vaccination response has been ongoing since late January, and to date 80% of the population have been vaccinated (0,64,209). However new areas of local transmission are being identified almost on weekly basis. Ongoing lab confirmed cases are still being reported from areas previously vaccinated, indicating coverage may not be sufficient to interrupt transmission. Independent monitoring currently being undertaken by the Center for Disease Control (CDC) indicates that the population data to calculate coverage may be heavily underestimated, which may explain ongoing transmission in areas thought to be a 00% covered by vaccination. To help address these issues a mop up campaign is planned in Luanda in the coming weeks, as well as additional vaccination in new areas identified with cases of local transmission, or at risk of further spread. Fig. Yellow Fever Cases with Local Transmission and vaccination in Angola Province and District 5 Dec June 206 Observations, points of concern and risks Local transmission has been reported in 0 highly populated provinces, including Luanda. Luanda Norte, Cunene, and Malange. The continued spread of the outbreak to new provinces and new districts. Spread to neighbouring countries. As the borders are porous with substantial cross border social and economic activities, further transmission cannot be excluded. Viremia travelling patients pose a risk for the establishment of local transmission, especially in countries where adequate vectors and susceptible human populations are present. Establishment of local transmission in other provinces where no autochthonous cases are reported. High index of suspicion of ongoing transmission in hard-to-reach areas like Cabinda. Inadequate surveillance system capable of identifying new foci or areas of cases emerging.

3 P a g e 3 Fig. 2: National Trend of Yellow Fever Suspected and Confirmed cases - Angola The epidemic curve for the outbreak (shown above) indicates the lab confirmed cases of Yellow Fever, shown in red, the suspected cases of yellow fever without lab confirmation shown in blue and suspected cases of yellow fever that meet case definition but came back as YF negative in green. The large number of green cases, meeting case definition but that are not YF is concerning and could indicate a concurrent outbreak of another illness. Investigations are ongoing and focuses on Hepatitis E and potentially leptospirosis. In addition, the lab confirmed yellow fever cases are reporting between 5-30% co-infection rates with malaria and other illness. This mixed pathology presentation with in the outbreak further complicates surveillance, detection and response. Figure 3: Angola Incident Management Team vaccination plan 206 With an average life expectancy of 52.3 years and infant mortality rate of 0.6 per,000 births, even before this YF outbreak, Angola had some of the poorest access to basic health services in the world. Angola relies heavily on oil production to finance virtually every aspect of its economy, infrastructure, services and its health care system. Of great concern is the deteriorating health care and sanitation services that are linked to the global down turn in oil prices. In recent days, the Incident Management Team in the country has decided on a detailed, per district vaccination plan for the additional 8. million vaccine doses that have been requested to be provided to Angola. This plan is divided into SIA completed Phase a Phase b Phase 2 Phase 3 4 phases named a, b, 2 and 3, with specific districts in 7 out of the 8 provinces targeted for preventative vaccination in each phase, based on a risk assessment and modelling of spread. In order to ensure adequate coverage of this vaccination campaign, strong social mobilization and risk communication will be key, particularly in light of the resistance to vaccination that has been reported recently in several areas. If vaccine is allocated for the implementation of this plan, it presents several operational challenges in terms of its use across the whole country, given the need for speed and coverage. Technical support will be needed in multiple

4 P a g e 4 districts concurrently and a high level of coordination will be required at both Luanda and provincial levels to ensure coordination of social mobilisation activities and roll out of campaigns. The volunteer network of CVA is uniquely placed to support this operation, and will play a vital role in its success. Summary of the current response Overview of Host National Society The CVA has headquarters in Luanda, as well as branch offices in all 8 provinces. They have a total of 3,668 volunteers, distributed according to the following table: Province # Volunteers Province # Volunteers Province # Volunteers Bengo 70 Cuanza Norte 20 Lunda Sul ND Benguela 33 Cunene 80 Malanje 20 Bie 93 Huambo 532 Moxico 240 Cabinda 50 Huila 280 Namibe 30 Cuando Cubango ND Luanda 208 Uige 56 Cuanza Sul 408 Lunda Norte 226 Zaire 22 The CVA has been responding to the YF outbreak since the third week of February 206, via an initial DREF of 50,672 Swiss franc. In mid-april, a 9,790 Swiss franc DREF extension was approved to support the deployment of an RDRT to support the CVA s response. The RDRT has been in country from the 30 th of April and has extended his mission so that he will remain in country through the first FACT rotation. A FACT was deployed in June 206 to support the response, consisting of a team leader, a health delegate and a social mobilization / community engagement specialist. A second deployment is now in place. DREF funds have been used principally to respond to the epicentre of the outbreak in Viana Municipality in Luanda province where, fortunately, the CVA headquarters are situated. Viana has a total population of.6 million people and was the target of an extensive vaccination campaign. The CVA participated in the response in Viana, in coordination with the MoH and other partners by: Participating with the Angolan Armed Forces (FAA) in the vaccination campaign in Luanda by vaccinating 30,400 people in CVA headquarters. b. Design and printing of 00,000 yellow fever flyers in collaboration with MoH and WHO, distribution started end of May. c. Partnering with Radio Viana to provide key yellow fever health information messages during 30-minute radio programme that was broadcasted twice a week. Nine (9) such programmes have been carried out so far. d. Working with the Viana municipality to develop a municipal social mobilization municipal plan. e. Training volunteers to conduct social mobilization activities in Viana, in particular door to door and mass education activities in community meeting points (schools, markets, taxi sites, etc.),up to 44 volunteers are participating. f. Ten (0) out of 4 Viana s communes were chosen for social mobilization activities based on rumours of yellow fever cases and reports of bad sanitation conditions. Door-to-door and mass education social mobilization campaign was conducted between 30 April 6 June 206, and reached 3,36 households and 05,655 individuals; of which 3,709 (3.5%) indicated they had not been vaccinated, and 3,57 (3.4%) indicated they did not have a mosquito bed net. Apart from activities in Viana municipality, UNICEF and other actors have been engaging directly at branch level to recruit CVA volunteers for social mobilization activities during vaccination campaigns. More coordination with headquarters is required for these activities. The CVA has also entered an agreement with UNICEF to provide social mobilization and health promotion activities in 7-0 provinces in the Country, focusing mainly on Yellow Fever, but also targeting malnutrition in 3 provinces affected with acute and chronic malnutrition (Cunune, Huila, Namibe). This agreement would provide approximately USD 340,000 to the CVA for implementation of these social mobilization activities.

5 P a g e 5 Overview of Red Cross Red Crescent Movement in-country Before the arrival of the FACT on 2 June, 206, the IFRC has had no presence in Angola since 20. In June, a FACT comprising 3 members was sent to Angola to support assessment and planning. This team comprised a team leader, health specialist and delegate focused on health promotion and social mobilization. This team is now in their second rotation. The ICRC maintains an office in Angola, run by national staff and has no delegates in country. The Spanish Red Cross (SRC) is present in Angola. SRC has delegate working with food security issues in relation to the ongoing drought in several of the south-central provinces. The CVA is in active communication with both ICRC and SRC and has coordinated food security, drought-related assessments with the SRC. Movement Coordination The CVA will continue to coordinate and implement the Yellow Fever operations. The IFRC will support CVA operations and will work in coordination with the CVA. The IFRC delegates will be based within the CVA HQ office. IFRC will provide coordination and technical support to the CVA as required. All communications and activities will be communicated to and coordinated through the CVA SG and Program Coordinator. Overview of non-rcrc actors in Angola The coordination of the Yellow Fever response and information sharing is organized by the Ministry of Health (MoH) supported by WHO. An incident manager from WHO has been appointed to manage the operation and a Global Outbreak Alert and Response Network (GOARN) team has been deployed, including 2 epidemiologists and logistics support. CDC are present on the ground and providing technical support. MSF Spain is operational and providing support to clinical case management and social mobilization in three provinces. UNICEF have reinforced their local team and are coordinating social mobilization activities. An EU assessment team is currently on the ground assessing needs. Needs analysis, beneficiary selection, risk assessment and scenario planning Angola current ranks 49 out of 88 countries on the UNDP Humanitarian Development Index. Despite progress since the end of a 40-year civil war, access to health care still remains extremely low and a recent drop in oil prices is negatively affecting the provision of essential services. Angola has experienced large outbreaks of Marburg and cholera in the past, and is currently affected by El Nino in the southern part of the country, which is currently negatively impacting food security and malnutrition indicators. The current Yellow Fever response in Angola has met with a number of challenges which has led to a slow scale-up by all partners; this has allowed the disease to spread across a large geographical area. Difficulties in detecting and confirming cases have also delayed vaccination access in some areas. With the addition of surge support from WHO and partners, including the deployment of FACT, the response is improving. This surge consist of up to 20 people across a number of specialities including entomology, epidemiology and risk communication, who will form teams to support ongoing activities at a provincial level. These teams will support local capacity to detect and respond to cases, as well as coordinate partners to ensure effective response. However, recent assessments at provincial level identify continuing gaps in response; the lack of penetration to the community level has been identified as a major limitation to early detection and vaccine coverage in the current capacity. Within recent weeks partners have been engaging with CVA to support improved response. UNICEF and WHO have been working with CVA branches to provide training and basic support in a number of districts to enhance case detection and social mobilisation. However, this support has been in an ad hoc and uncoordinated way and CVA branches have reported difficulties in fulfilling requests to support YF response outside of the areas covered by the initial DREF. Additional technical capacity, resources and logistical support will be required to ensure that the CVA can engage fully in the national coordination and provincial implementation. The full integration of CVA into the overall epidemic response will ensure they have the resources needed to participate effectively and support partners to reach the last mile and hence this EPOA and Emergency Appeal are now being launched. Reports of community resistance to vaccination have also impacted the effectiveness of campaigns and prevention interventions. CVA has been identified as a key partner to help build trust and break down resistance to vaccine especially in Luanda and surrounding provinces.

6 P a g e 6 Risk Assessment The risk of further spread of the virus within Angola is highly likely. Current planned surge support from WHO and partners to the provinces will support the need for improved rapid detection and response but this will be impacted by the availability of vaccine in a timely manner. Further exacerbating the risk is the ongoing exportation of cases and concurrent outbreaks in surrounding countries. The table below indicates the current global pictures of Yellow Fever as of 23/06/6 Total Confirmed, probable and suspected cases of yellow fever Total confirmed and suspected deaths from yellow fever Angola 3, DRC,06 75 Uganda* 68 6 Brazil * Peru * 56 3 IMPORTED CASES ONLY China 0 Kenya 2 Congo 88 0 N.B. This is not epidemiological data linked to Angola. Data is collated from WHO strategic Framework and Sit Reps. The table below indicates the best and worst case scenarios given the current surveillance data and availability of vaccine. Scenario Plan Best Case Most Likely Worst Case Further Spread in Angola The current surge support to the provinces by WHO and other partners improves surveillance and early detection of cases. The current dry season decreases vector density and current vaccination plans control local transmission. The outbreak is controlled in 8 to 2 weeks. The public health system is able to meet the demands of other health needs. The current surge of technical support to the provinces helps identify undetected areas of current transmission. Rapid vaccination of areas of local transmission and surrounding areas is able to occur immediately. Ongoing limited exportation occurs. Vaccination supply is able to meet demand with minimal delays. Social mobilization is effective and able to support coverage. The public health system is impacted by the outbreak and decreasing financial means and overall health outcomes including EPI are impacted. Ongoing local transmission occurs in multiple districts including continued exportation. Limited vaccine supply is unable to meet demand. The public health system is severely impacted and other outbreaks of vaccine-preventable and sanitation-related outbreaks occur. Vaccine supply is unable to meet demand and resistance against vaccination increases, limiting coverage and creating vulnerable pockets of population until the rainy season returns. Further Regional Spread The use of fractional dosing controls the risk in Kinshasa and Kongo districts limiting ongoing spread in DRC. Suspected outbreaks in Congo and Ethiopia are confirmed as exportation only. Improved control in Angola limits ongoing exportation and no further countries are effected by local transmission of YF. At least one other country is confirmed with local transmission. Fractional dosing allows for current vaccine supplies to meet demand in a timely manner. Humanitarian response is able to meet demand for response. Surveillance is able to detect the majority of cases early. Continued exportation of cases from Angola leads to more than three countries being infected with local transmission. The demand exceeds even that of fractional dosing supply and ongoing YF transmission occurs for a prolonged period of time. Global Spread All documented border crossings occur with a legitimate YF card stopping any further exportation of If exportation of cases occur they are quickly identified and local transmission does not Exportation of cases occur to country with a naïve population and the right vector control to support local transmission. Local

7 P a g e 7 cases by air travel. occur. transmission occurs in a country outside of the region, further stretching the demands on vaccine supply. In addition to expansion of the Yellow Fever crisis, the impact of economic down turn and El Nino could impact the overall health system leading to potential concurrent health crises for non-yf related illnesses. Ongoing assessment of the health system capacity to respond to non YF conditions is required and should be monitored closely. B. Operational strategy and plan Objectives:. The spread of Yellow Fever is stopped and morbidity and mortality from YF are reduced through collaborative efforts of all partners, with the CVA/IFRC providing support in three key areas: Community engagement through social mobilization and / or health promotion (particularly for vaccination campaigns); Community-based Disease Surveillance (CBDS); Vector Control / Environmental Sanitation. These are activities requiring community-based work where the NS can provide the greatest added value through its volunteer network. 2. The National Society is strengthened in its ability to respond to further disasters/epidemics and/or deterioration of health systems due to economic downturn, through provision of organizational development and capacity-building activities. The target population is the individuals in zones targeted for vaccination campaigns and those who are at risk of further spread. Based on the current vaccination plan from the Incident Management Team, the CVA would support 50% of the population targeted for vaccination in these areas, approximately 4 million people, plus an additional 5 million people indirectly through social mobilization. Assumptions: Vaccination and case-management for Yellow Fever are being carried out by other partners. Sufficient doses of YF Vaccine are available. Strategy: The key programs necessary to stop a Yellow Fever epidemic from occurring and reduce YF-related morbidity and mortality include: Vaccination Case Management Community engagement through Social Mobilization and/or Health promotion Community-based Disease Surveillance (CBDS) Vector Control/Environmental Sanitation Coverage of these strategies in the Angola YF outbreak will be assured by different partners in a coordinated manner. The CVA will concentrate its efforts on the last 3 strategies: Community engagement, in particular social mobilization to support the vaccination campaign; Community-based Disease Surveillance, and Vector Control/Environmental Sanitation, focusing activities at the community level through its volunteer network. Control spread of Yellow Fever. Community engagement: Social Mobilization and Health Promotion.. Social mobilization for Yellow Fever: A fixed social mobilization campaign is not ideal in an epidemic such as Yellow Fever, as the call-to-action messages need to change temporally and geographically, according to the phase of the epidemic currently ongoing in a particular district (see Figure 3). In the pre-epidemic phase (Phase I), where no suspected YF cases have yet been detected, messages can be focused on prevention of vector-borne diseases through vector control and personal protection, through use of mosquito repellent and bed nets. As the first suspected cases are reported (Phase II), messages can switch to how to identify YF symptoms and what to do if symptoms appear. As cases are confirmed and a vaccination

8 P a g e 8 campaign is planned and implemented (Phase III) messages focus on mobilizing individuals to get vaccinated. When the number of cases decreases (Phase IV), the messages can switch back again to broader prevention of vector borne diseases. By applying this flexible social mobilization strategy, the NS can ensure that the needs of the most vulnerable/at risk/affected populations are met. It also facilitates the task of conducing risk assessments and analysis by providing a responsive strategy as the needs change overtime and new geographical areas require support. Figure 4. Phases of the epidemic The highest priority of the Social Mobilization activities will be to ensure high coverage of vaccination campaigns by working in concert with the vaccination activities being carried out by the MoH with WHO support. The strategy proposed takes into account this moving target and introduces the flexibility necessary to ensure the social mobilization activities can follow the vaccination campaigns as they move to new districts. According to the vaccination plan recently released, 8. million vaccine doses will become available in upcoming weeks. Districts targeted for preventative vaccination using these doses have been agreed upon, based on risk assessment and modelling of spread. The districts have been prioritized into four phases a (red), b (pink), 2 (yellow) and 3 (green) (See Figure 3). Community engagement activities will sync with this vaccination plan, as follows: Vaccination phase Community engagement activities Epidemic phase (fig. 4 above) a Social mobilization in support of vaccination Phase III b Social mobilization in support of vaccination Phase III 2 Prepare population for vaccination campaign, YF signs and Phase II symptoms, prevention of mosquito bites (personal protection and clean-up of breeding sites) 3 Prepare population for vaccination campaign, YF signs and Phase II symptoms, prevention of mosquito bites (personal protection and clean-up of breeding sites) Other districts (Districts already vaccinated or not targeted for vaccination) Health promotion, prevention of vector borne diseases Phase I or IV As soon as the vaccination campaigns moves to districts in Phases 2 and 3, the community engagement activities will change accordingly to support vaccination coverage. As the data currently stands, it is projected that the vaccinations will roll out as per the map below:

9 P a g e 9 Social mobilization planning and coordination - The CVA, with support from the RDRT and international delegates, as required, will work in close collaboration with the Directorate of Social Mobilization at the Ministry of Health, as well as provincial and municipal health authorities to elaborate macro and micro-plans for social mobilization...2 Health Promotion for Vector-borne Diseases and Malnutrition As the YF cases decrease in particular provinces, community engagement will switch from short term Social mobilization to longer term Health Promotion activities to promote sustained behavioural change that helps prevent vector-borne diseases. The messages and activities will be adjusted accordingly. In addition, there are concerns over increasing acute and chronic malnutrition in 3 Southern Provinces (Cunene, Huila and Namibe), derived from recent droughts and flooding. In these 3provinces, health promotion for malnutrition prevention will be incorporated..2 Community-Based Disease Surveillance (CBDS) Volunteers will be trained in CBDS, allowing them to support early detection of suspected YF cases at the community level. A partnership with the CDC is envisaged to carry out this work, in order to provide an early response to reports by volunteers of suspected YF cases. A CDC team will be alerted of reports and sent out to investigate. The Yellow Fever epidemic is straining an already weak health care system; there is concern that other diseases, in particular infectious diseases with epidemic potential, may flare up. Thus, volunteers will also be trained to detect and report suspected measles and cholera cases as well as unusual events, to allow for early detection and response to other health threats. CBDS reporting will be done through SMS and phones and phone credit will be provided to the volunteers. Monitoring and supervision activities will be set up. Meetings with community leaders and community members to explain and discuss the importance of CBDS will be set up prior to commencement of activities, to ensure participation and support for volunteers. Care will be taken to

10 P a g e 0 report back to the community the outcomes of any suspected cases that were reported and next steps (e.g. upcoming vaccination campaigns), if appropriate. These activities are based on the assumption that there will be continued spread of YF to new districts in areas that have not as yet been vaccinated..3 Vector Control (VC) and Environmental Sanitation (ES) Volunteers will be trained in VC and ES to provide key health information messages to prevent mosquito, and other vector-borne diseases and support communities with clean-up activities. The latest epidemiological data reported by WHO show a high number of suspected YF cases that have been screened as negative for Yellow Fever, suggesting the increased surveillance is bringing to light other febrile illnesses in the communities. Malaria co-infection has also been reported in 30-50% of YF cases. Dengue and Chikungunya are also present in the country and spread by the same mosquito species that spreads Yellow Fever. Leptospirosis has also been evoked as potentially responsible for these non-yf febrile cases, particularly in view of the poor sanitation and waste accumulation in many areas. In this scenario, VC and ES activities are important to support the decrease not only of YF cases, but of other vector-borne illnesses. Vector Control and Environmental Sanitation activities taken up by volunteers will include providing information to households and at community gatherings, on the importance of personal protection, indoor spraying, clean-up and draining of potential mosquito-breeding sites and bed net use. The CVA will also work with the communities and the authorities (MoH and Ministry of Environment) to advocate for clean-up activities. Volunteers can participate in one-off cleaning activities with the communities, and support for ongoing clean-up will require the engagement of the municipal authorities. Additionally, monitoring of breeding sites can also be carried out by trained volunteers using a phone and GPS. Volunteers are trained to recognize mosquito larvae in water reservoirs in the communities and locate these. Information is collated, and can be used to adapt the response to include other VC activities such as use of larvicides. Beneficiary and community engagement and accountability: Community engagement will be central to the response strategy proposed by the CVA: Volunteers engaging in door to door social mobilization have been and will be collecting information about beliefs surrounding yellow fever, challenges encountered by beneficiaries for prevention and protection against the disease (e.g. not owning mosquito bed nets), as well as attitudes towards vaccination. A KAP survey is also envisaged to strengthen the findings reported by volunteers. Two-way communication with communities and beneficiaries will also be established through the YF IEC radio programs, where individuals will be able to ask questions through social media (Facebook) and to the radio, which will turn them over to the CVA to be answered in the upcoming program. Information collected from the beneficiaries through these means will allow adaptation of the health messages being provided to ensure pertinence and impact. Meetings will be set up with community leaders before launching the activities to ensure understanding of the program and its importance for individual and community health, as well as clarify any concerns and doubts the community may have regarding the volunteers activities. Community engagement will be key to ensure volunteers are alerted of any suspected YF case or other unusual event. Gender issues: The epidemic is affecting 70% men, and men are also the group more resistant to vaccination. Vaccination campaigns have been carried out from 9 am to 5 pm, hours at which many men are at work, further affecting the availability of vaccination for men. Additionally, migration of men working in mining operations and moving through different areas is playing a role in spreading of the disease. Vaccination campaigns are being adapted to facilitate vaccination for men. Social mobilization activities will be adapted to take into account these issues as well, in particular by addressing the barriers and resistance reported by men concerning vaccination. 2 NS Capacity Building Given the CVA s key role in supporting Angola s weak and strained health structures and the high probability that the NS will play a key role in responding to future epidemics and/or disasters, it is advisable that the CVA s operational capacity be supported so that they are better equipped to respond promptly and efficiently. The CVA has prioritized the 3 following problem areas which, if resolved, would increase their operational capacity. 2. Infrastructure

11 P a g e 2.. Flooding mitigation measures: The grounds upon which the building in which the CVA HQ is located approximately meter lower than neighboring buildings and the street which runs in front. During the rainy season the entire grounds are submerged by a large lake with a depth of 2 feet to over a meter, depending on the intensity of the rain. Accordingly, the entire ground floor of the building has been abandoned, and all activity currently takes place on the first floor of the building. Additionally, vehicles parked in front of the building (awaiting repair) were swamped by the collected rain water during the last rainy season which caused various damages to CVA vehicles. Accordingly, it is proposed that local engineers be contracted to provide the CVA with proposals on how to facilitate the drainage of collected rain water, and that the works detailed in the successful proposal be implemented Painting: these waters have damaged the painting on the building. For a relatively small sum, a fresh coat of paint would give the building a much more professional appearance for all the visitors to the CVA, and would boost CVA HQ staff morale considerably Internet connectivity: Currently, the wireless internet in the CVA building is not working. The few USB internet dongles that the CVA do have provide limited, slow, and inconsistent service; this impedes the efficacy with which CVA HQ staff are able to carry out their work. Therefore, this plan proposes a) that an IT technician be contracted to rehabilitate and/or replace the existing nonfunctioning Wi-Fi system at CVA HQ; and b) that the IFRC cover all connectivity charges over the course of these emergency operations. 2.2 Logistics 2.2. Transport: Currently, 2 of the CVA s Land Cruisers (troop carrier, Prado) require spare parts and maintenance to get them back up and running well. This plan proposes to provide the funds to repair and maintain these 2 vehicles. This will facilitate not only the implementation of YF programs, it will better enable the CVA to respond to future emergencies. Operational support services Human resources HR planning table Position Title Sector Area Time (months) Specific roles, responsibilities, tasks Operations Coordinator Operations 6 Coordination of all aspects of operations Public Health delegate with background in HP Health 6 Provide technical support to CVA staff and volunteers Expert in Hygiene Promotion and Behavioural Change Health 3 visits x 0 days per visit Develop materials and train staff and volunteers on YF-specific social mobilization and HP practices Logistics and supply chain Movements of the Ops Coordinator and Health Delegate, both in Luanda and the field, will be initially covered via local vehicle hire. Once the CVA vehicles are repaired and maintained it is envisioned that one of these could be allocated to the IFRC team. If air transport is required, all flights will be booked on Taag airlines, as per the security protocols of the IFRC. Movement of CVA staff and volunteers to, from and within the field will be conducted via local transport. Information technologies (IT) All international delegates will bring laptops and phones provided by their deploying NS. Local sim cards will be purchased to facilitate National and International telecommunication. As CVA has limited internet access, Internet access will be provided to IFRC personnel via locally purchased USB dongles (3G). Hotels in Luanda where IFRC personnel would be based have fairly fast Wi-Fi connections. NB. For those delegates with smartphones desiring a faster connection, the local service provider UNITEL can provide 4G data coverage via their phones which can then be set up as a Wi-Fi hotspot. FACT has done this, and it seems to be the best way to enhance connectivity. Information management: IM support to the operations will be provided remotely via SIMS. Communications

12 P a g e 2 Visibility of the work of the CVA volunteers will be ensured during the operation through local media and visibility material. The CVA management team will also periodically inform the authorities and public regarding the progress of the operation. Meanwhile, IFRC will prepare a fact sheet and identify spokespersons for media interviews, and aim to provide regular updates on the operation. The CVA, with support from IFRC regional communications teams, aims to coordinate various awareness and publicity activities, to sensitize the public, media and donors on the situation on the ground and the humanitarian response. The communications activities will be used to position the National Society with the authorities and other actors as one of the principal humanitarian organization in the country meeting the needs of those affected. Activities to date include: producing facts and figures, key messages, questions and answers, press releases and web stories; and conducting media interviews with print, television, radio and on-line organizations. Planned Activities: Support the CVA in the development and maintenance of its communication / advocacy plan, working with government and other partners, to help advance the emergency operation in a manner to best meet the needs of those affected and those at risk. Deploy a communications officer to Angola for 3 months to support communications related activities, including:- hiring a consultant to produce high quality photographs with extended captions, video b-roll and interviews; holding press conferences, either in Luanda, Nairobi or Geneva as warranted and making stakeholders available; producing weekly facts and figures, key messages and reactive lines, and sharing with relevant stakeholders. Security In collaboration with the operations team, work on advocacy messages to address issues linked to the outbreak, in Angola and the region, integrating health strategies, health promotion and addressing fear and lack of information. Engage with international media regarding the added value of Red Cross interventions and facilitate media field trips to raise awareness and raise the profile of the CVA and IFRC response. Maintain a social media presence throughout the operation utilizing IFRC sites such as Facebook and Twitter. Support the launch of this appeal and other milestones throughout the operation using people-centred, community-level information (web stories, blogs, video footage and photos) and sharing these communications material through various IFRC communications channels including the Africa web page, and Security will be managed by the Operations Coordinator according to the established IFRC Security Protocols. Currently, there are no limits to movement; nor is there a curfew in place. All security risks outlined in the security plan, e.g. petty theft, traffic accidents, avoiding demonstrations or being out at night in risky areas, etc. can be managed via the common-sense risk management protocols outlined in the security plan. If the situation on the ground changes, the Operations Coordinator, in consultation with IFRC Security Focal Point in Cluster or the Secretariat, will make the necessary adjustments. Planning, monitoring, evaluation, & reporting (PMER) As PMER has been built into the programs as they are being rolled out, consult the detailed operational plan below for YF PMER details. Administration and Finance The CVA administrator and head of finance will support operations, as needed. This will take the form of assisting to arrange Visas upon Arrival for incoming delegates, as well as assisting to arrange visa extensions and/or visa renewals as needed. Funds will be provided by the IFRC regional office in Pretoria to the operations via the CVA bank account. Regular cash requests, approval of expenditures, and regular acquittal of expenses will be overseen by the Ops Coordinator. Additionally, regional IFRC DM team will continue to provide administrative and finance support to the YF operations. NB. There is a great variance between the official exchange rate and the unofficial exchange rate, which at time of the writing of this EPOA was 7,000 Kwanzas for 00 dollars at the bank rate, and 50,000 per 00 dollars at the unofficial exchange rate. All operations will necessarily be conducted at the bank rate.

13 P a g e 3 C. DETAILED OPERATIONAL PLAN Health & care Outcome Community YF disease prevention is provided to the target population through social mobilization activities Output. Coverage of YF vaccination in the target population is increased Output.2 Knowledge, understanding and behaviour to prevent, detect and reduce YF disease is increased in target population Output.3 Other potential epidemic threats enhanced by the strain caused by YF on the health system- are prevented in the target population Output.4 Yellow Fever prevention activities are delivered in Viana, Luanda (This is all existing DREF activities completed) Activities planned Month Identify and recruit volunteers Training of volunteers on social mobilization for YF Supervision of volunteers Door to door social mobilization activities Provide key health messages on YF at community meeting points (schools, markets, etc.) Provide key health messages on YF to communities through radio programmes Establish a two-way communication with communities using FB and other social media to adapt YF health messages being provided. Carry out a KAP survey to ensure messages are effective for target population Support micro-planning at municipal level Adapt key health messages for YF based on KAP survey, as well as material for training of volunteers, door to door guideline activities and data collection forms. Produce and distribute RC T-shirts and other material to volunteers and staff to improve visibility for CVA at the community level. Outcome 2 Community-based disease surveillance is provided to the target population Output 2. Early detection of suspected yellow fever cases is increased in the target population Output 2.2 Early detection of other potential epidemic diseases (e.g. measles) is increased in the target population Activities planned Month Identify and recruit volunteers Training or volunteers Supervision of volunteers Hold meetings with community members to explain CBS Work with MoH to develop Standard Operating Procedures for follow up of suspected cases

14 P a g e 4 Establish dashboard for CBS (Magpie application) Buy mobile phones and phone credits for volunteers Maintain regular meetings with partners Outcome 3 Vector control and Environmental sanitation activities are carried out in the target population Output 3. The risk of YF and other vector-borne diseases in the community are reduced in the target population through community-based vector control and improved environmental sanitation Activities planned Month Identify and recruit volunteers Training or volunteers Supervision of volunteers Collaborate with MoH and Environment Ministry in vector control and environmental sanitation activities. Provide VC and ES social mobilization messages to communities through door-to door and mass information activities Support communities to advocate for environmental clean-up with appropriate authorities Carry out community clean-up activities Buy and distribute cleaning equipment Buy and distribute safety equipment for volunteers and staff National Society capacity building Needs analysis: refer to operational strategy, point 2 Outcome 4 NS capacity to respond to current and future epidemics and disasters is enhanced Output 4. Infrastructure faults and IT capacity of NS HQ is enhanced Activities planned Month Local technical experts are consulted on the development of a viable plan to either prevent the flooding of the CVA HQ grounds, or to propose appropriate evacuation or drainage plans) (expert s proposals) Flooding prevention or mitigation plan is approved Flooding prevention or mitigation works are implemented (HQ is not flooded in rainy season) Exterior damage to CVA HQ building by flood waters and sun is corrected by painting the building (building is painted) IT technician is contracted to propose works and materials necessary to ensure Wi-Fi internet connectivity in CVA HQ (proposal/pro forma

15 P a g e 5 factura) IT works are carried out (Wi-Fi connectivity present in HQ) Output 4.2 Logistical capacity of the NS is improved Activities planned Month Toyota Prado is repaired and necessary parts installed (Prado runs) Toyota LC (troop carrier is repaired, necessary spare parts installed, interior damage repaired) (Toyota LC is operational) Budget See the budget below.

16 P a g e 6 Contact Information For further information specifically related to this operation please contact: In Angola National Society Mr. Valter Bombo Guange Quifica, Secretary General; phone: ; vgquifica@gmail.com In Southern Africa Country Cluster Support Dr Michael Charles Acting Regional Representative for Southern Africa; Pretoria; phone: ; mobile: ; michael.charles@ifrc.org In the Africa Region Farid Abdulkadir, Head of DCPRR Unit, Nairobi, Kenya; phone ; farid.aiywar@ifrc.org Rishi Ramrakha, Head of Region logistics unit; phone: ; fax ; rishi.ramrakha@ifrc.org In Geneva Cristina Estrada, Response / Recovery Lead, DCPRR; phone: ; cristina.estrada@ifrc.org For Resource Mobilization and Pledges: In Africa Region: Fidelis Kangethe, Partnerships and Resource Mobilization Coordinator; Nairobi; phone: ; fidelis.kangethe@ifrc.org Please send all pledges for funding to zonerm.africa@ifrc.org For Performance and Accountability (planning, monitoring, evaluation and reporting) In Africa Region: Robert Ondrusek, PMER Coordinator Africa, phone: ; robert.ondrusek@ifrc.org How we work All IFRC 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 the Humanitarian Charter and Minimum Standards in Humanitarian Response (Sphere) in delivering assistance to the most vulnerable. The IFRC s vision is to inspire, encourage, facilitate and promote at all times all forms of humanitarian activities by National Societies, with a view to preventing and alleviating human suffering, and thereby contributing to the maintenance and promotion of human dignity and peace in the world.

17 International Federation of Red Cross and Red Crescent Societies BUDGET DETAILS Currency: CHF ANGOLA EPIDEMIC (YELLOW FEVER) Date: 28/06/6 Activity Account Description Quantities Quantities DREF Quantities DREF 2 EPOA Unit Cost Total. Health and Care 999,486 Outcome Community YF disease prevention is provided to the target population through social mobilization 894,576 Total Output. Output.-.3 Social Mobilisation is implemented A Meetings with community leaders unit ,940 A National Level Supervior flights flight ,000 A National Level superviosors per diem days ,360 A National Level supervsior accomodation days ,000 A Province Level supervisor transport days ,300 A Province level supervisor per diem days ,000 A Provisonal supervisor communication Unit A Volunteer Training support unit ,550 A Volunteer Per Diem 54, ,000 unit ,000 A03 70 Radio programming unit ,950 A03 70 Mega Phones unit ,856 A03 70 Priniting IEC material 7, ,000 unit.25 2,250 A03 70 Priniting M and E forms, ,500 unit A Mobile cinema kit (speakers, microphone lap top, projector etc) 3 4 unit 2, ,500 A03 70 Long sleeve t-shirts for visibility 3, ,500 unit ,750 Total Output ,858 Output.4 Yellow Fever prevention activities are delivered in Viana Lunda (THIS IS ALL EXISTING DREF ACTIVITES COMPLETED) A0 667 Transportation allowances for volunteers + team leaders (50 persons x 3 days) Person A0 680 Hire of room Days A0 680 Refreshments (coffee and lunch break) Days 6.7 2,426 A0 730 Stationery Person A0 680 Hire of Conference facility for national planning meeting - all branches 2 2 days A0 593 Transport for branch mangers to national meeting 8 8 Transfer ,700 A Per diem for volunteers (45 persons x 30 days),350,350 - Person ,695 A Per diem for team leaders (5 persons x 30 days) Person ,449 A02 70 Produce IEC materials and reporting forms (A4) 2, ,000 Item ,588 A02 70 Produce IEC materials and reporting forms (A4), Item ,488 Total Output.4 60,78 Outcome 2 Community-based disease surveillance is provided to the target population 34,200 Output 2. Early detection of suspected yellow fever cases is increased in the target population A Contribution to Magpi upload credits unit,200.00,200 A Phone credit for voulnteers SMS (800 voulnteers x 2usd/month x 5 months) 4,000 4,000 unit ,000 A Community meetings for sensitisation for community survillance unit ,000 A Purchase supervisor phones 0 0 units A Supervisor phone credit units A Techcnial Support visit interntional unit 6, ,000 A02 Total Output Cross border meetings 3 3 unit 5, ,000 34,200 Outcome 3 Vector control and Environmental sanitation activities are carried out in the target population 70,70 Output 3. The risk of YF and other vector-borne diseases in the community are reduced in the target population through community-based A Contract Mentor Initiative to support training in vector control unit 0, ,000 A Purchase clean up equipment 4 4 sets ,500 A Implement door to door sentisation before clean up days 3,500 3,500 days ,500 A Implment community clean up days days ,600 A Supervision of clean up campign per diems days A03 70 Printing costs for M and E units A Mobile phones for vector survillance units 70.00,400 Total Output.3 70,70 National Society capacity building 5,500 Outcome 4 NS capacity to respond to current and future epidemics and disasters is enhanced 5,500 Output Infrastructure faults, IT and logistics capacity of NS HQ is enhanced A HQ Drainage mitigation (office maintenance) repairs 7, ,500 A HQ Painting repairs 2, ,500 A Internet at HQ, repairs and costs repairs 3, ,000 A Vehicle repairs 2 2 repairs, ,500 Total Output ,500 National Society operation support costs (where not included in sector based activities) 5,935 A Per diem for yellow fever focal point ( person x 30 days) Person A Fuel Days 3.0 4,50 A Communication Unit A Stationery 6 4 month ,500 A Program director (40% of costs) 6 6 month ,680 A Finance director ( 40% of costs) 6 6 month ,680 A Volunteer insurance 3, ,455 person.50 5,250 Total NS support costs 0 5,935 IFRC operation support costs 324,9 A Flight for RDRT (revised from SACCST monitoring) 2 - person 2, ,000 A Accommodation for RDRT days ,800 A Seconded health staff salary 6 month 3, ,000 A Accommodation for seconded health staff 6 month 3, ,000 A Per diem for RDRT days ,000 A Local travel for RDRT days A Local communication costs for RDRT (internet and airtime) days 8.32,997 A Vehicle rental for Ops Manager and Health Co days ,920 A Local communication costs for Ops Manager and Med Co (6 months x 2 people) 80 2 days ,995 A Operations Manager (6 months) 6 months 0, ,000 A Accommodation for Ops manager 6 months 3, ,000 A Health Coordinator (6 months) 6 months 0, ,000 A Accommodation for Health Coordinator 6 months 3, ,000 A Field Visit of Technical Expert (3 field visits of 0 days) 3 visits 3, ,900 A Flights of Technical Expert 3 flights 3, ,000 A Field visit security expert assessment/capacity building NS visit 5, ,000 A Communicatoin vsist for 0 days vistis 3, ,300 A Flights for communicatoins flights 2, ,000 A Finance Support - from Cluster office (50% for 6 months) 6 month 2, ,000 A SOSC - Finance Support - from Cluster office (50% for 6 months) 6 month, ,500 A Bank charges and other financial costs - Transfer 5, ,000 Total IFRC support costs 324,9 SUB TOTAL BUDGET:,355,832 Programme support: 88,29 TOTAL BUDGET:,443,96