Summary of major revisions made to emergency plan of action:
The Operation updates seeks a timeframe extension of two months (new end date 11 February 2019) to ensure implementation of pending activities. Additional funding of CHF 44,189 is also being requested, bringing the overall operational budget to CHF 137,814.
An additional allocation is required, as the initial budget envisaged supplementary funding from the National Coordination Committee, which is led by the Ministry of Health and the Rwanda Biomedical Centre (RBC), but these funds are no longer available. The National EVD contingency plan was shared with all partners to facilitate their engagement and identify potential areas for support and contribution. The plan covers a duration of 6 months (August 2018 - January 2019) and has an estimated funding gap of USD 3 million out of a total budget of USD 3.5 million.
The MoH has supported training for 300 volunteers in community surveillance and contact tracing and 100 in Safe and Dignified Burials (SDB). Training materials and equipment are not sufficient and there is need to reinforce skills by conducting additional trainings with adequate equipment with the PPE and SDB kits that have been procured through the DREF. This second allocation will ensure that all volunteers are adequately prepared in the event of an EVD outbreak. The operational strategy remains the same as described in the initial Emergency Plan of Action.
A. SITUATION ANALYSIS
Description of the disaster On 1st August 2018, the Ministry of Health of the Democratic Republic of Congo declared the 10th outbreak of Ebola Virus Disease in North Kivu province. Subsequent cases were also reported in neighboring Ituri province. North Kivu and Ituri provinces are among the most populated provinces in the DRC that also share borders with Rwanda and Uganda. As of 11 November 2018, 333 Ebola Virus Disease (EVD) cases had been reported, of which 295 confirmed and 38 probable, with 209 deaths occurring. The case fatality rate stands at 63% overall.
Nine neighboring countries were put on high alert by the World Health Organization and advised that they are at high risk of spread of the virus. Rwanda, Uganda, South Sudan, and Burundi are ranked as Priority-1 and as such, have Emergency Plan of Action Operation Update Rwanda: Ebola Preparedness had EVD preparedness DREFs launch. The five other countries- Angola, Congo, Central African Republic, Tanzania, and Zambia are Priority-2. Preparedness activities have begun in these countries to ensure countries are able to respond in the event of an EVD outbreak. The Ministries of Health (MoH), WHO and partners are monitoring and investigating all alerts in affected areas in the Democratic Republic of Congo and in neighboring countries. To date,
EVD has been ruled out in all alerts from neighboring provinces and countries.
Population mobility, including cross-border movements, were identified as a significant risk for disease transmission in this outbreak due to the high number of traders, displaced populations and insecurity caused by rebels and militias in the area (Source IOM, 15 August 2018). Additionally, the security situation in North Kivu has hindered the implementation of response activities to control the EVD outbreak. Based on this context, the public health risk is considered very high at the national and regional levels.
Eleven districts are considered most at risk of the outbreak in Rwanda. These are Rusizi, Nyamasheke, Karongi, Rutsiro, Rubavu (bordering DRC), Nyabihu, Musanze, Burera, Gicumbi and Nyagatare (bordering Uganda) and Kigali city (comprised of three (3) localities). Kigali is also at risk because of the Kigali international airport and high population density of the city.
Rwanda Red Cross Society (RRCS) is part of the National Rapid Response Team (NRRT). The NRRT is the national level coordination team and is composed of the Ministry of Health (MoH)/Rwanda Bio-Medical Centre, the Centre for Disease Control (CDC), WHO, RRCS, UNICEF, National Reference Laboratory (NRL), FAO, Epidemiologists, and other partners. Weekly meetings are being held to update and coordinate the response strategies. RRCS was tasked with community surveillance/contact tracing, risk communication, social mobilization and community engagement, Safe and Dignified Burials (SDB) as well as Psychosocial Support (PSS). RRCS are also implementing infection prevention and control activities, such as decontamination/disinfection of public places and households, as well as health facilities if requested.