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Democratic Republic of the Congo: Population Movement, phase 1: community health response Emergency Appeal n° MDRCD023 - Emergency Plan of Action Operation Update n° 1

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Summary of major revisions made to emergency plan of action:

To date, the DRC RC has nearly completed its target of sensitization communities at risk of the cholera infection as describe in the first phase of the appeal that focuses on the essential epidemiological health and WATSAN needs. This start includes fundamental capacity building of newly formed territorial chapters and a volunteer base that is accustomed to basic lifesaving response activities. The successful growing of skills and support set up and knowledge of the evolving situation on the communities will permit the eventual expansion of the response into its second phase to address needs in Helath, nutrition and livelihood and eventual a potential third phase that would see the geographic expansion of the familiar activities.

In the EPoA published on December 22, 2017, the intervention area is broadly defined as the Lomami province, which is divided into 21 health zones with a total population of 2,443,000. After evaluating the epidemiological situation, it was decided that the response will not specifically target displaced, returnees and host families but instead those communities in the cholera affected areas (or at risk of being affected). Using official Ministry of Health epidemiology data and in collaborations with the health authorities in Lomami province, the DRC RC and IFRC proposed that the first phase of the EA to focus on reducing the risk of cholera in five health zones; Kabinda, Kalambayi, Kamiji, Kanda-Kanda and Ngandajika (total population 1,173,055).

At the time, Ngandajika was the only of the 5 zones with confirmed cholera deaths and the highest confirmed cases reported. Having an active presence in the zones has allowed the teams to focus the sensitization where the cases are still emerging, considering the existing government capacity to deliver sensitization as well as avoid duplication with other organisations doing similar work. Their reports will allow the DRC RC to proactively respond to cases with intensified campaigns as well as disinfection work.

The timing of response activities of the first phase is divided into two parts and has had activities revised and added;

First month:

Sensitization for the reduction of risks of contracting cholera, identifying new cases and reference to medical aid through house-by-house visits by 192 trained volunteers and 19 team leaders to reach 244,300 individuals in all 5 priority health zones. Train and supply materials and equipment for safe burials and household disinfection for suspected cases. Ensure the protection of volunteers (orientations, insurance, protection equipment, etc.)

Subsequent 7 months: In week 6 of 2018 the Ministry of Health warned of an increase in cholera cases, with 79% originating in the Grand Kasai region. This region includes the Lomami province where the Ngandajika health zone reported18 confirmed cases in week six and a total of 9 deaths this year. Given this epidemiological development, not all activities will need to be implemented in all of the five health zones and still require further evaluation to select the areas where. Therefore, the second phase will consist of two blocks of activities:

(i) Focus on disease surveillance in 4 Health Zones with very low caseloads. Minimum community based monitoring in case of a flare, and a gradual exit strategy with capacity building for the territorial branches. Activities will focus on:

• Surveillance and active case search: Training of 150 volunteers in Module 6 of the CBHFA training cycle in all 5 priority health zones. Use the training to highlight gender inclusion in the activities.

• In the 5 health zones, train focal points and supply them with materials and safety equipment to carry out household disinfection of cholera cases and safe and dignified burials. These focal points will be working in close collaboration with the local health authorities.

• Training of WATSAN focal points with the PHAST tool in the 15 territorial branches. This will ensure future capacity to report on needs and initate community based WATSAN activities.

• Liaising with other implementers in the health zones to discuss if RC volunteers could be used as agents in their program implementation (Save the Children is currently conducting an evaluation)

• Discussion with other RC Movement partners to evaluate possibility of bilateral program implementation

(ii) Concentrate risk reduction activities in the most affected Health Areas within the Ngandajika Health Zone. One hundred volunteers and 5 supervisors deliver intensified sensitization to 45,000 persons and WATSAN support to 1,500 households in most affected areas using vulnerability as selection criteria;

• WATSAN baseline and Household vulnerability assessment of 7,500 households

• Establish three chlorination points in the three most affected « health areas »in the health zone of Ngandajika

• Train population of targeted communities on safe water storage/household water treatment and safe use of chlorine tablets (aqua tab).

• Distribute up to 3000 covered containers (jerry cans) for transporting and storing drinking water at the household and soap bars to 1500 vulnerable HH.

• Distribute up to 2,065,500 chlorine tablets (aqua tab) for household water treatment, sufficient for 90 days, to 45,000 people.

(iii) Following an evaluation that will consider the impacts the displaced and returning families on their host communities, select areas to assists with structural WATSAN improvements. Concentrate risk reduction activities in the most affected Health Areas within the Ngandajika Health Zone. One hundred

• Provide safe water to the higher risk schools, market places and health centres by constructing 10 boreholes

• Monitor treatment, use and storage of water through household surveys and household water quality tests.

• Construct up to 10 latrines in public spaces such as schools, markets or health centres. Each latrine will consist of 4 blocks of 5 doors.

• Roll out PHAST (Participatory activity) to promote the construction and proper maintenance along with forming a sustainable promotion structure in the community by training of committees. Provision of essential consumables for maintenance and incentives to ensure most vulnerable can build latrines.

• Hygiene promotion activities in public spaces and at household level,

• Proposed BOCAC evaluation to help guide the capacity building of existing and newly established Territorial National Society chapters. Specific trainings to ensure basic capacity for WATSAN and disease surveillance activities across the province with minimum rehabilitation of NS Provincial offices and provision of basic IT equipment to ensure effective support to the activities and timely reporting by the National Society The funding coverage reached around 40% of the total budget. Efforts are being made to mobilize resources to the Emergency Appeal operation. A partners conference call with partner National Societies (pNSs) was held on 9 March 2018 to update on implementation and request for additional support. Following the partners call, bilateral discussion with partners are taking place exploring windows for new or supplementary contribution.

The EPoA budget was reduced from CHF 1,996,294 to CHF 1,784,251.