Ebola - following a full simulation exercise, a joint monitoring mission is deployed in Rwanda

World Health Organization Regional Office for Africa

Following the Full Simulation Exercise (FSIMEX) conducted in Rwanda at the beginning of January 2019 to assess Ebola Virus Disease (EVD) readiness/preparedness and response capacity in the country, an external Preparedness Joint Monitoring Mission (PJMM) team comprised of WHO specialists and partners relevant to the EVD preparedness efforts in Rwanda was deployed in the country.

The scope of the JMM was to provide additional support to Rwanda to:

  1. Strengthen its preparedness should there be an introduction of EVD into the country.
  2. Review the preparedness and readiness activities already undertaken. This was based on the findings from the FSIMEX that was conducted and the recommendations from the PJMM team.
  3. Advocate for prioritization of and support to national EVD preparedness capacity and capability to ensure operational readiness for responses to a potential importation of an EVD case.

The PJMM gathered experts from the WHO Regional Office for Africa (AFRO) and WHO headquarters in Geneva, Health Partners of the Rwandan Ministry of Health, WHO Country Office in Rwanda, RESOLVE, and donors from DIFID, USAID and CDC. The methodology implicated meeting with relevant stakeholders under the joint leadership of Rwandan authorities and the WHO Country Offic to review the evaluation tools used, Standard Operating Procedures (SOPs), protocols, and communications such as posters, bulletins, and progress reports. The meeting also involved conducting visits to the different sites and high-risk districts. The overall target was to update the EVD consolidated preparedness key performance indicators (KPI) for all the nine technical pillars, namely risk communication and community engagement, surveillance, laboratory, case management, assessment of Ebola Treatment Centers (ETCs), Rapid Response Team (RTT), Point of Entries (POEs), and Logistics and Vaccine.

Risk Communication and Community Engagement activities are central. Consequently, the Risk Communication and Community Engagement Technical Working group developed risk communications SOPs for EVD preparedness in the country. It was highly recommended to involve the Ministry of Information in the Technical Working Groups and the Emergency Operation Center (EOC). For standard communications like brochures in local languages as handouts, it was agreed that they should be available at Point of Entries (POEs), UNHCR transit centres, airports, other critical venues located in Rwanda.

Rwanda, being surrounded by other countries at risk and sharing borders with them, has an acute urgency to enhance EVD surveillance at POEs. As a result, there was a need to provide immediate access to equipment and supplies to the neighboring communities at transit and refugee camp settings to scale up timely case detection, reporting and investigation. Quarantine SOPs have also been developed for humanitarians crossing the borders. On Nov 30, 2018, the Rwanda ETC in Gisenyi was designated by the Rwanda Ministry of Health, the WHO Country Office in Rwanda, and the CDC as ready to be opened but with limited sustainability due to a restricted number of trained competent human resources to manage the center. Gisenyi is a city in Rubavu District in Rwanda's Western Province. The city is contiguous with Goma, a large agglomeration across the border in the Democratic Republic of the Congo (DRC).

Given the geographical position of Rwanda as a landlocked country sharing borders with Uganda, Burundi, Tanzania and DRC, POEs were determined to be critical. Daily reports are now shared with clinics in at POEs clinic and health centers, as well as with the Ministry of Health. For vaccination, there is an urgent need to scale-up the rollout of vaccinations to frontline health workers to ensure their protection.

The PJMM said that there was a critical need for more support for the Rwandan Refugee Transit Centers. A number of key preparedness measures will also have to be scaled-up, not only at POEs, but also district hospitals and ETCs.

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