cape verde final - unocha 5-year evaluation country report: cape verde 3 table of contents ! table...

5-YEAR EVALUATION OF THE CENTRAL EMERGENCY RESPONSE FUND COUNTRY STUDY: CAPE VERDE

On Behalf of OCHA

Authors: Angela Berry-Koch, MSc

CERF 5-Year Evaluation Country Report: Cape Verde

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This document has been prepared by Channel Research as part of the 5-‐‑Year Evaluation of the CERF, commissioned by OCHA.

This document is public and can be disseminated.

Please address all correspondence to:

Cecile Collin,

E-‐‑mail: [email protected]

Tel: +32 2 633 6529

Fax: +32 2 633 3092

UN General Assembly Resolution 60/124 sets the objective of the upgraded CERF:“…to ensure a more predictable and timely response to humanitarian emergencies, with the objectives of promoting early action and response to reduce loss of life, enhancing response to time-‐‑critical requirements and strengthening core elements of humanitarian response in underfunded crises, based on demonstrable needs and on priorities identified in consultation with the affected State as appropriate. ”

Route des Marnières 45A, 1380 Ohain, Belgium

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TABLE OF CONTENTS

TABLE OF CONTENTS ............................................................................................................ 3 ACRONYMS .............................................................................................................................. 4 MAP 6 INTRODUCTION ....................................................................................................................... 7 1. CONTEXT ........................................................................................................................... 10 2. PROCESSES ...................................................................................................................... 14 3. OUTPUTS ........................................................................................................................... 17 4. OUTCOMES ........................................................................................................................ 19 5. CONTRIBUTION ................................................................................................................. 21 6. CONCLUSIONS .................................................................................................................. 22 ANNEX I. LINKS TO THE TERMS OF REFERENCE AND THE INCEPTION REPORT ....... 23 ANNEX II. CERF PROCESS DESCRIPTION ......................................................................... 24 ANNEX III. BIOGRAPHICAL NOTICE OF THE MAIN WRITERS ........................................... 26 ANNEX IV. INTERVIEWS ....................................................................................................... 29 ANNEX V. COUNTRY PROJECTS SUMMARIES .................................................................. 30 ANNEX VI. SELECTED PROJECTS WITH SCORES ............................................................ 31 ANNEX VII. BIBLIOGRAPHY .................................................................................................. 32


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ACRONYMS

Acronym Details

CAP Consolidated Appeals Process

CAR Central African Republic

CERF Central Emergency Response Fund

CHF Common Humanitarian Fund

CDC Centres for Disease Control , US Government

CNDS Sanitary Department of the Nation Center

DAC Development Assistance Committee (of the OECD)

DFID Department for International Development (of the UK)

DRC Democratic Republic of Congo

DREF Disaster Emergency Fund (Red Cross)

ERC Emergency Relief Coordinator (the head of OCHA)

ERF Emergency Response Fund or Expanded Humanitarian Response Fund

EU European Union

FAO Food and Agriculture Organization

FMU Fund Management Unit (UNDP)

FTS Financial Tracking Service

GA General Assembly (of the United Nations)

GPRS Global Poverty Reduction Strategy

GHD Good Humanitarian Donorship

HC Humanitarian Coordinator

HCT Humanitarian Country Team

HDI Human Development Index

HDPT Humanitarian and Development Partnership Team

HQ Head Quarters

HRF Humanitarian Response Fund

LDC Least Developing Country

IDP Internally Displaced Person

IFRC International Federation of the Red Cross

IASC Inter-‐‑Agency Standing Committee


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Acronym Details

INGO International Non Governmental Organisations

M&E Monitoring and Evaluation

MDG Millennium Development Goal

MDTF Multi Donor Trust Fund

MSF-‐‑S Médecins Sans Frontières Suisse

NGO Non Governmental Organisations

NNGO National Non Governmental Organisations

OCHA United Nations Office for the Coordination of Humanitarian Affairs

OECD Organisation for Economic Cooperation and Development

PAF Performance and Accountability Framework

PBF Peace Building Fund

RC Resident Coordinator

RR Rapid Response (CERF funding window)

ToR Terms of Reference

UFE Under-‐‑funded emergency (CERF funding window)

UK United Kingdom

UN United Nations

UNCT United Nations Country Team

UNDP United Nations Development Programme

UNDAF United Nations Development Framework

UNFPA United Nations Fund for Population Activities

UNHCR United Nations High Commissioner for Refugees

UNICEF United Nations Children’s Fund

UNOPS United Nations Office for Project Services

USD United States Dollar

WASH Water Sanitation and Hygiene

WHO World Health Organization

WFP United Nations World Food Programme


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MAP


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INTRODUCTION 1. This country report examines the Central Emergency Response Fund (CERF)’s

contribution to the humanitarian response in Cape Verde following a massive outbreak of Dengue Fever in late 2009. It is one of 16 case studies conducted to inform the 5-‐‑year Evaluation of the Central Emergency Response Fund (CERF). Mandated by the UN General Assembly, the 5-‐‑year Evaluation of the CERF is managed by OCHA’s evaluation section (ESG), and conducted by Channel Research.

The CERF

2. The Central Emergency Response Fund (CERF) is a $500 million fund established to support rapid response and address critical humanitarian needs in underfunded emergencies. The CERF is managed by the UN'ʹs Under Secretary General for Humanitarian Affairs and Emergency Relief Coordinator (ERC), and supported by a secretariat and by other branches of the UN Office for the Coordination of Humanitarian Affairs (OCHA).

Methodology

Document review

3. This country report was conducted as a desk review, and no field visits were conducted. The documents that were reviewed consisted of the project submissions from the two agencies, (WHO and UNICEF) both original and revised, and the annual report from the Resident Coordinator of the UN system. Because of the dearth of documentation, additional research was conducted on the Dengue Fever outbreak in Cape Verde, primarily by website, and this included Red Cross movement sites, and the general UN sites for the country. Where technical questions arose as to the nature and patterns of Dengue outbreaks, some secondary literature searches were conducted.

Interviews

4. Only the CERF Secretariat was interviewed for this case study.

Constraints/Issues

5. The case study was constrained by a lack of formal data related to the CERF. The two project proposals were relatively brief, and monitoring of CERF projects depended on UN agencies’ own monitoring system in the absence of a centralised monitoring of CERF-‐‑funded projects. Although the case of Cape Verde was limited ins cope, involving two agencies only, more detail of documentation on process (how the projects were designed) and on outcomes, (measurable impact) would have been helpful. Also a lack of minutes or records of meetings, telephone calls and email exchanges was observed within the provided documentation. There were also poorly referenced citations in many UN projects or summary documents that provided facts that could not be substantiated from original sources.


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Analysis

6. The analysis for this study employed the CERF’s Performance and Accountability Framework (PAF), which defines a set of indicators at each level according to a logic model approach as a means of clarifying accountability and performance expectations around a core set of agree CERF outputs, outcomes and impacts.1

Reporting

7. The drafting of this report benefited from comments made by the steering and reference groups on the first country study, as well as more specific comments on this country report.

Key definitions

8. The case study is concerned with assessing the following2:

• Relevance/appropriateness: Relevance is concerned with assessing whether the project is in line with local needs and priorities (as well as donor policy). Appropriateness is the tailoring of humanitarian activities to local needs, increasing ownership, accountability and cost-‐‑effectiveness accordingly. (ALNAP 2006)

• Effectiveness: Effectiveness measures the extent to which an activity achieves its purpose, or whether this can be expected to happen on the basis of the outputs. Implicit within the criterion of effectiveness is timeliness. (ALNAP 2006)

• Efficiency: Efficiency measures the outputs – qualitative and quantitative – achieved as a result of inputs. This generally requires comparing alternative approaches to achieving an output, to see whether the most efficient approach has been used. (ALNAP 2006)

Overview

9. The report is structured as follows:

• Context: A description of the humanitarian context of the country, and how the CERF was used.

• Processes: A description and analysis of the submission process for the CERF and the prioritisation and selection of projects.

1 OCHA, Performance and Accountability Framework for the Central Emergency Response Fund (OCHA,

August 2010)

2 These criteria are defined by Beck, T. (2006); Evaluating humanitarian action using the OECD/DAC criteria for humanitarian agencies: An ALNAP guide for humanitarian agencies. (Overseas Development Institute: London, March 2006)


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• Outputs: An analysis of the CERF’s overall contribution to the country programme, its timeliness (timeframes), level of donor support, and interaction with other funds.

• Outcomes: An analysis of the outcomes of the CERF process, including the extent to which CERF projects addressed gender, vulnerability, and cross-‐‑cutting issues.

• Contribution: An analysis of the CERF’s contribution to meeting time-‐‑critical live-‐‑saving needs, including evidence for the extent to which the CERF contributed to this objective set by the General Assembly.

• Conclusions: An outline of conclusions reached by the evaluation team.


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1. CONTEXT 10. The Cape Verde Islands has experienced very few emergencies or disasters in its

history and made its first and only application for CERF in 2009 as a result of a severe outbreak of dengue fever. Cape Verde is an archipelago and includes 10 islands and 5 islets, located in the mid-‐‑Atlantic Ocean some 450 kilometers (about 300 mi.) off the west coast of Africa. The population is just under half a million and is spread over a mere 4,000 square kilometres. Cape Verde is a lower middle-‐‑income country. While some economic progress has been made in recent years, lifting it out of the Least Developing Country category, there is a growing disparity between rich and poor, and women especially remain highly vulnerable. 3

Dengue outbreak

11. In the last three months of 2009, Cape Verde suffered its first outbreak of dengue fever. Within a matter of weeks, it spread to affect 11% of the entire population in the capital city of Praia. On November 4, 2009, the Central Government declared a national epidemic of dengue, based on a total of 11,000 confirmed cases. The city of Praia was the main focus of the epidemic. By the end of December, a total of 21,090 cases were confirmed nationally, with 14,476 cases in the capital city of Praia.4 The epidemic was more severe in Praia because of inadequate basic sanitation and population density. Approximately one-‐‑fourth of the country’s total population is concentrated in Praia.

12. The sudden increase of cases in early November 2009 on some of the Cape Verde islands, put an enormous strain on the country’s limited health services capacity, and triggered a crisis. Hospitals lacked health workers with appropriate experience in managing cases of dengue. Control of the outbreak was mainly based on vector control, in order to stop transmission – and, the management of severe dengue cases to save lives.

International assistance

13. Within weeks of the dengue epidemic, the Government of Cape Verde launched an appeal for support from the international community and the United Nations. UN agencies readily responded to the appeal. The United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) deployed technical expertise to Cape Verde. In particular, WHO facilitated the arrival of South-‐‑South expertise from Thailand, Senegal and Brazil to support Government hospitals and doctors in case management. The UNICEF office in Senegal contributed mosquito nets to be used in hospitals and health centres. Additional UNICEF support included deployment of a communications expert for the design of a nationwide campaign to inform the population about preventative measures.5

3 United Nations Cape Verde, UN website. www.UN.org.cv -‐‑ Annual Report for 2009.

4 Ibid.

5 UNICEF Proposal, November 17, 2009.


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Request to CERF

14. As the epidemic widened, however, the support proved insufficient to cover needs. While WHO and other technical partners readily identified abandoned houses and cisterns, automobile wrecks and the sewage treatment station as major points of risk in Praia, insufficient funding was available for specific action to be rapidly taken. UNICEF and WHO then worked with OCHA in formulating a timely CERF request, which was swiftly approved. WHO received funds from the CERF to support the Government of Cape Verde in controlling the dengue fever outbreak and UNICEF received funds for vector control. 6 The table below shows the amounts requested from the CERF and provided to the two agencies, and the dates for which submissions and responses were made:

Table 2. CERF, time from submission to signature of Letter of Understanding (LOU)

TYPE AGENCY

TOTAL REQUIRED (FOR DENGUE RESPONSE) TOTAL CERF

DATE SUBMISSION

DATE ERC APPROVAL AND LOU SENT

DATE LOU SIGNED7

RR WHO US$ 600,000 US$ 314,580 20 Nov. * 25 Nov. 3 Dec

RR UNICEF US$ 210,000 US$ 159,758 20 Nov.* 25 Nov. 7 Dec

Total US$ 810,000 US$ 474,338 * Note: Original first submission was made 17 November, and revised completed 20 November, 2009.

Small grant 15. The chart below describes the activities that were included in the CERF grant and

demonstrates the complementary and integrative aspects of the Dengue management strategy:

6 2010, Annual Report of the Resident/Humanitarian Coordinator in Cape Verde. Petra Lantz, reporting period:

December 2009 to March 2010.


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Table 1. Project Description: Management of Dengue in Cape Verde

Sectors Objectives Expected Outcomes

Health • To provide continuous health information and strengthen surveillance and early detection and confirmation as well as investigation in Dengue affected municipalities and Islands

• An adequate surveillance system to identify target areas for urgent intervention for all stakeholders in place;

• Technical teams are in place with adequate knowledge for early detection, diagnosis and prompt referral of cases requiring supportive clinical care;

• Laboratory capacities strengthened for case confirmation (including co-‐‑infection of dengue and A H1N1) and severe cases monitoring.

• To contribute to the coordinated provision of essential life saving care of severe dengue-‐‑affected population

• Essential laboratory equipment and medical supplies in place to properly diagnose and manage DHF/DSS cases and prevent fatalities;

• Adequate and trained health workers and experts deployed to diagnose and support DHF/DSS and co-‐‑infection case management and prevent fatalities;

• Treatment protocol and control measure guidelines are available in all treatment centres.

WASH • To support physical and chemical vector control interventions to reduce vector population and stop transmission chain.

• Opened concrete inappropriate cisterns of abandoned houses are closed.

• Waste accesses of abandoned houses are treated and closed.

• Useless automobile wrecks with rainwater storage risk are moved and destroyed.

• Rainwater pockets are eradicated or treated with appropriate equipment.

• Critical domestic water storages are treated with appropriated equipment and closed.

• Stagnant water at the sewage


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treatment station of Praia is net protected.

• Half of the lamellar decanter of the sewage treatment station is put in stand by

• To support urgent social mobilization to prevent bad hygiene practices at intra and extra domiciliary levels

• Critical vector cottages are localised trough for orienting the collective intervention.

• Adequate social control vector practices messages are received by the communities.

• Adequate social control vector messages are understand by the communities.

• Adequate social control vector messages are practised by the communities.

• None appropriated control vector are continually adjusted.

16. The CERF grant to Cape Verde represents a very small grant compared to others, and it also involved relatively few agencies. The charts below show the difference between distribution of funds by agency of total CERF over the four years and the distribution in Cape Verde; with only two agencies involved.

Chart 1. Global Distribution of CERF by agency compared with Cape Verde

The two projects were interlinked and complementary. The UNICEF component was to support vector control (so that mosquitoes who pass dengue were prevented from breeding) and WHO was to support early case detection, proper treatment of cases, and better outreach to the community. WHO and UNICEF coordinated through the sector system, within the joint UN planning mechanism in the country.


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2. PROCESSES

2.1 Appropriateness/Relevance 17. The sudden and extreme nature of this dengue outbreak was evident by its rapid

spread and high fatality rate (4% of those with Hemorrhagic Dengue type). However, nearly one month had elapsed by the time the full process had been completed: from the submissions being completed (17 November), then revised (20 November), then sent and approved by the USG (25 November), and Letters of Understanding (LOU) were signed (7 December and 10 December for WHO and UNICEF respectively).8

18. One interesting finding in the literature is the fact that the LOU was signed by the Deputy Executive Director of UNICEF on 1 December (Tuesday) and the USG only on 7 December (next Monday). It is unknown why it took more than a week for this process, but it is likely because agencies were using their own funding without difficulty and hence did not feel the urgency to ensure these processes were faster.

19. The literature review indicate that the epidemic was declared on 4 November, which would indicate that the CERF request was actually submitted some 13 days after the start of the outbreak. While the CERF Secretariat acted quickly, it took the agencies an additional two weeks to sign the LOU and for funds to be dispersed. Was the process of using CERF in this manner appropriate and relevant – given the nature of such a sudden and rapidly spreading emergency? Trends over time suggest that cases had already been reduced before the CERF arrived, and no subsequent rise in dengue cases was reported. Thus, the CERF process seemed both appropriate and relevant because the both WHO and UNICEF could expend funds as of 24 November, when the grant was approved.

20. In addition, common trends of dengue in other parts of the world show a peak in the number of cases within weeks, and this often stays high for several months.9 Yet this was not the case in Cape Verde. The number of cases was reduced to almost normal within five weeks. (See following Graph). CERF processes enabled a resurgence of the outbreak to be prevented.

2.2 Effectiveness 21. While it appears that staff worked quickly on the ground to meet the Government’s

requests for priority actions10 (even without humanitarian reform structures), some comments from the agencies suggest they also felt the submission to the CERF would

8 Source: CERF Secretariat documents provided -‐‑ scanned letters and LOU signed by agencies.

9 Siquera et al. Dengue Fever, Brazil – 1981 – 2002. Emerging Infectious Diseases, www.cdc.gov.ed. Vol 11, No1. Jan 2005. Note: most Dengue patterns reach a height within weeks and either plateau or eventually reduce for various reasons, including vector cross breeding patterns and immunity among host populations.

10 The UN Resident/Humanitarian Coordinator’s Annual Report for Cape Verde, covering the period November 2009 to March 2010, states: “UNICEF and WHO worked with OCHA in formulating a timely request, which was swiftly approved.”


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have been more effective if it had been made earlier.11 Perhaps such a delay was because CERF experience was lacking among staff in Cape Verde, and the CERF Secretariat was unable to deploy staff to assist in the preparation of the submission.

22. There is evidence, in the project submissions, that partners were effectively consulted in the submission preparation. Partners included the “Câmara Municipal” (local government authorities for the city of Praia), the Department of Environment and Sanitation, the Department of Civil Protection, along with local NGOs e.g. Red Cross partnership. At the executive level, when the outbreak was occurring, a daily coordination meeting was held at the Sanitary Department National Centre (CNDS), including the Ministry of Health, National Civil Protection, Câmara Municipal (Praia), WHO and Pasteur Institute, as well as other health partners such as Médecins Sans Frontières Switzerland (MSF-‐‑S).12 Thus effective coordination mechanisms were in place to support the formulation and monitoring of the CERF in the work of dengue control.

2.3 Efficiency 23. The efficiency of the CERF process appeared to be strengthened by the very specific

nature of the request and the limited number of UN agencies involved. With the very specific nature of the crisis (a disease outbreak) and the few UN agencies involved (WHO and UNICEF), the proposals could easily be developed in coordination with the respective line ministries.

24. Moreover, efficiency appeared to be supported by the small size of Cape Verde, and the existence of significant partnerships in the country arising from the UNCT’s strong history of interagency coordination within the development context (e.g.. UNDAF and One UN).13 This probably had a positive impact on the efficiency of the process in the coordination, identification of priorities, and formulation of the proposals. However, because the structures existed for longer term planning, they were not necessarily adapted to a rapid response.

25. However, it is worth noting that the International Federation of the Red Cross (IFRC)’s Disaster Emergency Response Fund (DREF), for example, was used in the first weeks of the crisis whereas the CERF funding arrived only after the peak of the epidemic (see graph below). This comparison is crude and may be misleading because the DREF amount was far smaller,14 the mechanism is rather different from

11 UN One. Report on the Health Reform Process. February, 2010 (http://www.un.cv/files/SP8.pdf)

12 UNICEF, Dengue Outbreak, Original Application, 17 November, 2009.

13 http://www.un.cv/dao.php#10

14 The amount was small and only US$ 152,624 in DREF was raised to support 450 Red Cross volunteers that provided community-‐‑based promotion and sanitation support. It is likely that this, along with CERF had a positive outcome on the reduction of the outbreak. See IFRC Website: http://www.ifrc.org/docs/appeals/09/MDRCV001do.pdf


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the CERF, and as suggested above, UNICEF and WHO used the CERF to reimburse other funding used to jump-‐‑start their operations.15

Graph 1.

26. Nevertheless, some agency staff felt that the submission should have been made 20 days earlier and this would have been more efficient. There is little in the literature to pinpoint why the team waited. In all likelihood, it was due to staff inexperience in using the CERF, a lack of emergency personnel among UN agencies in Cape Verde, and low awareness that the CERF could be used in a disease outbreak, where use of CERF is not as common as in other types of disaster.

15 Comments from UNICEF and WHO staff on original draft f this report.


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3. OUTPUTS

3.1 Appropriateness/Relevance 27. The CERF outputs were appropriate and relevant insofar as they seemed strategic to a

disease crisis, with high a mortality risk and the need to stop the disease spreading through better vector control and case management. The CERF was granted in full to WHO and UNICEF according to their estimated requirements. WHO assessed total funding requirements at US$ 600,000, then requested and received US$ 314,580 toward this. UNICEF assessed total funding requirements at US$ 210,000, then requested and received US$ 159,758 toward this. Both agencies were implementing activities for which they have special expertise and which were technically appropriate to the crisis.

28. The outputs were also appropriate to the geographical dimension of the outbreak. As dengue has no vaccine and would impact all populations and age groups equally, WHO geared its activities toward more efficient disease detection, control and treatment, to reach the total population that would be at risk. This included 354,771 people (among them 58,022 children and 189,960 females) living in high epidemic zones in the capital and on a few islands. UNICEF targeted its sanitation and vector control activities to poorest groups in Praia city only -‐‑ and this included a coverage of 127,524 people, of which 14,583 were children and 65,305 were females. Thus, the interventions, the target areas and the specific life saving nature of the outputs were all appropriate and relative to the crisis.

3.2 Effectiveness 29. The incidence of dengue had already been reduced by the time the funds arrived, due

to various interventions: the DREF (Red Cross grant); arrival of international experts borrowed from other countries; concerted efforts by the Government using its own funds (the Government gave US$ 500,000 to the efforts), and the borrowing of funds in a private loan arrangement by the municipality.16 Thus the CERF was effective only in so far as all other partners were compliant and committed to supplementing CERF funding with other funding sources, and had confidence that CERF approval indicated the funding would be disbursed in the near future.

30. Further, the CERF funded the WHO support to permanent laboratory structures that would serve the country to prevent a resurgence of dengue in the future (through early case detection) and also other possible diseases that might threaten the population in the future, such as H1N1 and other communicable diseases. Thus, the outputs were both effective in stemming the immediate outbreak, but also in preventing future possible disease spread. Indeed, a literature search on events following the outbreak showed that no further dengue outbreaks were experienced later on in the year during the June to October rainy season. 17

16 RC/HC Annual Report on use of CERF. March 2010.

17 Ibid.


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3.3 Efficiency 31. The CERF outputs were efficient, because the spread of Dengue Fever was prevented,

and thus, lives were saved. The choice of partnerships was well articulated in the proposals and appropriate to the context. Expertise from various sources were pooled and in the case of UNICEF, over a three month period, CERF-‐‑supported activities were implemented by the “Câmara Municipal” of Praia and “Civil Protection”.

32. The choice of the Municipality of Praia as the main executor of the sanitation aspect of the project contributed to the efficiency of the outputs, and directly implemented through a collaboration of its internal services with environment and sanitation, Civil Protection, fire-‐‑fighters, the police, the army, local NGOs, and communities leaders. In addition, some 1,000 staff, and 20 appropriate and functioning vehicles with adequate equipments, were made available for the implementation of CERF funds.

33. In the case of WHO, expertise was brought in and seven staff hired in order to train local health staff and to improve the management of the disease at all levels: community, early detection (laboratory strengthening), case management and treatment, epidemiology and prevention. Forty health personnel were thus trained. The laboratory capacity of the country received major support with equipment and supplies through the CERF, which would have increase the efficiency in the management of future outbreaks of both this and other diseases.

34. Cross-‐‑cutting issues, such as gender and environment, were automatically included in project outputs, given the nature of working with the most vulnerable populations to prevent vector control as well as early case detection and management. Given the gender disparity in Cape Verde and the precarious state of women, the projects were able to efficiently target to geographical areas with highest risk groups.

35. Using CERF funds for paying international staff experts by WHO was important for bolstering the capacity for case detection and management of the disease. This will be the case where an emergency presents the demand for high-‐‑level technical staff that is not found in the local situation. The CERF allowed for the prompt deployment of essential international staff, and their presence appeared to have a multiplying effect in strengthening local capacities.


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4. OUTCOMES

4.1 Appropriateness/Relevance 36. The CERF was an appropriate means of responding to the phase of a major disease

outbreak, and the outcomes were relevant to the needs of the emergency. As soon as the CERF funding was approved on 23 November, both WHO and UNICEF were able to sustain support for activities that had already been initiated – and the Government and partners were able to respond accordingly.18

37. For UNICEF, outcomes were also relevant to sustaining reduction of the outbreak: surveillance and assessment of vector breeding, provision of equipment and activities required for vector control, and construction materials to fill-‐‑in spaces where standing water could support vector breeding, as well as sanitation treatments.

38. Overall, the CERF was appropriate in terms of the total funding outcome for responding to the dengue outbreak and represented some half of all funds received by the UN to respond to the crisis. The table below describes the CERF grant relative to humanitarian needs and total funds raised by the UN system:

Table 2. Overview of Humanitarian Funding and CERF RR grant in Cape Verde

Amount required for the humanitarian response:

$1,309,169

Total amount received for the humanitarian response:

$973,507

Breakdown of total country funding received by source:

a) CERF $474,338

b) COUNTRY LEVEL FUNDS and OTHER RAISED (Bilateral/Multilateral) $499,169

Source: Annual Report on CERF, UN RC/HC in Cape Verde, March 2010.

4.2 Effectiveness 39. Especially in the area of health, some of the goals of the CERF were adjusted over

time, given that the outbreak had been contained by the time the CERF arrived. According to WHO, outbreaks of further disease spread were prevented by the CERF – increasing UN effectiveness in future life-‐‑saving activities. WHO was able to strengthen the laboratory and general epidemiological capacities in the country.

18 Lantz Petra, Annual Report of the Resident/Humanitarian Coordinator on the Use of CERF grants. Period

December 2009 to March 2010.


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UNICEF was able to reduce all vector breeding points, including through its community education and outreach programmes of the municipality. 19

4.3 Efficiency 40. Achieving the efficiency of outcomes was hampered by the unpredictable nature of

the crisis. By the time this disease outbreak was detected in Cape Verde, there was a very small timeframe in which to prevent it from becoming an epidemic, especially in the crowded conditions and amongst vulnerable populations in Praia. However, the fact that CERF was available, even if late, did allow the Cape Verde Government to take out a private loan to buy the equipment needed to reduce vector breeding.

41. One observation from UNICEF reported an increase in the costs of construction material in the middle of the project.20 This may indicate a local inflation due to demand due to the emergency, leading to increased costs for the project with lowered efficiency. Bidding and correct UN procedures need to be always used in any situation where CERF funds are used, even if they are used to reimburse a loan. Given the limited scope of the desk review and limitations, there was an inability to confirm if a standard UNICEF type bidding procedures was used by the government, using private loans. If not, this could create an “artificial inflation”.

19 Barbazan,P, Yoksan, S, Gonzalez, JP, Dengue hemorrhagic fever epidemiology in Thailand: description and

forecasting of epidemics. Microbes and Infection, Volume 4, Issue 7, June 2002, Pages 699-‐‑705

20 UNICEF, Cape Verde, Monitoring Report (included in Annual Report), March 2010.


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5. CONTRIBUTION 42. The CERF was definitely used appropriately to meet time-‐‑critical life-‐‑saving needs.

Cape Verde was overwhelmed with the dengue outbreak. Hospitals were operating with limited number of health workers with little or no experience in managing of severe dengue cases. When the disease reached Praia, given its crowded conditions, a full epidemic was occurring.

43. Dengue haemorrhagic fever and shock syndrome are an immediate threat to life and carried a high fatality rate in Cape Verde: 4% of all people died who had the hemorrhagic form of the disease. Early detection and bringing patients to the hospital for appropriate case management was one of the primary ways to save lives, and this was strongly improved through the WHO CERF grant.

44. Equally, lives were saved through the UNICEF component of the CERF where prevention activities eliminated all places for the vector to breed (abandoned cars and other useless water depositories) as well as the closing of cisterns.

45. CERF funds also contributed to preventing further loss of life, though stopping the resurgence of the disease during the rainy months of June through October 2010.21

21 Although the documents included in this desk review did not include the period after March 2010,

examination of health statistics under UN UNDAF reporting for Cape Verde, (www.UN.cv) showed no second dengue outbreak reported. Thus the late funding could have reduced the possibility of a later outbreak, which would be equally life saving.


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6. CONCLUSIONS 46. A primary constraint of the CERF in Cape Verde was a lack of experience within the

UN Country Team in responding to emergencies, and a lack of familiarity with CERF procedures and parameters. If there had been a request at the earliest sign of a potential outbreak, rather than after it had already erupted, then CERF may have been more effective in preventing mortality. However, the UN waited for the Government to declare an epidemic, and thus the requirements were identified late into the process, leading to the need for Government and UN agencies alike to borrow funds for response, until CERF was disbursed.

47. Cape Verde had never experienced a dengue outbreak before and the UN Country Team lacked experience about the disease and its potential devastation. This raises an interesting paradox: in order for CERF to be fully effective and used efficiently, it must be identified as necessary early in the crisis, in many cases by technicians with little experience of emergency funding mechanisms. As the CERF Secretariat said, reflecting on this problem in Cape Verde, “a medical doctor is not normally trained in management”. Funds arrived late in Cape Verde because the request was made late in the progression of the outbreak, and because LOUs took too long to sign. This may indicate a need for managers of all agencies at all levels to recognize that CERF submissions for rapid response to disease outbreaks are more urgent than normal submissions.

48. A major drawback of the CERF is that it lacks stringent controls (bidding etc.) normally applied in UN agency procurement procedures. Without bidding, or a more formal process, some loss of funds might occur. Whether the inflation of construction material costs was “natural” in Cape Verde due to normal inflationary trends, or due to artificial pricing, needs to be examined by the UNCT. It may be important to ensure that fair procurement practices are in place for all CERF funded procurement.

49. Complementary funding mechanisms also need to be better studied between CERF and other potentially efficient response mechanisms, especially in disease outbreaks. It is recommended that greater dialogue occur between CERF managers and the IFRC, and ways be developed to use these funds in a complementary manner when such a crisis occurs. This can occur at local country level, in future preparedness planning as well at central levels for better complementary emergency response in general.

50. One positive outcome of this crisis for the UN agencies in the country, according to comments of UNICEF staff now in Cape Verde, is that emergency preparedness and response areas are now included in the ongoing consultation between the UN Country Team, and humanitarian considerations are now integrated in the workings of the UN in the country. It is recommended that the CERF aspects of emergency response be incorporated in any emergency training undertaken at the country level, and, especially given anticipated staff turnover, a Lessons Learned exercise be undertaken on how CERF was used in Cape Verde, why it worked or did not work, and how its use could be strengthened in the event of any future disasters.


23

ANNEX I. LINKS TO THE TERMS OF REFERENCE AND THE INCEPTION REPORT

The Terms of Reference and the Inception Report are not annexed here due to their length. They can be found at:

Terms of reference:

http://www.channelresearch.com/file_download/294/CERF_5YREVAL_Final_TOR_07.11.2010.pdf

http://www.channelresearch.com/file_download/294/CERF_5YREVAL_Final_TOR_Appendix_V_07.11.pdf

Inception report:

http://www.channelresearch.com/file_download/297/CERF-‐‑5-‐‑yr-‐‑Evaluation-‐‑Inception-‐‑Report-‐‑v200.pdf


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ANNEX II. CERF PROCESS DESCRIPTION RAPID RESPONSE GRANT PROCESS B1. Although there is a preference for applications from a country team, a UN agency can

make a request for CERF rapid response window funding at any time (e.g. WFP did so in December 2009 in Kenya). The only requirement, checked by the CERF Secretariat, is that the request be endorsed by the Humanitarian Coordinator (HC) or the Resident Coordinator (RC) in the absence of an HC. Such one-‐‑off requests are relatively rare, and the bulk of CERF rapid response funding goes to joint requests by several UN agencies.

B2. The Emergency Relief Coordinator may also take the initiative of suggesting to the HC or RC the possibility of requesting CERF rapid response funding (OCHA 2006; 2011). This happens only rarely, for example after the 2010 earthquake in Haiti when many UN staff, including top ranking ones, died and most UN buildings were destroyed, in Pakistan at the onset of the 2010 floods, and in DRC for Equateur Province in 2010.

B3. If requested by the UN country team, an informal indication may be given by the CERF Secretariat as to the likely scale of the CERF envelope for the particular crisis. There is normally a maximum limit of US$30 million for any one emergency or crisis (United Nations Secretariat, Secretary-‐‑General’s bulletin, 2006, 2010) but it is extremely rare that the full amount is allocated. The 2010 Pakistan floods are an example. Three RR allocations were made, the first two of which at the initiative of the ERC in August 2010. The initial allocation, at the onset of the floods, was revised up from an initial US$10 million to US$16.6 million in consultation with the HC and rapidly followed by a second one of US$13.4 million (i.e. a total of US$30 million). The CERF finally provided close to US$42 million for the response to the floods.

B4. The CERF Secretariat prefers to see a draft request prior to agreeing informally on an envelope. At a minimum, the CERF Secretariat has to be aware of the beneficiary numbers, justification, funding levels, and types of projects, before discussing the size of a submission. The CERF Secretariat often consults with the ERC on potential envelopes.

B5. Joint applications are prepared by the country team with the UN agencies discussing the amount to be allocated to each cluster (or agencies where clusters do not exist), and each cluster lead agency preparing proposals in consultation with cluster members. The level of formality of this process varies a lot, depending on how the HC manages the prioritisation process.

B6. The CERF Secretariat reviews the proposals, frequently leading to adjustments relating to budget issues. The CERF can make substantive comments, but it is assumed that the HC and HCT/clusters have the technical expertise to determine what the urgent needs are as well as the capacities of the agencies on the ground. Once the Secretariat signs off, the grants are reviewed and authorised by the Emergency Relief Coordinator and the agency in question signs a Letter of Understanding22 with the UN Secretariat for the release of the funds.

22 From second quarter of 2011 an umbrella LoU has been introduced and agencies will counter-‐‑sign an

approval letter from the ERC, instead of signing a LoU for each grant.


25

UNDERFUNDED EMERGENCY GRANT PROCESS

B7. Allocations from the CERF underfunded emergencies window (UFE) are made twice a year, and the two rounds coincide with the global Consolidated Appeal Process (CAP) launch and the CAP mid-‐‑year review. Allocations are made to both CAP and non-‐‑CAP countries with no predefined division between these. The criteria for selection of countries for UFE funding are the degree of funding shortfall, the severity of humanitarian needs, and type of activities and the implementation capacity. The ERC selects between 17 and 24 countries a year for underfunded emergency support with the bulk of funds (typically two thirds) allocated during the first round.

B8. For CAP countries, the CERF Secretariat undertakes an analysis of humanitarian indicators combined with an analysis of the level of funding support for the CAP (analysis at sector level for each CAP). For the first underfunded round the previous year’s CAP funding data is used for the analysis whereas the funding levels at the CAP mid-‐‑year review serve as reference for the second allocation.

B9. For non-‐‑CAP countries, UN agencies’ headquarters are invited to vote on which non-‐‑CAP emergencies they regard as the most underfunded. The voting process is supplemented with details from each agency on their ongoing humanitarian programmes in the proposed countries and the funding levels of these.

B10. The CERF Secretariat combines analysis of CAP and non-‐‑CAP countries and, based on the UFE criteria, prepares a ranked list of country candidates for the ERCs consideration and decision. The ERC decides of the list of countries for inclusions and on the funding envelope for each. The selected countries and proposed allocation envelopes are discussed with agency headquarter focal points.

B11. The amount decided by the ERC is notified to the RC/HC in a letter in which the ERC may direct the allocation, or parts of it, to particular underfunded sectors or regions in order to facilitate prioritisation and speed up the process. The RC/HC will have to confirm that the funds are needed and can be implemented according to the stipulated timeline and against the proposed activities.

B12. At the country level, the allocation process is similar for the preparation of a rapid response allocation. The only other differences for underfunded emergencies is that the grants for the first annual round must be implemented by 31 December of the same calendar year and for the second annual round by 30 June of the next calendar year (OCHA 2010). Again, agencies can ask for a no-‐‑cost extension.


26

ANNEX III. BIOGRAPHICAL NOTICE OF THE MAIN WRITERS

John Cosgrave is an independent evaluator based in Ireland. He has more than 30 years of experience of humanitarian action and development in nearly 60 countries. His initial academic training was in engineering, and he holds three masters level degrees (in engineering, management, and social science).

After two decades managing projects and programmes for NGOs in the aftermath of natural disasters and complex political emergencies John became a freelance consultant specialising in the evaluation of humanitarian action in 1997. Since 1997 John has led a great many evaluations, mostly of humanitarian action, and including many joint evaluations of humanitarian action and several funding studies, for a wide variety of clients including the UN, Donors, and NGOs.

John was the Evaluation Advisor and Coordinator for the Tsunami Evaluation Coalition and is used to working on politically complex evaluations. He has well developed evaluation skills and trains on humanitarian evaluation both for ALNAP and for the World Bank supported International Program for Development Evaluation Training (IPDET). John combines training with evaluation and brings examples from evaluation practice into the classroom, including for ALNAP and the IPDET. John’s writing includes the ALNAP pilot guide for Real-‐‑Time Evaluation.

Recent writing by John include: Responding to earthquakes: Learning from earthquake relief and recovery operations. (ALNAP and Provention, 2008) and the ALNAP Real-‐‑Time Evaluation pilot guide.

Mrs Marie Spaak is an independent consultant since 2008 who has worked in the humanitarian field since 1992, mostly with DG ECHO and OCHA. She has been based in the field (former Yugoslavia, Great Lakes emergency, Bangladesh, Indonesia, Russian Federation, Haiti in 2009 notably) and worked in both Brussels (ECHO) and Geneva (OCHA). She has in-‐‑depth knowledge of the UN humanitarian reform process, disaster preparedness and response, field coordination mechanisms and inter-‐‑agency processes, and direct experience of different types of pooled funding mechanisms (Indonesia, Indian Ocean tsunami, Somalia, Haiti). She is also familiar with donor perspectives due to her experience with DG ECHO and more recently, an independent mapping of humanitarian donor coordination at the field level carried out with Channel Research in 2009, for which DRC and Sudan were a case study.

She is a Belgian national and fluently speaks and writes French, English and Spanish. She holds a B.A. in Anthropology from Bryn Mawr College, USA, and subsequently studied international development cooperation (Belgium) and project cycle management (Spain).


27

M. Jock Baker began working as an independent consultant in 1999 following a career of over fifteen years in a series of field-‐‑based assignments with the United Nations, including the United Nations Development Program (UNDP), United Nations High Commission for Refugees (UNHCR), World Food Program (WFP), and the Office for Coordination of Humanitarian Assistance (OCHA). Mr. Baker works part-‐‑time as CARE International’s Programme Quality & Accountability Coordinator at the CARE International Secretariat in Geneva, Switzerland where he is the focal point for CARE’s accountability, program quality, disaster risk reduction and transition programming. Mr. Baker has led a number of thematic reviews of organizational policy in addition to participating in and leading a number of assessments, appraisals, participatory reviews and evaluations and he is skilled in workshop design and facilitation. He holds a BSc in Biological Sciences from the University of Edinburgh and a MSc degree in Economics from the London School of Economics & Political Science. Mr. Baker’s assignments as an independent consultant include Team Leader for and Evaluation of UNHCR’s Kosovo Women’s Initiative, Senior Evaluator for an Interagency Real-‐‑Time Evaluation of Cyclone Nargis commissioned by UNOCHA, Micro-‐‑Finance Specialist & Conflict Analyst for an Asian Development Bank appraisal in eastern Sri Lanka, contributing author/editor for the Sphere Handbook, technical reviewer for the World Bank’s Post-‐‑Conflict Trust Fund, Transition Adviser in Rwanda for the Program on Negotiation at Harvard Law School, disaster management technical adviser for CBS Film Productions Inc., IDP Relief & Reintegration Adviser for the Government of the Philippines and Local Integration Specialist for UNHCR in Indonesia. Mr. Baker has also managed or led a number of humanitarian evaluations for CARE International, including an interagency evaluation for INGO tsunami responses, an interagency evaluation following hurricane Stan in Guatemala in 2005 and an evaluation of CARE Bangladesh’s response following Cyclone Sidr. Mr. Baker is also CARE International’s representative to ALNAP and was a member of the OECD-‐‑DAC team which peer reviewed WFP’s evaluation function in 2007.

Angela Berry-‐‑Koch brings 34 years of humanitarian experience to this evaluation. She has worked as a staff member for over twenty years with UNHCR , UNICEF and OCHA. This consultant brings a wealth of experience in nutrition, food security and child protection issues, and has authored numerous important guidelines and manuals for the UN system at large. She has also provided consultancy services in reproductive health and HIV/AIDS to UNDP, UNFPA and UNIFEM in various country offices, primarily in Latin America. With a Masters in Science in Human Nutrition from London School of Hygiene and Tropical Medicine, she is an expert in areas of food security and food aid as well as nutrition in humanitarian situations, having forged the first consultations on human dietary requirements and standards of food aid in emergencies in the 1980’s. In the past years she has revised various guidelines for the UN system, including the UNHCR/WFP food assessment guidelines in emergencies. Ms. Berry-‐‑Koch has authored many publications, including those related to use of famine foods used in the Horn of Africa, deficiency disease syndromes in refugee populations, and human rights of displaced


28

populations in Latin America.

Mrs Cécile Collin is a permanent area manager of Channel Research for 5,5 years in charge of Francophone clients and the UN. She is experienced in undertaking complex consultancies missions, evaluations, mid term review and impact assessments related to international assistance, emergencies and post disaster support. She has been a consultant in more than 16 missions, most of them in Africa, notably the Democratic Republic of Congo and Central African Republic including governance, interventions in unstable context, peace building, protection and human rights. She has practical experience of developing and implementing policies and strategies in the areas of multi-‐‑sectoral initiatives.

In 2006, she created Channel Research Burundi, subsidiary of Channel Research Belgium in the Great Lakes with the aim to promote African expertise and local capacity building. She took part notably to the CHF evaluation in Central African republic, evaluation of Conflict Prevention and Peace Building Programme for 11 donors, bilateral and multilateral in Eastern DRC, evaluation of post-‐‑disaster programmes of the AFD (Agence Française de Développement), a fact finding mission in Central African Republic and evaluation of rapid humanitarian assistance using Norwegian 6x6 military trucks for NORAD.

As a consultant, Mrs Collin benefits from a good knowledge of different evaluation and impact assessment methodologies as well as of general skills in organizational and financial analysis, economics, communication and management, as a graduated in Social sciences and economics (BA) and business administration, performance monitoring (MA). Mrs Cécile Collin is a French national and speaks English, French, Italian and German.

Mrs Annina Mattsson is a full-‐‑time area manager and evaluator at Channel Research. She has experience in the evaluation of humanitarian aid, peace building and development programmes in the Middle East, Africa, and South Asia. Working for Channel Research, Mrs Mattsson has gained experience of large multi-‐‑donor, multi-‐‑sector and multi-‐‑country evaluations. She was a key team member in the Sida commissioned follow-‐‑up evaluation of the linkages between relief, rehabilitation and development in the response to the Indian Ocean tsunami, the joint donor evaluation of conflict prevention and peace building initiatives in Southern Sudan and has just finished managing and working on the OCHA funded evaluation of the CHF. A part from being an evaluator, she is also advising organizations on their monitoring and evaluation systems.

Mrs Mattsson has carried out short-‐‑ and longer term missions to Bangladesh, Indonesia, Jordan, Kenya, Kosovo, Liberia, Maldives, Palestinian Territories, Sierra Leone, Sri Lanka, Sudan, Thailand, Uganda and the United Arab Emirates. She is a Finnish citizen, based in Dubai, and speaks fluent Finnish, Swedish, English, Spanish and French, while she is conversational in colloquial Arabic.


29

ANNEX IV. INTERVIEWS Note: No persons were met in Desk Reviews.

Cape Verde Number Location

CERF Secretariat 1 (Interview and written comments.)

New York

OCHA

NGO 0

UN staff (Written comments from UNICEF and WHO.)

Cape Verde and New York/Geneva

Cluster Lead N/A


30

ANNEX V. COUNTRY PROJECTS SUMMARIES

Agency – Window – Sector – Grant amount – Project number and emergency type Di

sbur

sem

ent y

ear

Days

to d

isbur

sem

ent

Title Activities (note: the text is unedited apart from removal of surplus carriage returns and tabs)

Revie

wed

UNICEF - RR - Water

and sanitation -

US$159,758 (09-

CEF-064) -

2009 98 Response to a massive Dengue

outbreak in Cape Verde

450 opened concrete inappropriate cisterns of abandoned houses are closed 300

waste accesses of abandoned houses are treated and closed 500 useless automobile

wrecks with rainwater storage risk of are moved and eradicated 700 rainwater pockets

are eradicated or treated with appropriate equipment 5,000 critical domestic water

storages are treated with appropriated equipment and closed 1,200 m2 of stagnant

water at the sewage treatment station of Praia is net protected 50% of the lamellar

decanter of the sewage treatment station is put in stand by 100% of critical vector

cottages are localised trough for orienting the collective intervention 95% of adequate

social control vector practices messages are received by the communities 90% of

adequate social control vector messages are understand by the communities 80% of

adequate social control vector messages are practised by the communities 100% of

none appropriated control vector are continually adjusted in a participative and gender

approach

Y

WHO - RR - Health -

US$314,580 (09-

WHO-069) -

2009 99 Response to a massive Dengue

outbreak in Cape Verde

An adequate surveillance system for rapid identification of target areas for urgent

intervention for all stakeholders in place Technical teams are in place with adequate

knowledge for case investigation Laboratory capacity strengthened for case

confirmation and sever cases monitoring Essential laboratory equipment and supplies

in place to manage DHF/DSS and severe co-infection cases Adequate and trained

health workers and experts deployed to support case management Treatment protocol

and control measure guidelines are available in all treatment centres

Y


31

ANNEX VI. SELECTED PROJECTS WITH SCORES

Proj

ect ,

ag

enci

es, s

ecto

r, bu

dget

A

ctiv

ity

Doc

umen

ts

avai

labl

e

Gen

der M

arke

r

Rea

sons

for

scor

e

Vuln

erab

ility

mar

ker

Reas

on fo

r Sco

re

Cros

s-cu

tting

m

arke

r

Reas

on fo

r sco

re

CV: 09-CEF-064-RR. UNICEF: Water and sanitation - $159,758

• 450 opened concrete inappropriate cisterns of abandoned houses are closed. - - • 300 waste accesses of abandoned houses are treated and closed. - - • 500 useless automobile wrecks with rainwater storage risk of are moved and eradicated. - - • 700 rainwater pockets are eradicated or treated with appropriate equipment. - - • 5,000 critical domestic water storages are treated with appropriated equipment and closed. - - • 1,200 m2 of stagnant water at the sewage treatment station of Praia is net protected. - - • 50% of the lamellar decanter of the sewage treatment station is put in stand by. - - • 100% of critical vector cottages are localised trough for orienting the collective intervention. - - • 95% of adequate social control vector practices messages are received by the communities. - - • 90% of adequate social control vector messages are understand by the communities. - - • 80% of adequate social control vector messages are practised by the communities. - - • 100% of none appropriated control vector are continually adjusted in a participative and gender approach.

Initial and final proposals, overarching proposal, RC report

1 The proposal discusses targetting women and children who are said to be at risk due to the type of clothing worn. (Short clothing increased the risk of mosquito bites).

0 No particular attention to any vulnerable group other than Women and Children

0 No partiuclar attention to cross cutting issues, although there is number of abandoned car wrecks suggest that there are serious environmental and urban sanitation management concerns

CV: 09-WHO-069-RR. WHO: Health - $314,580

• An adequate surveillance system for rapid identification of target areas for urgent intervention for all stakeholders in place - - • Technical teams are in place with adequate knowledge for case investigation - - • Laboratory capacity strengthened for case confirmation and sever cases monitoring - - • Essential laboratory equipment and supplies in place to manage DHF/DSS and severe co-infection cases - - • Adequate and trained health workers and experts deployed to support case management - - • Treatment protocol and control measure guidelines are available in all treatment centres

Initial and final proposals, overarching proposal, RC report

0 No specific attention to gender.

0 No particular attention to any vulnerable group

0 No particular attention to cross-cutting issues even though the capacity limits in hospitals suggest the HR is a major issue


32

ANNEX VII. BIBLIOGRAPHY Application Template for Resident/Humanitarian Coordinators, CERF grants 2009, Lanz Petra, Cape Verde.

OCHA, Performance and Accountability Framework for the Central Emergency Response Fund (OCHA, August 2010)

Beck, T. (2006); Evaluating humanitarian action using the OECD/DAC criteria for humanitarian agencies: An ALNAP guide for humanitarian agencies. (Overseas Development Institute: London, March 2006)

United Nations, OCHA and UNICEF. LOU letters scanned, and signed by agencies. 2009 Siquera et al. Dengue Fever, Brazil – 1981 – 2002. Emerging Infectious Diseases, www.cdc.gov.ed. Vol 11, No1. Jan 2005.

UNICEF, 2010. Report within the UN Resident/Humanitarian Coordinator’s Annual Report for Cape Verde, covering the period November 2009 to March 2010

Cape Verde -‐‑ UN One. Report on the Health Reform Process. February, 2010 (http://www.un.cv/files/SP8.pdf)

UNICEF Original Project Submission, November 17, 2009. UNICEF Final Project Submission, November 20, 2009 WHO, Original Project Submission, November 17, 2009 WHO, Final Project Submission, November 20, 2009

WHO, 2010. Report within the RC/HC Annual Report of the Resident/Humanitarian Coordinator in Cape Verde. Reporting period: December 2009 to March 2010. UNICEF, 2010. Report within the RC/HC Annual Report of the Resident/Humanitarian Coordinator in Cape Verde. Reporting period: December 2009 to March 2010. Barbazan,P, Yoksan, S, Gonzalez, JP, Dengue hemorrhagic fever epidemiology in Thailand: description and forecasting of epidemics. Microbes and Infection, Volume 4, Issue 7, June 2002, Pages 699-‐‑705.

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