Emergency Plan of Action operation update

Transcription

1 Emergency Plan of Action operation update Niger / Sahel: Epidemic (Meningitis & Measles) DREF Operation n :MDRNE015 Glide n EP NER Operations update n 1 Operation start date: 25 April 2015 Overall budget allocation: Original allocation: CHF 100,428 Additional allocation n 1: CHF 102,770 Total allocation: CHF 203,198 Timeframe covered by this update: 24 April to 20 May 2015 Operations timeframe: Two months (New end date: 30 June 2015) Total estimated Red Cross and Red Crescent response to date: CHF 203,198 Host National Society presence (volunteers, staff, branches): Niger Red Cross Society; 700 volunteers, eight staff (for Dosso, Niamey and Tillabery regions) Red Cross Red Crescent Movement partners actively involved in the operation: International Federation of Red Cross and Red Crescent Societies, Luxembourg Red Cross Other partner organizations actively involved in the operation: Government (Ministry of Public Health), Médecins Sans Frontières, United Nations Children s Fund, and World Health Organization Request for extend timeframe by six weeks (New end date: 30 June 2015); and an additional allocation of CHF 102,770 to expand the activities planned into eight new districts, following the escalation of the epidemic in these areas. An additional 71,000 beneficiaries (10,000 households) will be reached through meningitis prevention and control activities (Total: 281,000 people / 40,000 households). A. Situation analysis Description of the disaster Niger is a West African country located in the heart of the African meningitis belt, which stretches from Senegal to Djibouti. The hot and dry climate is favourable to the outbreak of meningitis epidemics generally between November and May. From 31 December 2014 meningitis cases have been recorded countrywide at a slow rate; however since the beginning of April 2015, suspected cases have increased. As of April 2015, the number of suspected cases had reached 1,456 including 145 deaths (lethality rate of 9.9%) with the worst affected areas including with the worst affected areas including Dosso, Doutchi, Gaya, Niamey I, Niamey II and Niamey III districts. In parallel, a measles epidemic was also confirmed in regions in the north of the country, with Agadez, Maradi and Zinder worst affected. NRC volunteers at the treatment centre NRCS As of 25 April 2015, the number of suspected cases had reached 3,370 suspected cases with six deaths. Initial laboratory results released indicated that the principal bacteria parentage detected in the laboratory were: Neisseria meningitides (Nm) W; 40%, Nm C (33.85%) and Streptococcus pneumonia (23.08%); the W strain not being the one

2 previously experienced in the country; and not responding to existing vaccines. However, the trend has changed over time, 13, out of 1,296 samples analysed by CERMES between 29 December and 13 April, 45.6% (534) were positive. The main germs involved are: Neisseria meningitides (Nm) C: 71.6%, Nm W: 15% and Streptococcus pneumonia: 8.6%. On 21 April 2015, the Prime Minister declared a need of 1.2 million of new vaccine (trivalent A, C, W) doses for mass vaccination campaigns in the affected districts (Niamey, Doutchi, Gaya). However few vaccines were available and the Government of Niger (GoN) has made appeals to its international partners to contribute to ensuring that there is 100 per cent coverage. On 2 May 2015, the International Federation of Red Cross and Red Crescent Societies (IFRC) released CHF 100,428 from the Disaster Relief Emergency Fund (DREF) to support the Red Cross Society of Niger (NRCS) respond to the needs of the affected population. The DREF operation was intended to support 210,000 people (30,000 households) in Dosso and Niamey (meningitis response), and Agadez and Zinder (measles response), over a period of six weeks. As of 20 May 2015, it is estimated that 60 per cent of the activities planned have been completed, and progress made in accordance with the agreed Emergency Plan of Action (EPoA) in the following areas: Refresher training of 100 volunteers on the prevention and control of measles (as well as on surveillance and referral, the use of SMS, nutritional screening techniques and hygiene promotion); and mobilization to carry out awareness raising / sensitization campaigns (using a door to door strategy), which have reached 99,675 people (10,313 households) at risk, as well as deployment to treatment centres. In addition, two radio stations have been contracted to broadcast awareness messages on meningitis three times per day for a period of one month. Training of 10 supervisors to coordinate the volunteers activities in the communities. Table 1: Awareness raising / sensitization (using door to door strategy), 25 April 16 May 2015 Region District Number of households reached Number of people reached Niamey Niamey II 4,465 54,009 Dosso Doutchi 3,066 27,269 Dosso Gaya 2,782 18,397 TOTAL 10,313 99,675 As of 16 May 2015, the number of suspected meningitis cases has reached 6,609, including 443 deaths (lethality rate of 6.7%); and initially limited to three districts in Niamey (Niamey I, Niamey II, Niamey III) and two districts in Dosso region (Doutchi, Gaya) the epidemic has spread to others regions and districts of the country. Please refer to Needs analysis and scenario planning section for further information. In regards to the measles outbreak, cases have not spread beyond the three regions above and the indications are a reducing caseload, which has been attributed to selective vaccinations campaigns carried out in the districts of Agadez and Zinder. This Operations Update is requesting to extend the timeframe by six weeks; and an additional allocation of CHF to 102,770 expand the activities planned into eight additional districts (10 in total: (Doutchi, Fillingué Gaya, Kollo, Ouallam Niamey I, II III, IV, and V) with awareness raising / sensitization campaigns, which will include the training of additional volunteers and supervisors; as well as preparedness for response in 10 other districts that have not been affected, but are at risk. Following the stabilization of the measles epidemic, activities planned in Agadez and Zinder will be cancelled. Nonetheless, an additional 71,000 people (10,000 households) will be reached (In total: 281,000 people / 40,000 households) with meningitis prevention and control activities. The DREF operation will end on 30 June 2015, and a final report will be made available on 30 September 2015 (Three months after the end of the DREF operation). The major donors and partners of the DREF include the Red Cross Societies and governments of Australia, Austria, Belgium, Canada, Denmark, Ireland, Italy, Japan, Luxembourg, Monaco, the Netherlands, Norway, Spain, Sweden and the USA, as well as DG ECHO, the UK Department for International Development (DFID) the Medtronic, Zurich and Coca Cola Foundations and other corporate and private donors. The IFRC, on behalf of the Red Cross Society of Niger would like to extend many thanks to all partners for their generous contributions Summary of current response

3 Overview of Host National Society From the beginning of both epidemics, the NRCS has been monitoring the situation in collaboration with the Ministry of Public Health (MoPH) and through its volunteer network available in different branch committees. The NRCS is also a member of the National Crisis Committee (established by the MoPH) that meets regularly to monitor the epidemiological situation. Due to its long standing experience in managing the epidemics and other disasters, the MoPH has called on the assistance of the NRCS to conduct social mobilization in the affected areas. By 30 April 2015, 100 volunteers had received a refresher on the prevention and control of measles and meningitis, and deployed, initially in Niamey region (commune II), Dosso region (Doutchi and Gaya) to carry out awareness raising / sensitization activities in the communities using a house to house strategy. In collaboration with MoPH workers, the volunteers have started sensitization activities in the most affected areas in Niamey, and around the treatment centres. The NRCS has also liaised with its regional committees in other affected areas of the country, to obtain additional information and assess needs. In addition, volunteers have been alerted and remain in regular contact with health authorities. The MoPH has requested that the NRCS participate in a technical committee responsible for the organization and implementation of awareness raising / sensitization campaigns Overview of Red Cross Red Crescent Movement in country The IFRC is providing assistance through its Niger country representation, Sahel regional representation, and Africa zone office. Since the onset of the disaster, there has been regular contact with the IFRC Niger and Africa zone disaster management department. On 18 April 2015, a Disaster Management Information System alert was issued, which was followed by an Operational Strategy Call involving participants from the IFRC Secretariat, Africa zone and Niger country representation. It was agreed that an EPoA + Budget developed to request for a DREF. Following the DREF allocation, the IFRC Secretariat team liaised with the region and the zone to provide adequate support to the NRCS (through the deployment of a health emergency officer from the Secretariat). Through this Operations Update, the deployment of a Regional Disaster Response Team (RDRT) member experienced in epidemic response is also planned to support the effective implementation of the DREF operation. Since the onset of the epidemics, there has been regular consultation between all members of the Movement present in country; and the IFRC Niger country representative alerted both the Sahel regional and zone offices. The IFRC Niger country representation has also worked in collaboration with the NRCS health unit to collect information, assess the situation and propose the response to the situation. Monthly coordination meetings are regularly held, with the last meeting was organised by ICRC on 23 April 2015; updates on the epidemics were shared. The NRCS will also be encouraged to organize internal and external coordination and cluster meetings with different government and other agencies on a regular basis. Other Movement partners in country include: the International Committee of the Red Cross (ICRC), as well as Partner National Societies (PNS) comprising the Belgian Red Cross, French Red Cross, Iranian Red Cross, Irish Red Cross, Luxembourg Red Cross, Qatar Red Cross and Spanish Red Cross, which are based in the capital of Niamey. The Luxembourg Red Cross has supported the construction of an additional treatment facility. Overview of non-rcrc actors in country A National Task Force has been established, which is led by the MoPH, and meets on a weekly basis. In addition, the MoPH has also established a National Crisis Committee to also monitor the situation. On 15 April, 2015, the MoPH carried out a press conference, which provided information on the situation and the actions carried out, in progress and preventive measures in regards to meningitis. On 21 April 2015, the Prime Minister officially declared the epidemic and launched an appeal to international partners to assist with the response, specifically with the provision of vaccines (for meningitis). The MoPH has worked in collaboration with other organizations to mobilize children for measles vaccinations. Other organizations involved in the response include CDC Atlanta, Médecins Sans Frontières (MSF), United Nations Children s Fund (UNICEF) and the World Health Organization WHO), which have participated in joint field missions with the MoPH to assess the situation, and provided medical staff and treatment facilities. Surveillance and Laboratory Surveillance activities have been reinforced by The MoPH has reinforced surveillance activities, with support from the Centre for Disease Control and Prevention (CDC) and WHO, with daily transfer of information on meningitis situation to the central level in Niamey, and seems satisfactory despite some challenges in delay of transmission of information in some rural areas mainly due to poor phone network connection. All samples collected are sent to

4 Niamey CERMES (Medical Research Centre) for analysis; CDC supported with a mobile laboratory attached to the treatment centres of Lazaret in Niamey. Case management From 30 April the MoPH in the National Hospital, meningitis case management centres Lazaret I (350 patient beds) and Lazaret II (120 patient beds) were established in Niamey with support from MSF Belgium and Switzerland which run and manage the centres. Referrals of cases are being facilitated in Niamey by an ambulance network link to a call center all managed by MSF, which is also expanding their support in in case management in Dosso and Tillabery regions. Currently a decentralized case management approach is being implemented within primary health care facilities (CSI) handling cases and refers the complicated cases to the meningitis treatment centers (Lazaret I or II). Concerning the affected districts located in the regions (Dosso, Tillabery), this decentralized approach has been applied from the onset of the epidemic Vaccination From 30 April 2015, vaccination campaigns have started using polysaccharide trivalent vaccine (A, C, W), and are still ongoing in some areas. Given the shortage of vaccines, children aged between two and 15 years are only targeted by these vaccination campaigns. On 15 May 2015, a technical committee was established to plan and organise the mass vaccination campaign in Ouallam district, using the anti-meningococcal conjugate tetravalent vaccine just released by the ICG Group. Communication Main ongoing activities include radio messaging, press conference; a TV show/debate is also being organised. Needs analysis and scenario planning Needs Assessment In April 2015, a meningitis epidemic was declared following a considerable increase in the number of confirmed cases, with the majority of cases aged four -15 years old. According to the MoPH, Niamey is the epicenter of the epidemic where 4,313 cases (235 deaths) out of the 6,609 cases have been reported. Initially estimated at 281,000, the population at risk will continue to increase as the epidemic spread. As of this Operations Update, 11 districts are in an epidemic situation, while five others have already crossed the alert threshold. It is expected that this number would increase due to the insufficient quantity of vaccines available in the country. As of Operations Update, with the exception of the NRCS there is no other organization carrying out awareness raising / sensitization campaigns for meningitis prevention and control; and an given the evolution of the epidemic, and based on assessments (carried out on 13 and 14 May 2015 in Dosso, Kollo and Ouallam) there is a need to now increase the activities planned. Please refer to Table 2: Situation of Meningitis by region from 31 December 2014 to 15 May 2015 (Source: Ministry of Public Health) Table 2: Situation of Meningitis by region from 31 December 2014 to 15 May 2015 (Source: Ministry of Public Health) Region Meningitis Confirmed cases Deaths Lethality (%) Agadez Diffa* Dosso Maradi Niamey Tahoua Tillabery Zinder Total 6, *Laboratory result: negative The NRCS will ensure that the DREF operation is aligned with the IFRC s commitment to realize gender equality and diversity, by adapting a beneficiary selection criteria that targets (women headed-households, people with disabilities, etc.); however children will be targeted through the activities planned since they have been identified as being most

5 vulnerable to the epidemics. Other aspects considered will include prevention of sexual violence and gender-based violence, and the protection of children. Risk Assessment Vaccines stocks are still largely insufficient to cover the needs. In addition given the shortage of meningococcal vaccines (A, C, W) at international level, it is likely that a timely response with a mass vaccination campaign targeting all people in need in the country will not be possible. Indeed the current vaccination strategy (focus on districts in most areas affected by epidemic, only on children between 2-15 years due to insufficient stocks) is not likely to provide sufficient herd immunity in the communities in order to significantly impact on the spread of the outbreak. Therefore, one could anticipate that in this context, as the dry and hot season continues, spread of meningitis will increase as the gaps in vaccines availability at international level are still observed. Due to the shortage of the vaccines, and evolution of the epidemic to date, it is possible that it will spread to districts across the country may spread in many more districts. B. Operational strategy and plan Overall Objective To contribute to the reduction of the spread of meningitis among the population at risk in 10 districts* (Doutchi, Fillingué Gaya, Kollo, Ouallam Niamey I, II III, IV, and V); and prepare for an imminent outbreak* in 15 other districts. *Additional eight areas included through this Operations Update; and inclusion of preparedness for imminent outbreak in an additional 15 districts. Proposed strategy As per the agreed strategy, the following activities were prioritized within this DREF operation for implementation in Dosso and Niamey districts (meningitis) and Agadez and Zinder districts (measles): Meningitis response activities (Dosso and Niamey) Refresher training of volunteers (100) in the Dosso and Niamey districts (50 per area) on prevention and control of meningitis (as well as on surveillance and referral, the use of SMS, nutritional screening techniques and hygiene promotion) would be carried out; and was budgeted at CHF 30 per participant per (one-day). Following the refresher training, the volunteers would be mobilized to carry out sensitization activities at community level, treatment and vaccination centres as well as surveillance and referral. In total, 20 volunteers would be mobilized for 42 days (seven days per week for six weeks) to carry out sensitization on meningitis at treatment and vaccination centres. In total, 80 volunteers would be mobilized for 30 days (five days per week for six weeks) to carry out community level sensitization on meningitis, which would also be combined with Mid-Upper Arm Circumference (MUAC) screening and referral of children under five years with moderate/severe malnutrition). Community level sensitization would be carried out from 08:00 to 12:00 due to these extreme weather conditions that prevail in the areas of implementation. Each volunteer would be issued with a per diem of CHF 7 per day. Please note that that per diem rate for volunteers was increased compared to the MDRNE014 Niger Epidemic (Cholera) operation (CHF 5), which is being carried out concurrently due to increased living costs in the Dosso and Niamey areas versus Diffa region. Cell phones were to be issued to volunteers to support surveillance at community level, and enable suspected cases to be reported quickly via SMS. In addition, CHF 7 approx. was budgeted to enable cases (100) to be transported to the nearest health centre. Information, communication and education (IEC) materials (leaflets and image boxes) would be also be issued to volunteers to assist them with the sensitization activities planned Training of teachers (30) at the NRCS primary school on the prevention and control of meningitis (definition, symptoms, prevention, and actions to take) would be carried out; and was been budgeted at CHF 40 per participant per day (two days). Please note that the MoH prioritized the vaccination of children of primary school age, given at those below 15 years old have been mostly affected (five deaths in schools have been reported), hence the inclusion of this training in order to ensure that they ere able to detect the signs of meningitis and refer immediately the suspected cases for treatment, as well as mobilize students to attend the vaccination centres. Training of supervisors (10) on supporting volunteers with the implementation of the activities planned would be carried out; and was budgeted that CHF 80 per participant per day (two days), and included allowance for per

6 diem, accommodation and transportation. Each supervisor would be deployed to the areas of implementation for 30 days (five days per week for six weeks), and were to be issued a per diem of CHF 8 per day. Measles response activities (Agadez and Zinder) Refresher training of volunteers (100) in the Agadez and Zinder regions (25 per region) on the prevention and control of measles (as well as on surveillance and referral, the use of SMS, nutritional screening techniques and hygiene promotion); and was budgeted at CHF 40 per participant per (one-day). Please note that the Agadez and Zinder areas are 1,000 km approx. from Niamey, and such the cost of this training was increased compared to the meningitis training (CHF 30) as transportation of trainers needed to be factored. Following the refresher training, the volunteers would be mobilized to carry out sensitization activities at community level, surveillance and referral, which would also be combined with MUAC screening and referral of children under five years with moderate/severe malnutrition) Community level sensitization would be carried out from 08:00 to 12:00 due to the extreme weather conditions that prevail in the areas of implementation. Each volunteer would be issued with a per diem of CHF 10 per day. Please note that that per diem rate for volunteers is increased compared to the meningitis response (CHF 7), which was due to the long distances that volunteers were expected to travel in Agadez and Zinder regions, and as such transportation needed to be factored. Cell phones would be issued to volunteers to support surveillance at community level, and enable suspected cases to be reported quickly via SMS. In addition, CHF 7 approx. was budgeted to enable cases (100) to be transported to the nearest health centre. IEC materials (leaflets and image boxes) were already available for community sensitization on measles and therefore were not budgeted within this DREF operation. Training of supervisors (10) on supporting volunteers with the implementation of the activities planned would be carried out; and was budgeted at CHF 80 per participant per day (two days) including allowance for per diem, accommodation and transportation, as well as provision for the trainer and training hall. Each supervisor would be deployed to the areas of implementation for 30 days (five days per week for six weeks), and were to be issued a per diem of CHF 8 per day. Through this Operations Update, the NRCS now intends to revise the proposed strategy of the DREF operation expanding the activities planned related to the prevention and control of meningitis; and cancelling the activities planned related to the prevention and control of measles. Please refer below for the additional activities now planned. Meningitis response activities Refresher training of volunteers (250) in preparedness for epidemic response, in readiness of an imminent response to meningitis should cases occur in other districts across the country; and has been budgeted at CHF 20 per participant. Refresher training of volunteers (200) on the prevention and control of meningitis (as well as on surveillance and referral, the use of SMS, nutritional screening techniques and hygiene promotion) will be carried out. Please note that this equates to an additional 100 volunteers. In total, 164 will be mobilized for 40 days (five days per week for eight weeks) to carry out community level sensitization on meningitis; and 28 will be mobilized for 56 days (seven days per week for eight weeks) to treatment centres. Please note that eight volunteers have been deployed to health centres and are now not available to support the implementation of the DREF operation. Training of supervisors (50) on supporting volunteers with the implementation of the activities planned; and has been budgeted at CHF 80 per participant per day (two days), and includes allowance for per diem, accommodation and transportation. Please note that this equates to an additional 40 supervisors. Each supervisor will be deployed to the areas of implementation for 40 days (five days per week for eight weeks). Procurement of 50 cell phones to support surveillance at community level, and enable suspected cases to be reported quickly via SMS. Please note that this equates to an additional cell phones, which are required following the increase in the number of volunteers and supervisors being mobilized to support the implementation of the DREF operation. Training of volunteers (173 (Niamey I (29), Niamey III (43), Niamey IV (35) and Niamey V (66))) on mass sensitization techniques (five days); and has been budgeted at CHF 20 per participant. Following the training, the volunteers will then be mobilized to carry out a five day mass sensitization campaign on the prevention and control of meningitis in the four communes, where there has been an increase in cases. Deployment of a Regional Disaster Response Team (RDRT) member experienced in epidemic response to support the effective implementation of the DREF operation, for a period of one month; and budgeted at CHF 6,000 per month. Lessons learned workshop, which will be used to inform future operations; and budgeted at CHF 3,000. Measles response activities

7 Measles activities stopped to focus on meningitis response All the activities planned will be carried out in cooperation with the community and through advocacy to the community, religious and traditional leaders as well as other actors. By attending coordination meetings at national level, a continuous assessment and analysis of the situation will be accomplished. Please note that the timeframe for this DREF operation is two months, which according to the previous experience corresponds to the beginning of the rain season (end of epidemic). It is expected that when the rain starts, the spread of meningitis will stop. The proposed strategy has been informed by the lessons learnt from the 2010 meningitis response which were as follows: After the operation, the volunteers felt themselves able to save the lives of the affected people, Hygiene and health education, early case detection and referral, and sensitization have contributed in reducing the number of victims; Hygiene and health education, and sensitization have led to long-term behavior change preventing and reducing the impact of future outbreaks; The public has come to know more about the role of the Red Cross/Red Crescent Movement, NRCS visibility has increased. Operational support services Human resources The DREF operation required the mobilization of the following personnel: The NHQ NRCS health department staff (two doctors and one assistant), as well as a finance assistant, have been assigned to support the regional committees implementation of the DREF operation, and provision have been made for allowances (for two months). 373 community volunteers will be trained, equipped and deployed according to an agreed schedule (in rotation). Each volunteer will receive a per diem of CHF 7 per day. In addition, 250 volunteers will be mobilized for refresher training in preparedness for epidemic response, in readiness of an imminent response in other districts across the country. 50 supervisors, which will be trained to support the management of the volunteers. Each supervisor will receive a per diem of CHF 8 per day. The IFRC Niger country representations operations manager is responsible for the overall coordination of the DREF operation, with support from the IFRC country representative. In addition, the IFRC Secretariat has deployed an emergency health officer specialized in measles and meningitis response for a period of two weeks to assist with the planning and implementation of the DREF operation. An IFRC driver has also been recruited for a period of six weeks. After the support of Geneva personnel, an RDRT (epidemics experienced) will need to be deployed to for the remaining period for the operation (budgeted for CHF 6,000). Logistics and supply chain Logistics and supply chain support to the operation includes delivering a range of items in line with operational priorities. The primary tasks may include: Local procurement of all items (cell phones, hand gel, gloves, masks, training materials etc.) has been carried out in accordance with the agreed IFRC and NRCS guidelines. Reception and storage of items before delivery to distribution sites is being managed according to IFRC warehouse management rules and regulations, as well the coordination of transport of all relief items. The IFRC rented one leasing vehicle to support the implementation of the DREF operation, which has been extend to a period of six weeks to support the expansion of the DREF operation, which includes provision for fuel and maintenance (CHF 2,680). Information technologies (IT) The IFRC IT manager works closely with the Communication Coordinator of the NS to ensure information sharing. In addition, 20 cell phones have been procured and used to support the referral of suspected measles or meningitis

8 cases to health centres via SMS. An additional 30 cell phones will now be procured to support the expansion of the DREF operation. Communications The NRCS NHQ works in collaboration with the IFRC Niger country representation to ensure the Communication and visibility of the DREF operation will be ensured through collaboration between the NRCS NHQ and IFRC Niger country representation, and will include the raising-awareness of the activities planned, as well as the preparation of case studies/photographs for use on the IFRC websites, and social media platforms (Twitter). As noted, NRCS issued alerts on the situation via the DMIS; and on 2 May 2015, issued an Emergency Plan of Action. Weekly updates have been shared with the region and the zone and continuous information sharing will be carried out with the MoPH, partner organizations and the media as is appropriate. Security The security situation is stable in the affected regions. However, the IFRC Niger country remains responsible for the security of all IFRC personnel in country and all IFRC operations are to be conducted in accordance with IFRC minimum security requirements and the security plans for Niger. Ad hoc security measures are taken in cooperation with ICRC, the NRCS and PNS present in the country. IFRC security regulations were last updated in September 2014 and according to the situation in North-East of Nigeria, will be reviewed in 2015 prior to the last support mission of Africa zone security coordinator in Niger. Security and safety of volunteers involved in the implementation activities planned will also be ensured through the issue of protective equipment (hand gels, gloves and masks) along with drinking water given the extreme weather conditions (heat, sun etc.) in the areas of implementation. In addition, all staff and volunteers involved in the operation have been vaccinated against meningitis prior to deployment to the areas of implementation to ensure that they are able to work safely (CHF 16,000). Please note that the free MoH vaccines are not available to staff and volunteers as the most vulnerable groups (children of primary school age) have been prioritized. Volunteers insurance has been also included. Planning, monitoring, evaluation, & reporting (PMER) The IFRC Sahel regional representation supports the implementation of the DREF operation through its regional communication, finance, health and PMER senior officers, as well as from the regional representative for advocacy and humanitarian diplomacy. As noted, the IFRC Niger country representations operations manager is responsible for the overall coordination of the DREF operation, and monitoring mission costs have budgeted to enable them to visit all areas of implementation during the DREF operation. The IFRC Niger country representations operations manager works in collaboration with their NRCS counterpart to ensure that a proper monitoring and reporting system is established, which is accordance with IFRC standards. In addition, the IFRC emergency health officer, and IFRC Sahel regional health coordinator will also support the planning, implementation and monitoring of the DREF operation as part of their planned missions. Branch and NHQ level monitoring mission costs (fuel) have also been conducted to visit the areas of implementation in order to ensure that the activities planned have been carried out in accordance with the Emergency Plan of Action. At the end of the DREF operation, lessons learned workshop will be organized. Administration and Finance A Memorandum of Understanding (MoU) was agreed between the IFRC Niger country representation and NRCS, which outlined the parties responsibilities to implement the activities planned within the DREF operation, and ensure that the appropriate guidelines are complied with in terms of the use of DREF allocations. NRCS has a permanent administrative and financial department, which ensures the proper use of financial resources in accordance with conditions a MoU. C. Detailed Operational Plan Quality programming / Areas common to all sectors Quality programming/ Areas common to all sectors

9 Outcome 1: Continuous assessment, analysis and coordination to inform the design and implementation of the DREF operation Activities Outputs Output 1.1: Planning, monitoring and reporting on activities planned within the DREF operation in the areas of implementation Is implementation on time? % of achievement 87.5% % progress (estimate) Deployment of IFRC emergency health officer to support planning and implementation of the DREF operation (Target: One mission) Branch monitoring of activities planned in the areas of implementation (Agadez, Dosso, Niamey and Zinder) NHQ monitoring of activities planned in the areas of implementation (Agadez, Dosso, Niamey and Zinder) IFRC monitoring of activities planned in the areas of implementation (Agadez, Dosso, Niamey and Zinder) Lessons learned workshop Yes No X 100% X 50% X 100% X 100% X 0% Progress towards outcomes Following the DREF allocation, an IFRC emergency health officer (from the Secretariat) was deployed to support the IFRC Niger country representation and NRCS with planning the implementation of the DREF operation. The IFRC emergency health officer participated in several meetings organised by the MoPH, WHO and other partner organisations, and conducted field missions both in Niamey and out of Niamey (Dosso and Tillabery). Unfortunately the deployment was short and there will be a need to deploy an RDRT for the remaining timeframe of the DREF operation Branch committees have been active in monitoring the situation and reporting it to the NHQ level; and have also been in contact with MoPH structures in their respective zones to ensure coordination and that assistance is complementary. Please note that the committees have been more active in Niamey and Dosso than Agadez and Zinder, since it was observed that the MoPH had organised mass vaccination in the affected zone and the situation was improved Regular NHQ monitoring of the situation has been carried out by the NRCS health department, with support from the NRCS Secretary Executive. The NRCS health department is composed of two doctors and an assistant, which are all fully engaged in the DREF operation. One doctor has been responsible for the monitoring of the measles situation, and the second has been responsible for monitoring the meningitis situation. The assistant has been responsible for reporting and data recording. In addition to participating in different meetings, NRCS health department have also carried out field missions to support the field team in collaboration with IFRC country representation From the onset of the epidemic, the IFRC country representation has been following the situation and sharing information with other Movement partners. The IFRC country representation has also participated in the epidemic related meetings, as well as carried out assessments and monitoring activities. The IFRC Niger country representative and the IFRC operations manager based in Niamey are continuing to provide assistance to the NRCS with the implementation of the DREF operation As noted, at the end of the DREF operation lessons learned workshop will be carried out.

10 Early warning and emergency response preparedness Emergency warning and emergency response preparedness Outcome 1: Immediate risk of meningitis to the health of the population is reduced through preparedness activities in 10 districts over a period of eight weeks Activities Outputs Output 1.1: Capacity of Niger Red Cross Society to prepare for potential meningitis response and new areas is strengthened Is implementation on time? % of achievement 0% % progress (estimate) Refresher training of volunteers in preparedness for epidemic response (Target: 250 volunteers) Progress towards outcomes Yes No X 0% Following the escalation of the epidemic; and continuing lack of vaccines, it has been identified that there is a need to provide refresher training for 250 volunteers in preparedness for epidemic response, in readiness for an imminent response in other districts across the country; and this is included as a new activity in the expansion of the DREF operation through this Operations Update. Health & care Health & care (activities related to the Meningitis) Outcome 1: Immediate risk of meningitis to the health of the population is reduced through prevention and control activities in affected districts district over a period of eight weeks Activities Outputs Output 1.1: Capacity of Niger Red Cross Society to respond to the meningitis epidemic in the affected area is strengthened Output 1.2: Target population in the affected areas are provided with sensitization to improve the knowledge and practices on the prevention and control of meningitis (New target: 281,000 people / 40,000 households people) Is implementation on time? % of achievement 50% 61% % progress (estimate) Refresher training for volunteers on prevention and control of meningitis, MUAC, SMS and HP (New target: 200 volunteers) Yes No X 50% *Additional 100 volunteers included through this Operations Update.

11 1.1.2 Training of teachers on prevention and control of meningitis (Target: 30 teachers) Training of supervisors on management of volunteers (Target: 50 supervisors)* *Additional 40 supervisors included through this Operations Update Procure/equip volunteers (and supervisors) with protective equipment kits ((hand gels, gloves and masks) (Target: 415 kits) *Additional protective equipment kits for 265 volunteers and 40 supervisors included through this Operations Update Procure/equip volunteers with cell phones for SMS surveillance and referral (Target: 50 cell phones) *Additional 30 cell phones kits included through this Operations Update Training of volunteers in mass sensitization (Target: 173 volunteers)* *Additional activity included through this Operations Update Conduct awareness raising / sensitization campaigns for meningitis prevention and control in the communities (Target: 281,000 people / 40,000 households) *Additional 71,000 people targeted through this Operations Update Nutritional (MUAC) screening in children under 5 combined with the sensitization activities in the communities Referrals of identified suspected meningitis SAM & MAM cases to management centres via SMS Conduct awareness raising / sensitization campaigns for meningitis prevention and control in the treatment centres(target: 10 volunteers per day by treatment centre Conduct awareness raising / sensitization campaigns for meningitis prevention and control on the vaccination sites (Target: 10 volunteers per day by site) Progress towards outcomes X 20% X 25% X 40% X 0% x 61% x N/A x x N/A x 280% x 0% In total, 100 volunteers from the Doutchi (25), Gaya (25), and Niamey II (50) districts, which had been worst affected by the epidemic, have received refresher training on the prevention and control of meningitis, MUAC, SMS and HP, which equates to 100 per cent of the intended target (100). Following the escalation of the epidemic, it has been identified that an additional 100 volunteers should receive refresher training, and this is included in the expansion of the DREF operation through this Operations Update. In total, 200 volunteers will receive refresher training on the prevention and control of meningitis, MUAC, SMS and HP. Please note that in Niamey II, eight volunteers have been deployed to health centres, leaving 42 available to support the DREF operation (and 192 in total) Training of teachers on the prevention and control of meningitis has been cancelled, as it has been identified that community awareness raising / sensitization campaigns should be prioritized. Nonetheless, it is expected that teachers will be among the communities targeted by these activities In total, 10 supervisors have been trained to coordinate the volunteers activities in the communities, which equates to 100 per cent of the intended target (100). The supervisors collect data and submit/communicate them to the National level for sharing with the MoPH and other partners. Following the escalation of the epidemic, it has been identified that an additional 40 supervisors will need to be trained, and this is included in the expansion of the DREF operation through this Operations Update. In total, 50 supervisors will be trained In total, 100 volunteers (and 10 supervisors) have been equipped with protective materials (hand gels, gloves and masks, which equate to 100 per cent the intended target (100). Hand gel and the gloves are very useful

12 for the volunteers deployed to the treatment centres. Knowing that masks (nose covers) are not used for protecting against meningitis germs, volunteers can put on them to protect themselves against wind and sand. In addition, all volunteers and personnel (NRCS and IFRC) have been vaccinated against meningitis. Following the increase in the number of volunteers (265) and supervisors (40), an additional 305 kits will be required; and this is included in the expansion of the DREF operation through this Operations Update. In addition, more volunteers will also need to be vaccinated (and has been budgeted.) In total, 20 phones have been procured and provided to the volunteers, supervisors and health centres to enable a rapid communication when new cases are detected, which equates to 200 per cent of the intended target (10). Following the increase in the number of volunteers and supervisors, an additional 30 cell phones will be required; and this is included in the expansion of the DREF operation through this Operations Update Following the escalation of the epidemic, it has been identified that 173 volunteers (Niamey I (29), Niamey III (43), Niamey IV (35) and Niamey V (66)) should receive a day training, which will enable them to carry out a mass sensitization exercise in these communes, where there has been an increase in cases; and this is included as a new activity in the expansion of the DREF operation through this Operations Update In total, 99,675 people (10,313 households) have been reached through awareness raising / sensitization campaigns for meningitis prevention and control carried out from 26 April 2015 in Doutchi, Gaya and Niamey, which equates to 47 per cent of the intended target (210,000). In addition, two radio stations have also been contracted to broadcast awareness messages on meningitis three times per day for a period of one month. Following the escalation of the epidemic, and expansion of the DREF operation through this Operations Update, it is now expected that additional awareness raising / sensitization campaigns will be carried out Dosso, Doutchi, Fillingué, Kollo, Niamey and Ouallam. In total, 281,000 people (40,000 households) will be reached through awareness raising / sensitization campaigns (including mass sensitization) Nutritional screening (MUAC) has been carried out by volunteers during awareness raising / sensitization campaigns. As of this Operations update, eight children under five years old have been screened, but not confirmed as suffering from malnutrition As of this Operations Update, no suspected meningitis SAM and MAM cases have been identified / referred to management centres At the onset of the epidemic, only one treatment centre (Lazaret I) was operational and it was intended that 10 volunteers would be required; however as the number of cases has increased, a second treatment centre (Lazaret II) was put in place. In total 28 volunteers have been deployed to Lazaret I and Lazaret II on a rotation scheme (day and night) to ensure effective awareness raising / sensitization campaigns, as well as hygiene promotion and transportation of patients the stretchers; and this is included in the expansion of the DREF operation through this Operations Update Awareness raising / sensitization campaigns for meningitis prevention and control on the vaccination sites has not been progressed. Due to the insufficient available vaccines, it was complicated for the volunteers to know where the vaccination sites were, and as to avoid confusion, instead concentrated their efforts in the communities. Health and Care (activities related to the measles) Outcome 2: Immediate risk of measles to the health of the population is reduced through prevention and control activities in Agadez and Zinder over a period of six weeks. Outputs Output 1.1: Capacity of Niger Red Cross Society to respond to the measles epidemic in the affected area is strengthened Output 1.2: Target population in the affected areas are provided with sensitization to improve the knowledge and practices on the prevention and control of measles (Agadez and Zinder) (Target: 10,000 households people / 70,000 people) % of achievement NA NA

13 Activities Is implementation on time? % progress (estimate) Refresher training for volunteers on prevention and control of measles, MUAC, SMS and HP (Target: 50 volunteers (25 per region) Training of supervisors on management of volunteers (Target: 10 supervisors) Procure/equip volunteers (and supervisors) with protective equipment kits (hand gels, gloves and masks) (Target: 50 kits) Procure/equip volunteers with cell phones for SMS surveillance and referral (Target: 10 cell phones) Conduct awareness raising / sensitization campaigns for the measles prevention and control in the communities (Target: 10,000 households people / 70,000 people) Nutritional (MUAC) screening in children under 5 combined with the sensitization activities in the communities Referrals of identified suspected measles, SAM & MAM cases to management centres via SMS Progress towards outcomes: Yes No Activities planned have been cancelled due to the positive evolution of the measles outbreak including a significant decrease in caseload following a MoPH mass vaccination campaign in Agadez and Zinder, which were the worst affected districts. D. Budget (see attached budget summary for details) Contact information For further information specifically related to this operation please contact: Niger Red Cross Society: Ali Bandiaré, President; Tel: ; crniger@intnet.net IFRC Country Representation: Pierre Kana, Country Representative; Tel: ; pierre.kana@ifrc.org IFRC Regional Representation: Momodou Lamin Fye, Regional Representative for Sahel; phone: or ; momodoulamin.fye@ifrc.org IFRC Zone: Daniel Bolaños Gonzalez, Disaster Management Coordinator, Phone: ; daniel.bolanos@ifrc.org In Geneva: Cristina Estrada, Operations Support, Phone: , cristina.estrada@ifrc.org Regional Logistics Unit: Rishi Ramrakha; Phone , rishi.ramrakha@ifrc.org For Resource Mobilization and Pledges: IFRC West and Central Africa: Elisabeth Seck, Resource Mobilization Officer; phone: ; elisabeth.seck@ifrc.org For Performance and Accountability (planning, monitoring, evaluation and reporting) In IFRC Zone: Robert Ondrusek, PMER Coordinator; Phone: ; robert.ondrusek@ifrc.org

14 How we work All IFRC assistance seeks to adhere to the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGO s) in Disaster Relief and the Humanitarian Charter and Minimum Standards in Humanitarian Response (Sphere) in delivering assistance to the most vulnerable. The IFRC s vision is to inspire, encourage, facilitate and promote at all times all forms of humanitarian activities by National Societies, with a view to preventing and alleviating human suffering, and thereby contributing to the maintenance and promotion of human dignity and peace in the world.

15 DREF OPERATION 02/06/2015 MDRNE015 Budget Group DREF grant budget Expenditure CHF Shelter - Relief 0 0 Shelter - Transitional 0 0 Construction - Housing 0 0 Construction - Facilities 0 0 Construction - Materials 0 0 Clothing & Textiles 0 0 Food 0 0 Seeds & Plants 0 0 Water, Sanitation & Hygiene 0 0 Medical & First Aid 16,000 0 Teaching Materials 25,700 Utensils & Tools 0 0 Other Supplies & Services Emergency Response Units 0 0 Cash Disbursements 0 0 Total RELIEF ITEMS, CONSTRUCTION AND SUPPLIES 42,469 0 Land & Buildings 0 0 Vehicles Purchase 0 0 Computer & Telecom Equipment 0 0 Office/Household Furniture & Equipment 0 0 Medical Equipment 0 0 Other Machinery & Equipment 0 0 Total LAND, VEHICLES AND EQUIPMENT 0 0 Storage, Warehousing 0 0 Distribution & Monitoring 0 0 Transport & Vehicle Costs 4,780 Logistics Services 0 0 Total LOGISTICS, TRANSPORT AND STORAGE 4,780 0 International Staff 0 0 Regionally Deployed Staff 6,000 National Staff 0 0 National Society Staff 2,660 0 Volunteers 81,534 Total PERSONNEL 90,194 0 Consultants 0 0 Professional Fees 0 0 Total CONSULTANTS & PROFESSIONAL FEES 0 0 Workshops & Training 26,920 Total WORKSHOP & TRAINING 26,920 0 Travel 12,000 Information & Public Relations 0 0 Office Costs 2,100 0 Communications 6,000 0 Financial Charges 6,333 0 Other General Expenses 0 0 Shared Support Services Total GENERAL EXPENDITURES 26,433 0 Programme and Supplementary Services Recovery 12,402 0 Total INDIRECT COSTS 12,402 0 TOTAL BUDGET 203,198 0