Date post: | 09-Aug-2015 |
Category: |
Documents |
Upload: | sajjad-mohammad-sajid |
View: | 20 times |
Download: | 2 times |
National Ebola Response Centre (NERC)
Plans and Secretariat1st December 2014
Operation ‘WAS’
• The Mission• The Context• The Proposed Strategy• Timelines and Delivery• Measuring Success and Operational Achievements• Post Operation “WAS”
The Mission
To significantly slow down the transmission of Ebola in the Western Area to a level that will enable the WAERC to completely eradicate it within 42 days thereafter
For the records, Operation ‘WAS’:
Is Not: Is Meant to:
An exercise that will send soldiers into people’s homes to drag them out into Holding and Treatment Centres
Enhance the WAERC structures to enable them adequately meet the demands of a potential surge in emerging cases
An exercise that will promote ‘vigilante-ism’ in communities
Utilise community structures and volunteers to support existing surveillance, contact monitoring and social mobilisation teams
Designed to allow community teams to perform triage or handle suspected cases in the communities
Link community teams to appropriate WAERC teams as a means of reducing delays that increase the risks of further transmissions in the community
The Context
Daily Rate of Confirmed Cases per 100,000 (Sit-Rep 23 November, 2014)3.0
2.5
2.0
1.5
1.0
0.5
0
Bonthe
Pujehun
KambiaKono
Koinadugu Bo
Moyamba
Kenema
Tonkolili
National
Western (urban)
Kailahun
Port Loko
Bombali
Western (rural)
The Context1. Recent KAP II study - comprehensive knowledge significantly lower
in the Western Area with greatest tendencies to engage in unsafe practices
2. Western Area basic repro currently highest
3. Swabs of corpses confirm that ebola patients are remaining in the community longer than they should
4. Combination of insufficient beds and persistent non-compliant behaviours and practices
5. WAERC efforts to break transmission hampered by inadequate resources and operational limitations
The Strategy
To enhance case finding,
contact monitoring and
social mobilisation
Use Malaria MDA as spring
board
Enhance operational capacity of
WAERC/WACC
Enhance operational capacity of WAERC
Enhancing Operational Capacity by:
Securing sufficientbed capacity
2,052 confirmed cases in Western Area as of 1st December of which currently infectious level is estimated at 563
MDA and Operation WAS will initially push up reported cases and increase bed demand
Sufficient bed capacity will be required to meet current and generated demand
Ensuring WAERC adequately resourced
Inadequate resources currently impacting ability of WAERC teams to comply with SOPs re: decontamination, quarantine, contact tracing and monitoring etc
Non compliance hampers efforts to break transmission (early detection and isolation)
Additional resources must be deployed ahead of active case finding and community mobilisation
Ensuring lab capacity and processes adequate & effective
Improvements required in labs efficiency timing, labelling, transportation etc
In collaboration with Lab Technical Working Group, confirm adequate capacity and resolution of systemic and procedural issues
Bed Capacity and Pipeline
Facility NameOperational Status
Opening Date
Beds as at 1st Dec
Beds as at 8th Dec
Beds as at 15th Dec
Beds as at 22nd Dec
Beds as at 29th Dec
Paed Beds at 29th Dec Operator
Police Training Sch-Hastings 2 EHC 12/8/2014 0 100 250 250 250 RSLAF/MOHConnaught Hospital active 16 16 16 16 16 2 Kings/MOHMacauley Street Hospital active 7 7 15 15 15 Kings/GOALLumley Hospital active 12 12 12 12 12 2 Kings / GOAL34th Military Hospital active 10 10 10 10 10 RSLAFOla During Childrens Hospital***** active 20 20 20 20 20 20 Cap Anamur/GOALNewton Healthcare Centre active 12 15 15 15 15 Kings / GOALPCMH (Maternity Hospital)*** 12/1/2014 12 12 12 12 12 PIHKing Harmen Road Hospital* 12/8/2014 0 2 2 2 2 Kings/MOHKissy Mental Hospital** 12/1/2014 0 4 4 4 4 Kings/MOHRokupa active 22 22 22 22 22 Kings / GOALLakka Emergency Hospital active 10 10 22 22 22 EmergencyChina-SL Friendship Hospital, Jui active 40 40 40 40 40 Chinese GovtPrince of Wales School ETC & EHC 12/8/2014 0 8 20 36 36 MSF SwitzerlandADRA Waterloo Hospital 12/1/2014 0 66 66 66 66 MOHSPolice Training Sch-Hastings 1 ETC active 125 125 125 125 125 MOHS/RSLAFPolice Training Sch-Hastings 2 ETC 11/30/2014 0 0 20 20 20 MOHS/RSLAFHastings Airfiled ETC 12/14/2014 0 0 5 5 5 Aspen MedicalKerry Town ETC active 11 11 20 20 20 Save the ChildrenGoderich ETC + Lakka Emergency ETC**** 12/14/2014 12 12 30 30 60 Emergency34 Military Hospital ETC 12/1/2014 10 20 30 30 30 RSLAFPrince of Wales School ETC & EHC 12/8/2014 0 12 12 32 64 MSF SwitzerlandHolding Centres 161 278 460 476 476Treatment Centres 158 246 308 328 390Total Beds 319 524 768 804 866
W. Area Centre Mapping
Bed Capacity and Demand Forecast
1st December 15th December 29th December
Estimated number of infectious 563 670 753
Confirmed Holding Beds 144 443 459
Confirmed Treatment Beds 156 298 390
Total Western Area Beds 300 741 849
Scale up of bed capacity
Beds as at 1st Dec Beds as at 8th Dec Beds as at 15th Dec Beds as at 22nd Dec Beds as at 29th Dec0
100
200
300
400
500
600
700
800
900
Treatment Centres
Holding Centres
Ensuring WAERC adequately resourced
WAERC Non –Compliance Resources required for resolution Cost for 6 weeks (Le)
Houses not decontaminated after corpses removed
• 13 Vehicles• Risk allowance for 20 decontamination teams• Fuel and operating costs• Fleet management
2,963,750,000
Homes not sprayed after removal of live suspect patients
• 16 motorbikes• Risk allowance for 32 sprayers• Fuel and operating costs• Fleet management
209,250,000
Nurses and drivers unable to follow protocols for safe transfer of
patients
• Risk allowance for 16 nurses and drivers• Fuel and operating costs• Fleet management 225,000,000
Homes not quarantined within 24hrs of positive lab results
• 9 Quarantine Officers• 21 motorbikes• 21 motorbike drivers • Risk allowance • Fuel and ongoing operating costs• Fleet Management
408,375,000
Ensuring WAERC adequately resourced
Operational challenges Resources required for resolution Cost for 6 weeks (Le)
DSOs inadequately resources to respond to alerts across 11 Western Area zones and existing and new holding facilities
• 35 District Surveillance Officers (DSOs)• 48 motorbikes• Risk allowance for 20 decontamination teams• Fuel and operating costs• Fleet management
784,125,000
No quality assurance personnel checking to see whether roles are being carried out or that the roles are being executed diligently (Specific Focus on DSOs and CTs)
• 11 Quality Assurance Officers• 5 vehicles• 5 drivers• Risk allowance for 20 quality assurance officers• Office and equipment• Fuel and operating costs• Fleet management
233,437,500
Total Leones 4,823,937,500
Total US Dollars 1,026,369.00
Labs capacity and processes
Lab. Location
Lab. Operator
Operating hours
Reported Max daily capacity
Max samples per run
Lab Run Duration
Batch Run Times
Jui Chinese ? 68 34 ? ?
Kerry Town PHE 06:00 - 22:00 200 n/a batch processing ? n/a
Lakka NICD 09:00:00 - 21:00 58 29 ? 09:00, 15:00
Goderich ⁰ Emergency 08.00 - 20.00 80 ?? ?
⁰ To be opened from 14th December
Use Malaria MDAas spring board
Active case finding, contact monitoring and
social mobilisation
Two fold impact anticipated Phased approach beginning with hotspots
Malaria treatment eliminating related febrile cases
Use existing WAERC structures of DSOs and CTs
Household campaign will potentially expose more ebola cases
Augmented by community involvement via wards
Align MDA strategy with WAS messaging Delivery mechanism and appropriate clear messaging and script to be developed by WAERC and relevant pillars
Lessons learnt from MDA to be incorporated
Difference context of Western Urban and Western Rural to be reflected
Malaria MDA and Active Case Finding…
Community-WAERC Linkages
Ward Councilors(1 per Ward – Ward Team Leaders)
Ward Section Representatives(10 reps per Ward – Section Team Leaders)
Ward Section Teams (10 Teams per Section; x Members Per Team)
MayorW. A. Urban
ChairmanW. A. Rural
HouseholdsHouseholds
WAERC Social Mobilisation Consortium
(SMAC)
WAERC Social Mobilisation Consortium
(SMAC)
WAERC Surveillance Teams
WAERC
CT Teams
Messages & Gloves
Monitoring
Alerts
W. Area District ERC W. Area Command Centre
Waterloo Model
Messages & Home IPC Items (e.g. Gloves)
Community Structures
Community Mobilisation Intensity
•High transmission Communities will have temporary community-based Triage facilities and additional motorbikes for transporting samples
Timelines and Delivery
30-N
ov-1
4
01-D
ec-1
4
02-D
ec-1
4
03-D
ec-1
4
04-D
ec-1
4
05-D
ec-1
4
06-D
ec-1
4
07-D
ec-1
4
08-D
ec-1
4
09-D
ec-1
4
10-D
ec-1
4
11-D
ec-1
4
12-D
ec-1
4
13-D
ec-1
4
14-D
ec-1
4
15-D
ec-1
4
16-D
ec-1
4
17-D
ec-1
4
18-D
ec-1
4
19-D
ec-1
4
20-D
ec-1
4
21-D
ec-1
4
22-D
ec-1
4
23-D
ec-1
4
24-D
ec-1
4
25-D
ec-1
4
26-D
ec-1
4
27-D
ec-1
4
28-D
ec-1
4
29-D
ec-1
4
30-D
ec-1
4
31-D
ec-1
4
01-J
an-1
5
02-J
an-1
5
03-J
an-1
5
04-J
an-1
5
05-J
an-1
5
06-J
an-1
5
Delivery Commencement Delivered by:
Planning
Confirm engagement with Malaria MDADetermine Engagement Messaging
Determine Delivery MesagingDetermine phased hotspot approach
Collaborate with LTWG re labsStaff training as required
Confirm delivery of beds against scheduleSecure funding for WAERC operationl activities
Confirm roll-out programme
Operational Mobilisation
Procure Staff, Vehicles and other resourcesStaff training as required
Operation Break Camp Delivery
Roll-out of Operation Break Camp
Post Operation Break Camp
Review of Lessons LearntDevelopment of Strategies
Delivery Completion
Post Operation ‘WAS’
Operation ‘WAS’ Delivery‘WAS’
Potential Bottlenecks
• Bed capacity• Lab capacity (Efficiency) • Financial resources
– risk allowance– medical and non-medical supplies
• Transportation – Patients– Samples– Corpses
Measuring Success
• Sustained reduction in R0 in Western Area zones for 42 days subsequent to completion of ‘WAS’
• Sustained improvement in operational effectiveness of WAERC, measured against agreed KPIs and benchmarks
• Sustained improvement in lab process measured against agreed detailed KPIs and benchmarks (inc sampling, testing turnaround time, accuracy)
• Improvement in data capture specifically risk exposure, addresses, line list recording and patient outcomes
Measuring Operational AchievementsOutcome Area Indicators
Increased early detection and
isolation (>90% from ≈53%)
Reduction in number and proportion of deaths that test EVD positive Initial increase in the number of cases; and subsequent ‘flattening out’ of new cases
Behavioral changeIncrease in number and proportion of alerts (117+Community level) that meet case definition
Improved response capacity
Reduction in time delays between alerts and response for all aspects (triage, lab results, referrals, quarantine, burials, psycho-social assistance)
Post Operation ‘WAS’
• Lessons learnt exercise• Continuity of approach re early recognition • Triage for ebola in all healthcare facilities• Triage for ebola in communities• Monitor impact on referral and other social behaviours