Attachments
EXECUTIVE SUMMARY
Background
Cholera is an acute gastrointestinal infection caused by the bacterium Vibrio Cholerae serogroup O1 or O139, and is often linked to unsafe drinking water, lack of proper sanitation and personal hygiene. It adversely affects mostly the poor and vulnerable populations in countries, which are already deprived of proper health facilities and conducive environmental conditions. The disease spreads through oro-fecal transmission by the ingestion of contaminated food or water or by person-to-person contact. It has a short incubation period of 2 hours to 5 days and the number of affected cases can rapidly increase across large regions. Cholera is a significant threat to global public health leading to an estimated 3-5 million cases per year worldwide, with an annual toll of 100,000 deaths. The disease was first reported in 1817 from the Ganges Delta of India and since then the ongoing 7th pandemic has emerged from Indonesia, reached Africa in 1970 and Somalia happens to be one of the early affected countries. Over the past few decades,
Somalia has witnessed the occurrence of repeated AWD/Cholera disease outbreaks that have caused high morbidity and mortality across the country.
The Somali health system has suffered from decades of disruption due to the extended civil conflicts that have contributed to a significant paucity of health professionals and an increase in the population lacking access to essential health services with a devastating impact on the health status of the general population.
Moreover, while the internally displaced persons are estimated at 2.7 million, over 5.4 million are acutely food insecure. Other factors with devastating health consequences were the repeated droughts and the two famines of 1992 and 2011 that cumulatively wiped out over half a million people. In the Somalia transition to recovery, the country has formulated futuristic health policies and strategies that are being rapidly translated into action with a focus on key priorities to attain Universal Health Coverage (UHC). The development of a national strategy on the prevention and control of cholera outbreaks and endemicity constitutes an integral part of the national health system recovery process being currently pursued at all levels. The disease is also affected by climatic changes. Cholera control falls both within the ambit of emergency response in the case of outbreaks, and the normal developmental efforts when the disease is endemic in high-risk areas. The latter requires enhanced epidemiological and laboratory surveillance to identify endemic areas and rapidly detect, confirm, and respond to outbreaks by ensuring universal access to safe water, basic sanitation facilities, community engagement for behavioral changes and improved hygiene practices. Quick access to Oral Rehydration Solution (ORS) therapy can successfully cure most cases, while intravenous fluids and antibiotics are required for severe cases. Prevention with OCV is safe and effective. Cholera is preventable with the tools we have today, rendering the goal of its elimination within reach.
Situation Analysis
To assess the situation and the prevention and control efforts carried out at federal, state, regional, district and community levels, a common understanding of the pursued definitions and characterization of disease transmission patterns by the health professionals, related social sectors and partner organizations was necessary and accordingly developed as outlined below. A cholera situation assessment and cholera prevention and control strategy development consultations were quite exhaustive across the country, deliberating on the strategic priorities to be pursued in the prevention and control of cholera. During these consultation processes, several ministries and agencies as well as the Mogadishu Regional Administration Authority were briefed about their potential support and involvement, as well as the alignment of their sectoral strategies with the nationwide envisaged strategy for cholera prevention and control. During these consultations the following methodological approach was pursued:
i) A district cholera risk profile: The assessment was carried out by outlining a set of criteria including the occurrence of confirmed cholera outbreaks over the past three years; general performance of the health system network; access to medical supplies and vaccines and the ability of locally operating health professionals to freely deliver services in the area. Moreover, the security related access of the local population to health care services or referral care; the availability of safe drinking water and proper sanitation; and the presence of IDPs’ concentration areas in the districts were also assessed.