With funding support from the UNICEF, Start Fund , UK Start Network, and Higher Life Foundation, Oxfam in Zimbabwe is implementing the Cholera Response project in Glen View and Budiriro, the epicenter of the current cholera outbreak.
This emergency response is being implemented for three months starting from mid-September. Among other activities the project is focusing on improving access to basic water supplies at household level and schools in the area.
Oxfam Cholera Response Manager, Lyn Chinembiri said they are already on the ground distributing non-food items that include water buckets and soap in schools affected by the cholera outbreak.
“With assistance from UNICEF we have distributed non-food items that include soap, protective clothes and buckets to schools that were affected by the outbreak as well as mobile toilets for the Cholera Treatment Centre,” said Chinembiri. In addition, the project conducted water testing of water sources to establish if boreholes in the affected areas were safe for domestic use. Oxfam in Zimbabwe is also raising awareness on the cholera outbreak through various forms such as posters and pamphlets.
Notes and Background
The cholera outbreak was declared a state of emergency by the Ministry of Health and Child Care on September 6. So far 6 428 suspected and 96 confirmed cases have been reported along with 45 deaths. An estimated 12 percent of the suspected and confirmed cases are children under five years of age.
Oxfam with support from its partners is responding to the cholera outbreak with multiple initiatives that include distribution of non-food items to more than 1 000 households, water testing, water trucking, distribution of IEC materials, provision of toilets to cholera treatment centre. As we seek to scale up the response Oxfam seeks to undertake some media and communication activities to help in the spread of key messages in the prevention of cholera.
Oxfam intends to use multiple media formats in reaching out to its audience with targeted messages in the fight against cholera.
What Oxfam is doing
- Oxfam has carried out a rapid assessment with the City of Harare, and the report has been shared, with the key issue being noted to be around contaminated water.
- City of Harare is working on the response plan as well as identifying the key gaps per sector in the response and these are going to be shared with the respective thematic groups which include, WaSH, Social Mobilisation, Case Management, Laboratory testing, Logistics and Information and Surveillance.
- Oxfam has also done the following: • Facilitated a UNICEF fact finding mission in Glen View and Budiriro.
- A UNICEF support visit was carried out with the Deputy Rep (Amina Muhammed), the Chief of WaSH (Aidan Cronin), the WaSH officer (Kwanayi Meki) and the Emergency specialist (Blessing Zindi) to the CTC and the team also took the opportunity to interact with the health promoters, MSF and City of Harare staff. They encouraged Oxfam to think around supporting the City of Harare to set up oral rehydration points in addition to the ongoing activities as most cases are being presented as severely dehydrated.
- Oxfam field team hosted a donor visit from DFID and UNICEF in Glenview on the 20th.
- Oxfam will also be hosting a Harare Partners meeting on September 24 at our offices to ensure better coordination and information sharing among the Partners working in the response because Oxfam is the focal agent for the Province.
Hygiene promotion
i.Community Transect Walk • A transect walk around Tichagarika shopping Centre noted increased demand for mineral water as households were also buying this for drinking water.
- There is panic in the community as people are quickly sharing their fears and recent experiences of deceased victims and other affected people to anyone whom they think to be involved in the response programme. As such, some suspected cholera patients around the epicenter were refusing to visit the CTC with fear of being transferred to BRIDH and possibly die, as the grapevine in the community is reporting that they are high deaths at the Glenview polyclinic.
- Cases of severely dehydrated people were observed during the field visit • Streams of raw sewage are still present in the epicenter although City Council is also putting effort to unblock the sewer.
- NFI Distribution
- As part of the PCA we have received NFIs for 1 000 households, the kit comprises a 1 x 20 litre bucket, 1 x 20 litre jerry can, 2 bars of 1kg soap and 6 strips of aqua tablets enough for a three months’ supply.
- UNICEF has also commenced delivery of the NFI kit (jerry cans were delivered) targeting 5 000 households, as such registration of households for NFI’s resumed with health promoters registering the remaining streets within the epicenter and in other surrounding streets.
- Distribution of 8 400 aqua tablet strips to Budiriro and Glen View Poly Clinic to be given to all those attended to in the cholera treatment units.
- 80% of the registered households have been reached; the consolidation will happen and the kit now comprises of a jerry can/buckets, 2 bars of soap, and 3 strips of aqua tablets. Therefore, the NFI distribution to the registered beneficiaries is complete and information is being consolidated.
- Nearly 900 households from the epicenter (89Crescent, 2nd Circle, 88 and part of Budiriro 1) were registered as beneficiaries for the NFI distribution. 350 households have received NFI’s consisting of buckets with taps, 2 bars of soap for hand washing, 1 jerry can and 6 strips of aqua tablets. However, the kits will be revised to meet the increased numbers in the epicenter which exceed our stock of 1 000 households as we do not have adequate stock now to cater for all the affected households. • A total of 3 238 households over the period in review received their NFI’s (3 strips of aqua tablets, 1 by20 liter jerry can, 1kg bar of soap and IEC on cholera spread and prevention) cumulatively 4 759 households have been reached in Glenview making use of the UNICEF stock.
- 3 schools were reached giving a total of 10 schools reached (7 Primary and 3 Secondary) in Glenview received buckets with tap (352), soap (353 bars), IEC material on handwashing, cholera prevention (532 posters) and aqua tabs (3 192 strips). Total enrolment in the schools is 22’624 pupils (11’529 boys and 11’095 girls).
- 59 NFIs in two schools in Budiriro were distributed to support safe water treatment and handwashing with soap. However, there are no more buckets with taps in stock and as such the list of schools who have received NFI’s will be shared with World Vision to ensure those who have not received do benefit.
iii. Hygiene Promotion:
- Key messages:
o Point of use water treatment with aqua tablets and or water guard
o Hand washing with soap at key time
o Rehydration with salt and sugar solution
o Seeking early treatment
- Training of 28 community health promoters from City of Harare in Glen view. 24 additional health promoters were sensitized on hand washing, diarrhoeal diseases, Sugar Salt Solution, and safe water chain. Mobilised 12 City Health Promoters for Budiriro. In total, 50 (48 F & 2 M) health promoters are now active in Glenview and are divided into 7 groups targeting the household areas where most cases are coming from.
- Mass cholera awareness was conducted with breastfeeding mothers and those living with HIV/AIDS at Glenview polyclinic. Monthly allocation of Aqua tabs was also distributed to these groups.
- Hygiene awareness was also conducted during the distribution.
- A sensitisation training for 44 participants (32 females and 12 males) on cholera spread and prevention was conducted with school health focal persons, religious sector representatives and business community representatives within Glenview with facilitation being done by City Health and Oxfam.
Issues raised by participants was the need for the local authority to increase their reaction time of unblocking sewer and improvement on waste collection. However, participants committed to cascade information within their organisations to increase awareness.
- School health focal persons also underwent a mini training and they are to educate pupils about cholera transmission and prevention.
- School assessments were done in conjunction with UNICEF and City of Harare key issues from the assessment include:
– Schools need to be encouraged to set up handwashing stations at main entrance points
– Need to speed up distribution of NFI’s within the schools
– School hygiene promotion targeting every teacher needs to be done as some were not sure of the signs and symptoms of cholera
– There is need to ensure that each school has enough IEC material so that each classroom has a poster.
- A kit of 49 NFI’s were distributed in the remaining 2 schools in Glenview bringing a total of 12 out of 12 registered schools in Glenview having received the kit. However, it should also be noted that the ECD level children are having a hard time using the bucket with tap, the teachers have noted that the tap is very hard for the kids to open once closed, and if the children do not ask for assistance they are not able to access the clean and treated water placed around the blocks. This was noted at one school and Oxfam will do a further analysis on this in the other schools to check if this is the same.
- 7 schools in Glenview were assessed today bringing a cumulative total of 11 out of 12 registered schools in Glenview suburb having been assessed. Key issues noted were;
– All the schools depend on motorised boreholes for their water supply instead of municipal water, and innovative ways of ensuring good water quality needs to be thought through within the schools, as the possibility of surface run off contamination due to inadequate drainage of waste water is there.
– Handwashing facilities are present in all institutions but the use of these stations needs to be improved especially through ensuring the availability and use of soap at these stations
– Improper disposal of sanitary pads is rampant in most schools, and the only method available to the schools for their disposal is burning
– School Health clubs are said to be present and active in the schools.
- School WaSH assessments conducted in 17 out of 19 Council Primary and Secondary Schools in Budiriro, indicates that boreholes are the main water source for all the schools and 40% of them have been disconnected from municipal water. Point of use water treatment is low amongst the schools with only 25% treating water with either water guard or aqua tablets, however 60% of the schools have health clubs.
- The areas were most cases were coming from in Glenview has all been reached with hygiene messaging through the door to door sessions, and there is now a general reduction in the number of people coming to the Glenview CTC, and an assumption can be made that the communities are now practicing better hygiene based from the knowledge gained through door to door and access to enabling inputs received through the NFI distributions.
- In Glenview, cumulatively 6 399 households with 11 750 people (6 866 females and 4 884males) have been reached through door to door in Glenview.
- In Budiriro cumulatively, 13 846 households with 23 346 people (13 470females and 9 876males) have been reached in the 2 districts.
- 50 pastors from various churches and branches within Harare where trained at Miracle Power Impact Church under the Evangelical Fellowship in Zimbabwe in Glen View on cholera its spread and prevention, the training was facilitated by Oxfam and Ministry of Health.The Glen View/Budiriro community uses water from the following sources:
o Community boreholes (hand pump and solar motorised),
o Institutional boreholes (e. g schools, private business),
o Private dug wells at household level and Municipal water.
- Challenges at communal handpumps include poor sanitary conditions, litter near water points, blocking of soak aways leading to ponding of water on the runoff channel, ponding of water in the apron, growth of algae on the pump stand.
- In February 2017, inline chlorinators were fitted on handpumps, 10 in Glen View and 10 in Budiriro, those tested to date however tested negative for chlorine, including the solar powered community motorised borehole also tested negative for chlorine.
- Chlorine tests done on the Municipal water indicated free residual Chlorine of 0.3 mg/l, which is a marked improvement from previous readings done by the City. • Municipal water remains safe and effort is clearly being made to ensure that there is adequate free residual chlorine for the end user with readings ranging from 0.3 to 1.0 mg/l in some instances
- 20 packs of bulk water treatment chemicals were given to Higher Life who are to truck 560000 litres of water into Glenview.
- Visited Harare Water Works along Coventry with City Health to assess the water that will be trucked by Higher Life Foundation into Glenview and Budiriro, however the assessment did not happen as water was not available due to a pipe burst.
- An area in Budiriro 3 remains affected with low water provision due to the terrain and the team will be highlighting this to the Harare Water team in the regular coordination meetings.
- Oxfam is also supporting on monitoring the trucked water, and the residual chlorine levels of the water tank at Tichagarika shops installed by Higher Life Foundation had a free residual Chlorine of 0,3mg/l, which is within the recommended standards.
- Delta has trucked a cumulative of 40 000 litres of water to Glen View CTC. Spar Zimbabwe has trucked a cumulative 100 000 litres of water at 20’000 litres per day. Higher life Foundation is trucking 25 000 litres of water daily being delivered to 5 000 liter tanks where standpipes have been installed at 5 different locations, which include Tichagarika Shopping Center, Simudzirai primary (where a borehole and a well were decommissioned respectively after testing positive for E. Coli, salmonella and vibrio cholerae), Glen View 3 shops, Glen View 4 shops and Glen View 5 Primary school (which had been closed after students had fallen ill). Trucked water is Municipal water that is being sourced from Harare Water Works along either Coventry or in Highfield. It is averaging a chlorine dosage of 0.3 mg/l.
- 56 water samples from 56 sites have been collected to date for microbiological analysis from different water sources. Only 5 results have been received to date due to resource challenges being experienced at the Government Analyst Laboratory. Oxfam, under the Start Fund is currently in the process of procuring laboratory consumables from suppliers to help support the lab based on their required needs, however it should still be noted that their full needs are yet to be met.
However, preliminary results based on Oxfam’s own analysis has shown faecal contamination in mostly well water and some boreholes too.. Preliminary results showed faecal contamination in one of the two electric motorized boreholes at Glenview 5 Primary school, however the school has recently reopened their borehole after installation of a water purification system over the last weekend.
- Higher life foundation is in the process of installing 19 other 5’000 litre tanks with standpipes in the outbreak area in different locations which will be advised.
Sanitation
- Distribution of IEC material on hand washing and cholera spread to the two clinics and MSF, as well as City of Harare. • Mobile latrines were also delivered to the two CTU
- City of Harare Water personnel have requested for assistance from Oxfam for long rubber gloves so they can attend to blocked sewers
- 12 extra mobile toilets have been sourced and will be delivered to BRIDH, Glenview CTC and Budiriro CTC.
Handover of Cleaning materials to Glenview and Budiriro
Environmental Cleaning Tools which include Wheelbarrows, Rakes, Gloves, Gumboots and Dust Masks were donated in Glen View and Budiriro to support City of Harare clean-up campaigns.
Clean up campaigns in Glenview (Glenview 3 shops) and Budiriro (Budiriro 1 shops)
The nation of Zimbabwe is facing a challenge in waste management, particularly the urban centers and growth points. The drivers of this environmental challenge include; the rapid urban population increase and shortage of housing, resulting in higher population density in the existing suburbs and emergence of slums. During the week, a total of two (2) clean ups were conducted one in each suburb in collaborating with Anti-Litter Monitors and City of Harare and the objectives of the clean-up were as follows:
- To ensure the environment is safe, clean and healthy
- To ensure environmental sustainability
- To promote environmental awareness
- To restore community pride
- To engage communities in long term environmental initiatives.
- To eradicate diseases, such as cholera, typhoid which thrive in dirty environments.
Roadshows (Currently underway in Glen View and Budiriro)
Objectives
- To raise awareness that Cholera is now taking lives and that it has become a state of life and death.
- To educate the general public on the signs and symptoms of Cholera.
- To disseminate information on the proper measures to take in order to avoid contracting and transmitting cholera.
- To encourage the use of Salt and Sugar Solution and teach people the correct proportions to use.
- To emphasise to the public to utilise the available referral systems that is to visit the CTU urgently.
- To promote general hygiene.
- To encourage residents to get vaccinated at their respective centers.
- To emphasize to the public to utilize the available referral systems that is to visit the CTU urgently.
- To promote general hygiene.
- To encourage residents to get vaccinated at their respective centers.
Additional Oxfam Current Activity We have the Enough Campaign.
Enough is a worldwide campaign that has sparked a movement against violence towards women and girls, to address negative social norms in their specific contexts.
“Our goal is to change widely accepted and harmful social norms that too often justify violence against women and girls to ones that promote gender equality and non-violence”
The campaign brings people of all genders, ages, and backgrounds together; to transform the normal. It works to challenge and make us reflect on our own behavior, supports ordinary people to speak out against violence and present alternatives to harmful norms
