Nepal: Potential diarrhoea outbreak

Emergency appeal n° MDRNP004

13 May 2010

This Emergency Appeal seeks CHF 738,960 (USD 664,175 or EUR 527,232) in cash, kind, or services to support the Nepal Red Cross Society to assist 189,000 beneficiaries for 9 months, and will be completed by 13 February 2011. A Final Report will be made available by 13 May 2011 (three months after the end of the operation). CHF 200,000 (USD 179,855 or EUR 142,718) was allocated from the International Federation of Red Cross and Red Crescent’s Disaster Relief Emergency Fund (DREF) to support this operation. Unearmarked funds to replenish DREF are encouraged.

Summary: With the increase in temperatures over the past few weeks and scarcity of safe drinking water sources, diarrhoea cases are on the rise in remote districts of the mid- and far-western regions of Nepal, with 17 deaths and 300 cases of infection officially reported to date. The government is on high alert and has given instructions to authorities at district level to be well prepared for possible diarrhoea outbreaks. The government has classified the 75 districts of the country into three risk categories: high (category A) – 26 districts; medium (category B) – 33 districts; and low (category C) – 16 districts, based on the situation reports and historical frequency of disease occurrence. The Nepal Red Cross Society (NRCS) has been mobilising volunteer teams to support the efforts of government authorities and humanitarian agencies involved in the water, sanitation and hygiene (WASH) cluster to undertake emergency hygiene promotion campaigns and preposition relief supplies. However, to make a significant impact, these efforts need to be scaled up, particularly in the vulnerable mid- and far- western remote districts where NRCS is the only operational organisation. Moreover, as the monsoon season

Nepal Red Cross volunteers transporting a patient to nearby health centre during the acute watery diarrhoea outbreak in 2009. Photo: Nepal Red Cross Society.

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is fast approaching, it is likely that a greater number of communities and districts are at risk of a rapid spread of diarrhoea, as has been seen in previous years. This Emergency Appeal is being launched at the request of NRCS and seeks funding to take early and sustained action to prevent the further spread of diarrhoeal diseases and reduce the risk of potential outbreaks, which last year claimed an estimated 371 lives and affected some 67,000 people in 17 districts. Efforts will be focused on emergency hygiene promotion activities, the prepositioning and distribution of diarrhoea prevention kits and the provision of safe water and sanitation facilities for the most vulnerable communities. This operation builds on the experience of NRCS in responding to the acute watery diarrhoea outbreak in 2009 which emphasised the need to address the long-term chronic needs of communities to prevent recurrences. The operation will include the conduct of baseline assessments in the affected communities with a view to developing a transition plan to move from an emergency operation to a long-term five-year development approach in line with the development plans of the NRCS. All activities will be carried out in close coordination with the government and other partners in the water, sanitation and hygiene (WASH) cluster. This operation is expected to be implemented over nine months, and will therefore be completed by 13 February 2011. A final report will be made available three months after the end of the operation (by 13 May 2011). <Click here to view the attached Emergency Appeal Budget; click here to view contact details; click here to view the map of the affected areas.>

The situation Diarrhoea is endemic throughout Nepal. Almost every year, Nepal faces an outbreak due to unsafe hygiene practices, open defecation and lack of access to safe drinking water. Additionally, poor health infrastructure, surveillance and laboratory facilities mean that highly transmissible pathogens such as vibrio cholera cannot be detected quickly at the local level, resulting in a delay in diagnosis and management, leading to high mortality and morbidity rates. Although the past few decades have shown significant improvements in overall health indicators, Nepal is still struggling to close the gap and reach the Millennium Development Goals in the areas of health and water and sanitation.

The peak of diarrhoea outbreaks usually occur during the monsoon period when higher temperatures and heavy rains increase the spread of water-borne diseases. The situation is further exacerbated by the geographic and logistical difficulties of reaching communities in remote areas to provide hygiene awareness, medical treatment and safe drinking water, as well as the traditional beliefs and practices of some communities which discourage them from seeking medical attention.

Statistics over the past five years indicate a disturbing trend of increasing cases, including the presence of vibrio cholera in some years: • 2005 - 3,137 persons affected, 37 deaths

• 2006 - 3,136 persons affected, 23 deaths

• 2007 - 33,746 persons affected, 247 deaths

• 2008 - 6,515 persons affected, 38 deaths

• 2009 - 67,000 persons affected, 371 deaths

Source: EDCD, 29 April 2010

Potential for an outbreak in 2010 Although it is still pre-monsoon, there have already been reports of 17 deaths in the mid- and far- western districts of the country and a total of 300 reported cases of infection across 18 districts.

Reported Outbreak of DiarrhoealDiseases (2005-09)

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Although the current situation is not as yet classified as an outbreak, it has triggered the concern of the government, UN agencies, non-governmental organisations and the media to act more rapidly this year to prevent mortalities. Given previous trends, it is anticipated that without an immediate and sustained intervention, the country could soon be facing an outbreak with numbers of deaths similar to or higher than previous years once the monsoon begins. All deaths reported so far this year have occurred in people’s homes, which reflect the experience of the outbreak in 2009. It is estimated that the total number of cases is under-reported. Moreover, these deaths could have been prevented if the people affected had received appropriate and timely medical treatment at local health posts and had access to safe drinking water. Poor infrastructure and difficult access to health services in remote districts continue to pose great challenges for remote communities. This is particularly so for marginalised groups and for those whose traditional beliefs and practices discourage them from seeking medical treatment. Districts most at risk Based on the trends of the past five years, the government’s Epidemiology and Disease Control Division (EDCD) of the Department of Health Services, has categorized all 75 districts into high (category A), medium (category B), and low (category C) risk groups.

Most of the districts currently affected fall under the high and medium risk groups and were also severely affected by the outbreak in 2009. Eighteen districts have been identified for immediate action. This assessment is based on a combination of their remoteness and the percentage of marginalised people within the population, as well as areas where other agencies are not operational.

Urgent action needed to save lives Rapid assessments conducted in a number of districts by the Nepal Red Cross Society (NRCS) public health in emergencies unit and concerned district chapters during the last week of April, indicate an urgent need for water, sanitation and hygiene promotion activities. At the household level there is also need for soap, water purifiers and oral rehydration solution to prevent further infection.

Assessments also indicate the need to address the chronic vulnerabilities in the communities in order to prevent outbreaks from occurring in the future. This can be achieved through increased access to safe water supplies, ensuring sustainable and improved excreta disposal, and the need to change long-standing hygiene behaviour and cultural practices.

On 28 April, the Office of the United Nations Resident and Humanitarian Coordinator issued a press statement in response to the current situation calling for a dramatic increase in investment in water and sanitation facilities in high risk communities to break the tragic cycle of waterborne illnesses.

Category A Category B Category C Sankhuwsava Bhojpur Sunsari Saptari Jhapa Morang Khotang Siraha Ilam Udayapur Okhaldhunga Dhankuta Dhanusha Rasuwa Solukhumbu Mahottari Nuwakot Kathmandu Sarlahi Chitwan Bhaktapur Parsa Ramechap Lalitpur Bara Rukum Kaski Dolakha Rolpa Baglung Myagdi Sindhupalchok Manag Kapilvastu Dhading Mustang Nawalparasi Makwanpur Rupandehi Banke Kavre Kanchanpur Humla Sindhuli Darchula Jumla Gorkha Gulmi Mugu Lamjung Dolpa Arghakhachi Kalikot Palpa Jajarkot Tanahu Doti Syangja Baitadi Taplejung Achham Parbat Rautahat Bardiya Bajhang Surkhet Bajura Dailekh Salyan Pyuthan Dang Dadeldhura Kailali Panchthar Terhathum Source: EDCD, 29

April 2010

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Coordination and partnerships National / district coordination mechanisms Current efforts to reduce the risks of an outbreak are being lead by the EDCD and district committees together with the water, sanitation and hygiene (WASH) cluster (including NRCS as partner), at both national and district levels. Several coordination meetings have been conducted at district level involving district authorities, WASH cluster partners and other relevant organisations and a mapping exercise has been undertaken to identify the capacities in each highly vulnerable district. On 29 April, the EDCD called an emergency meeting of the national level health and WASH clusters to identify ways forward for preventing a possible outbreak. This meeting was joined by NRCS and the International Federation. The meeting concluded that an outbreak is almost certain unless preventive measures are taken up as a matter of urgency. In particular it was concluded that:

• District disaster response committees (DDRCs) would provide overall coordination, collection and dissemination to all stakeholders, including media at district level.

• Health and WASH clusters would be established to support DDRCs at district level for preparedness interventions.

• A consistent approach to hygiene promotion campaigns, including information, education, communication materials, hygiene kits and other supplies would be developed (based on standards already agreed by the clusters and from previous experience).

• WASH clusters at district level would identify/map the partners for social mobilisation at village development committee (VDC) level.

Thus, decisions around NRCS activities and the selection of districts and VDCs will be taken in consultation and collaboration with the national and district level health and WASH cluster coordination mechanisms. The UN Humanitarian Coordinator has been kept informed about the current operation and UNOCHA will be supporting the dissemination of information to the humanitarian and donor community in Nepal.

Coordination within NRCS and with Movement partners NRCS has established an internal coordination mechanism which will be used for the management of this operation:

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* Proposed committee Within the Movement, partner national societies in-country have been involved in the planning of this operation and the International Federation, together with NRCS, will continue to facilitate the coordination and communication with partner national societies and International Committee of Red Cross (ICRC) throughout. This will be particularly important during the planning for longer term activities where it is hoped that partners will be active in supporting NRCS to develop a comprehensive five-year plan and will help to mobilise additional technical expertise and resources where needed.

Preparedness activities of the government The EDCD has been strengthening its epidemic preparedness in a number of districts through the prepositioning of drugs and supplies and undertaking joint surveillance activities with the World Health Organisation. All health workers in district health offices have been placed on high alert and are preparing to respond to possible outbreaks. Preparedness activities of other organisations UNICEF and other humanitarian partners have been pre-positioning emergency WASH supplies to service up to 100,000 people and other organisations are undertaking social mobilisation campaigns on hygiene promotion and distributing oral rehydration solution, household level chlorine tablets and soap in areas which were most affected last year. UNDP has funded drinking water and sanitation activities in three districts for 6,640 households. Further updates will be available from upcoming cluster and Inter-Agency Standing Committee meetings. Relevant standards and policies NRCS is also following the standards and materials agreed by the WASH cluster to ensure consistency in materials and hygiene promotion efforts between partners and across different

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districts, as well as adhering to Sphere Standards and the Code of Conduct. The following NRCS policies and strategies are also applicable to the current situation: disaster management policy, water and sanitation health policy and strategic health plan, public health in emergencies guidelines and the Fifth Development Plan. Additionally, NRCS activities are guided by the district disaster preparedness plans, the government national disaster management policy, national health plan and the International Federation’s Global Disaster Management Strategy 2007-2012 and Strategy 2020, all of which are directed towards achieving the Millennium Development Goals.

Red Cross and Red Crescent action Learning from past operations NRCS has recently undertaken a review of its role in the acute watery diarrhoea outbreak response in 2009, during which NRCS responded in 17 outbreak-affected districts and reaching almost 790,000 people. Almost 2,000 Red Cross volunteers were mobilised at the grass root level in the most remote areas and were involved in door-to-door visits, distribution of information, education, communication materials and health supplies such as oral rehydration solution and water purifiers, as well as supporting toilet construction. Joint monitoring was conducted by NRCS district chapters together with government officials and other key actors.

Some key lessons from this operation include the need to provide more intensive and sustained interventions at community level to truly break the cycle of continuing outbreaks and to ensure greater consistency in quality and type of activities across the districts, but which are responsive to the needs of each community. Immediate action As part of its role as auxiliary to the public authorities, NRCS is already mobilising volunteer teams to support the efforts of government authorities and humanitarian agencies involved in the WASH cluster to undertake hygiene promotion campaigns and preposition medical and relief supplies. Rapid assessments were also conducted in a number of districts by the NRCS public health in emergencies unit and concerned district chapters during the last week of April. Activities of some of the districts in response to the current situation is summarized in the table below:

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District Risk Category Nepal Red Cross Society activities to date

Jajarkot Category A • Conducted coordination meeting with respective stakeholders;

• District chapter volunteers mobilized; • Water purification tablets (20,000 tablets) distributed-

drinking water programme provided the aqua tablets and Red Cross volunteers distributed them. 

Rukum Category B • Sub-chapter volunteers and junior/youth mobilized for awareness raising;

• District health office is conducting a health camp for affected people and Red Cross Volunteers supporting them by providing referral and stretcher services;

• District chapter has sent alert information to all the trained volunteers in the water and sanitation national disaster response team (NDRT).

Kanchanpur Category C • Awareness raising campaigns among communities; • Information, education, communication materials

distributed to the affected village development commitees.

Dadeldhura Category B • District chapter directed all sub-chapters to conduct village development commitee-level coordination meetings with respective stakeholders and to conduct awareness raising;

• Distribution of information, education, communication materials from last year’s stocks.

Baitadi Category A • Village development commitees-level working committee (5 members) formed of NRCS first aid volunteers and they will be mobilized for awareness raising;

• Plan to develop such kind of committees at ward level;• Stakeholder meetings conducted and agreed to

distribute water purifiers through NRCS volunteers.

The needs Based on the initial rapid needs assessment and from experience of past outbreaks in the selected districts, the needs can be classified into immediate and longer term: Immediate needs 1. Knoweldge of good water, sanitation, hygiene and health practices. 2. Information and access to health services. 3. Safe drinking water (provided at household level through the diarrhea prevention kits). 4. Excreta disposal facilities. Longer term needs 1. Sustainable and safe drinking water. 2. Sustainable and appropriate excreta disposal facilities. 3. Knowledge and implementation of good water, sanitation and health practices. Interventions for the longer term must be multi-faceted and should contribute to the overall social and economic progress of the population. Interventions should also be conducted in such a way that they strengthen the capacities of NRCS to both effectively respond to health emergencies and also to address the chronic underlying causes.

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Beneficiary selection The activities supported by this Emergency Appeal aim to reach 31,500 households (189,000 beneficiaries) in a total of 70 village development commitees across seven selected districts as follows: Table 1: Target population and geographical coverage

Source: CBS, 2001

The specific criteria used to select the most vulnerable districts include those which are: 1. Identified as high or medium risk of outbreak based on historical data. 2. Reporting increasing cases of diarrhoeal disease. 3. Located in remote areas with limited access to regular health services. 4. Have low human development indicators. 5. Identified by assessments and/or by the government and the WASH cluster as

currently facing gaps in humanitarian services.

Within each district, approximately ten village development committees will be identified in consultation with key partners, based on:

1. Disadvantaged group (DAG) mapping. 2. Resource mapping and gaps identified by the WASH cluster. 3. Presence of Red Cross network (eg. sub-chapters). 4. Availability of trained human resources.

The proposed operation Planned activities

The focus of the NRCS operation covered by this Emergency Appeal is to address the gaps identified from the resource mapping undertaken by the government and the WASH cluster to reduce the immediate risk of a diarrhoea outbreak as well as the long-term risk of waterborne disease. This will be carried out in seven of the most vulnerable districts, namely: Bajura, Bajhang, Baitadi, Rukum, Jajarkot, Achham and Dadeldhura. The NRCS will conduct intensive water, sanitation and hygiene promotion campaigns including awareness-raising and information about treatment facilities through volunteer mobilisation and will provide diarrhoea prevention kits (soap, oral rehydration solution and chlorine tablets) and other supplies like information, education, communication materials, and stretchers at community level.

NRCS district chapters, through the local sub-chapters, will be responsible for implementation at the local level. Further, the Red Cross youth and junior circles will be mobilised at grass root level. Continuous efforts will also be made to strengthen the public health in emergencies unit at the headquarters level through training and skills development. This operation will be flexible in scaling up the response activities in the event that the numbers of cases in other prone districts rapidly increase and the needs change. In response to the changing

Region Districts Total population Male Female Total

H/H Total VDCs

NRCS VDC

coverage

NRCS H/H

coverage, per VDC

Mid West

Jajarkot 154,097 78,275 75,821 27,590 30 10 450 Rukum 219,404 11,114 108,289 39,006 43 10 450

Far West

Achham 261,363 123,173 138,190 49,728 75 10 450 Dadeldhura 146,318 70,705 75,613 25,492 21 10 450 Bajura 124,193 61,461 62,732 23,265 27 10 450 Baitadi 265,113 128,405 136,708 45,675 63 10 450 Bhajang 193,103 93,272 99,832 33,051 47 10 450

Total VDCS / Households 70 31,500Total number of beneficiaries (based on 6 person households) 189,000

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situation, a plan and budget for the scale up of operations will be developed for additional districts and supported potentially through this appeal. Addressing longer term needs While the above activities focus on the prevention of immediate outbreaks, longer term activities must also be implemented to ensure that communities remain resilient to outbreaks in the future. This includes the access to sustainable and safe water supplies, the elimination of open defecation, changing community health practices and supporting the overall social and economic progress for the population of the mid- and far-western regions. The experience of the Water and Sanitation Unit (under the Community Development Department) in implementing long-term water and sanitation programmes will be utilised to conduct the long-term programme. The NRCS will utilise standard International Federation water and sanitation software approaches (in line with the Global Water and Sanitation Initiative), including participatory hygiene and sanitation transformation (PHAST) in order to ensure the community is engaged in designing and implementing their own water, sanitation and hygiene promotion programme and to increase the likelihood of achieving sustainable impact. The timeframe for undertaking these activities is consistant with the lessons learnt from the review of NRCS long-term water and sanitation programmes and the realities of achieving sustainable behaviour change. Sustainable changes in these communities will come through an ethnic and gender-based approach which also requires meaningful representation of men and women from disadvantaged groups. ‘Meaningful’ does not necessarily mean equal representation in numbers. Rather, it takes into account the historical disadvantage these groups have faced and the various social dynamics that account for the lower levels of their representation in social and economic spheres of community life. Gender discrimination will be discouraged through advocacy and promotion of humanitarian values. The Red Cross Fundamental Principles will be widely disseminated and humanitarian values will be integrated into all components of the operation. The above can only be achieved by working closely with key actors at the central and local levels and will require a sustained effort which will extend beyond the scope of the current Emergency Appeal. However, the current operation provides an opportunity to undertake some groundwork for the development of a longer term five-year strategy to strengthen the capacities of NRCS to respond to public health emergencies in the future and to engage in a more sustainable way to improve the overall health situation of communities. This will be achieved by undertaking baseline assessments in the targeted districts and the development of a transition plan to shift from current short term operations to a longer-term development approach by the end of this operation. Further, efforts will be made to integrate health and hygiene promotion where possible in NRCS's community based programmes. Appropriate guidelines on emergency health response will be developed and the human resource database for trained health in emergencies personnel will be updated regularly at the district and central levels. Ensuring good monitoring and evaluation During this operation, efforts will be made to ensure activities are functioning effectively through good supervision and reporting from district to national level. Below is a brief schedule of proposed monitoring and evaluation visits:

Monthly District chapter reviews of current village development committee operations.Monthly District chapter coordination meetings with relevant partners.Within 3 months First round of field monitoring visits by relevant NRCS headquarters (with

participation from International Federation/partner national societies as appropriate).

Within 6 months Mid-term monitoring and evaluation by NRCS headquarters and International Federation/partner national societies technical experts.

Within 6 months Second round of field monitoring visits by relevant NRCS headquarters (with participation from International Federation/partner national societies as appropriate).

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Within 9 months Third round of field monitoring visits by relevant NRCS headquarters (with participation from International Federation/partner national societies as appropriate) including beneficiary survey.

After 9 months Final review and evaluation of the operation involving all relevant NRCS district chapters, headquarters and International Federation/partner national societies technical experts.

Operation Plan of Action

Outcome: The risk of a diarrhoea outbreak is reduced in seven of the most vulnerable districts in the mid- and far- western region of Nepal, through support provided to 31,500 households (189,000 beneficiaries).

Outputs (expected results) Activities plannedProvision of safe drinking water, sanitation facilities, diarrhoea prevention kits and referral services to the most vulnerable communities and households in seven districts.

• Orientation and training for relevant district level staff and volunteers in WASH, epidemic control and rapid assessment and the mobilization of 2,000 trained volunteers;

• Procurement of 33,500 diarrhoea prevention kits1 in accordance with the International Federation procurement procedures;

• Immediate distribution of 31,500 diarrhoea prevention kits to identified households and prepositioning of additional 2,000 diarrhoea kits in mid and far western region warehouses for use in current and other potentially affected districts in the region;

• Training for and deployment of water and sanitation kit 2 from the Kuala Lumpur Regional Logistics Unit warehouse, to provide safe drinking water, sanitation and hygiene promotion to vulnerable households in selected village development committees;

• 350 community orientation sessions to promote point of use water treatment options, specifically use of chlorine tablets, boiling and Sodis (solar treatment) during volunteer household visits;

• Provision of support to 700 selected households to construct low cost latrines through maximum utilization of local raw materials;

• Provision of animal shed management support to 700 vulnerable households;

• During household visits, volunteers to provide referral services to people affected by diarrhoea to encourage them to visit health posts for treatment, in coordination with national/local health authorities;

• Through grass root networks of volunteers, support national/local health authorities in household level surveillance of diarrhoea cases.

Improved hygiene practices through increased water, sanitation and hygiene awareness for 31,500 households in 70 village development committees.

• Practical orientation by volunteers to 31,500 households, to prepare oral rehydration solution and chlorine solution and ensure proper use;

• Dissemination of daily WASH messages through FM radio in all seven districts;

• Reproduce health education/information, information, education, communication materials;

• Conduct household visits by trained volunteers on hygiene awareness, water treatment and sanitation including distribution of diarrhoea kits and information, education, communication materials;

• Initiation by volunteers of five community-organised drinking water source improvement campaigns in all 70 village development committees;

• Volunteer-organised street drama events in all 70 village development committees;

1 Diarrhoea prevention kit includes: chlorine, hand washing soap, oral rehydration salts and bag for 1 household for 2 months. This is the standardised WASH cluster kit for Nepal.

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• 10 hand washing demonstrations and hygiene promotion in schools and communities in all 70 village development committees;

• Volunteer-organised ‘Ignition Participatory Rural Appraisal’, to discourage open defecation in five village clusters in all 70 village development committees;

• Procurement and distribution of brochures/pamphlets, hoarding boards and banners for awareness for 70 village development committees as well as 77 volunteer mobilizer support and visibility packs.

Strengthened capacity of NRCS for responding to public health emergencies and to undertake longer term activities to improve the overall health condition of communities.

• Training for relevant headquarter and district level staff and volunteers in water and sanitation national disaster response team and public health in emergencies;

• Conduct baseline assessments in all seven districts with a view to developing a transition plan from short term response to a longer term development approach, in consultation with other relevant stakeholders;

• Strengthen community-based health and first aid activities to create a sustainable community approach through training of trainers/volunteers, and involvement of community leaders and members;

• Ensure the implementation of a common approach to volunteer mobilisation, induction, support and recognition across all programmes that leads to strengthened branch volunteer base and volunteer management capacities for the future.

Logistics For the success of this operation, efficient and timely coordination and delivery of logistical support should be met. The International Federation will liaise and coordinate actions with all appropriate key logistics actors to ensure that the operation uses all information and resources as efficiently and effectively as possible. Where required, this operation will: • Liaise with the IFRC Kuala Lumpur Regional Logistic Unit (RLU) to mobilize in the most appropriate way

the health and watsan materials/items required for this operation. • Where required, and in conjunction with the Kuala Lumpur RLU, carry out local and international

procurement following the International Federation procedures and processes. • Ensure the operation has the fleet assets – light and heavy – as required to carry out the planned

activities. • Assess and reinforce the local logistics capacity of NRCS.

Communications – Advocacy and Public information The steady flow of timely and accurate information between those working in the field and other major stakeholders will support the programme objectives of this emergency appeal, increase the profile, funding and other support for the NRCS and the International Federation, and provide a platform on which to advocate in the interests of vulnerable populations. In close collaboration with the operation, information about the operation will be provided at district level for affected communities to support their relief and recovery.

Donors and partner national societies will receive information and materials they can use to promote this operation such as news stories, profiles of beneficiaries and audio visual resources showing the impact of the operation on affected communities.

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The provision of additional audio visual equipment and support from external communications experts will help to build the information and public relations capacity of NRCS for future emergencies, and emergency communications training will be provided to district chapters. A joint field visit with media to ensure good visibility and support for the operation will be undertaken during the operation.

Capacity of the National Society The NRCS functions as an auxiliary to the government and is the only humanitarian organisation in Nepal to be represented as an ex-officio member of the district disaster reduction committee (DDRC). Through its strong and nation-wide volunteer network and as the largest humanitarian organisation in the country, it also bears the trust and responsibility of being the primary responder during emergencies. Additionally, the NRCS three-year development plan 2008-2010 identifies public health in emergencies as a priority within the core areas of disaster management and health and care in the community. Over the past two decades, NRCS has accumulated significant experience in the area of public health and has effectively carried out awareness raising through social mobilisation on health-related issues. NRCS is also the leading national first aid provider, not only in training but also for emergency response, as demonstrated during the recent protests and strikes in the capital and other major cities. Until recently, its experience and capacity to prevent or respond to public health emergencies has been limited. However, in 2009, with support from various partners, NRCS responded to an outbreak of acute watery diarrhoea and conducted response activities in 17 affected districts of the mid and far west region of Nepal.

Through this successful operation, NRCS has been able to develop its capacities at both central and district levels. Currently, NRCS has a water and sanitation national disaster response team, approximately 60 WASH volunteers, and 27 personnel trained in public health emergencies. With these capacities on the ground, NRCS is in a good position to respond rapidly and effectively to the current situation. However, there is still a need for NRCS to further strengthen its preparedness and response mechanisms to reach the most vulnerable and isolated communities and to ensure that interventions are focussed not only on the short term needs of communities but are able to address underlying risk factors.

Capacity of the International Federation The International Federation has been present in Nepal for a number of years and currently the country office is comprised of one country representative, an administration/liaison officer, a finance officer and three general support staff. The primary role of the office is to support the NRCS in monitoring and implementation of ongoing disaster operations and disaster risk reduction/disaster preparedness programmes, health initiatives and organizational development. The country office also facilitates the mobilization of technical expertise and resources, supports NRCS in the development and maintenance of partnerships both within and external to the Red Cross/Red Crescent Movement; and undertakes an international representation role through active engagement with the humanitarian and donor community in various national forums, committees and initiatives.

The country office is further supported by the South Asia regional office in New Delhi and the Asia Pacific zone office in Kuala Lumpur, which provide technical support in the areas of disaster management; health and care; water and sanitation; organizational development; logistics; resource mobilization; planning, monitoring, evaluation and reporting; and communications. The Asia Pacific Disaster Management Unit in Kuala Lumpur is coordinating international support for this operation. Budget summary See attached budget (Annex 1) for details.

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How we work All International Federation assistance seeks to adhere to the Code of Conduct for the International Red Cross and Red Crescent Movement and Non-Governmental Organizations (NGOs) in Disaster Relief and the Humanitarian Charter and Minimum Standards in Disaster Response (Sphere) in delivering assistance to the most vulnerable. The IFRC’s vision is to inspire, encourage, facilitate and promote at all times all forms of humanitarian activities by National Societies, with a view to preventing and alleviating human suffering, and thereby contributing to the maintenance and promotion of human dignity and peace in the world.

The IFRC’s work is guided by Strategy 2020 which puts forward three strategic aims: 1. Save lives, protect livelihoods, and strengthen

recovery from disaster and crises. 2. Enable healthy and safe living. 3. Promote social inclusion and a culture of non-

violence and peace.

Contact information For further information specifically related to this operation please contact:

In Nepal: Nepal Red Cross Society:

• Pitambar Aryal, NRCS director of disaster management; mobile: +977 9851105681; email: pitambar.aryal@nrcs.org.

In Nepal: IFRC country office:

• Victoria Bannon, Federation representative, mobile: +977 9851047071; email: victoria.bannon@ifrc.org.

In India: IFRC South Asia regional office:

• Azmat Ulla, Head of regional office, phone: +91 11 2411 1125; fax: +91 11 2411 1128; email: azmat.ulla@ifrc.org.

• Michael Higginson, Regional programme coordinator, +91 11 2411 1125; fax: +91 11 2411 1128; email: michael.higginson@ifrc.org. In Malaysia: IFRC Asia Pacific zone office, phone: +603 9207 5700

• Jagan Chapagain, Deputy Head of Zone, email: jagan.chapagain@ifrc.org. • Elzat Mamutalieva, Operations Coordinator, phone: +603 9 207 5727;

mobile: +6019 274 4960, email: elzat.mamutalieva@ifrc.org. • Jeremy Francis, regional logistics coordinator, phone: +603 9207 5753, fax: +603 2168 8573,

email: jeremy.francis@ifrc.org. • Penny Elghady, resource mobilization and PMER coordinator, phone: +603 9207 5775,

email: penny.elghady@ifrc.org. • Please send all funding pledges to zonerm.asiapacific@ifrc.org. • For media enquiries: Jason Smith, zone communications manager, mobile: +6012 387 0829,

email: jason.smith@ifrc.org.

<Emergency Appeal budget and map below; click here to return to the title page>

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MDRNP004 - Nepal Potential Diarrhoea Outbreak

BUDGET SUMMARYTOTAL BUDGET CHF

11,669137,551181,911

55,194Other Supplies & Services 5,835

392,160

4,5844,584

14,50338,94153,444

32,256National Staff 6,001National Society Staff 64,363

10,002112,623

47,73547,735

20,0043,001

20,25413,578

4,1682,100

20,20983,314

45,10145,101

738,960

738,960

Budget Group

Construction - MaterialsWater & SanitationMedical & First AidTeaching Materials

Total Supplies

Computer & Telecom

Transport & Vehicle CostsTotal Transport & Storage

International Staff

Total Land, vehicles & equipment

ConsultantsTotal Personnel

Professional FeesFinancial ChargesOther General ExpensesTotal General Expenditure

Program Support

Dsitribution & Monitoring

Workshops & TrainingTotal Workshops & Training

TravelInformation & Public RelationOffice CostsCommunications

Total Programme Support

NET EMERGENCY APPEAL NEEDS

TOTAL BUDGET

!\

Dolpa

Humla

Mugu

Dang

Kailali

Go

rkh

a

Do

ti

Bajh

ang

Jumla

Must

ang

Rukum

Taple

jung

Ilam

Kaski

Ba

jura

SurkhetMyagdi

Rolpa

Sindhuli

Banke

Manang

Jaja

rkot

So

lukh

um

bu

SalyanBardiya

Dola

kha

Jhapa

Bara

Palpa

Kalikot

Chitawan

Mo

ran

g

Dar

chau

la

Parsa

Kavre

Baglung

Sankh

uw

asa

bha

Baitadi

Makwanpur

Tanahu

Achham

Dailekh

Bhojp

ur

Lamjung

Gulmi

Nawalparasi

Sarlah

i

Saptari

Sindhupalchok

Siraha

Kapilbastu

Su

nsa

ri

Udayapur

Dhading

Khotang

RasuwaPyuthan

Kanchanpur

Nuwakot

Dadeldhura

Dhanusa

Ramechhap

Syangja

Panchthar

Rupandehi

Rautahat MahottariDhankuta

Arghakhanchi

Okhaldhunga

Parbat

Terhathum

Lalitpur

Kathmandu

ChinaChina

IndiaIndia

NepalNepal

The maps used do not imply the expression of any opinion on the part of the International Federation of the Red Cross and Red Crescent Societies or National Societies concerning the legal status of a territory or of its authorities.Map data sources: ESRI, DEVINFO, International Federation, MDRNP004.mxd

Nepal: Epidemic

MDRNP00414 May 2010

High risk

Medium risk

Low risk

0 10050km !I