CO-Cholera Outbreak While the epidemiological investigation already highlights that all the cases are concentrated in households within a range of lessthan 500M from the lake, Oxfam will map additional areas in Rubondo Village for preparedness actions. This will include identification of vulnerable populations and specific local risk factors, as well as a mapping of existing safe water sources, and sanitation systems. The at-risk areas will be supported with water supply/pipeline extensions, and intensified cholera focusedand community-oriented hygiene education
Water Supply Improvements:
Access to safe water supplies in adequate quantities has been identified as the key driver to the current cholera outbreak. Focus will be on increasing water availability (quality and quantity) and long sustainability of water supplies. Interventions will include.
a) Setting up of three (3) water trucking sites: Interventions will focus on establishing water trucking locations as an immediate measure in collaboration with Nsamizi – the UNHCR IP for WASH. Already three (3) trucking areas has been established by Nsamizi, with a request from UNHCR to establish three (3) additional trucking sites owing to higher demand for treated water. Each trucking location will have 10,000l plastic tank each having two (2) tap stands with four (4) faucets. The water trucking will operate for 45 days while sustainable options are being explored.
b) Construction of 100m3 clear water tank in Juru: Improving water quality of Rwabahinda Water Supply System requires iron removal before pumping to the elevated tankfor distribution. UNHCR and Oxfam has identified this to be the longer-term solution to the recurrent cholera outbreak. A budget for construction of the aerator has been secured by UNHCR, but there is a gap for a holding tank for the clarified water to complete the treatment process and increase reliability and access to good quality water for refugees.
c) Water pipeline extensions: The extensions will target areas in Rubondo village where access to safe water supply is still low. 2kms of pipeline extension plus four (4) tap stands is planned from the existing Juru/Kyanashana water supply scheme. Management of the water points will finally be integrated into the overall governance model for Nakivale (government utility model)
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d) Water treatment and FRC monitoring: This will include chlorination and FRC monitoring both at household and communal tap stand level. Water treatment attendants will be engaged who will closely monitor FRC levels at the trucking sites and communal tap stands daily. At household level the attendants will work closely with village health teams (VHTs) in FRC monitoring. The aim will be to ensure not less than 1mg/l residual chlorine at communal tap stands and 0.5mg/l athousehold level
Hygiene/health promotion and Sanitation
The ongoing COVID 19 risk communication will be enhanced with Implementation. of Cholera focused hygiene promotion (reinforced messages about safe drinking water, hygiene, and sanitation), risk communication and social mobilisation strategies with strong focus on community engagement. Oxfam will undertake mass cholera vaccination sensitization campaigns in close coordination with MTI, Nsamizi and Isingiro District Local Governmental to increase vaccine uptake. Village Health Team Structure (VHT) will be utilised for risk communication, household level water quality monitoring, community-based surveillance as well as in providing referrals so that sick gets medical attention as soon as possible. Use of VHT is also in line with sustainability strategy and linkages with government systems/structures.
Specific activities will include.
a) Based on identified hotspots and risk factors, development, translation, printing and disseminating cholera focused IEC materialswill be done in close collaboration with MoH, DLG of Isingiro, Nsamizi. IEC materials will be context specific, and will focus on prevention by the community and reducing the severity of the outbreak. Identification of the hotspots will be done jointly with the communities leaders, VHTs and Oxfam Public Health Team. Dissemination of developed IEC materials will be through public posters (water points, markets. Notice boards), billboards, , community meetings, radio talk shows and spot messaging and boda boda talk talk. The project will continue to strengthen and/ or link established referral pathways to existing UNHCR Interagency Feedback, Referral and Resolution Mechanism (FRRM).
b) Cholera prevention awareness and sensitization campaigns: This will include enhancing communication on cholera control strategies, hygiene promotion, and cholera risk. The activity will aim to ensure every person is correctly informed about the basic facts on cholera and adopts the appropriate behaviours to prevent infection and the spread. Due to the COVID-19related restrictions, Oxfam will employ; 1) boda boda talk talk playing pre-recorded messages (jointly developed by MoH, and WASH and Health Partners) in public places e.g. markets etc, 2) radio talk shows and spot messaging, 3) door-to-door campaigns by VHTs, 4)During Religious meetings (churches and Mosques) and during social mobilization and dialogue meetings. The campaigns will focus on the importance of drinking chlorinated/treated water, safe excreta disposal, safe water chain, handwashing and home-based oral rehydration and referrals. The campaigns will also dispel/counter rumours and false stories on causes of cholera and treatment.
c) Procurement and Installation of bulk handwashing facilities at health centres, marketplaces and Reception centre. This will be accompaniedby intensive hand hygiene campaigns to promote handwashing practice at public places and institutions.
d) Purchase and distributionof PPEs (Face masks, sanitizers, reflector jackets and overcoats) to VHTs to enable deliver on their roles effectively.
e) Purchaseand distribution of latrine cleaning kits including hard brushes, metallic buckets, rubber squeezers and detergents to enhance operation and maintaince of sanitary facilities at the reception centre and health facilities within the settlement.
f) Purchase and distribution of soap for personal hygiene for 5,000 high risk and vulnerable refugees in the settlement. This will enhance personal / hand hygiene practice to enhance infection prevention and control measures within the settlement. Each vulnerable refugee will receive 500g (two months soap supply) over the project period.
g) Construction of emergency communal latrines and bathing shelter for new refugees being relocated from Nyakabande transit centre in Kisoro (UNHCR has already confirmed Nakivale and Oruchinga settlements asthe next destination for the new refugees)
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h) The project will engage 40 VHTs for 4 months to undertake community engagement, mobilization and risk communication on cholera prevention and hygiene promotion, record keeping, reporting and documentation. These will be facilitated with 52,000 per person per month for 2 months. The project will as well as support 40 VHTs with 5,000 airtime per person per months for a period of 2 months, this will enhance communication, community surveillance and timely reporting.
i) Community engagement dialogues will be held twice in a month to document feedback and inform improvements in approaches (helping people define hot spots and practical mitigation measures)