fight against cholera an integrated approach for a public...

Franck Haaser, Head of emergencies, Veolia

Environment Foundation 13th March, 2012, Marseille

Fight against cholera

An integrated approach for a public health concern

Democratic Republic of Congo

Gregory Bulit, WASH Specialist, Solidarites International, 13th March, 2012, Marseille

Cholera in Democratic Republic of Congo

Eric D. Mintz, and Richard L. Guerrant., NEJM

,2009.

WORLD:

• 2002-2006: 724,108 cases and 17,386 deaths from cholera (WHO)

• More than 94% of cases and 97% of deaths linked to epidemics occurring in Africa.

DEMOCRATIC REPUBLIC OF CONGO: • 2002-2006: 100,667 cases and 3,866 deaths, meaning 14% of the cases and 22% of the deaths notified in the world.

• D.R.C. ranked first country worldwide in terms of reported cases and deaths

Continental scale National scale Provincial scale

Identification of priority areas

• Statistical analysis enabled the ranking of different

risk factors for the prevalence of cholera: o 1st: Lakes o 2nd: Roads o 3rd: Harbors o 4th: Railways

• These risk factors were validated by risk modeling

2008: Strategic Plan for the elimination of Cholera in DRC

Activities: -Reinforcement of epidemiologic surveillance -Reinforcement of preventive measures in the priority health areas -Implementation of long term WASH interventions in source areas -Improvement of case management -Reinforcement of coordination -Promotion of operational research activities

:

2011: Toward an interministerial strategy of fight against cholera

Preparatory meeting held in Kinshasa on 10th and 11th May 2011 Objective: reinforcement of the coordination between ministries involved in the fight against cholera. Committed Ministries:

Public health Plan Energy Rural development Environment

Redaction of a multi sectorial plan for elimination of cholera in DRC

Case Study: Uvira, South Kivu

2010

Health: Reinforcement of the epidemiologic surveillance

WASH: Mapping of the water distribution network Definition of priority interventions (Rehabilitation of electro mechanic equipments in the treatment plant, replacement of valves)

2011

Health: Epidemiologic data analysis, identification of priority areas

WASH: Implementation of priority program, drafting of a master for improvement of tha water supply system of the city of Uvira

Partners involved: Ministry of Public Health (4th Direction) Regideso Oxfam GB Veolia Environnement Foundation

Uvira: Reinforcement of Epidemiologic surveillance

0 1 000 2 000

meters

0 1 000 2 000

meters

0 1 000 2 000

meters

0 1 000 2 000

meters

0 1 000 2 000

meters

0 1 000 2 000

meters

Période pré-épidémique Semaine 29

Période pré-épidémique Semaine 30

Démarrage épidémique Semaine 34

Regroupement de cas

Pic épidémique Semaine 36 Décroissance épidémique Décroissance épidémique

Better efficiency of emergency activities

Better definition of priority areas

Master Plan for improvement of water access in Uvira

Poste Montant (€) %

Total 6,800,000

Kalemie: from operational research to action

• 2007-2008: Within the framework of the national strategy for cholera elimination, reinforced by the regional cholera workshop led in Lubumbashi en 2009, Kalemie is defined as pilot town to fight against cholera through an integrated health and wash approach

High incidence is linked to rainy season

-A first epidemiological study of environmental and social determinants is done, for instance: seasonality of epidemics in Kalemie links between epidemics outbreak and population movement such as fishermen travelling between Kalemie and the villages around. -

Source: MSP RDC

What has been done ?

- a mapping and coding of the areas most at risk is done for the whole city, - Cholera Treatment Centre’s staff is trained to register every affected person and localized its area, avenue, house through codes allowing a better monitoring of the epidemics and faster responses.


Partners: Public Health Ministry, Université de France Comté, Veolia Fundation, Solidarités International


Source: SI, VF, Regideso

2008-2009 Drinking water system master plan is done together with Regideso, Veolia Fundation and Solidarites International. The master plan proposes successive rehabilitation phases to be implemented. A first phase is done in 2009 by improving equipments in the treatment plant and pumping station and replacing key valves on the main line.

2009-2010: Initial studies were completed by a WASH cluster analysis to confirm the impact of sudden drinking water system breakdown on epidemics . Attraction of donors for investing in the further priority steps.


Source: WASH cluster


What has been done so far ? - 21 storage tank 7 cubic meter are built and equiped with 10 taps each, allowing the distribution of 3200 cm monthly, spread over the areas most at risk of cholera (1) - 2300 linear meters of HDPE 250mm OD to replace a former main line severely damaged (2)

- Construction of one 500 cubic meters tank with operation room (3)

3

1

2


What has been done so far ? - ongoing construction of a new treatment plant by Katanga government funds

-training of Regideso technical staff for ensuring safe steel pipes welding - training of tapstands committees member and Regideso staff

3

1

2


Conclusions and lessons learned - still a lot to be done for completing the master plan, but the integrated Health-WASH approach and realistic master plan has proved to be efficient in attracting stakeholders from various areas (public, private, NGOs, donors) and convincing them to unify their effort around a single ambitious project.

- progressive increase of water access in Kalémie seems to have already an impact on cholera in the district which have registered in 2011 the lower number of cases since 2000

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fight against cholera an integrated approach for a public...

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