Ebola virus disease preparedness/Progress Report - WHO | World … · simulations including table top exercises, skill drills, functional exercises and a manual for exercise development.

Ebola virus disease

preparedness Progress Report

October 2014 – June 2015

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Table of Contents

I. Background and Introduction ............................................................................................................. - 4 -

II. Why Ebola Preparedness? .................................................................................................................. - 5 -

III. WHO’s strategy to accelerate Ebola preparedness .......................................................................... - 6 -

a) Development of tools and guidance ................................................................................................ - 6 -

Ebola virus disease Preparedness Checklist ....................................................................................... - 6 -

Simulations and exercises................................................................................................................... - 7 -

b) Direct country support ................................................................................................................. - 7 -

Global EVD preparedness activities ................................................................................................... - 7 -

Multi-partner Preparedness Strengthening Missions in priority countries in the African region ...... - 9 -

c) Strengthening WHO’s human resources for Ebola preparedness ................................................... - 9 -

A Global Preparedness Strengthening Team ...................................................................................... - 9 -

Country EVD Preparedness Officers................................................................................................ - 10 -

d) Provision of supplies and equipment for Ebola ......................................................................... - 11 -

e) Monitoring implementation ........................................................................................................... - 11 -

IV. Follow-up support from WHO to priority countries ..................................................................... - 13 -

a) Initial findings and baseline assessments ...................................................................................... - 13 -

b) Follow-up PST country visits .................................................................................................... - 15 -

c) Ongoing and targeted technical assistance .................................................................................... - 15 -

V. Overall Progress ............................................................................................................................... - 19 -

VI. Current priorities and future directions ......................................................................................... - 21 -

a) Demonstrating system functionality through simulation exercises ............................................... - 21 -

b) Longer term plans for preparedness strengthening .................................................................... - 21 -

Building strong partnerships to ensure sustainability ....................................................................... - 21 -

VIII. Acknowledgements .................................................................................................................... - 22 -

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I. Background and Introduction The unprecedented Ebola virus disease (EVD) outbreak in West Africa has again illustrated the need for countries to promptly detect and respond to public health emergencies. It requires all countries to intensify implementation of the International Health Regulations (IHR) (2005) core capacities and actively undertake health system strengthening. All countries in the world are at some risk of EVD introduction. Once introduced to a new country, the likelihood of its spread depends on the overall strength of the health system and the level of preparedness to detect, respond to and manage the outbreak. From 8 to 10 October 2014, WHO convened a meeting of international partners in Brazzaville, Republic of Congo, to further intensify, harmonize and coordinate efforts to support currently unaffected countries to be as prepared as possible to detect and safely contain an introduction of EVD. During the Brazzaville consultation, WHO and partners identified four groups of countries, based on factors to facilitate the most targeted and effective implementation of preparedness actions. The factors included: (i) the proximity to countries with widespread and intense transmission; (ii) transport, travel and trade routes to and from affected countries; (iii) the relative strength of health systems; and, (iv) ongoing humanitarian crises or other emergencies. The four groups of prioritized countries are:

Priority 1: Guinea-Bissau, Mali, Senegal and Côte d’Ivoire.

Priority 2: Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, Gambia, Ghana, Mauritania, Nigeria, South Sudan and Togo.

Priority 3: All other countries on the African continent.

Priority 4: Countries in other regions. WHO has provided support to all four groups of countries in all six WHO regions. This report focuses largely on the activities undertaken to support Priority 1 and Priority 2 countries as an integral part of the WHO Ebola Response Roadmap and the 2015 WHO Strategic Response Plan for the West African Ebola Outbreak.

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II. Why Ebola Preparedness? The immediate aim is for all countries to urgently ensure that they are operationally ready to effectively and safely detect, investigate and report potential EVD cases and to mount an effective response. The overall goal is to strengthen the implementation of the IHR and ensure that the core capacities to manage public health emergencies remain central to resilient health systems. The specific objectives of the WHO’s EVD preparedness work are to:

Provide tailored, targeted technical guidance tools and support to strengthen preparedness capacities; operationalise plans; test and improve processess and procedures through field exercises and drills; and support the implementation of

Preparedness plans, including logistics support;

Foster inter-country collaboration and networking, including cross-border communication, cooperation, and exchanges;

Provide leadership and coordinate partners to fully support one national plan and the steering role of national authorities;

Coordinate global advocacy and support to EVD preparedness, document and disseminate experiences, lessons learned and good practices, monitor progress, and evaluate outcomes.

WHO’s work in Ebola preparedness

Supported more than 150 countries across all 6 WHO regions to determine whether countries

are adequately prepared to respond to Ebola and other disease outbreaks.

Conducted 221 multi-partner deployments to 15 priority African countries since October 2014

Spent 1584 days in the field and provided dedicated assistance to 15 priority countries

between October 2014 and June 2015.

Provided dedicated support to priority countries over the next 6 months through 14 Ebola

Preparedness Officers and three subject matter experts.

Delivering contingency response and personal protective equipment to all countries on the

African continent

50% of priority countries have achieved a score of at least 50% based on the Ebola

preparedness checklist (7% in Dec 2014)

Achieved an average implementation score of 44% in priority countries based on WHO’s

Ebola Preparedness Checklist

EVD Preparedness activities in WHO’s six regions

AFRO - In the African region, a rapid assessment completed in September 2014 revealed significant

preparedness gaps across the 41 non-affected countries surveyed. On the basis of this survey, AFRO identified

the countries it considered as priority for intensified preparedness support.

EMRO - In addition to preparedness missions to 21 countries, EMRO developed and rolled out a training

course for rapid response field-training course in United Arab Emirates (10-14 May 2015), Morocco (18-22

May 2015), and Jordan (24-29 May 2015). All 22 EMRO countries were able to participate in the training and

simulations that addressed Ebola as well as other emerging risks, such as MERS coronavirus.

EURO – WHO provided technical support to Member States based on specific requests, and assisted the

establishment of bilateral contacts between countries without recognized filovirus diagnostic capacities with

the two WHO Collaborating Centre labs in the region. A Preparedness Questionnaire for EU/EEA countries

and Switzerland was implemented through restricted EC Early Warning and Response System (EWRS), and

Ebola missions and assessments was undertaken as part of other technical missions and workshops.

PAHO - Between October 2014 and March 2015, multidisciplinary technical missions (with a duration of

3 days on average) involving several partner institutions were led by the Pan American Sanitary Bureau

(PASB) in 25 countries. From this missions, PAHO highlight a number of ongoing areas for further work in

coordination, detection, isolation and response. WHO/PAHO is currently supporting national authorities in the

implementation of recommendations formulated during the in-country missions. More information can be

found here.

SEARO - Regular updates from all countries in the region are received on preparedenss status against the

WHO checklist. Country assessements and support in organising tabletop exercises has occurred in all

SEARO countries. Ongoing activities cover technical support for coordination and planning, support to

produce and disseminate guidance and SOPs, training on laboratory testing, and provision of PPEs and

supplies.

WPRO – WPRO has conducted two region-wide activities to assess and check the level of Ebola

preparedness in the Region: (1) An online survey administered to the National IHR Focal Points (NFPs) in

each Member State and 26 countries responded; (2) a regional EVD simulation exercise conducted with the

NFPs (23 countries participated), WPRO and Country Offices.

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III. WHO’s strategy to accelerate Ebola preparedness

a) Development of tools and guidance

On the basis of existing national and international preparedness efforts and building on previous work to develop core capacity requirements under the IHR, a set of tools has been developed to support countries to intensify and accelerate preparedness across eleven key components.

Ebola virus disease Preparedness Checklist

The Comprehensive Ebola Preparedness

Checklist 1 was developed with partners in October 2014. The Checklist covers the key components considered essential for country readiness, and specific tasks, resources and reference materials. Following feedback from countries and partners involved in Ebola preparedness activities, the Checklist was revised during a two day partner consultation meeting in January 2015. Revisions included minimum preparedness activities for all countries (including those outside of Africa) and additional EVD-specific activities necessary for the fourteen high-risk countries. The Checklist was also updated to reflect newly developed reference materials and progress indicators were refined for each of the key

1 http://apps.who.int/ebola/publications-and-technical-

guidelines/consolidated-ebola-virus-disease-preparedness-

checklist

Ebola Preparedness support to priority countries is provided across the following

components

1. Overall coordination: High-level committees and operational Incident Management Structures

to manage and coordinate preparedness and response activities;

2. Rapid Response Teams (RRTs): Trained and equipped RRTs to respond to alerts across the

country;

3. Public awareness and community engagement: Risk Communication plans and activities

implemented using technically correct messaging and community engagement strategies;

4. Infection Prevention and Control (IPC): Standard and additional precautions for IPC are

strengthened to establish safe working conditions;

5. Case management: Safe clinical management strategies are available for all EVD patients in

health facilities, and burials can be conducted safely and in a dignified manner;

6. Epidemiological Surveillance: A surveillance system exists to manage alerts and immediately

notify cases from across the country, including from within local communities;

7. Contact tracing: Trained contact tracing teams ready to identify and follow-up any direct

contacts with EVD cases;

8. Laboratory: Procedures and agreements to ensure safe sample collection, transport and analysis

within an appropriate laboratory nationally and internationally;

9. Points of Entry: Plans and procedures available to detect and manage EVD cases at major

borders, land-crossings, ports and airports;

10. Overall budget: Sufficient funds and mechanisms to pay high-risk workers are available to

enable early action to be taken in any location in the country;

11. Logistics: to ensure that the logistical capacities needed to implement the above listed

functional areas are in place. This includes areas related to supply chain management

and staffing required to support the response.

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components. In addition, a stand-alone component on logistics was added. Since October 2014, the EVD Checklist has been used by countries in all WHO regions to assess their level of preparedness, to identify gaps that require additional support, and to guide their efforts to strengthen alert and response capacities.

Simulations and exercises

In order to provide an evidenced-based approach to assessing levels of preparedness, WHO has developed a suite of robust simulations including table top exercises, skill drills, functional exercises and a manual for exercise development. Simulation tools are used by countries and partners to test their level of preparedness and system-wide approaches. Simulation exercises improve operational readiness for response by:

Revealing planning weaknesses and resource gaps in a controlled environment;

Improving coordination and clarify roles and responsibilities;

Developing enthusiasm, knowledge, skills, and willingness to participate in emergencies;

Gaining public recognition and trust of the emergency response system;

Testing equipment; and,

Testing operational guidelines and Standard Operating Procedures.

The suite of tools is currently being rolled out in priority countries that have reached 50% implementation of the preparedness checklist.

b) Direct country support

Global EVD preparedness activities

Significant efforts have been made in all WHO regions to strengthen Ebola preparedness. These have included regional surveys to assess country

capacity to respond to Ebola, country visits to strengthen specific components, Rapid Response Team trainings at national levels, and post-visit evaluations to monitor the implementation of recommendations made to countries. The WHO Regional Offices also have response plans with emergency operating centres and rapid response teams in place or being established. Stockpiles of essential personal protective equipment have been pre-positioned to respond to the immediate needs of countries that detect an EVD case. Some short highlights from the six WHO Regional Offices follow. Regional Office for Africa (AFRO) In the African region, a rapid assessment completed in September 2014 revealed significant preparedness gaps across the 41 non-affected countries surveyed. On the basis of this survey, AFRO identified the countries it considered as priority for intensified preparedness support. Activities in these countries are covered in this report. Regional Office for the Eastern Mediterranean (EMRO) In addition to preparedness missions to 21 countries, EMRO developed and rolled out a training course for rapid response field-training course in the United Arab Emirates (10–14 May 2015), Morocco (18–22 May 2015), and Jordan (24–29 May 2015). All 22 EMRO countries were able to participate in the training and simulations that addressed Ebola as well as other emerging risks, such as MERS coronavirus. Regional Office for Europe (EURO) WHO provided technical support to Member States based on specific requests, and assisted the establishment of bilateral contacts between countries without recognized filovirus diagnostic capacities with the two WHO Collaborating Centre labs in the region. A Preparedness Questionnaire for EU/EEA countries and Switzerland was implemented through restricted EC Early Warning and Response System (EWRS),

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and Ebola missions and assessments was undertaken as part of other technical missions and workshops. Regional Office for the Americas (PAHO) Between October 2014 and March 2015, multidisciplinary technical missions (with a duration of 3 days on average) involving several partner institutions were led by the Pan American Sanitary Bureau (PASB) in 25 countries. From this missions, PAHO highlighted a number of ongoing areas for further work in coordination, detection, isolation and response. PAHO is currently supporting national authorities in the implementation of recommendations formulated during the in-country missions. More information can be found here. Regional Office for South-East Asia (SEARO) Regular updates from all countries in the region are received on preparedenss status against the WHO Checklist. Country assessements and support in organising tabletop exercises took

place in all SEARO countries. Ongoing activities cover technical support for coordination and planning, support to produce and disseminate guidance and SOPs, training on laboratory testing, and provision of PPEs and supplies. Regional Office for the Western Pacific (WPRO) WPRO has conducted two region-wide activities to assess and check the level of Ebola preparedness in the Region: (1) An online survey administered to the National IHR Focal Points (NFPs) in each Member State and 26 countries responded; (2) a regional EVD simulation exercise conducted with the NFPs (23 countries participated), WPRO and Country Offices.

Benin Country Visit

Between 17 and 21 November 2014, a PST mission led by WHO was deployed to Benin, comprising a group of

infectious disease experts from the U.S. Centres for Disease Control and Prevention, Canada Public Health

Institute, Centre Pasteur of Lyon in France, and other partner organizations. Coincidentally, during the team’s

visit, an outbreak of Lassa viral haemorrhagic fever was detected in Tanguiéta town in Northern Benin. The team

worked closely with Benin national authorities to successfully control the outbreak using measures similar to

those used for an EVD outbreak.

The Team and the Benin Ministry of Health joined forces to initiate an EVD-type response to the Lassa fever

outbreak and worked with the hospital staff to build an isolation centre, taught them how to use personal

protective equipment (PPE) and began monitoring more than 200 people who had come in contact with Lassa

fever patients. While the experts in Tanguiéta led the response to the Lassa fever outbreak, other members of the

WHO-led team stayed in Cotonou, completing the mission they had been sent to accomplish. They assessed

Benin’s ability to safely detect, investigate and report potential Ebola cases; the Team also trained health

personnel through field visits, table-top exercises and simulation of Ebola care in a hospital environment.

The WHO-led mission to Benin highlighted the importance of preparedness and coordination at all levels – for a

rapid, systematic and effective response to any event.

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Multi-partner Preparedness Strengthening Missions in priority countries in the African region

Initial missions to priority countries were undertaken through multidisciplinary and multi-partners Preparedness Strengthening Teams (PST) between October 2014 and December 2014. The missions consisted primarily of technical meetings with Ministries of Health and WHO Country Offices, visits to the field and table top and field exercises to review National Contingency Plans and other relevant documents to assess the strengths and weaknesses. The objectives of each visit were to identify immediate steps required to become operationally ready, and to develop EVD preparedness and response plans. The PST missions provided support to the development of budgeted national operational plans, with preparedness requirements prioritized according to each country’s context and needs. Countries received technical support to identify key areas for improvement and initial capacity-building activities in priority areas (e.g., surveillance, contact tracing, infection prevention and control, case management, logistics, etc.). Countries also received assistance to mobilize immediate support in key sectors such as logistics, training, and setting up Emergency Operation Centres (EOC). A high level of country ownership and involvement of senior management and key partners at international and national levels was central to their success. The main outcomes of the PST missions included operational plans with key milestones at 30, 60 and 90 days and comprehensive reports, which contained specific recommendations for action. Since January follow-up visits have been conducted to countries to monitor progress and establish longer term technical support in targeted technical areas. These are presented in further detail in the following sections.

c) Strengthening WHO’s human resources for Ebola preparedness

A Global Preparedness Strengthening Team

A dedicated Preparedness Team to support EVD preparedness in high-risk countries for EVD was created under the EVD Roadmap. Based in WHO headquarters and working to support WHO regional offices, the role of the Team is to:

Provide tailored, targeted technical support

to strengthen EVD capacities in human

resources; operationalize plans; test and

improve procedures through field exercises

and drills, and support the implementation

of Preparedness plans with finance and

logistics;

Provide leadership and coordinate partners

to fully support one national plan in each

priority country; and,

Strengthen the implementation of the IHR

and health systems.

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Country EVD Preparedness Officers

To provide continuity at country level, EVD Preparedness Officers recruited as international WHO staff have been deployed in all high risk countries for a period of six months. Their key roles are to provide ongoing support for the implementation of national EVD plans, to increase readiness to detect and respond to a suspected or confirmed EVD case, and to coordinate partner activities in the implementation of national plans. EVD Preparedness Officers provide country support in the following areas: i. Information, planning and procedures Providing access to technical guidance and standards, develop detailed work plans for the Country Office and support the MoH in planning; advise on the establishment of emergency operations centres, and support the development of Standard Operating Procedures for incident command and field operation. ii. Partner coordination Engaging with inter-agency and health partners, coordinating activities and tracking implementation of partner activities in line with the national EVD preparedness plan. iii. Human resources and training The identification of human resource needs across all areas of the Checklist, and in the emergency operations centres, including the need for training and sharing validated training material iv. Workplan development and monitoring Ensuring the country has a costed workplan for EVD preparedness and response, and tracking funding flows towards the achievement of the national plan. As of June 2015, eleven EVD Preparedness Officers are in place (Benin, Cameroon, Côte d’Ivoire, Ethiopia, Ghana, Guinea-Bissau, Mali, Mauritania, Senegal, Gambia and Togo) and

additional three officers will begin their appointments between 1–15 July 2015.

Togo country visit

A PST mission visited Togo from 24 November

2014 to 1 December 2014, to support the country in

the implementation of its plan of prevention and

response to a possible outbreak of EVD.

The Team comprised experts from WHO Geneva,

WHO AFRO and the French Foreign Ministry and

other partners. The PST worked with key focal

points at the national level and technical and

financial partners at the country level and reviewed

key documents including national response plans,

guidelines, and technical documents.

The Team also conducted an EVD simulation

exercise, assessed and reviewed capacities based on

the EVD Preparedness Checklist, and made

recommendations.

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d) Provision of supplies and equipment for Ebola

Standard Viral Haemorrhagic Fever (VHF) Modules have been provided to all priority countries. Each module contains the minimum stocks to cater for the required equipment and staff protection needs while supporting 10 patient beds for 10 days. Each priority country has received 1, 2 or 3 Modules (500 PPE sets each) and a separate Training Module containing 50 sets of PPE. A contingency stockpile is ready and in place in Accra and Dubai for all countries in the world that may have an immediate need arising from an introduction of EVD. In distributing this equipment, priority has been given to countries on the African continent. Figure 3 shows the status of the distribution of PPE emergency stocks on the African continent.

Figure 1. Distribution of emergency PPE stocks on the African continent

e) Monitoring implementation

To track the status and progress made by countries on the components of the EVD Preparedness Checklist, WHO has developed a colour-coded dashboard. The Dashboard shows progress in the status of individual components within each component; it is green if all tasks per component have been completed, orange if 1-74% of tasks have been completed, and red if none of the tasks has been initiated. The visual representation of information allows rapid interpretation of information and better prioritization of available resources to ensure that gaps are met with the appropriate levels of WHO and partner support. The Dashboard is used to track progress made by countries over time relative to their baseline status and to prioritise preparedness activities at the country level. The dashboard is a quantitative tool, as such, it does not display complementary qualitative information publically. The three coloured states displayed are Not started, In process, and Completed. The scoring is assigned based on the weighting of individual EVD Checklist tasks, and the percentage of those that have been completed. Minimum and additional requirement scores are aggregated to provide the component scores. The overall score per country is an average of the component scores.

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Figure 2. A Snapshot of the Ebola Preparedness Dashboard, June 30, 2015

Country

Combined Preparedne

ss Coordinatio

n

Rapid Response

Teams Public

Awareness

Infection Prevention and Control

Case Manageme

nt

Safe and Dignified Burials

Epidemiological

Surveillance

Contact Tracing Laboratory

Capacities at Points of

Entry Budget Logistics

Benin 23% 63% 0% 75% 0% 0% 0% 50% 75% 25% 5% 10% 0%

Burkina Faso 56% 53% 45% 100% 50% 50% 43% 45% 50% 100% 100% 60% 28%

Cameroon 26% 50% 10% 0% 50% 13% 0% 10% 50% 100% 0% 50% 0%

CAR

4% 10% 0% 0% 0% 0% 0% 0% 0% 50% 0% 10% 0%

Cote d'Ivoire 73% 65% 100% 100% 85% 75% 60% 70% 75% 100% 70% 35% 58%

Ethiopia 53% 40% 50% 75% 70% 75% 60% 70% 25% 25% 100% 40% 0%

Ghana 32% 0% 60% 50% 50% 38% 0% 70% 50% 50% 0% 25% 0%

Guinea-Bissau 57% 75% 90% 50% 50% 100% 25% 85% 40% 100% 78% 10% 0%

Mali 84% 100% 90% 100% 100% 100% 100% 80% 75% 100% 95% 50% 35%

Mauritania 27% 43% 45% 0% 50% 50% 0% 30% 0% 75% 8% 35% 5%

Niger 34% 43% 45% 75% 15% 63% 18% 45% 0% 75% 35% 20% 15%

Senegal 67% 70% 90% 100% 35% 100% 100% 100% 0% 100% 48% 10% 88%

Gambia 59% 53% 10% 75% 80% 63% 68% 55% 40% 50% 93% 65% 60%

Togo 23% 18% 0% 0% 0% 50% 18% 50% 0% 100% 8% 50% 5%

0%

Not started 0-74%

In process >74%

Completed

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IV. Follow-up support from WHO to priority countries

a) Initial findings and baseline assessments

During the first set of PST missions, an overall assessments of the preparedness status using the EVD Preparedness Checklist showed that that the 14 countries were at different stages of completed preparedness activities. The range of overall preparedness scores registered at the close of the missions was between 3% and 50%.

Overarching findings that emerged from initial country PST missions highlighted the need for improved cross-border coordination of activities between the three affected countries and their neighbours; better coordination among partners supporting national preparedness and response plans; stronger community engagement during preparedness and response; and strengthened capacities to detect EVD cases and communicate and investigate alerts. Specifically, key findings across all the missions, highlighted the need for:

Technical and human resources, in particular harmonized guidance, standard operating procedures, and trained personnel as well as tailored technical support and coordination of local and international partners in implementing activities;

Funding support: there was an immediate need to identify funds for EVD preparedness and human resource support in all countries and a need to engage a broader range of

4% 8%

14%

3%

22%

50%

14%

27%

4%

44%

19%

11%

44%

8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline Score

Figure 3. Initial Preparedness Dashboard scores by Country

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partners to provide both technical and financial support. The donor community at the country and international levels has proactively engaged to support the budgeted 30, 60, 90 day plans.

Equipment: all countries assessed through the baseline mission were found to be in need of basic and specialized equipment and supplies, such as PPE, communication technologies, ambulances and health facility infrastructure, including the basic services, such as running water and electricity, necessary to mount an effective response.

Training: in conjunction with the need for additional human resources, the need for documentation and to exchange/share experiences and lessons learnt, and to harmonize training in-country to ensure quality control was identified.

Significant differences were observed between preparedness components, see Figure 6. On average, laboratory activities were further advanced, as were activities for public awareness, surveillance, and case management. However, preparedness scores for logistics, contact tracing, and coordination were, on average, low, with many of the required tasks not implemented. Key challenges highlighted during the initial PST missions included:

Overlapping agendas and initiatives and other ongoing priorities, which posed logistical challenges;

Issues of prioritization of EVD preparedness activities in some countries where other ongoing emergencies or programmes were considered as higher priority; and,

Concerns regarding the long-term sustainability of capacity building efforts.

18%

23%

7%

11%

23%

27%

48%

5%

34%

15%

18%

21%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Budget

Case Management

Contact Tracing

Coordination

Epidemiological Surveillance

Infection Prevention & Control

Laboratory

Logistics

Public Awareness

Rapid Response Team

Safe Burials

Travel/Point of Entry (PoE)

Figure 4. Average Component Score across priority EVD preparedness countries from initial missions

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b) Follow-up PST country visits The second phase of WHO’s support to priority countries has shifted from a mission based approach to targeted deployments to address specific activities. Using the results and plans drawn up during the initial PST country visits, WHO, in collaboration with the national authorities and partners, leveraged a pool of technical experts from WHO and partners to achieve the following key objectives :

Provide tailored, targeted technical support to strengthen EVD preparedness in across selected components;

Provide leadership and strengthen partner support to one national preparedness plan;

Build capacities through training, consultations and exercises ;

Immediately and effectively use currently committed resources;

Strengthen partner coordination at the country level; and,

Contribute to the strengthening of national core capacities under the International Health Regulations (2005) as part of the health system.

WHO and partners moved to a more tailored approach, shifting from follow-up missions to specific technical interventions aimed at maximizing support at the country level. Taking into account lessons learnt from the first round of PST missions, WHO was able to adapt its methodology to match country needs. As a result, individuals and teams deployed were able to tailor interventions to address particular gaps. Specific activities conducted during second phase technical support missions have included:

Review of alert and response systems and mechanisms in place in countries including through field visits;

Tailored and targeted training addressing all elements of EVD Preparedness Checklist including safe and dignified burials, contract tracing, clinical management, surveillance, data management, etc.;

Logistics assessments (including assessment of stock management systems, storage capacities, material available) and directed support and training in the establishment of electronic stock management and supply chain systems;

Development of Standard Operating Procedures across all alert and response activities.

Provision of specific technical advice to health authorities for the establishment of functional Ebola Treatment Centers that provide a safe working environment for healthcare workers;

Support to activity prioritization, budgeting and resource mobilization processes;

Review of the implementation status of recommendations from the first PST missions;

The development of WHO Country Office workplans for Ebola preparedness in all priority countries; and,

Facilitation of field based simulation exercises to assess and test system functionality.

c) Ongoing and targeted technical assistance

WHO is continuing to deploy experts to support national preparedness plans and will continue these activities whilst working towards sustainable capacities for the detection and response to public health events as required under the IHR (2005). International partners and networks, such as the Global Outbreak Alert and Response Network (GOARN), the International Association of National Public Health Institutes and the United States Centers for Disease Control and Prevention (CDC), have provided significant staff contributions to WHO’s preparedness activities and represent approximately half of the total deployments, see Figure 5.

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In line with the approach to providing targeted technical support to countries, the average length of stay in countries has increased over time, see Table 1. There have been a total of 236 external, CDC, WHO AFRO, and other WHO personnel deployed into 15 high-risk African countries for EVD since October 2014 for the EVD Preparedness Strengthening Team. The majority of technical experts have been supporting epidemiology, social mobilization, logistics and coordination, see Table 2.

Table 1. Number of deployments by month in days

Month Staff Deployed Total Days of Deployment Average Days Deployed by Month

October 2014 21 107 5

November 2014 87 561 6

December 2014 31 223 7

January 2015 0 0 0

February 2015 47 316 7

March 2015 16 149 9

April 2015 11 143 13

May 2015 8 85 11

June 2015 15 188 12.5

Total 236 1772

Table 2. Number of deployments by functional role

Functional Role Other WHO

WHO AFRO

CDC External Recruitment

Total

Clinical 3 3 6

Coordination 25 7 12 37

Epidemiology 6 18 24 27 73

Field Operations Management 3 3

Infection Prevention and Control 2 4 9 13

Laboratory 1 4 7 12

Logistics 6 23 27

Point of entry 1 1 2

Social Mobilization 3 6 29 36

Team Leader 9 3 12

Total 59 42 24 111 236

Other partners

47%

Other WHO 25%

WHO AFRO 18%

CDC 10%

Figure 5. Preparedness Team Deployment Source Organization

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Côte d’Ivoire follow up visit

On 30–31 January, WHO received reports of 11 confirmed EVD cases from two villages in the prefecture of

Lola, approximately 40km from the Guinea and Côte d’Ivoire border.

A WHO investigation team in Guinea was rapidly deployed to Lola prefecture and the Red Cross/UNICEF teams

were reinforced. A WHO HQ/AFRO mission was deployed on 2 February to assess the local situation in the

neighbouring areas of Côte d’Ivoire and define measures to further increase early detection capacities, and

response readiness. The goal of the mission was also to facilitate preparations for a tripartite meeting between

Guinea, Liberia and Côte d’Ivoire in Lola and to establish joint activities for information and resource sharing at

the local level. The follow-up PST arrived in Côte d’Ivoire a few days later to support the implementation of the

country plan and to strengthen cross-border initiatives. Part of the team joined the first mission in the field to

organize a pre-cross border meeting and finalize the assessment of borders.

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Guinea-Bissau follow up visit

As a consequence of the recent EVD cases in the bordering Boke prefecture (Guinea), Guinea-Bissau entered a

state of high alert.

WHO, with the support of the local Country Office, UNICEF, MSF, IFRC, IMC, CDC, INEM, IFCR, Red Cross,

IOM and DGS, immediately deployed experts for supporting the country needs in this urgent situation. A long

term support plan was established, and in the following months experts in Epidemiological Surveillance and

Community Engagement are being deployed in the two districts (Gabú and Tombali) bordering the Boke

prefecture.

The support to Guinea-Bissau will expand in the upcoming weeks, in order to address more specific needs and to

support the two newly established sub-national offices.

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V. Overall Progress

Between October 2014 and June 2015, significant and verifiable progress towards achieving the activities across all components outlined in the Preparedness Checklist has been observed, see Figure 6. Progress has been observed in the development and strengthening of Rapid Response Teams (average gain of 30%), in surveillance (average gain of 31%), and in coordination (overall gain of 38%). While progress has still been seen, logistics, safe and dignified burials, budget and infection prevention and control have shown the least overall gains. This may be explained by the existence of fewer ‘quick wins’ in these areas compared with other components, or in the actual establishment of the systems at country level. In order to respond to the different rates of progress seen across preparedness components, WHO has employed experts to provide direct and continuous support to priority countries in: (i) infection prevention and control (IPC), (ii)

coordination and simulation exercises, and, (iii) logistics. These experts are rotating between priority countries over a period of six months to provide technical guidance and mentorship to improve the transfer of sustainable skills to these high risk countries, and to increase the learning between countries. The support provided has also highlighted several substantive challenges in priority countries, most notably, the need for further long-term and significant strengthening of core public health systems and functions. In addition, further efforts are needed to work with countries to ensure that fully functioning incident management systems can staff Emergency Operations Centers (EOCs); to develop and finalize Standard Operating Procedures (SOPs), in particular for alert and response; to take stock of trainings carried out and conduct targeted training in case management, epidemiology, contact tracing, and infection prevention and control based on standard training modules; and to ensure that

4% 8%

14%

3%

22%

50%

14%

27%

4%

44%

19%

11%

44%

8%

23%

56%

26%

4%

73%

53% 59%

32%

57%

84%

27%

34%

67%

23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Overall Score

Figure 6. Overall baseline and current scores by priority country

Baseline Score June 2015 Score

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effective communication mechanisms are in place for those involved at all levels of EVD response. Since the baseline missions took place, all countries have improved their overall preparedness scores. Much work remains, though it is encouraging that the highest risk countries have shown significant progress, see Figures 6 and 7.

18%

23%

7%

11%

23%

27%

48%

5%

34%

15%

18%

21%

34%

55%

34%

49%

54%

45%

75%

21%

57%

45%

35%

46%

Budget

Case Management

Contact Tracing

Coordination

Epidemiological Surveillance

Infection Prevention &Control

Laboratory

Logistics

Public Awareness

Rapid Response Team

Safe Burials

Travel/Point of Entry (PoE)

Figure 7. Average Component scores across priority EVD preparedness countries

Avg June 2015 by Component Avg Baseline by Component

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VI. Current priorities and future directions

Over the next six months, WHO will continue to provide technical support targeted at strengthening country capacity across all components of Ebola preparedness. WHO will maintain the necessary human resources at both international and country levels in order to maintain its dedicated, and country-directed activities. WHO will continue to provide a convening function to help align international and national partners around national Ebola preparedness and response plans. WHO will continue to monitor the implementation of preparedness tasks and activities in order to encourage countries to maintain the momentum achieved and sustain the progress already made.

a) Demonstrating system functionality through simulation exercises

In addition to the ongoing provision of technical support to countries, WHO is building upon the information reported through the Dashboard by countries to demonstrate functional capacities using simulations to test alert and response systems in countries. Simulation exercises are currently being implemented in countries that have reached the threshold of an overall score of 50% or over for implementation of tasks included in the EVD Preparedness Checklist. The Dashboard scores will help the Preparedness Strengthening Team prioritize and schedule the exercises. Priority will be given to the four high risk EVD countries. Exercises have already taken place or are scheduled in Côte d’Ivoire, the Gambia, Ghana, Mali and Senegal. Exercises will be planned in the remaining priority countries until all priority countries test

their response systems at least once over the next six months.

b) Longer term plans for preparedness strengthening

The EVD outbreak and the related Ebola preparedness assessment missions demonstrated that many countries do not have adequately resilient health systems and IHR core capacities to effectively respond if confronted by EVD or other serious public health security threat. In this context, the preparedness efforts for Ebola in the high priority countries should be sustained and completed. At the same time, countries are at risk of public health threats and the current preparedness efforts should be expanded in scope so that the capacities needed to prevent, control, and respond to these risks are firmly established.

Building strong partnerships to ensure sustainability

WHO is encouraging continued cooperative work between countries, as well as partnerships between local, national, and international organizations. WHO and other partners must continue their preparedness activities and capacity building to strengthen preparedness activities for other emerging and epidemic prone diseases. With the interest shown by technical and financial partners in supporting the development of capacities globally, there is a greater need for harmonization of approaches and coordination under national plans. Additional support, not only in preparedness, but also in the implementation and maintenance of the IHR core capacities, within robust health systems, will require support in strategic and operational planning, in overall governance, and in provision of health care packages which will remain in place throughout any public health emergency.

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VII. Immediate financial needs for 2015

WHO is currently seeking immediate additional funds to sustain its Ebola Preparedness activities throughout 2015 and lay the foundations for accelerated programmes to strengthen emergency preparedness and IHR core capacities. A critical financial gap exists for the roll-out of further activities in Priority 2 countries (Benin, Burkina Faso, Cameroon, Central African Republic, Democratic Republic of the Congo, the Gambia, Ghana, Mauritania, Nigeria, South Sudan and Togo).

VIII. Acknowledgements

WHO would like to acknowledge the role of national and international NGOs in their ongoing support to Ministries of Health, as well as the technical partners who have made so much of the preparedness work, detailed in this report, possible. The activities carried out by WHO in priority countries in Africa were made possible thanks to the generous contributions received from the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), the European Union, the Government of the Netherlands and from Canada's Department of Foreign Affairs, Trade and Development (DFATD). WHO also acknowledges the valuable contributions of other donors to preparedness activities at the country level.

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Partner organizations that deployed experts

Antigone Consortium

Bernhard Nocht Institute for Tropical Medicine

Cambridge University

European Center for Disease Prevention and Control (ECDC)

GGD Kennemerland

Institut National de Santé Publique du Québec (INSPQ)

Institut tropical et de santé publique Suisse (Swiss TPH)

Instituto Nacional de Emergência Médica (INEM)

International Organization for Migration (IOM)

Johns Hopkins University

Matraco Consultants

Ministry of Foreign Affairs, France

Ministry of Health, Cuba

Ministry of Health, Egypt

Ministry of Health, Portugal

Public Health England

Queensland University of Technology

Swiss Federal Office of Public Health

Trinity College Dublin

U.S. Centres for Disease Control and Prevention (CDC)

United Nations Children's Fund (UNICEF)

United Nations Office for the Coordination of Humanitarian Affairs (OCHA)

United States Agency for International Development (USAID)

World Food Programme

Partner organisations that provided in-country experts

ALIMA

Care International

Centre Pasteur Cameroun

ESTHER

Ethiopian Public Health Institute

European Union

Fondation Mérieux

International Federation of the Red Cross Societies (IFRC)

Médecins Sans Frontières (MSF)

Right to Play

Save the Children

U.S. Centres for Disease Control and Prevention (CDC)

United Nations Children's Fund (UNICEF)

United Nations Development Programme (UNDP)

United Nations Population Fund (UNFPA)

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5

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