6E – Suggested logical framework for cholera preparedness and response Goal: To reduce the spread and limit mortality from cholera through an integrated approach CO-ORDINATION, INSTITUTIONAL FRAMEWORK, INFORMATION MANAGEMENT Objective: To improve leadership and coordination of cholera preparedness and response, ensuring a cholera risk reduction focus and including all related sectors, levels and stakeholders/partners. Expected result: Effective coordination mechanisms are established and provide guidance for all sectors and stakeholders/partners on common approaches and standards for cholera preparedness and response, ensure all gaps and vulnerabilities are covered without duplication. Outcome Suggested indicators Suggested activities Reference (in the toolkit) Multi-sectoral coordination framework for cholera preparedness and response (including taskforce and technical working groups, coordination structures) is established and functional Terms of reference for the cholera taskforce with defined coordination arrangements and structures including technical (sub) working groups and sub-national coordination platforms with clear functions, roles and responsibilities # and % of meetings held by the multi-sectoral national taskforce per identified time period (daily or weekly during an outbreak, quarterly periods) # and % of meetings held by the sub-national taskforces or weekly during an outbreak, quarterly inter-outbreak periods) # and % of cross border coordination meetings held (daily or weekly during an outbreak, quarterly inter-outbreak periods) Who does what where matrix document Establish a cholera taskforce (or similar overall coordination mechanism) at national level, integrating all related sectors and stakeholders. Support coordination functions and regular meetings (to analyse epidemiologic data, conduct risk assessments, preparedness and response planning, reporting, information management, definition of technical standards, resource gap analysis and mobilization, etc.). Identify and define technical (sub) working groups (i.e. surveillance, case management, WASH, community mobilization) as necessary for coordinating cholera preparedness and response activities. Identify and define coordination structures and at sub-national level, and promote their engagement into national activities. Set up cross-border coordination mechanisms among Ministries of Health and/or responsible authorities/stakeholders at local level. Develop a who does what where and when (4W) document and keep it updated on a regular basis. Chapter 5 Annex 5A outbreak
Outcome Suggested indicators Suggested activities Reference (in the toolkit) People access and use safe water supply for all purposes but specially for drinking and cooking % of people accessing and using safe water (from chlorinated sources/by using household water treatment methods) for drinking and other purposes. % of samples from water sources reporting more than 0.5 mg/l of FRC % of people treating water for drinking at household level and having a FRC of 0.2 mg/l. % of people recognising/indicating household water treatment and storage practices in FGD/household interviews and observation. [Especially in high risk area and when there is indication of contamination of the water source] repair/ improve water points and undertake shock/emergency chlorination before they reinitiate their operation. Undertake bucket chlorination in centralised water points (boreholes, wells, hand pumps). [In areas where water supply systems are not available] Provide safe drinking water through water trucking, centralised treatment and distribution, etc. Train water vendors in safe water production and handling and in certain contexts in point of use/ household water treatment and [as appropriate] provide the required supplies for undertaking it. Distribute supplies for household water treatment [including water containers, as per necessary]. Monitor water quality at water distribution points and household level; and undertake follow up actions when problems are reported. Chapter 9 Households, communities, institutions and food outlets practice safe food hygiene and follow national food safety standards (when existent) % of inspections on institutions/outlets reporting good hygiene conditions % of people recognising/indicating safe food hygiene practices in FGD/household interviews. Train food providers on environmental health and food safety. Communicate and undertake community mobilization to promote safe food practices among households. Conduct regular inspections on institutions and food outlets to monitor Chapter 9 Infants are given safe fluids and food % of children under 6 months being exclusively breastfed % of mothers using safe water in food production when they introduce solid food to infants -Provide health and hygiene education messages into all interventions at the community and facility level on how to ensure safe infant and young child feeding Chapter 7 and 9
Establishment of a network of prepared Cholera Treatment Centres including ORP’s # of CTC/CTU and ORP per population according to the national standards Map of all health facilities that have standards to be a treatment center Document outlining resource needs for treatment facilities including materials for a stockpile of supplies Warehouse supply list for stockpile Identify and map health facilities and partners with capacity to run cholera treatment centres. Establish standards for setting up CTC/CTU’s and ORPs Identify and train partners on how to establish treatment centers and monitor quality Identify resource needs for the facilities including trained staff, supplies, data collection materials, oversight and funding Stockpile heath, WASH and communications supplies and materials for use in high risk areas Establish a database mapping all trainings completed by trainees and trainers for cholera Establish a referral system Chpater and annexes 8 Children and adults who have AWD/cholera are effectively managed at treatment centers with quality services # and % of health staff trained on case management protocols # and % of treatment facilities that have standard treatment guidelines available % no stockouts of supplies including ORS, zinc, IVF, antibiotics according to level of care) in CTC’s or other treatment facilities # and % of treatment facilities that have monitored quality of services in the last month (using CTC/CTU evaluation form) CFR for each treatment center Identify and train/refresh health staff including community health workers on early detection/active case finding, case management, infection control (see section above) in facilities and managing and reporting data Distribute standard treatment guidelines for health at all levels Provide health, WASH and communications supplies on a regular basis Supervise health staff providing treatment on a routine basis Monitor the quality of treatment centres on a regular basis Integrate management of cholera into standard training for diarrhoea including IMCI and Integrated Community Case Management (iCCM) Chapter 8 Annex 8H
Cases in the community are detected early and adequately managed and referred % of patients presenting at the health facility within 24h of developing symptoms # and % of community-based health works trained # trained community-based health workers/500 population % stockouts of health worker supplies % of caregivers recognising/indicating why and how to access/use ORS, breastfeeding, proper feeding, care seeking, through FGD or household interviews. Identify and train community-based health workers in detection, community-based surveillance, case management, hygiene and health promotion and reporting Disseminate guidelines and standards to community-based health workers Provide materials such as ORS, zinc, aquatabs, IEC materials to community-based health workers Establish ORP at community level and the associated supply chain. Especially in high risk distribute ORS at household level and disseminate information on how to access them at community level. Identify suitable home-made rehydration fluids and define – with the responsible health authorities –endorsement/support for their use. Undertake communication and community mobilization activities for early detection of dehydration, rehydration at household level (using ORS or another government- supported rehydration fluid) and early care seeking for treatment. Set up case referral systems and train/provide information to community health workers on location of cholera treatment centres. Chapter 9 Population at risk is effectively vaccinated against cholera % coverage of target population with 2 doses of oral cholera vaccine (OCV) Undertake risk assessment to inform on areas and population at risk and targeted for vaccination Prepare a strategy for OCV use for target populations with all stakeholders Procure OCVs from UNICEF supply division Conduct a communications campaign for OCV with other key messages such as health, hygiene and sanitation. Develop and carry out a vaccination campaign Evaluate and document campaign results including coverage, acceptance and impact Chapter 4 4A