Highlights. 10,984 Total (URT) suspected/ confirmed cases. 166 Total (URT) deaths. 2,9 million People targeted by CERF funding

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1 United Republic of Tanzania Cholera outbreak 2015 Office of the Resident Coordinator Situation Report No. 3 (as of 8th December 2015 This report is produced by Office of the Resident Coordinator (RCO) in collaboration with humanitarian partners. It covers the period from 20 th November 2015 to 7 December The next report will be issued on or around 4 th January Highlights Cumulative number of suspected/confirmed cholera cases for URT is 10,984 with 166 cumulative total deaths as 6 th December. 12 regions on mainland reported a total of 97 new suspected Cholera cases on 7 December. Mara and Mwanza records more than half (52%) of all reported new cases. The reduction in number of cases has leverage off for the past 13 days, 7 days moving average has is between 70 and 80 cases per days, however with migrating hotspot regions. President Magufuli announced 9 th December (Independence Day) to be used for environmental cleaning Zanzibar has reported a total of 572 suspected/ confirmed cholera cases and 7 deaths making the Case Fatality Rate of 1.2% Source: Ministry of Health and Social Welfare Cholera Outbreak Situation Report 7 th December ,984 Total (URT) suspected/ confirmed cases 166 Total (URT) deaths 19 of 30 Regions affected 572 Suspected/confirmed cases in Zanzibar 7 Deaths in Zanzibar 2,9 million People targeted by CERF funding

2 No. of reported cases Situation Overview Tanzania Cholera Outbreak Situation Report No. 1 2 Tanzania is battling a major cholera outbreak which has so far affected nineteen of the thirty regions in the country. The outbreak started in Dar es Salaam, in late August 2015, and has progressively extended to nineteen regions of Tanzania, stretching local capacities and resources, with high risk in terms of lives and economic impact. Cumulatively, 10,984 cholera cases (both Mainland and Zanzibar) and 166 deaths have been recorded (as of December 6). Over 42% of the cases are reported from Dar es Salaam. The case fatality rate of 1.5% is considered high by WHO standards. The new President, Dr. John Pombe Magufuli, has issued a directive to cancel the Independence Day celebrations on 9 December, and instead the day and the funds be used for activities related to Cholera control in the country. Regional Commissioners are responding by mobilizing the public and other sectors to participate in the response. 250 Trend of new reported cholera cases, Tanzaania, August 21st - December 7th Date of reporting Mbeya Katavi Rukwa Kagera Manyara Lindi Tabora Tanga Arusha Shinyanga Singida Geita Mara Mwanza Dodoma Kigoma Pwani Morogoro Dar es Salaam 7 Days Moving average for Total cases Source: Ministry of Health and Social Welfare Cholera Outbreak Situation Report 7 th December 2015 The total number of suspected/confirmed cholera cases as of 4 th December 2015 is 572 out of these, 274 (47.9%) from Unguja and 298 (52.1%) from Pemba with a total of 7 deaths making the Case Fatality Rate 1.2%, which is above the WHO recommended level of less than 1%. A joint field visit to Pemba was conducted in the period November The aim of the visit was to conduct a rapid assessment of the situation and provide advice and support to control Cholera Cases By Date Zanzibar the outbreak in Pemba. Cholera 01 Nov. to 1 Dec preparedness and response 20 coordination committees were set at the Regional and District levels. Advise and support was provided on the set up of the Cholera Treatment Center in Kojani, on improvement of case management, 10 infection prevention procedures and community mobilization for the containment of the outbreak. The issue of data quality and data use for decision 0 making was also discussed in depth with various MOH officials in the island. Encouraging public health measures have been taken that include closure of Unguja Pemba

3 Tanzania Cholera Outbreak Situation Report No. 1 3 street vending of food and drinks in Kojani Island, community involvement in cleaning the environment and the recent ban on open defecation on the beach. This has enabled the number of cholera cases to drop drastically in Kojani. Funding The funding requirement for the emergency is estimated at $6 million. CERF have allocated $1,5 million to UNICEF and WHO for implementation of live saving activities. WHO Cholera Repose Plan is costed to $3,5 million. Other planned interventions have had to be discontinued by WHO and UNICEF, due to lack of insufficient resources provided for the cholera response. Government of Tanzania have announced the allocation of TSH 9 million (approx. $450,000) to Ministry of Health and Social Welfare (MoHSW). The government and local authorities have also committed resources in terms of commodities, staff time and infrastructure; but these efforts still leave a lot of gaps. Humanitarian Response Government and local authorities are increasingly engaged and are expected to provide further funding to scale up response effort and mobilization of water and sanitation public utilities like DAWASCO (Dar es Salaam Water and Sewerage Corporation), DAWASA (Dar es Salaam Water Supply Authority) and water departments of the municipalities. A National Cholera Response plan is being finalized. Partners including US Centre for Disease Control, UNICEF, WHO, the Tanzania Red Cross and Medicines Sans Frontiers, Population Services International (PSI) are scaling up their response. WHO will mobilize additional international support through the Global Outbreak Alert and Response Network (GOARN). WHO Cholera Repose Plan focused on: 1) Strengthening outbreak response coordination at national and subnational levels; 2) Support the control and containment of the spread of the cholera outbreak; and 3) Support Cholera preparedness activities in the non-affected and/or at risk areas Needs: Health Support deployment of multidisciplinary teams from national level to hotspot Regions Support implementation and monitoring of the intensive social mobilization campaign Response: Training of Trainers conducted in Dar es Salaam, Mwanza, Dodoma, Tanga, Kagera and Singida for health staff per region. 8,000 treatment wall charts have been printed and will be distributed to CTCs. Capacity building and laboratory assessments conducted in Dar es Salaam (Amana Laboratory) and Tanga Mwanza, Arusha, Singida and Dodoma. WHO provided one Diarrheal Disease Kit, various medicines, medical supplies and more than 1.1 million chlorine tablets for household treatment of water on 18 th of November This has alleviated the shortage of medicines and medical supplies in Pemba. WHO Surveillance officers are supporting outbreak response in the Regions: Tanga, Mwanza, Dodoma, Singida, Kagera and Kigoma Orientation of 300 community leaders to support intensive social mobilization campaign was conducted for the 3 Municipalities in Dar es Salaam. Orientation of 200 volunteers is underway and house to house sensitization to commence this week. Social Mobilization Response Plan is finalized. Planned response Ensure training packages are more comprehensive Finalize National Facilitator s and Learner s guides Support TOTs to conduct cascade training Work with the social mobilization team to explore mechanisms for ensuring availability of ORS at community level through Community Oral Rehydration Points Finalize documentation of laboratory needs from all the affected regions Deploy staff to conduct capacity building and supportive supervision to newly affected Regions Share with Regions the reporting template documenting samples tested and status of reagents Consider expanding testing range to include Rotavirus, Shigella and Salmonella

4 Tanzania Cholera Outbreak Situation Report No. 1 4 Finalize RDT SOPs Gaps & Constraints: Essential cholera supplies at MSD are running low, including ORS. Diagnostic supplies are out of stock. Low availability of lab reagents and poor adherence to testing guidelines The major challenges observed in Zanzibar includes inadequate human resources at all levels and especially at the CTC, inadequate community education and social mobilization and inadequate use of data for programmatic and policy decision making. Needs: Water, Sanitation and Hygiene Expedite implementation of WASH interventions in affected Wards Finalize WASH Response Plan Response: On-going provision of safe water through water kiosks. Registration of water bouzers. Inspection of food premises in Dar es Salaam and distribution of WaterGuard in the Regions. Discussion with DAWASCO on mechanisms for super chlorination and bulk chlorination. Health workers trained by MOHSW in the use of Cholera prevention flips charts and house to house social mobilization commenced in the most cholera affected wards of Dar Es Salaam. The Story of Cholera video Tanzanian Swahili version cleared for distribution and to begin TV broadcast week beginning 7 December to link in with Independance Day which has been declared a national clean-up day to combat Cholera by President Magufuli.. The Story of Cholera - audio track will also be delivered to radio stations around the country to reinforce the TV broadcasts. SMS and PUSH messaging information on demand campaign for Cholera up and running and ready for launch in week beginning 7 December. Two new TV spots on Household Water Treatment and Handwashing with Soap in production and scheduled for broadcast week beginning 7 December IEC and Water Guard support provided to Zanzibar UNICEF supported production of IEC materials for Dar and other regions In Kigoma refugees camps the Health Information Team (HIT) provided education on diarrheal diseases including cholera through music band performance, drama, provision of education to primary schools. UNICEF provided 50 cartons of chlorine tablets and 95,000 cholera leaflets to Pemba Field visit to Zanzibar by UNICEF Tanzania Cholera Consultant and ESARO Consultant Cholera Action Plan for WASH and Social Mobilisation developed with Zanzibar MOH ESARO field mission completed and recommendations included in planned response on chlorination below. Planned response Community sensitization through TRCS and water quality monitoring Technical expertise for WASH C4D and WASH Emergencies to support Social mobilization and water chlorination respectively Support PSI for Social Marketing of ORS, WaterGuard and soap across the country Support the chlorination of water bowsers and sensitize and train water vendors in chlorination with WaterGuard. High level advocacy with Ministry of Water for super chlorination Joint water quality monitoring Ensure food safety through hygiene and sanitation promotion Enforce Public Health by-laws in all affected Regions Follow up and document distribution of WaterGuard in Dar es Salaam Gaps & Constraints: Only 59% of households in Dar es Salaam have access to piped water. Some illicit traders of water interfere with municipal water pipe system exposing the water to contamination with sewage. In this context, even water sources deemed safe have been contaminated.

5 Tanzania Cholera Outbreak Situation Report No. 1 5 Limited enforcement of public health by-laws Capacity to respond to the ever increasing geographical spread of cholera in regions and districts outstrips current response capacity due to limited number of partners and funding constraints Closing down all shallow wells located beside pit latrines and/or open defecation areas is hampered by lack of alternative sources of water supply. Need for coordinated mass communication campaign backed by high level political support. While CERF funds have been gratefully received, the epidemic remains under funded given its scale and geographical scope. Few partners engaged with the epidemic General Coordination The response is lead by the National Cholera Task Force; which comprises of regional and municipal authorities, Ministry of Health & Social Welfare (MOHSW, WHO, UNICEF, CDC and other partners). This has been activated and holds weekly coordination meetings. Six technical sub-committees have been formed at national level: Water, sanitation and hygiene (WASH); Social mobilization; Surveillance; Laboratory; Curative; Logistics and administrative sub-committees. The sub-committees meet on a daily basis to update on the response and the situation in their respective areas of responsibility. The sub-committees report to the national cholera task force and liaise with the implementing district health and local government authorities. The cholera response coordination structures are replicated at regional and district levels.. Production of daily Situation Reports, review of daily subcommittee activities and planning of field visits is undertaken through the Emergency Operations Center (EOC). WCO is supporting finalization of the National Cholera Response Plan. With WHO support, MOHSW has deployed multidisciplinary teams to affected Regions to strengthen coordination and support response activities. To strengthen coordination of partners involved in the response, WCO convened a partner s meeting to jointly review response operations and agree on concrete next steps. High level advocacy is required for effective engagement of other key Ministries in the response (e.g. Ministry of Water, Information and Education). For Zanzibar a multi-sectoral Coordination Committee has been established under the leadership of the 2nd Vice President s office, which meets on a daily basis. Unguja Zonal Medical Office has set up committees on case management, surveillance and burial, logistics, health promotion and social mobilization and laboratory. Pemba has been advised to emulate Unguja s approach in response to the outbreak. There is a committee set up in Pemba before the outbreak starts. For further information, please contact: Mona Folkesson, Coordination Specialist, mona.folkesson@one.un.org, Tel: