AFR/RC65/9 25 November 2015
REGIONAL COMMITTEE FOR AFRICA Sixty-fifth session N’Djamena, Republic of Chad, 23–27 November 2015 Agenda item 13
ORIGINAL: ENGLISH
THE AFRICAN PUBLIC HEALTH EMERGENCY FUND: STOCKTAKING
Report of the Secretariat
CONTENTS Paragraphs BACKGROUND .......................................................................................................................... 1–4 ISSUES AND CHALLENGES .................................................................................................... 5–8 ACTIONS PROPOSED.............................................................................................................. 9–14 ANNEXES Page 1. 2. APHEF: Status of Member States’ contributions as of 31 July 2015 ..................................... 4 APHEF: Status of funds utilization and disbursement as of 31 July 2015 ............................. 6
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BACKGROUND 1. The ministers of health in the WHO African Region adopted Resolution AFR/RC59/R51 in 2009 on strengthening outbreak preparedness and response in the Region, urging Member States to ensure that adequate financial resources were provided to the African Public Health Emergency Fund (APHEF or the Fund) as stipulated in the APHEF terms of reference proposed by the WHO Secretariat. APHEF was established in 2012 as a solidarity mechanism of Member States of the WHO African Region to improve their response to public health emergencies, in accordance with Regional Committee Resolution AFR/RC61/R32 and Article 50 (f) of the WHO Constitution based on the assessed contribution formula. APHEF is expected to supplement funding from Member States and partners whenever public health emergencies occur. 2. From the establishment of APHEF in 2012 to July 2015, 13 of the 47 Member States3 had contributed a total of US$ 3 619 438, while outstanding contributions amounted to US$ 196 380 562. A summary of the yearly contributions by Member States is attached as Annex 1. A total of US$ 2 300 676 has been disbursed from APHEF for urgent financial assistance to 11 countries4 (Annex 2), upon request, to respond to declared public health emergencies. Of the 11 countries, only two had made contributions to the Fund. 3. APHEF supported life-saving interventions to improve access to quality health care in three districts in the Central African Republic as well as the strengthening of emergency surgical services for war-related emergencies in South Sudan. It also supported the provision of health care services to communities affected by floods in Burundi, Malawi and Zimbabwe. Furthermore, APHEF contributed to the Ebola virus disease outbreak response in the Democratic Republic of Congo, Guinea, Liberia and Sierra Leone. In Cameroon, APHEF supported the provision of essential health care services to refugees from the Central African Republic. The Fund also provided financial support to Niger during the outbreak of meningococcal meningitis in the country. In the above cases, APHEF funds were made available within a few days after the declaration of the emergency. These funds catalysed and supported immediate response activities before other funding mechanisms could be activated. 4. APHEF is beginning to prove its worth through its various interventions to date. However, its optimal functioning is undermined by significant challenges. Certain actions have been proposed to mitigate these challenges.
1
2
3
4
Resolution AFR/RC59/R5: Strengthening outbreak preparedness and response in the African Region in the context of the current influenza pandemic. In: Fifty-ninth session of the WHO Regional Committee for Africa, Kigali, Rwanda, 31 August–4 September 2009, Final report, Brazzaville, World Health Organization, Regional Office for Africa, 2009 (AFR/RC59/19) pp.13–16. Resolution AFR/RC61/R3: Framework document for the African Public Health Emergency Fund. In: Sixtyfirst session of the WHO Regional Committee for Africa, Yamoussoukro, Cote d’Ivoire, 29 August–2 September 2011, Final report, Brazzaville, World Health Organization, Regional Office for Africa, 2009 (AFR/RC61/14) pp.10–12. Angola, Benin, Chad, Democratic Republic of Congo, Eritrea, Ethiopia, Gabon, Gambia, Lesotho, Liberia, Mauritius, Rwanda and Seychelles. Burundi, Cameroon, Central African Republic, Democratic Republic of Congo, Guinea, Liberia, Malawi, Niger, Sierra Leone, South Sudan and Zimbabwe.
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ISSUES AND CHALLENGES 5. Persistently low level of APHEF contributions: As of July 2015, only four Member States 5 had paid their contributions for the year. Total country contributions over the Fund’s four years of existence (2012–2015) amount to US$ 3 619 438, or 1.8% of the expected amount of US$ 200 million. Late reporting on APHEF disbursements at country level: As of July 2015, only five6 6. of the 11 countries which received APHEF funds had submitted their technical and financial reports. The Fund’s operations manual requires that final reports be submitted to the Secretariat not later than three months after project completion. Linkage with the new WHO Global Contingency Fund for Emergencies (CFE): The 7. CFE is being established within the context of WHO’s emergency reform. A link between the CFE and the APHEF will be established in order to ensure complementarity. Concomitance of emergencies: In 2012, the African Region had two protracted 8. emergencies that could be classified as grade 2 according to the WHO Emergency Response Framework. These arose from armed conflicts in the Democratic Republic of the Congo and Mali. So far, in 2015, five countries have had emergencies classified as grade 3 (the highest level). These are Guinea, Liberia and Sierra Leone for the Ebola viral disease outbreak, and the Central African Republic and South Sudan for armed conflict. Five countries have had grade 2 emergencies, namely Malawi and Mozambique for flooding and in Nigeria, Niger and Chad for insurgencies. The funding has not been available to respond to this large number of emergencies. As a result, there is a notable shortage of available funding for each situation. For example, of the total US$ 51 760 000 requested by the Central African Republic, the Democratic Republic of Congo and South Sudan from global sources in 2015, only US$ 3 280 326 has been made available, and by April 2015 only South Sudan had received the funds. Consequently, APHEF as a solidarity mechanism for African countries is needed more than ever to boost emergency response funding in the Region. ACTIONS PROPOSED Member States 9. To honour their commitments to APHEF by paying their contributions.
WHO 10. Strengthen the APHEF Secretariat as appropriate such that it fully plays its role, particularly for advocacy and resource mobilization. 11. Carry out an assessment to understand the underlying factors that impede Member States’ contribution.
5 6
Gabon, Eritrea, Lesotho and Mauritius. Cameroon, Democratic Republic of Congo, Guinea, South Sudan and Zimbabwe.
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12.
Establish a multidisciplinary expert group to: (i) (ii) (iii) Renew the current format of APHEF and propose alternatives; Review the criteria for determining each Member State’s contribution; and Reconsider eligibility criteria.
13. Intensify high-level advocacy and facilitate consultations between Ministers of Health, Ministers of finance and other relevant ministers, with a view to prioritizing the payment of Member States’ contributions. 14. The Regional Committee examined and endorsed the actions proposed.
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ANNEX 1: APHEF: Status of Member States’ contributions as of 31 July 2015 2012 Member State Expected Scale of assessment (yearly assessment – (%) US$) (1) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Algeria Angola Benin Botswana Burkina Faso Burundi Cabo Verde Cameroon Central African Republic Chad Comoros Congo Côte d'Ivoire Democratic Republic of Congo Equatorial Guinea Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya 19.74 3.50 0.81 1.80 0.77 0.01 0.20 3.23 0.16 0.37 0.07 0.81 3.09 0.01 0.77 0.01 0.01 1.45 0.07 1.78 0.42 0.01 3.69 9 870 000 1 750 000 405 000 900 000 385 000 5000 1 00 000 1 615 000 80 000 185 000 35 000 405 000 1 545 000 5000 385 000 5 000 5000 725 000 35 000 890 000 210 000 5000 1 845 000 5 000 4 975 25 725 000 35 000 890 000 210 000 5000 1 845 000 5 000 385 000 1 750 590 Received (US$) (2) Total outstanding contribution (US$) (3) = (1 - 2) 9 870 000 –590 405 000 900 000 385 000 5000 100 000 1 615 000 80 000 185 000 35 000 405 000 1 545 000 Expected (yearly assessment – US$) (4) 9 870 000 1 750 000 4 050 00 900 000 385 000 5000 100 000 1 615 000 80 000 185 000 35 000 405 000 1 545 000 5000 385 000 5000 5 000 725 000 35 000 890 000 210 000 5000 1 845 000 2013 Received (US$) (5) Total outstanding contribution (US$) (6) = (3 + 4 - 5) 1 9740 000 1 749 410 810 000 1 800 000 770 000 10 000 200 000 3 230 000 160 000 370 000 70 000 810 000 3 090 000 5000 770 000 5000 50 25 1 450 000 70 000 1 780 000 420 000 10 000 3 690 000 Expected (yearly assessment – US$) (7) 9 870 000 1 750 000 405 000 900 000 385 000 5000 100 000 1 615 000 80 000 185 000 35 000 405 000 1 545 000 5000 385 000 5000 5000 725 000 35 000 890 000 210 000 5000 1 845 000 36 403 9 974 183 555 1 014 203 2014 Received (US$) (8) Total outstanding contribution (US$) (9) = (6 + 7-8 ) 29 610 000 3 499 410 200 797 2 700 000 1 155 000 15 000 300 000 4 845 000 240 000 371 445 105 000 1 215 000 4 635 000 10 000 1 155 000 10 000 10 025 2 175 000 68 597 2 670 000 630 000 15 000 5 535 000 Expected (yearly assessment – US$) (10) 9 870 000 1 750 000 405 000 900 000 385 000 5000 100 000 1 615 000 80 000 185 000 35000 405 000 1 545 000 5000 385 000 5000 5000 725 000 35 000 890 000 210 000 5000 1 845 000 382 577 5 000 2015 Received (US$) (11) Total outstanding contribution (US$) (12) = (9 + 10 -11) 39 480 000 5 249 410 605 797 3 600 000 1 540 000 20 000 400 000 6 460 000 320 000 556 445 140 000 1620 000 6 180 000 15 000 1 540 000 26 15 025 2 517 423 103 597 3 560 000 840 000 20 000 7 380 000
AFR/RC65/9 Page 5 2012 Member State Scale of Expected assessment (yearly (%) assessment – US$) 0.34 0.01 0.63 0.01 0.80 0.39 1.27 0.64 1.44 0.01 22.00 0.01 0.01 1.72 0.17 0.01 22.00 – 0.52 0.24 1.30 1.88 1.26 0.56 100.00 170 000 5000 315 000 5 000 400 000 195 000 635 000 320 000 720 000 5000 11 000 000 5000 5 000 860 000 85 000 5000 11 000 000 – 260 000 120 000 650 000 940 000 630 000 280 000 50 000 000 1 770 540 4975 Received (US$) Total outstanding contribution (US$) 170 000 5000 315 000 5000 400 000 195 000 635 000 320 000 720 000 5000 11 000 000 25 5 000 860 000 85 000 5000 11 000 000 – 260 000 120 000 650 000 940 000 630 000 280 000 48 229 460 Expected (yearly assessment – US$) 170 000 5000 315 000 5000 400 000 195 000 635 000 320 000 720 000 5000 11 000 000 5000 5 000 860 000 85 000 5000 11 000 000 – 260 000 120 000 650 000 940 000 630 000 280 000 50 000 000 4961 4961 2013 Received (US$) Total outstanding contribution (US$) 340 000 10 000 630 000 10 000 800 000 390 000 1270 000 6 400 00 1 440 000 10 000 22 000 000 64 10 000 1 720 000 170 000 10 000 22 000 000 – 520 000 240 000 1 300 000 1 880 000 1 260 000 560 000 98 224 499 Expected (yearly assessment – US$) 170 000 5000 315 000 5000 400 000 195 000 6 350 00 320 000 7 200 00 5000 11 000 000 5000 5000 860 000 85 000 5000 11 000 000 – 260 000 120 000 650 000 940 000 630 000 280 000 50 000 000 1 263 735 4650 14 950 2014 Received (US$) Total outstanding contribution (US$) 510 000 50 945 000 15 000 1 200 000 585 000 1 905 000 960 000 2 160 000 15 000 33 000 000 5064 15 000 2 580 000 250 350 15 000 33 000 000 – 780 000 360 000 1 950 000 2 820 000 1 890 000 840 000 146 970 738 Expected (yearly assessment – US$) 170 000 5000 315 000 5000 400 000 195 000 635 000 320 000 720 000 5000 11 000 000 5000 5000 860 000 85 000 5000 11 000 000 – 260 000 120 000 650 000 940 000 630 000 280 000 50 000 000 580 202 25 000 2015 Received (US$) 167 625 Total outstanding contribution (US$) 512 375 5050 1 260 000 20 000 1 600 000 780 000 2 515 000 1 280 000 2 880 000 20 000 44 000 000 10 064 20 000 3440 000 335 350 20 000 44 000 000 – 1 040 000 480 000 2 600 000 3 760 000 2 520 000 1 120 000 196 380 562
24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47
Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Sao Tome and Principe Senegal Seychelles Sierra Leone South Africa South Sudan* Swaziland Togo Uganda United Republic of Tanzania Zambia Zimbabwe Grand Total
*South Sudan had not yet been included in the assessment by the time of this report.
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ANNEX 2: APHEF: Status of funds utilization and disbursement as of 31 July 2015 Date of request Country Reason for request Amount requested (US$) Amount approved/ disbursed (US$) Summary of APHEF support to affected countries On 9 and 10 February 2014, Bujumbura experienced torrential rainfall with severe flooding that resulted in massive destruction of property and population displacement. At least 20 000 people, or 3784 households, were affected, with 77 dead and 182 injured. 279 760 148 360 The risk of epidemics, especially cholera and other diarrhoeal diseases, malaria and acute respiratory infections was very high. APHEF funds contributed to the provision of emergency medical supplies and prevention of disease epidemics. Following unrelenting torrential rains in February 2014, the Tokwe Mukosi Dam rapidly flooded, threatening to cause a displacement of the communities within its basin. A phased relocation plan was implemented, targeting 6393 families (32 000 people) and their 18 764 cattle to make way for the dam. The area of relocation did not have basic social services or facilities and the nearest district hospital was 52 km away. 2 7 March 2014 Zimbabwe Response to flooding which caused population displacement 250 000 65 500 The risk of disease outbreak in both the flooded and the relocation areas was high, especially for cholera and other diarrhoeal diseases, malaria and acute respiratory tract infections. Given the magnitude of the threat of extensive flooding, the president of Zimbabwe declared a state of disaster. APHEF resources supported the establishment of temporary health facilities, facilitation of referrals and provision of emergency and essential medicines for the relocated population. The crisis in the Central African Republic, fuelled by armed conflict, resulted in the total destruction of basic infrastructure and loss of essential social services, including health services. The ministry of public health requested APHEF support to restore health services for the most vulnerable communities in Bangui at the Paediatric Hospital Complex and in the district hospitals of Mbaiki and Boda. APHEF’s contribution supported the implementation of the free health care policy for 3 months, thus facilitating a return to the normal health services system after that period. The humanitarian crisis experienced by South Sudan since December 2013 has led to the disruption of essential health services. Health facilities were looted and destroyed. The State hospitals in Jonglei, Upper Nile and Unity states, the epicentre of the crisis, were among those providing only minimal services despite the increased demand. Between the onset of the crisis and March 2014, over 10 000 wounded patients were treated and more than 400 referred patients transported to Juba Teaching Hospital by air, which is a very costly means of transport. There are obvious gaps in life-saving surgical interventions since operating theatres are no longer functioning. APHEF funds helped address the critical emergency surgery needs by reviving the operating theatres in Bor, Malakal and Bentiu hospitals and strengthening emergency surgical operations at Juba University Teaching Hospital. The Ebola outbreak in Guinea was declared by the government in February 2014. Detailed investigation revealed that the disease had started in the country in December 2013 and had spread to neighbouring Liberia. By the end of March 2013, over 150 cases (including 102 deaths) had been reported from five districts including the capital city, Conakry. Health workers were among those reported to have the disease, suggesting gaps in infection prevention and control. APHEF’s contribution helped enhance the investigation and response to control the Ebola outbreak. The deterioration of the security situation in the Central African Republic from December 2013 generated a daily influx of refugees into Cameroon. Between December 2013 and 14 March 2014, a total of 48 000 new refugees were received in Cameroon. The districts receiving the refugees are facing the challenge of providing essential health care to the increased population in their catchment areas. In addition, the risk of disease epidemics was very high. APHEF’s contribution was used to provide supportive resources, specifically in mobilizing emergency medical kits, strengthening surveillance and early warning mechanisms for early detection and response to epidemics, and
1
28 February 2014
Burundi
Response to flooding which caused massive destruction and population displacement in Bujumbura
3
13 March 2014
Central African Republic
Provision and restoration of free health care services for the most vulnerable population following intensified armed conflict that led to total collapse of health systems
421 678
279 723
4
27 March 2014
South Sudan
Re-establishment of free surgical care in three state hospitals following armed conflict that caused the collapse of health care services in the affected areas
641 200
523 200
5
3 April 2014
Guinea
Control of Ebola virus disease outbreak that caused widespread and high mortality
386 090
140 440
6
14 April 2014
Cameroon
Contribution to the provision of essential health care services to refugees from the Central African Republic
192 634
68 700
AFR/RC65/9 Page 7 Date of request Country Reason for request Amount requested (US$) Amount approved/ disbursed (US$) Summary of APHEF support to affected countries supporting polio and measles vaccination. The Ministry of Health and Social Welfare in Liberia declared an Ebola outbreak in April 2014. The outbreak was epidemiologically linked to the ongoing outbreak in Guinea. As of 21 April 2014, a cumulative total of 26 clinical cases, six of which had laboratory confirmation, and 20 probable or suspected cases, including 13 deaths, were reported. All the six patients with laboratory-confirmed Ebola, including three health care workers, died. 7 17 April 2014 Liberia Control of the Ebola virus disease outbreak 317 770 100 150 The Government of Liberia, in collaboration with partners, initiated response activities including enhanced surveillance for early case identification and contact tracing, case management, social mobilization and detailed investigation. However, significant gaps existed in these areas as well as in laboratory coordination and confirmation of cases. APHEF helped in raising additional resources to strengthen all aspects of the outbreak response. On Monday, 26 May 2014, the Government of Sierra Leone, through its Ministry of Health and Sanitation, declared an outbreak of the Ebola virus disease in the country following the laboratory confirmation of a suspected case from Kailahun District, located along the border with Guinea and Liberia. A total of 60 cases had been confirmed for Ebola virus disease by 20 June. It was critical to organize an adequate response to contain the outbreak of the disease in Kailahun and other high risk districts. APHEF’s contribution helped to stop the transmission of the Ebola virus disease and reduce its morbidity and mortality. The Ebola virus disease is highly contagious and starts with a fever accompanied by diarrhoea, vomiting, severe fatigue and sometimes bleeding. It is transmitted by direct contact with sick or infected animals. From 24 August 2014, the Democratic Republic of the Congo was faced with the likelihood of an Ebola epidemic. By 30 August 2014, the country had recorded 53 cases, of which 13 had laboratory confirmation, and 31 deaths. APHEF’s contribution helped to contain the outbreak and reducing morbidity and mortality from the disease. Flooding in Malawi started on 8 January 2015. On 13 January the president declared a state of disaster after persistent rains caused flooding in 15 districts. Four of these districts – Chikhwana, Nsanje, Phalombe and Mulanje – were heavily affected by the floods. Their routine critical health services were disrupted. Moreover, their personnel capacity and medical supplies were not enough to cope with the needs of the 638 000 affected people. APHEF’s contribution filled the gaps in the critical medical supplies needed to strengthen the delivery of basic health services and epidemic preparedness and response in the four most affected districts. From 29 December 2014 to 26 April 2015, the Ministry of Public Health of Niger notified WHO of 2005 suspected cases of meningococcal meningitis, including 162 deaths. Suspected cases had been reported in seven of the eight regions in Niger, with meningococcal meningitis outbreaks confirmed in several areas of the Dosso and Niamey regions. Three of the five districts in Niger had exceeded the epidemic threshold. Laboratory tests confirmed the predominance of Neisseria meningitidis serogroup C in the affected areas, with Neisseria meningitides serogroup W also being identified in several samples. APHEF contributed in supplementing the efforts of the government to provide an efficient and effective response to the epidemic through proper case management and reactive immunization, and to strengthen all aspects of outbreak response.
8
20 June 2014
Sierra Leone
Support the emergency response to the Ebola viral haemorrhagic fever epidemic in Sierra Leone
245 578
169 439
9
2 September 2014
Democratic Republic of the Congo
Control of Ebola virus disease in the country
391 200
346 100
10
16 February 2015
Malawi
Strengthening basic health care provision to flood-affected communities
369 564
359 564
11
26 April 2015
Niger
To strengthen meningococcal meningitis outbreaks response
371 401
99 500
3 356 471
2 300 676