AFRICAN DEVELOPMENT BANK
SIERRA LEONE
EMERGENCY ASSISTANCE TO SUPPORT EFFORTS AT CONTROLLING CHOLERA
EPIDEMIC
SEPTEMBER 2012
Human Development Department (OSHD)
&
Country and Regional Department – West B (ORWB)
Table of Contents ACRONYMS ………………………………………………………………………………………….......i
PROJECT SIMPLIFIED LOGICAL FRAMEWORK…………………………………………………….ii
1. BACKGROUNG AND JUSTIFICATION FOR EMERGENCY ASSISTANCE………… 1
1.1 BACKGROUND – THE CHOLERA OUTBREAK AND EMERGENCE CRISIS…………………... 1
1.2 JUSTIFICATION FOR EMERGENCY ASSISTANCE…………………….…………………..........1
2. OVERVIEW OF THE APPEAL FOR EMERGENCY ASSISTANCE………..…………… 2
3. THE PROPOSED EMERGENCY ASSISTANCE OPERATION…………………………. 2
3.1 OBJECTIVES AND DESCRIPTION OF THE EMERGENCY ASSISTANCE………………… …… .2
3.2 IMPLEMENTATION ARRANGEMENTS AND SCHEDULE………………………………… …… . 3
3.3 PROCUREMENT………………………………………………………………………………………… 3
3.4 DISBURSEMENT ARRANGEMENTS…………………………………………………………………..3
3.5 COST AND SOURCE OF FINANCE……………………………………………………… ………...4
3.6 DURATION………………………………………………………………………… ……….4
3.7 REPORTING, SUPERVISION AND AUDITING………………………………………… ……………4
4. CONCLUSIONS, RECOMMENDATIONS AND CONDITIONS FOR DISBURSEMENT…. 4
4.1 CONCLUSIONS AND RECOMMENDATIONS……………………………………….. ……………… 4
4.2 CONDITIONS FOR DISBURSEMENT………………………………………………………………… 5
ANNEX I: ACTIVITIES AND BUDGET OVER THE SIX MONT IMPLEMENTATION PERIOD
ANNEX II: TABLE OF CUMULATIVE CASES AND DEATHS
ANNEX III: MAP OF SIERRA LEONE SHOWING AFFECTED DISTRICTS
ANNEX IV: GOVERNMENT OF SIERRA LEONE RESPONSE PLAN
ANNEX V: GOVERNMENT OF SIERRA LEONE DECLARATION
i
LIST OF ACRONYMS AND ABBREVIATIONS
ADF African Development Fund
AfDB African Development Bank
CSP Country Strategy Paper
DFID Department for International Development, UK
DHMT District Health Management Team
DP Development Partner
DPC Disease Prevention & Control
EC European Commission
GoSL Government of Sierra Leone
JAS Joint Assistance Strategy
JICA Japan International Cooperation Agency
MDGs Millennium Development Goals
MoHS Ministry of Health and Sanitation
OCHA United Nations Office for the Coordination of Humanitarian Affairs
PHU Peripheral Health Units
SRF Special Relief Fund
UNICEF United Nations Children’s Fund
USAID United States Agency for International Development
WASH Water, Sanitation and Hygiene
WHO World Health Organisation
WHO-AFRO World Health Organisation – Africa Region
ii
PROJECT LOGICAL FRAMEWORK (PROJECT MATRIX)
Country and Project Name: SIERRA LEONE – Proposal for a grant of US$ 755,262 as emergency assistance for cholera epidemic control
Purpose of the project: Support the efforts of the Government and Development Partners in the control of the cholera epidemic
RESULTS CHAIN PERFORMANCE INDICATORS MEANS OF
VERIFICATION
RISK/MITIGATION
MEASURES Indicator Baseline -2012 Target
IMP
AC
T
Improved health status and access to
safe water and sanitary facilities
* Reduction in Infant
and under-5
Mortality Rates
*Reduction in
incidence of water
related diseases
*Infant Mortality
is 128 per 1,000
live births
* Current under-
five mortality rate
is 217 per 1,000
live births
* Data not
available for water
related diseases
* Reduce under-
five and infant
mortality rates
from the baseline
level to less than
70 per 1,000 live
births
Monitoring report
Survey
MoHS report
Risk: Resources not adequate
for the large numbers of affected
population.
Mitigation: Bank emergency
support is part of a wider
program expected to cover the
global requirements.
OU
TC
OM
ES
*Improved sanitary & hygienic
practices in schools, health facilities
and communities
* Institutional capacity to manage
cholera emergencies improved
* Cholera outbreak in affected areas
controlled and contained from further
propagation
* Cholera cases in
affected districts
dropped
* Fatality rate
reduced
* Infection rate in
non-affected districts
* 13,324 current
cases
* 1.7%
* 0
* Reduce cases of
cholera to < 50 by
December 2012
* <0.1%
* 0
Monitoring Reports
Surveys
MOHS Records and
reports
Risk: Non-functioning health
systems and management
mechanisms
Mitigation: Bank to engage
senior management of MOHS
and Partners
OU
TP
UT
S
Component 1:* Water and sanitation
facilities provided for schools and
health facilities
*Training of teachers, community
volunteers and health staff in hygiene
promotion conducted
Component 2:Safe Excreta disposal
solution improved in 10 districts
* additional number
of schools and health
facilities having
access to water and
sanitation facilities;
* Number of
teachers, volunteers
and health staff
trained
* Number of Districts
covered
* Data not
available
* 0
* Data not
available
* 70 schools
10 district
hospitals
40 PHUs
* 140 teachers
120 health staff
and 20 WSD staff
trained
* 10 Districts
Report produced by
UNICEF
MOHS Reports
DHMT records and
reports
Risk: Construction materials not
readily available in country
Mitigation: UNICEF has a long
experience in providing such
assistance (purchase, shipment,
customs clearance,
transportation, distribution and
monitoring of construction
work).
KE
Y
AC
TIV
ITIE
S
Component 1: Provision of water, sanitation and hygiene promotion facilities for 70 schools , 10 district
hospitals and 40 PHUs and Improving Safe Excreta disposal solution in communal areas
Component 2: UNICEF cross-sectoral (5%) and Administrative fee (5%)
Inputs:
Component 1: US $ 680,797
Component 2: US $ 69,203
Total Cost: US $ 750,000
1
1. BACKGROUND AND JUSTIFICATION FOR EMERGENCY ASSISTANCE
1.1 Background – The Cholera Outbreak and Emergency Crisis
1.1.1 The Ministry of Health of Sierra Leone declared an outbreak of cholera in February 2012
which has then affected Port Loko, Kambia and Pujehun Districts. Ever since, the epidemic has
continued to spread nationwide with 11 of the 13 districts of the country affected. As at August 28
2012, national cumulative from Jan. 2012 is 14,225 cases with 235 deaths and a fatality rate of
1.7%. Most of the cases (49%) are reported in the western district in which the capital, Freetown is
located. Only Koinadugu and Kailahun Districts have not reported cases of cholera. (details in
annex)
1.1.2 Given the heavy rains and the associated floods, poor access to safe water and sanitation and
the re-opening of schools by mid-September, it is feared that the incidence will continue to rise and
maybe triple in the next 2 months if necessary urgent actions are not undertaken.
1.1.3 The Ministry of Health together with UNICEF and WHO and the Health and WASH partners
has developed a comprehensive and coordinated cholera response operational plan to address the
needs of the population in the affected areas. The plan has 3 main sectoral components – Health,
Social Mobilization and Water and Sanitation (WASH). In the absence of the United Nations
Office for the Coordination of Humanitarian Affairs (OCHA) the emergency response initiative on
the part of the development partners is being spear-headed by UNICEF and WHO that work in
close collaboration with the MOHS. The plan has an estimated cost of USD 10, 679,104. Thus far,
funding has been received from CERF to the value of US$ 2,500,000 and DFID - £2 million
pledged to six NGOs including Oxfam, Save the Children, IRC, Concern, CARE and British Red
Cross.
1.2 Justification for Emergency Assistance
1.2.1 The current emergency situation is beyond the capacity of the government and its agencies to
handle without significant support from the international community. The Cholera Emergency
Response Plan developed by partners in collaboration with the Government amounts to USD 10,
679,104 with a funding gap of about USD 2, 658,840.
1.2.2 Failure to control the epidemic will lead to additional loss of lives in a country characterized
by high incidence of poverty. There is also the potential of the epidemic spreading to neighboring
countries following the huge magnitude of interactions and movements across borders if not
urgently contained.
1.2.3 The proposal can be implemented expeditiously within short period. UNICEF, the proposed
implementing partner is experienced in implementing similar kinds of emergency operations.
2
1.2.4 The present Emergency Assistance proposal is in accordance with the Bank Group Policy
Guidelines and is consistent with the current Bank Group provisions under the Revised Policy
Guidelines for Emergency Relief Assistance, and General Regulations of the Special Relief Fund
(ADB/BD/WP/2008/211). The request falls under emergency criteria item (i) emergency situation
arising from Natural Disasters - droughts, earthquakes, floods, hurricanes, landslides, volcanoes,
crop pest invasions, etc.
2. OVERVIEW OF THE APPEAL FOR EMERGENCY ASSISTANCE
2.1 On the 17th
of August 2012, His Excellency, the President of the Republic of Sierra Leone
declared the cholera epidemic as a Public Health Emergency and launched an appeal for assistance
towards the emerging situation. Following the declaration, a Presidential Task Force headed by the
Chief of Staff was constituted responsible for high level coordination of the support and the entire
response to the epidemic. A Cholera Command and Control Centre (C4) have also been established.
2.2 Prior to the declaration, development partners led by WHO and UNICEF had risen to the
challenge having observed the increasing spread and impact by supporting the creation of a national
cholera control task force headed by the MoHS and responsible for the coordination of efforts of all
stakeholders. This body has 3 technical teams reporting routinely to it namely;
Case management & logistics team chaired by the health ministry (Disease Prevention &
Control – DPC) with MSF as co-chair
Water & Sanitation and Social Mobilization team chaired by the health ministry (Education
division) with ACF as co-chair
Data management team chaired by DPC with WHO as co-chair
3. THE PROPOSED EMERGENCY ASSISTANCE OPERATION
3.1 Objectives and Description of the Emergency Assistance
3.1.1 The general objective of the emergency assistance operation is to contribute to the reduction
of mortality and morbidity in Sierra Leone arising from the current cholera outbreak in the country
which has affected virtually all the districts.
3.1.2 The Bank’s assistance shall basically be in support of the water and sanitation (WASH)
component of the consolidated response plan put in place by the government in collaboration with
development partners. The decision for the AfDB to focus on WASH is informed by the fact that
the subcomponent has the greatest chunk of the total plan budget gap Specifically, the assistance
will support the under-listed activities:
training of community volunteers or teachers for water chlorination when the schools share
the water point with the neighboring population;
Maintenance of schools and health center water systems and distribution of related supplies
3
Promoting cleaning systems for school and health center latrines and reactivation or
implementation of hand washing station in these facilities
3.2 Implementation Arrangements and schedule
3.2.1 According to the Bank’s Revised Policy Guidelines and Procedures for Emergency Relief
assistance and General Regulations of the Special Relief Fund (ADB/BD/WP/2008/211/Rev.1/,
ADB/BD/WP/2008/173/Rev.1), implementation of the emergency humanitarian relief assistance
will be entrusted to appropriate organizations operating in the field at the time of the emergency.
They include United Nations agencies, or an appropriate Government agency or NGO. The
Government of Sierra Leone has selected the United Nations Children’s Fund (UNICEF) which is
coordinating development partners’ activities under the WASH subcomponent of the consolidated
response plan, as the Implementing Agency. UNICEF will thus be entrusted with the
implementation of the emergency relief assistance operation.
3.3 Procurement
3.3.1 In line with the relevant provisions: the revised Policy Guidelines and procedures for
emergency relief Assistance (cf. Paragraph 1.1.1) the delivery of Bank’s and donors’ contribution
for this emergency assistance will be entrusted to UNICEF that has considerable experience in this
field of emergencies. In accordance with Article 3.8 of the Revised Policy Guidelines and
Procedures for Emergency Relief Assistance, given the unique nature of emergency operations, the
restriction of procurement eligibility is not applicable.
3.3.2 The Bank’s Rules and Procedures for Procurement of Goods and Works (2008), notably
paragraph 3.101, permits the Borrower, the Government of Sierra Leone to use UNICEF, as a
specialized agency in handling procurement, however this rule requires the selection of UNICEF to
follow rules and procedures for selection of Consultants, however as this case is of health plight and
epidemic emergency in the country, retaining UNICEF use as a specialized agency is considered on
direct contracting in accordance with the rule 3.6 (e) of the Bank’s rules and procedures for
procurement of goods and works. UNICEF will be using its own procurement procedures in
handling procurement in this emergency operation as provided in paragraph 3.9 (procurement from
specialized agents acting as supplier using their own procedures) due to the small value of health
goods to be supplied, and paragraph 3.10 (using specialized agents as procurement agents). As the
Bank’s rules and procedures for procurement of goods and services in paragraph 3.18, requires
procurement of goods and works under disaster and emergency assistance to incorporate greater
flexibility, UNICEF will be using its own procurement procedures in carrying out all procurements
in this emergency operation.
3.4 Disbursement Arrangements
In view of the nature of procurement arrangements under this operation, it is recommended that the
grant resources be disbursed in one tranche upon submission to the Bank by UNICEF of the
following:
1 Paragraph 3.10 addresses use of specialized agencies as procurement agents.
4
i) A bank account where the proceeds of the grant will be deposited;
ii) Signed Letter of Agreement (LOA) entered into between the Bank, GoSL and UNICEF
3.5 Cost and Source of Finance
The total cost of the Bank’s emergency assistance to Sierra Leone is US$ 750,000. The cost
breakdown is attached in annex 1. The funds provided by the Bank are restricted and earmarked for
the purposes of urgent humanitarian response to the cholera epidemic
3.6 Duration
The Guidelines and Procedures stipulate that emergency humanitarian relief assistance is typically a
short-term operation, lasting not more than 6 months. Consequently, a period of six months from the
date of approval of the memorandum has been proposed for the execution of this emergency relief
assistance. Funds not disbursed after the 6 month duration of the project will be cancelled.
3.7 Reporting, Supervision and Auditing
UNICEF will not prepare separate financial and audit reports for the operation, however, will submit
to the Bank their normal consolidated and audited report for the year ended 2012. The report will
confirm the utilization of the fund in line with the Letter of Agreement. UNICEF will deduct an
administrative cost of not more than 7% from the ADB grant. For visibility, the Bank’s name and
contribution should appear in the UNHCR 2012 consolidated financial report disclosing the list of
contributors for the year.
There will not be specific field supervision missions for the operation; however, the Bank will closely
monitor the progress made in the emergency response intervention through other Bank missions in
Sierra Leone.
4. CONCLUSION, RECOMMENDATIONS AND CONDITIONS FOR DISBURSEMENT
4.1 Conclusion and Recommendations
4.1.1 Conclusion
The cholera epidemic in Sierra Leone calls for urgent attention, given the government’s
insufficient capacity to control it. Financing gaps exist in the consolidated response plan put
together by the government with support from partners to effectively contain the epidemic and
prevent the likelihood of occurrence in the near future. This proposal for a grant to the country is not
only timely but essential in complementing the efforts of the Government and other donors.
5
4.1.2 Recommendations
It is, therefore, recommended that the Board of Directors assist the Government of Sierra Leone with
a grant of US$ 750,000 to support national efforts to prevent and contain further spread of cholera as
well reduce the risk of mortality due to the disease.
4.2 Conditions for Disbursement
The grant resources will be disbursed in one tranche upon fulfillment of the following conditions;
i) Submission by UNICEF’s of a bank account where the proceeds of the grant will be
deposited;
ii) Signature of the tripartite Letter of Agreement to be entered into between the Bank,
GoSL and UNICEF.
Annex 1: Budget
Description
(including complete technical specifications) Qty Unit Duration Unit
Unit
Price (US $)
Total
Amount (US$)
Result 1: Increase access to safe water for population affected by cholera 202,147.01
Training and capacitation of chlorinators 55,800.00
Support to Environmental Health Division
(MoH) for refresher trainings in the districts 1.00 Unit 3 month 18,600.00 55,800.00
Supplies, commodities and materials 146,347.01
Aqua Tabs (33 mg) 7,600,000.00 Unit 1 unit 0.01 82,080.00
Chlorine (HTH 70%, 45kg) 20 keg 1 unit 588.00 11,760.00
Chlorine Pool tester, Visual block-simple 40 Unit 1 unit 10.36 414.40
Chlorine test DPD 1 Box of 250 tests 80 Unit 1 unit 7.30 584.00
freight and clearing charges 83,078.40 Fft 1 unit 0.62 51,508.61
Result 2: Access to safe water and sanitation is improved and monitored for schools in most affected areas 171,650.00
Installation, repairing and maintenance of the school's water and sanitation systems in 70 schools 50,750.00
Hand Pumps and protection of wells 70.00 Unit 1 unit 350.00 24,500.00
Repairing latrines 105.00 Unit 1 unit 250.00 26,250.00
Training of 140 teachers (2 per school) and volunteers for chlorination and cleaning of latrines 23,400.00
Refresher Trainings of Teachers and Water
Committees 15.00 sessions 2 Day 500.00 15,000.00
Supplies: HTH, Buckets, DPD testers 70.00 Unit 1 unit 120.00 8,400.00
Hygiene Promotion Activities and Hand Washing Stations in 150 schools 97,500.00
Hygiene Promotion Activities 150 Schools 2 month 200.00 60,000.00
Hand washing station in 150 schools 150 Schools 1 unit 250.00 37,500.00
- 2 -
Result 3: Target CTU/CTC has access to safe and specialized water and sanitation facilities. Target PHU receiving cholera cases in 8 districts have access to
safe water 218,200.00
Training for Contamination Control and Water treatment in 10 District Hospitals and 40 PHU 21,200.00
Training of 120 health staff and 20 WSD staff
on chlorination and monitoring of water quality 60.00 sessions 1 unit 150.00 9,000.00
Training of 120 health staff on infection control and hygiene practices
50.00 sessions 1 unit 160.00 8,000.00
Training and IEC materials 60.00 kit 1 unit 70.00 4,200.00
Installation, repairing and maintenance of water and sanitation Facilities in 10 District Hospitals and 40 PHU 149,000.00
Construction/repairing of sanitation facilities in
10 district hospitals and 40 PHUs 50.00 Units 2 latrines 500.00 50,000.00
Liquid Waste Disposal 10.00 District Hosp. 2 Blocs 1,000.00 20,000.00
Repairing and maintenance of small water
systems and water storages in 10 district
hospitals and 40 PHUs
50.00 Health Unit 1 unit 1,000.00 50,000.00
Water distribution 10.00 Units 2 month 1,200.00 24,000.00
Safe medical waste disposal 10.00 Units 1 unit 500.00 5,000.00
Supplies 48,000.00
Supply of 50 sanitation kits to 10 district hospitals and 40 PHUs
50.00 kits 1 Unit 400.00 20,000.00
Supplies for DHMTs (HTH70%, 45kg=keg) 14.00 districts 4 Keg 500.00 28,000.00
Result 4: Access and use of safe excreta disposal methods is improved in the 10 targeted district's communal areas 88,800.00
Promote cleaning/Repairing system for communal/public latrines 64,800.00
Repairing and maintenance of communal latrines 120.00 latrines 2 month 270.00 64,800.00
Promote safe excreta disposal in homes where cases are reported 24,000.00
Hygiene promotion Forums and Community Mobilization
8.00 districts 6 sessions 500.00 24,000.00
- 3 -
Cross sectoral (5%) (costs that cannot be assigned to one result e.g. visibility, evaluation) 33,500.00
M&E 1.00 unit 1 lumpsum 10,500.00 10,500.00
Field Visit 1.00 Fft 3 month 4,000.00 12,000.00
Others (visibility, communications) 1.00 Fft 1 month 11,000.00 11,000.00
Subtotal 714,297
PSC (5%) 35,703
Total 750,000
Section 4 - Means & Costs
Result 1 202,147.00
Result 2 171,650.00
Result 3 218,200.00
Result 4 88,800.00
Other Costs 33,500.00
PSC 35,703.00
TOTAL 750,000.00
Annex 2 : Table of cumulative cases and deaths from cholera in Sierra Leone.
1 Janv – 28 August, 2012
Annex 3 : Map of Sierra Leone showing the Affected
Non Cholera affected regions
Cholera affected regions
Annex 4: Epidemic Response Budget and Partners Contribution & Gap
Response Planned Budget 10,679,104
Funding Allocated 7,020,264
Pipeline Funding 1,000,000
Funding Gap 2,658,840
Pipeline
Central
Emergency
Response Fund
(CERF)
Allocations
Irish Aid** ECHO** DFID* USAID
ACF 504,468 504,468
MSF - B 500,000 500,000
OXFAM 187,500 803,784 991,284
UNICEF 1,649,014 250,000 1,899,014 1,000,000
WHO 850,986 850,986
British Red Cross 281,600 281,600
Save the Children (UK) 560,000 560,000
International Rescue Committee 197,314 197,314
CARE International 385,195 385,195
Concern worldwide 850,403 850,403
2,500,000 250,000 1,191,968 3,078,296 7,020,264 1,000,000
SIERRA LEONE CHOLERA RESPONSE PLAN BUDGET
Allocated
Recipient agencies
Total
Allocation
s
NOTE:
*6 NGOs selected as recipient agencies; exchange rate £1.00 = $1.6.
** Amount pledged in EURO , ex. rate used 1.25
Annex 5: Emergency Declaration Note
- 2 -
Annex 6 : Government Request
Annex 7: Emergency Declaration Note
