AFRICAN DEVELOPMENT BANK

CARBO VERDE

PROPOSAL FOR A GRANT OF US$ 1 MILLION FOR EMERGENCY

ASSISTANCE TO SUPPORT CABO VERDE PREPAREDNESS AND

RESPONSE PLAN TO FIGHT THE ZIKA VIRUS OUTBREAK

OSHD/OSAN/GECL/DEPARTMENTS

September 2016

TABLE OF CONTENTS

ABBREVIATIONS ................................................................................................................................. i

1 BACKGROUND AND RATIONALE ........................................................................................... 1

1.1 Background – The Zika Outbreak ............................................................................................ 1

1.2. Justification for Emergency Assistance ................................................................................... 2

2 OVERVIEW OF THE APPEAL FOR EMERGENCY ASSISTANCE ......................................... 3

3 THE PROPOSED EMERGENCY ASSISTANCE OPERATION ................................................. 3

3.1 Objective, Beneficiaries and description of Assistance ........................................................... 3

3.2 Project Components .................................................................................................................. 4

3.3 Cost and Source of Financing ................................................................................................... 5

4 IMPLEMENTATION ORGANIZATION AND MANAGEMENT .............................................. 5

4.1 Implementation Arrangements ................................................................................................. 5

4.2 Procurement .............................................................................................................................. 6

4.3 Disbursement ............................................................................................................................ 6

4.4 Implementation Schedule .......................................................................................................... 6

4.5 Reporting, Supervision and Auditing ........................................................................................ 7

5 CONCLUSIONS AND RECOMMENDATIONS ......................................................................... 7

5.1 Conclusion ................................................................................................................................ 7

5.2 Conditions of Disbursement ...................................................................................................... 7

5.3 Recommendations ..................................................................................................................... 7

ANNEX II: Provisional Schedule of the Assistance

Annex IV: Government of Cabo Verde Request for Emergency Assistance letter

Annex V: Global spread of Zika virus, 2013-2016

i

ABBREVIATIONS

AfDB African Development Bank

ECOWAS Economic Community of Western African States

WHO World Health Organization

ORTS Transition Support Department

OSHD Human Development Department

PPE Personal Protective Equipment

GBS Guillain-Barre Syndrome

WHO-AFRO World Health Organization - Africa Region

WAHO West African Health Organization

NGO Non-Governmental Organization

EDPLN Emerging Dangerous Pathogens Laboratory Network

EOC Emergency Operation Center

GHSA Global Health Security Agenda

GOARN Global Outbreak Alert and Response Network

HSE Health Security and Emergencies Cluster

IDSR Integrated Disease Surveillance and Response

IHR International Health Regulations

IMS Incident Management System

ISERS Integrated Surveillance and Epidemic Response Service

IVM Integrated Vector Management

JEE Joint External Evaluation

EOC Emergency Operation Center

NPHI National Public Health Institute

PHE Public Health and Environment

PID

PPE

Pasteur Institute Dakar

Personal Protection Equipment

RMNCH Reproductive, Maternal, Newborn, Child and Adolescent Health Task Force

PHEIC Public Health Emergency of International Concern

UNCT United Nations Country Team

ii

Country and project title: EMERGENCY ASSISTANCE TO SUPPORT THE PREPAREDENSS AND RESPONSE PLAN TO FIGHT THE ZIKA VIRUS OUTBREAK IN CABO VERDE

Objective of project: The ultimate goal of this project is to prevent and reduce morbidity and complications due to Zika virus through prompt identification and effective management of cases and

contacts, effective social mobilization and psychosocial support to the affected communities.

RESULTS CHAIN

PERFORMANCE INDICATORS

MEANS OF

VERIFICATI

ON

RISKS / MEANS OF MITIGATION

Indicator

Baseline 2016 Target 2017

IMP

AC

T Reduced morbidity due to Zika Number of cases of

microcephaly

Number of cases of

Guillain-Barré syndrome

200 cases/10000

1.5 per 1000

Less than 95 cases/10000

Less than 0.24 per 1000 Zika virus infections

Outbreak

reports

OU

TC

OM

ES

Good quality infection control; Timely detection and response to alert and suspected

cases within the community;

Effective case management.

Number of alert cases responded to within 24 hours

of notification

Less than 50% 100% Epidemic/Outbreak reports

Risk: Community resistance to project activities

Means of mitigation : Deploy social scientists

and anthropologists to further assess the reasons for community resistance and provide

recommendations on how to address resistance

; Intensification of community education;

Risk: Poor Zika epidemic preparedness and

infection control in the rest of the country

Means of mitigation : Establish, train and

equip national and regional response teams ;

disserminate Zika management and infection control guidelines in high-risk (neighbouring)

districts and referral hospitals;

Improved patient referral, access to hard-to-reach areas for surveillance and contact tracing, effective burial

arrangements;

Timely notification of suspected cases and home visits by the community alert system.

Number of suspected cases

notified timely

30% 100%

Epidemic/Outbreak reports

Improved epidemic response

Number of suspected Zika

cases

Free toll number fully

functional

7580

0

0

1

OU

TP

UT

S

Component 1: Strengthening legislation, coordination

and empowerment.

Existing legislative framework, laws and policies

revised

Adequate numbers of knowledgeable health

workers trained

Partner inputs coordinated

Number of legislative

framework, laws and

policies revised

Numbers of health workers trained

% of workers trained

Number of coordination

meetings

Number of timely situation

reports produced;

0

40

Less than 10%

10

2

5

200

50% of health workers

30

12

Health reports

Training

reports

Health reports

Health reports

Risk: Poor detection and control of Zika

Means of mitigation : Ensure effective infection control through provision of PPEs,

training, guidelines and standard operating

procedures to health facilities in all health facilities

Risk: Delayed availability of funds Means of mitigation : WHO will re-

programme available funds to cater for the

most urgently needed or critical activities

iii

Component 2: Strengthen prevention and preparedness

for timely detection

Vector control commodities and transmission control

supplies readily available in at risk districts

Training in vector surveillance and integrated vector

management (IVM) methods conducted

National plan of IVM developed

IVM interventions manual for the control of disease

vectors developed

Trainers in RMNCH trained

Number of PPEs, insecticide

spraying equipment (IRS, larviciding), supplies

distributed;

Number of staff trained

National plan for implementation of IVM with

a gender perspective

IVM manual

Number of health workers

trained in RMNCH and Zika

case management

0

0

0

0

Less than 20%

70

30 (50% women)

1

1

More than 80% of health workers

– 50% women?

Epidemic/Outbreak reports

iv

Component 3: Strengthen response to Zika virus and

other arbovirus outbreaks

Risk communication, social mobilisation and

community engagement plan with a gender perspective developed

Health workers trained for adequate psychosocial

support with a gender perspective, in particular to women in reproductive health and their partners

PPEs for vector control agents equipped with PPEs

RRT on (i) Zika contingency plan, (ii) IMS, (iii)

technical guidelines (including case definitions, case

management, risk communications, situation reports, incident management), and adapt RRT operational

guidelines trained

One comprehensive Zika functional simulation

exercise undertaken

M&E framework and Plan for Zika Response developed and Zika After Action Review Conducted

Number of IEC materials

produced and distributed;

Number of training materials

distributed Number of health workers

trained for psychosocial

support

Number of PPE distributed

Number of RRT Trained

Number of simulation

participants

0

0

0

0

0

0

100,000 IEC materials produced

and distributed

5,000 training materials available

50 health workers trained for

psychosocial support

66 RRT members trained

A simulation report with key gaps

& recommendations

and action plan identified

1 M&E framework and Plans

Zika After Action Review and

lessons learned report

Epidemic/Out

break reports

Simulation

report

M&E

framework

and Plans and 2 Reports (mid

& end term)

Zika After

Action Review

report

KE

Y A

CT

IVIT

IES

COMPONENTS INPUTS

Component 1: Revision of the existing legislative framework, laws and policies

Training of health workers and coordination meetings

Resource : USD 1 Million

Component 2: Procurement of Vector control commodities and infection control supplies readily available in at risk districts

Training of health workers in RMNCH and capacity building for planning and implementation of IVM to control disease vectors.

Component 3: Development of risk communication, social mobilization and community engagement plan

Mass production of training materials

Procurement of PPEs

1

1 BACKGROUND AND RATIONALE

1.1 Background – The Zika Outbreak

1.1.1 In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the

first confirmed Zika virus infection in Brazil. A year later, as of 27 July 2016, Zika virus infection

(Zika) had spread to 67 countries and territories (Figure 1 &Annex V) through continuing mosquito-

borne transmission with a total of about 88,000 of which over 6,500 are confirmed. Non-vector borne

(sexual transmission) Zika virus infection has also been documented in eleven countries. The current

Zika outbreaks and their close association with an increase in microcephaly, other congenital

malformations, and Guillain-Barre Syndrome (GBS) reported in at least 15 countries and territories

including Cabo Verde have caused increasing alarm in countries across the world.

Figure 1: Cumulative number of countries, territories and areas by WHO region reporting

mosquito-borne Zika virus transmission in years (2007–2014), and monthly from 1 January 2015

to 27 July 2016

1.1.2 The first case of Zika virus infection in Africa was reported to the WHO in Cabo Verde in

2015. In late September 2015, the Central Hospital in Praia, the capital of Cabo Verde, reported “skin

rash and pruritus without fever” cases. After an epidemiological assessment of the situation and in

cognizance of the ongoing Zika virus outbreak in Brazil, and the associated travel between the two

countries, MOH requested support from WHO and PID for further tests to investigate other causes,

specifically for Zika virus infection. Of the 64 samples sent to the PID, 17 were found positive for IgM

Zika virus antibodies in October 2015. As of 29 July 2016, about 7,580 suspected cases of Zika virus

infection had been registered in Cabo Verde with 556 confirmed. As of July 30 2016, nine (9) cases of

microcephaly were reported from Cabo Verde.

1.1.3 Over the past 7 years, Cabo Verde experienced two major vector-borne epidemics, Dengue

in 2009-2010 and Zika from late 2015 to date. These epidemics have also highlighted the vulnerability

of Cabo Verde to the introduction of other vector-borne diseases such as yellow fever and chikungunya

and also pointed to their potential disruptive impact. The high mobility of people to and from Cabo

Verde further exposes the country to this vulnerability1. However, the ability of the district health teams

to detect and respond to these epidemic outbreaks in a timely manner is limited. Lack of community

alert systems in many districts, lack of human, financial and material resources are some key challenges

for effectively preparing a response to outbreaks. This implies the need to set up an integrated approach

for emergency response, control and preparedness against vector borne diseases.

1 Epidemiological Bulletin, MoH, Cabo Verde.

2

1.1.4 To fight the Zika outbreak, the national authorities in Cabo Verde have been working with

partners to develop and implement the Preparedness and Response Plan. The planned activities

are aimed at strengthening the country’s capacity to detect and adequately respond to Zika and other

mosquito-borne viral diseases. It also provides the basis for close partner coordination and collaboration

in addressing the Zika virus outbreak to ensure that national response activities are supported to the

fullest extent possible, in an approach which integrates the social, economic, and environmental

determinants of health and incorporates a human rights and gender equality perspective. The plan

complements the ongoing efforts to enhance core capacities for the implementation of International

Health Regulations (IHR) and Integrated Disease Surveillance and Response (IDSR) in Cabo Verde in

line with the Global Health Security Agenda.

1.1.5 Considering the exceptional and urgent nature of the situation, the risk of spread to other

African countries, management is proposing an exceptional assistance operation to control this

outbreak. Faced with the threat of spread to the rest of the African region and to avert the scale of the

Ebola Virus epidemic, which renders any action within a single country incomplete and inadequate, it

is recommended that Special Relief Fund resources be used.

1.2. Justification for Emergency Assistance

1.2.1 WHO declared the Zika virus disease an International Public Health Emergency (PHEIC)

on 1st February 2016. At the time, WHO predicted as many as four million people could be infected

by the end of the year and that the outbreak is in many ways worse that the Ebola outbreak which

claimed more than 12,000 lives. It is a silent infection which – in a group of highly vulnerable

individuals i.e. pregnant women is associated with grievous birth defects. These malformations and

neurological complications will have dramatic psychosocial and social impact on the families due to

unsure future for these babies. Though the socio-economic impact has not been estimated yet, it is

believed that this will be huge if no appropriate and timely response is provided. Overall, the global risk

assessment has not changed since and based on the evidence available, WHO does not see a decline in

the outbreak.

1.2.2 Furthermore, given the rapid spread across Latin America and its presence in Cabo Verde,

the WHO warns it is most likely the outbreak will spread to the rest of Africa. In fact as of 13th

July, Guinea Bissau recorded its first 3 confirmed cases. The concern is that, the strain of the virus that

has spread very rapidly in the Americas is unknown to African populations and its importation into

Africa may lead to more acute disease and severe sequealea. The recent association of this Asian strain

of Zika virus infection with neurological complications such as microcephaly and Guillain-Barré

syndrome is a priority public health concern especially in Africa due to its socio-economic impact in

the context of weak health care systems.

1.2.3 Cabo Verde’s economy which is based on tourism will be damaged if the Zika is not quickly

controlled. The country is a first class tourist destination in the world and was visited by a half million

tourists last year with two flights with Fortaleza Brazil every week. The heavy burden and socio

economic impact will affect families and the country as a whole. WHO recommends that Cabo Verde

and high risk countries in Africa should be a priority for regional and international systems support and

investment in disease and vector surveillance, case management and vector control in the context of

integrated vector control. Furthermore, in the wake of the Ebola outbreak, if urgent action is not taken

to contain its spread it could further cripple the weakened health systems in Cabo Verde with severe

socio-economic repercussions.

1.2.4 Gender issues related to Zika are diverse and can affect social progress, human rights and

economic development. The link between Zika virus infection during pregnancy and birth challenges

poses yet another threat for girls and women of reproductive age. Mothers and female members of the

family are likely to be the caregivers of micro-cephalic babies taking time away from work. This will

result in huge economic costs to household from lost productivity. To this end project aims to support

a holistic response to Zika virus that will include addressing root causes that prevent girls and young

women from realizing their sexual and reproductive health choices and improving access to

reproductive health services and care.

3

1.2.5 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/BDIWP/2008/211). The request falls under emergency criteria item (iii) as it aims for the

adoption of reasonable measures to reduce the risk of further spread of the Zika in Cabo Verde and to

avert its spread to the rest of the Africa region. The emergency situation is beyond the capacity of the

government and its agencies to handle without significant support from the international community.

The activities proposed under the plan can be carried out expeditiously and effectively within the

required timeframe of one year.

2 OVERVIEW OF THE APPEAL FOR EMERGENCY ASSISTANCE

2.1 Following the importation of Zika Infection into Cabo Verde and the rapid increase in the

number of cases the Government of Cabo Verde submitted a request for the Banks support on

the 19th of April 2016. The request and immediate need is to support Cabo Verde to implement their

Preparedness and Response Plan which aims at strengthening the country capacity to detect and

adequately respond to Zika, and other mosquito-borne viral diseases. This plan will be implemented

within a period of one year for a total cost of € 2 436 200 and has 6 major components focusing on

preparedness, detection, response, monitoring and research. The plan will be jointly implemented in

collaboration with key technical and operational partners led by the WHO. In addition, research

institutions will actively participate in generating the relevant scientific information and evidence to

guide public health response.

2.3 In addition, the WHO/AFRO also recently assessed the potential risk of Zika virus spread and

capacity to cope in 47 African countries. Their findings indicate that all African countries are at some

risk of Zika virus outbreak. Twenty were found to be at HIGH2 risk, twenty at MEDIUM3 risk and only

seven at LOW4 risk. Beyond supporting Cabo Verde the Bank should consider supporting its High Risk

RMCs to prepare them for Zika’s arrival to avert a crisis similar to the Ebola situation. Finally,

reinforcing coordination of the overall health response is critical. To this, incident managers from the

six WHO Regional Offices and headquarters, as well as relevant technical and support staff, met in

Washington D.C., USA on 4 and 5 May 2016 to review past and ongoing activities, to discuss key

lessons and to develop a strategy for future action to ensure that the response collaboration continues to

work effectively.

2.4 Given the urgent nature of the situation and threat to the sub region we are proposing an

exceptional assistance operation to control this outbreak and recommend that Special Relief Fund

resources of $1 million be used. The WHO will be the executing agency for this operation as it is the

specialized agency of the United Nations for health issues and also given their experience in controlling

the Ebola Virus Disease outbreak. In addition, WHO is the main technical agency currently providing

support to Cabo Verde.

3 THE PROPOSED EMERGENCY ASSISTANCE OPERATION

3.1 Objective, Beneficiaries and description of Assistance

3.1.1 The ultimate goal of this project is to strengthen Cabo Verde’s capacity to prevent, detect,

control and strengthen response towards Zika virus disease outbreak and other mosquito-borne

viral diseases. Specifically, the project will support the implementation of the National Preparedness,

Response and Recovery Plan which details out the following objectives and associated total costs in the

table 1 below. Given that other partners will contribute to the financing of this plan, the Banks assistance

under this project will be limited to 1 million USD for the following 3 objectives of the plan; (a)

Strengthen legislation, leadership and overall coordination of preparedness and response to Zika and

2 High Risk (Comoros, Guinea-Bissau, Central African Republic, Madagascar, South Sudan, Ethiopia, Cape Verde, Chad, Togo, Nigeria,

Equatorial Guinea, Burundi, Angola, Benin, Cote d'Ivoire, Liberia, Mozambique, Eritrea, Cameroon, Mauritania), 3 Medium Risk (Mali, Malawi, Senegal, Congo, Guinea, Niger, DRC, Burkina Faso, Zimbabwe, Tanzania, Kenya, Sao Tome and Principe,

Rwanda, Sierra Leone, Uganda, Algeria, Gambia, Seychelles, Gabon, Botswana) 4 Low Risk (Zambia, Lesotho, Ghana, Mauritius, Swaziland, Namibia, South Africa)

4

other arboviruses, (b) Enhance prevention and preparedness to reduce magnitude and timely detection

and response to arbovirus infection and its possible consequences, (c) Strengthen response to Zika virus

and other arbovirus outbreaks including the investigation of microcephaly and other neurological

syndromes.

Table 1: Objectives of the Cabo Verde National Preparedness, Response and Recovery Plan

Objective Budget (€)

OBJECTIVE 1. Coordinate: Strengthen legislation, leadership and overall

coordination of preparedness and response to Zika and other arboviruses 377 000

OBJECTIVE 2. Prepare: Enhance prevention and preparedness to reduce magnitude

and timely detection and response to arbovirus infection and its possible consequences 125 000

OBJECTIVE 3. Detect: Enhance epidemiological and entomological surveillance;

and confirmation of Zika infection and other arboviruses 1 413 200

OBJECTIVE 4. Respond: Strengthen response to Zika virus and other arbovirus

outbreaks including the investigation of microcephaly and other neurological

syndromes 241 000

OBJECTIVE 5. Conduct monitoring, research and development of new products for

Zika virus (e.g. diagnostics, vaccines, etc.) 280 000

TOTAL 2 436 200

3.2 Project Components

(i) Component 1: Strengthening legislation, coordination and social empowerment.

The project will review existing laws, policies and verify alignment with International Health

Regulations (IHR), the global health security agenda and national needs. Propose amendments and/or

enact new legislation to address identified gaps and promote equitable and geographical access to

reproductive health rights including access to safe abortion services for Zika-positive women or women

with a fetal impairment. To strengthen coordination mechanisms, an Incident management System

(IMS) will be established to strengthen coordination including Emergency Operations Centers (EOCs)

and preparedness and response to Zika and other viruses with epidemic potential. A One Health

Approach (human and animal, vector and environment) will be integrated in preparedness and response

to Zika and other arboviruses and national and municipal committees and commissions to strengthen

their operational capacity will be reinforced. Inter-sectoral collaboration and coordination would be

strengthened through memorandum of understanding between relevant sectors.

(ii) Component 2: Strengthen prevention and preparedness for timely detection

The project will enhance prevention and preparedness in order to mitigate effects, improve timely

detection and response to Zika and other arboviruses, including its possible neurologic syndromes. Key

interventions include updating the national IDSR technical guidelines to include Zika, Dengue,

Chikungunya and other arboviruses; Replenishment of the national emergency stocks of vector control

commodities, essential medicines including reproductive health commodities and laboratory reagents

and supplies; Capacity building on preparedness for Zika virus and other arboviruses at national and

local levels; Building capacity of health workers on health education and prevention of arbovirus

infection and orientation of NGO’s and other partners on health education and community engagement

on vector control and protection strategies.

(iii) Component 3: Strengthen response to Zika virus and other arbovirus outbreaks

The project will enhance vector control capacity at national and sub national level, including private

healthcare workers and other reproductive health providers; Develop a risk communication, social

mobilisation and community engagement plan; Establish a coordination mechanism involving public

and private Reproductive Health partners including NGOs to ensure access to and availability of

contraceptive services and safe abortion services for Zika-positive women or women with a fetal

impairment, in accordance with Cabo Verde legislation; Develop and disseminate targeted information

on the Zika virus, personal and household, environmental prevention and protection messages,

5

including Zika signs and symptoms and possible complications, when and where to seek care, and

personal and community engagement in different high risk populations (including pregnant women and

adolescents, private healthcare providers); Enhance national Zika clinical case management; Strengthen

capacity of health workers and non-health actors including NGOs, community influencers in

community engagement in different settings; Strengthen a coordinated multi-sectoral psycho-social

support response mechanism and reinforce coordinated Rapid Response Team capacity at national and

sub national levels.

Monitoring and Evaluation of the project will be undertaken at mid- term and at the end of the project.

This will enable establish whether the project has met the desired objectives and provide for

organizational and country learning and sharing of successes with other stakeholders. The outcomes

will inform the Zika After-Action-Review to be conducted at the deactivation of the emergency

response phase.

3.3 Cost and Source of Financing

The total cost of the above activities is estimated at USD 1 million including administrative costs

of WHO country office in Cabo Verde (table 2). The transaction will be financed from the Special

Relief Fund of the Bank. The detailed costing of the Banks USD 1 million grant by categories of

expenditure is provided in Annex III.

Table 2: Summary costs by component

Description of activities Cost

(UA)

Cost

(USD)

Percentage

%

Component 1: Strengthening legislation, coordination and

social empowerment. 266,413 372,978 37

Component 2: Strengthen prevention and preparedness for

timely detection 111,600 156,240 16

Component 3: Strengthen response to Zika virus and other

arbovirus outbreaks 289,544 405,361 41

WHO administrative cost : 7% 46,729 65,421 7

Grand total 714,286 1,000,000 100

It is expected the National Preparedness plan will be jointly financed by other partners. To date DFID

has contributed $250,000 and WHO is providing technical assistance.

4. IMPLEMENTATION ORGANIZATION AND MANAGEMENT

4.1 Implementation Arrangements

4.1.1 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/ADF/WP/2008/173/Rev./1) the 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.

4.1.2 Following the recommendations of the IHR Emergency Committee on Zika virus, as

endorsed by the WHO Director General by declaring the event as PHEIC on 1st February 2016,

the WHO HQ and WHO Regional office for Africa established an incident management system

to coordinate Zika preparedness and response globally and regionally. This implies support to

Member States for: (i) reinforcing the Incident management Systems to strengthen their coordination

(including EOCs) to include the preparedness to respond to Zika, dengue, chikungunya and yellow

fever; (ii) actively engaging other sectors (environment, agriculture, tourism, infrastructure, etc.) to

prepare and respond to Zika virus and other arboviruses through a multisectoral approach; (iii)

strengthening the surveillance capacity for early detection of Zika virus by widely disseminating the

6

technical guidelines to early detect emergence of clusters of cases and ensuring adequate laboratory

capacity; (iv) implementing entomological assessments and other vector control activities regarding

Zika virus, dengue, chikungunya and yellow fever as climate conditions affect mosquitoes‘ breeding;

and (v) raising awareness among health care workers and communities. Key guiding documents have

been disseminated to the WHO Country Representatives including the information note, technical

guidelines on Zika to share with Member States, United Nations Country Team (UNCT) and partners

and recommendations to increase collaboration with UNCT and partners were highlighted. The Bank

has a long working relationship with the WHO guided by an MOU.

4.1.3 Furthermore, in line with WHO Global Emergency Reform, the World Health Assembly 69

approved the new Health Emergencies Programme in May 2016. The programme adds operational

capabilities for outbreaks and humanitarian emergencies to complement its traditional technical and

normative roles. The new programme is designed to deliver rapid, predictable, and comprehensive

support to countries and communities as they prepare for, face or recover from emergencies caused by

any type of hazard to human health, whether disease outbreaks, natural or man-made disasters or

conflicts. WHO will provide leadership within the context of the International Health Regulations and

health, in relation to the broader humanitarian and disaster-management system. As health cluster lead,

it will draw on the respective strengths and expertise of a wide range of partners and Member States.

4.1.4 The WHO country office in Cabo Verde in exercise of this mandate will work collaboratively

with other development partners and government of Cabo Verde to control Zika spread. To this

end, for this project, the WHO Cabo Verde Country Office will be responsible for the day-to-day

management of the project activities. A joint Memorandum of Agreement will be signed between the

Bank, WHO and the Government of Cabo Verde. Options for funding from other donors are also being

explored.

4.2 Procurement

4.2.1 WHO is a specialized agency of the United Nations for health-related issues. In this respect,

it has been the executing agency to several emergency aid operations financed by the Bank. It therefore

has the qualifications and experience necessary to effectively coordinate the implementation of this

operation on emergency humanitarian aid. In the past 2 years, five Ebola operations have benefited from

SRF funding with very good results. Ebola has been contained. In accordance with the Procurement

Policy for Bank Group Funded Operations, October 2015 Section 5.3 (e) and Section 6.5, the WHO as

implementing agency, will be responsible for the acquisition and distribution of goods and services

needed for the fight against Zika disease, following its own Procurement Policy and Rules as well as

the Rules and Regulations related to prohibited practices and sanctions. The process should guarantee

a competitive process for the procurement of the goods and services. The Bank, through a provision in

the Protocol of Agreement, may exercise a post review of the procurement process.

4.3 Disbursement

4.3.1 Funds for this project will be channeled directly to and managed by the WHO Country

Office (WCO) in Cabo Verde. A completion report and a project financial statement will be prepared

by the WCO and will be submitted to the Bank three months after the end of the project (30 November

2017).

4.3.2 Given the nature of this operation, it is recommended that funds are disbursed in a single

tranche upon submission to the Bank by WHO of the following: i) A Bank account where the proceeds of the grant will be deposited;

ii) A signed Tripartite Letter of Agreement (LOA) entered into between the Bank, the Government

of Cabo Verde and WHO.

4.4 Implementation Schedule

4.4.1 Overall the project will work within existing Zika coordination structures at national and

district levels which include a national taskforce. The project will be implemented in close

7

collaboration with Ministry of Health (MOH) Cabo Verde and other relevant health partners to avoid

duplication. The project will be implemented for 12 months starting from 31st August 2016.

4.4.2 The transaction will be implemented in the short time and the total duration does not exceed

12 months.

4.5 Reporting, Supervision and Auditing

4.5.1 .At the end of the operation, WHO-AFRO will provide the Bank and the Government a

detailed technical and financial report within three months following completion of the

emergency activities. Given that UN agencies do not prepare audit reports for each separate

institution, WHO-AFRO will produce a report at the end of the transaction certifying compliance with

the terms of the Tripartite Letter of Agreement (LAT). WHO-AFRO cannot deduct more than 7% of

the budget for administrative costs. The Bank will provide continuous monitoring of the progress made

in relation to the intervention. WHO AFRO will prepare quarterly progress reports to inform on the

progress of the operation. All reports will be forwarded to headquarter and country offices of the Bank

and the relevant state structures.

5 CONCLUSIONS AND RECOMMENDATIONS

5.1 Conclusion

The magnitude and potential spread of Zika Virus disease outbreak in Cabo Verde require

significant and robust response capacities and structures. This outbreak poses serious challenges in

terms of human capacity, financial, operational and logistics requirements and threatens national and

international health. This funding proposal will complement the efforts of government and other

partners to mobilize and involve all sectors, including civil society and communities to develop a

coordinated and effective response to the outbreak.

5.2 Recommendation

It is recommended that the Board of Directors approves this emergency assistance for the amount

of One million USD (USD 1,000,000) to support the Government of Cabo Verde’s efforts to urgently

strengthen its Zika response capacity.

I

ANNEX I : Information on the Zika outbreak in Cabo Verde

Table 1 (a): Number of Suspected Cases as of 3 July 2016

District 2016 as of 29 05 2016 Cumulative 2015-2016 Confirmed cases

1 Praia 181 4940 518

2 Sao Domingos 17 151 0

3 Santa Cruz 35 198 51

4 Tarrafal 21 62 6

5 Sao Miguel 18 46 5

6 Sao Filipe 508 1462 142

7 Maio 5 502 38

8 Mosteiros 11 29 8

9 Sao Vicente 4 8 0

10 Boa Vista 28 154 3

11 Santa Catarina 8 30 13

12 Rib.Grd Sto Antao 0 1 No sample tested

13 Brava 1 4 7

National 837 7587 791

Source: Institute Pasteur of Dakar.

Table 1 (b): Number of Confirmed Cases per region

Island Confirmed Cases

1 Santiago 422

2 Fogo 92

3 Maio 33

4 Brava 6

5 Boa Vista 3

6 Sao Vicente 0

7 Total 791

II

ANNEX II: Provisional Schedule of the Assistance

Activities Agency Responsible Deadline

Board approval on lapse-time basis AfDB September 2016

Signature of the Grant

Protocol/effectiveness

AfDB/WHO September 2016

Signature of the Letter of Agreement

with a view to implementation of the

operation’s activities

AfDB/WHO October 2016

Submission of the disbursement

request

WHO October 2016

Disbursement AfDB October 2016

Procurement/Delivery WHO September 2017

Submission of a technical and financial

report

WHO January 2017

Submission of mid and end term M&E

report

WHO January 2017

III

ANNEX III: Cost Summary of the Assistance by Component and Expenditure Category

Cost Summary by Component

Description of activities Cost (UA) Cost (USD) Percentage

(%)

Component 1: Strengthening legislation, coordination and

social empowerment. 266,413 372,978

1.1. Revision of the existing legislative framework, laws, policies

in line with IHR and GHSA (including shipment of samples of

samples, research and vaccine development)

4,762 6,667

37

1.2. Develop and disseminate guidelines on reproductive health

rights (RHR) 794 1,111

1.3. Develop a pre-test a plan for Emergency Operations Centers

(EOCs) 794 1,111

1.4. Procure and install equipment for Emergency Operations

Centers (EOCs) 238,095 333,333

1.5. Organize 2 meetings One Health Approach (2x25=50

participants x USD 504/participant) 18,000 25,200

1.6. Prepare and share annual multisectoral workplan with national

and subnational response partners 3,969 5,556

Component 2: Strengthen prevention and preparedness for

timely detection 111,600 156,240

2.1. Develop, disseminate materials for risk communication and

vector control, and institute testing for Zika screening on ante

natal on blood donors services

31,500 44,100

16

2.2. Replenish the national emergency stocks of vector control

commodities, essential medicines including reproductive health

commodities

31,500 44,100

2.3. Training of Trainers RMNCH 35 Focal Points on Zika

prevention (17 health delegations, 6 central level, 12 hospitals) 12,600 17,640

2.4. Train 50 health workers on health education and prevention of

arbovirus infection (USD 504/participant) 18,000 25,200

2.5. Train 50 participants (including NGOs, civil society and other

partners) on health education and community engagement on

vector control and protection strategies (USD504/participant)

18,000 25,200

Component 3: Strengthen response to Zika virus and other

arbovirus outbreaks 289,544 405,361

3.1. Review and update the national operational manual on vector

control including community messages 2,520 3,528

41

3.2. Train 30 vectors control officers (national and sub national

level) 12,600 17,640

3.3. Purchase PPEs for 70 vector control agents 17,640 24,696

3.4. Training of Trainers RMNCH 35 Focal Points clinical

management of Zika virus infections and other arborivus in pre-

pregnancy, pregnancy, post-partum and infancy (10 health

delegations, 6 central level, 4 hospitals)

12,600 17,640

3.5. Train 50 health workers on healthcare workers on clinical

management Zika virus infections and other arborivus in pre-

pregnancy, pregnancy, post-partum and infancy

(USD504/participant)

18,000 25,200

3.6. Develop a risk communication, social mobilisation and

community engagement plan 2,520 3,528

IV

3.7. Develop, test and disseminate of health education training

packages on the management Zika virus (Focus groups 100

participants) for health workers and non-health actors (Religious,

civil society)

25,200 35,280

3.8. Develop, test risk communications, perceptions and

messages to increase community engagement to respond to Zika

virus disease

31,500 44,100

3.9. Orient psycho-social counsellors in Zika response (30

participants) 12,600 17,640

3.10. Provide accessible prenatal counselling services and

commodities including for adolescent girls 22,680 31,752

3.11. Adapt blood transfusion and sexual transmission guidelines 1,260 1,764

3.12. Provide specific 5 days training provided to RRTs on (i) Zika

contingency plan, (ii) IMS, (iii) technical guidelines (including case

definitions, case management, risk communications, situation

reports, incident management), and adapt RRT operational

guidelines at national and sub-national levels (National 15, Health

delegation 3x17=51) 66 participants

70,714 99,000

3.13 Develop and implement one comprehensive Zika simulation

exercise (functional) to stress-test the emergency readiness

capability at national and sub-national levels in the high risk

districts

22,709 31,792

3.14 Conduct Zika After Action Review at the deactivation of the

emergency response phase. 8,430 11,801

3.15 Develop a clear framework to guide M&E for Zika

Response, and a corresponding M&E plan for implementation 28,571 40,000

WHO administrative cost : 7% 46,729 65,421 7

Grand total 714,286 1,000,000 100

Project Expenditure by Category

Expenditure category

Activity Cost (UA) Cost (USD)

Goods*

Equipment for emergency centers and PPEs 255,735 358,029 Procurement of supplies and

logistics

Services Training of health workers and other

stakeholders 411,822 576,550

Operation

WHO administrative cost (7%), institutional

support for national and regional structures,

and activity coordination

46,729 65,421

Total 714,286 1,000,000

*NB: Procurements will be based on WHO rules of procedure.

V

Annex IV: Government of Cabo Verde Request for Emergency Assistance letter

VI

VII

Annex V: Global spread of Zika virus, 2013-2016