Concept of Operations – UN Scale-up Strategy
This United Nations scale-up strategy provides a framework for organizing the response by the United Nations system in support of the Government of the DRC’s public health response priorities as well as to enhance the overall enabling environment within which the response is situated.
The implementation of this scale-up strategy will be directed by the Ebola Emergency Response Team (EERT) chaired by the Ebola Emergency Response Coordinator (EERC) and the ADG of WHO for Regional Emergencies, serving equally as co-chairs, with the participation of all Heads of United Nations AFPs involved in the response and one representative of the INGOs. The EERT will oversee the implementation of United Nations support across five main pillars identified as essential for an effective response to end the Ebola outbreak. Primary among these pillars is the support to the public health response led by the Ministry of Public Health. This pillar will inform and drive the four other pillars that aim to provide an enabling and conducive environment for a safe and effective response as well as enhance the overall effectiveness of United Nations support.
In relation to coordination within the pillars, the first pillar will continue to be coordinated by the MoH supported by the WHO at the national, provincial, and sub-coordination levels through the government Committee and sub-committee system. WHO will seek to mobilize and coordinate additional technical support from GOARN technical partners and networks for the public health response. The EERC will have the coordination lead for pillars two and three, with a strengthening of UN coordination with NGOs central to pillar three. The World Bank will lead the coordination of the fourth pillar related to financial management and WHO and OCHA will be leading the fifth on strengthened regional preparedness.
In relation to coordination between the pillars, OCHA will establish an information management architecture, including monitoring and analysis as well as input from the INGOs through the partner coordination forum, to support inter-pillar decision-making by the EERT on mission critical activities, the prioritization of response activities as well as resource mobilization and allocation.
The EERT will also establish appropriate local mechanisms in Butembo, Beni and Bunia for inter-pillar coordination as well as for liaison with the national EOC in Goma.
In addition, throughout implementation, the strategy will be reviewed and adapted to ensure that it continues to meet GoDRC priorities and expectations as well as the needs and requirements of the response overall. This includes a monthly operational review of implementation of the strategy by the EERT allowing for course corrections as well as a quarterly strategic review by the EERT.
1. Strengthened public health response led by WHO in support of the Ministry of Health to adapt strategies to enable: a) early detection, isolation and treatment of EVD cases; b) expanded and streamlined vaccination (both ring and targeted geographic); and c) decrease of nosocomial transmission in public and private health centers.
In support of the above objectives and under the overall coordination of the Ebola Emergency Operations Center (EOC) at the national, sub-national and field level, the public health response will be led via the following technical commissions:
1.1 Risk Communications and Community Engagement: Enhance dialogue and partnerships between Ebola response teams and individuals or communities in affected areas enabling community ownership in the response and real time exchange of information, opinion and advice to inform adjustments for the public health response and the identification and prioritization of activities to be implemented through Pillar 3 (UNICEF, WHO).
1.2 Surveillance, Contacting Tracing & Vaccination: Strengthen active and passive case finding and case investigation to facilitate: triage of alerts; rapid isolation; establishment of contact lists and follow up; expanded access to vaccination with streamlined consent and follow-up; adjusted dosage, expanded eligibility; and the potential introduction of new vaccination candidates. Enhanced analysis of population mobility trends and reinforcement of points of entry and points of control by IOM to strengthen detection of cases and contacts along mobility routes in affected and non-affected areas and along international borders. (WHO)
1.3 Laboratories: Deployment of GenExp at all Ebola Treatment Centers with close linkages to decentralized transit centers for rapid diagnostics and support for treatment. Scale-up of real time sequencing to better support epidemiological investigations and response operations (WHO).
1.4 Clinical Management and Isolation: Provision of high quality patient care that includes medical, nutritional and psychological care at dedicated, bio-secure Ebola treatment centers allowing individualized patient care and improved rapid isolation of suspected cases through decentralized transit centers that are integrated into health structures. Follow-up of Ebola survivors in a structured program that provides clinical, biological and psychosocial support and includes care of ophthalmologic complications. Confirmed patients to have opportunity to enroll in ethically approved clinical research protocols (WHO).
1.5 Infection Prevention and Control: Capacity building, supervision and mentoring of healthcare workers and provision of supplies to eliminate nosocomial transmission in health care facilities and in affected communities to improve infection prevention and control, including the provisions of supplies and household decontamination for confirmed and probable cases (WHO/UNICEF).
1.6 Safe and Dignified Burials: Train local capacity to ensure safe and dignified burials for all confirmed and probable cases (IFRC).
1.7 Psychosocial Support: Provide patients with EVD and their families psychosocial support through direct psycho/social care and provision of social support and food assistance to affected individuals and households (UNICEF, WFP).
1.8 Operational Readiness in at Risk Provinces: Strengthen operational readiness capability for at risk provinces and health zones in the DRC (WHO).
2. Strengthened political engagement, security and operations support led by EERC to provide: a) a safer working environment and enhanced area security; b) a conducive environment for the response, to improve acceptance and facilitate access; c) an effective, flexible and rapid response.
2.1 Safe work environment and enhanced security: Enhance area security and improve access, reducing the reliance on escorts, in addition to improving security for the local population in the Ebola affected areas, facilitating a conducive environment for the response (EERC with UNDSS, MONUSCO, and OCHA for civil-military coordination).
2.2 Enhanced political engagement: Engagement with national, provincial and local authorities, traditional leaders, and civil society to promote a conducive environment for the ongoing response, to improve acceptance and facilitate access (EERC, supported by MONUSCO and UNDP).
2.3 Effective common support services: Provision of a flexible, rapid and effective response through provision of common operational support through logistics and air operations (WFP, as a last resort, MONUSCO); scale-up of logistics and operational support for an enhanced security environment, particularly in Butembo (MONUSCO); availability of surge capacity to adjust rapidly to changes in requirements (WFP).
3. Strengthened support to communities affected by Ebola led by the EERC and supported by OCHA and UNICEF, in coordination with an expanded IASC, INGO and NGO representation, to provide: a) a targeted government-led social safety net program; b) greater community ownership and better relationships with affected communities; and c) strengthened humanitarian coordination.
3.1 Community works: Provide an enhanced program of community works through the local government social safety network, Fonds Social de la Republique (FSRDC), to implement “quick impact operations” for community resilience, including expanded cash-for-work programs in the epidemic hotspots (World Bank).
3.2 Community ownership and essential services: Mitigate any structural impact of the Ebola epidemic and response on community resilience and the provision of essential services. UNICEF and partners such as WFP, UNFPA, national and international NGOs, will implement complimentary programs to respond to critical community needs to facilitate community ownership and acceptance. Prioritization of activities will be informed by community engagement activities and dialogue conducted under pillar one (UNICEF).
3.3 Enhanced coordination of the broader humanitarian response in affected areas: to assess, identify, and coordinate priority responses of the broader humanitarian context in the affected area and link Ebola-specific mechanisms with the broader humanitarian response, including the existing regional cluster system (OCHA). The Coordination Partners’ Forum (Forum de Coordination des Partenaires, FCP) to be established at the sub-coordination level will allow the needs identified by the INGO community and other partners, including through community feedback mechanisms, to inform both the Ebola as well as broader humanitarian response.
4. Strengthened financial planning, monitoring and reporting, led by the World Bank working with key donors to provide: a) financial requirements and budget planning; b) donor coordination; c) timely and sustainable financing; d) capacity to manage and report on the financing and KPIs of the response as requested by key donor group.
4.1 Financial Planning & Resource Mobilization to ensure adequate and timely flows of funds by activity, by implementing agency, and prioritized by type of location, i.e. hotpots, active spots, at risk areas (World Bank).
4.2 Financial Reporting, Monitoring & Performance Management to establish and operationalize financial, key performance indicator (KPI), and activity reporting mechanisms. Ensure clear accountability mechanisms for implementation of response activities by identified partners. The KPI reporting system will build upon and expand the existing reporting system (OCHA).
4.3 Payments to National Workers streamline the process of recording and disbursing hazard payments of workers contracted by MOH, including registering all contracted workers in an electronic database, harmonizing allowance rates and establishing a mechanism for rapid follow up of complaints (UNDP).
5. Strengthened preparedness for surrounding countries led by WHO and supported by OCHA and IASC partners to ensure countries bordering the DRC are a) operationally ready; b) prepared to implement timely and effective risk mitigation; and c) have detection and response measures for EVD to manage cross border alerts and transmission.
5.1 Assessing Country Preparedness Capacity: Assess existing capacities and identify potential gaps in preparedness to detect and respond to imported cases of EVD (WHO).
5.2 Strengthen Operational Readiness: risk-based multi-sectoral strengthening of capacities to prevent, detect and respond to EVD (WHO/OCHA).
5.3 Managing Cross-Border Alerts and Transmission: in line with International Health Regulations (2005), establish clear communication channels internationally and between countries to notify and manage cross-border alerts and transmission (WHO/IOM).