May 30, 2015 - Sierra Leone aims to end the Ebola outbreak within the next few months and to get to zero as quickly as possible. WHO will continue to support.
EVOLVING WHO’S CONTRIBUTION TO EBOLA RESPONSE AND RECOVERY IN SIERRA LEONE
World Health Organization Sierra Leone 30 May 2015
INTRODUCTION The Ebola epidemic in Sierra Leone began in May 2014 and peaked during November and December 2014. A sharp decline in the number of new Ebola cases in subsequent months reflects the success of concerted surveillance and case management efforts by national and international partners. Sierra Leone is now in a position where the country’s Ebola efforts can work towards a dual purpose: sustaining work on the response phase, while building towards the recovery and resilience phases. The Government’s Recovery and Transition Priorities document has set the national agenda for moving forward in 2015 and beyond. Sierra Leone aims to end the Ebola outbreak within the next few months WHO Situation Report, 6 May 2015 and to get to zero as quickly as possible. WHO will continue to support the Government in leading the outbreak response by maintaining a presence across all districts and responding to the Government’s priorities at the national level to ensure surveillance is maintained. It is not possible to predict exactly when the transmission of Ebola will end in Sierra Leone, but it may be after the UN Mission for Ebola Emergency Response (UNMEER) has ceased its operations. Therefore WHO Sierra Leone will build on the experiences of WHO in Liberia, which is in the process of transitioning technical leadership of Ebola response and early recovery from UNMEER. UNMEER in Sierra Leone is expected to close its operations by the end of July, and WHO Sierra Leone is preparing to transition as into the role of key technical partner to the MOHS, in addition to performing public health functions at the national and district level. The Government’s Recovery and Transition Plan has set the national agenda for moving forward in 2015 and beyond. The health elements of this document were developed in close collaboration with all partners. The Government has asked WHO to play a key role for the health pillar working under the leadership of the Ministry of Health and with partners such as the UK Department for International Development. Sierra Leone faces challenging conditions in which to restart essential services and ensure the wider recovery. Sierra Leone has a total of 1,246 healthcare facilities, and many have been repurposed for the Ebola response. The Ebola outbreak has led to a 21% decrease in the number of children being vaccinated, 23% decrease in institutional deliveries, and as much as 90% drop in family planning visits. Local healthcare workers need to be trained to be vigilant and adhere to strict infection prevention and control (IPC) protocols. At the same time communities need to gain confidence and be encouraged to utilize health facilities and services leading to reductions in maternal and child mortality. To maintain zero cases, WHO will continue working closely with the Government to ensure a strong information management and surveillance system is in place.
WHO has worked with the Government and the international community in developing the health strategies and approaches required to control and end this Ebola outbreak. WHO is still engaged on the front line, supporting the implementation of many of the major health interventions. In support of the response operation, WHO currently has approximately 160 staff deployed in all 13 districts of Sierra Leone. This is the largest emergency operation the Organization has ever undertaken. In all of its operations, WHO is working under the leadership of the Government, the NERC as well as the MOHS. WHO continues to provide technical, normative, material and operational support to the relevant Ministries. WHO has collaborated closely with UNMEER and UN agency partners – especially UNICEF, WFP, OCHA, UNFPA, and UNDP – to ensure coherent and effective operations across all response activities. WHO has also coordinated and collaborated closely with other partners – including the African Union, US Centers for Disease Control (CDC), Médecins Sans Frontières (MSF), International Federation of the Red Cross (IFRC), International Organization for Migration (IOM), UNAIDS and partners of Global Outbreak Alert and Response Network (GOARN) – to extend coverage of the key surveillance, clinical and public health interventions for the response. WHO is committed to strengthening these partnerships which are vital to ending the outbreak. The WHO will continue to respond to and work closely with the Sierra Leone government in getting to zero Ebola cases, as well as supporting the transition towards recovery from the Ebola epidemic and building a resilient healthcare system. This document provides an overview of what the WHO aims at deliver during this period.
RESPONDING TO AN EVOLVING SITUATION The strategic objectives for WHO are to: 1. Stop transmission of the Ebola virus 2. Prevent new outbreaks of the Ebola virus in new areas 3. Safely reactivate essential health services and increase resilience 4. Coordinate national and district level Ebola response The WHO response to the Ebola epidemic in Sierra Leone consists of three interrelated phases: recovery, response and resilience.
RESPONSE PHASE: GETTING TO AND MAINTAINING ZERO EBOLA CASES Having moved past the peak number of Ebola cases in November and December 2014, the focus is now on getting to zero Ebola cases. This includes maintaining effective IPC in healthcare facilities, and maintaining robust surveillance activities in all districts. This area of activity is crucial in preventing and rapidly controlling the next Ebola outbreak, and underpins any further health systems strengthening activity. During this phase the WHO will continue in its role as one frontline responder, while also providing technical, normative, material and operational support to relevant Ministries of the Sierra Leone government. Communities, together with their governments and international responders, are working collaboratively to better understand the risks, manage the risks, identify and trace people with Ebola and their contacts, treat the infected and provide safe and dignified burials for those that have lost their lives. The following sections explain the status of each aspect of the response and WHO’s role within each.
UN STEPP Strategy
ACTIVE SURVEILLANCE Active surveillance and contact tracing will continue, identifying suspected Ebola cases through integrated disease surveillance at public and private health facilities as well as community event-based surveillance. WHO and partners are working with government establishing capacity to conduct integrated epidemiological case investigations with anthropological contributions and engagement with communities to establish transmission chains and identify contacts. Contacts will continue to be systematically monitored for 21 days, across national and district borders. Reliable management of epidemiological and socio-cultural data to design and implement targeted Ebola response strategies, as well as continued laboratory diagnostic capacities for Ebola, will be essential. Even after the last case has been identified, a long period of active surveillance will be required to ensure all chains of transmission have been found and that there has been no re-emergence. At the request of the government WHO, together with CDC, is engaged in the design and implementation of heightened surveillance and alerts frameworks in compliance with Integrated Disease Surveillance and Response (IDSR) and International Health Regulations (IHR) recommendations. This includes dedicated cross-border strategies, strengthening of the alerts system, and reinforcement of the capacity to verify and investigate alerts. COMMUNITY ENGAGEMENT Communities have been, and will continue to be, the most critical part of an effective response. The mainstreaming of community engagement within service delivery will continue, for example through the training of frontline staff in trust building and communication skills, and re-orientating social mobilization activities to address service uptake. By utilizing the infrastructure and networks developed during the Ebola response as the foundations for
community engagement, the WHO will help build capacity and sustainability. This will be done by providing technical and operational support to directorate focusing on health promotion within the Ministry of Health and Sanitation. The capacity to systematically develop and execute tailored community engagement strategies will need to be strengthened at the district level. Respectful and timely engagement of communities before and during critical response events, such as case investigations and burials, can mitigate community resistance and ensure support for safe operations. Tailored strategies to engage with different groups – chiefs, religious leaders, women and youth – are required. Similarly, response teams need to be sensitive to the community context when responding to alerts. Anthropological analysis combined with expertise in community engagement and strengthening the leadership of health promotion is proving effective at guiding operational and technical approaches so that the voices and perspectives of communities are taken into account during decision-making. OPTIMIZE CASE MANAGEMENT A key element of building community trust is to provide the highest standard of care for all Ebola cases – and to keep family members informed of the progress of their loved ones. Establishing community liaison officers at treatment centers has been important good practice. Case management capacity, triage and IPC need to be sustained to increase survival rates and avoid health workers becoming infected with the disease. It is also important to manage the capacity and geographical distribution of Ebola treatment centers and foreign medical teams as the epidemiological situation changes. This will include: support for the decommissioning and repurposing Ebola Treatment Units as well as community care centers no longer required for patient isolation; redeployment of foreign medical staff to assist with the safe reactivation of essential non-Ebola healthcare services; and using existing Ebola treatment centers to conduct clinical trials of new treatments. The longer-term health complications of Ebola survivors are currently being studied and guidelines for their treatment and care will be developed in order to minimize the impact of the disease on an already traumatized population. These guidelines will then be used by national and international medical teams going forward.
RECOVERY PHASE: DELIVERING SAFE AND EFFECTIVE HEALTHCARE The recovery phase will be characterised by restoring access to essential health services, reopening schools, protecting the vulnerable, and promoting private sector growth and recovery. The Ebola epidemic took hold in Sierra Leone in large part due to structural weaknesses in its health system. Key components that were lacking include: insufficient numbers of qualified health workers; inadequate surveillance and information systems; weak medicine supply systems; inadequate infrastructure and logistics; and poor governance. The two key priorities in this phase are to ensure continuing safety in healthcare facilities, and to restore access to essential health services. This phase is expected to extend from mid-2015 and continue into 2018. This includes the “transition towards development” outlined in the Government’s Recovery and Transition Priorities.
Active surveillance continues to remain a priority during this phase, with a move towards the roll out of the IDSR framework. WHO will assist localise this system to Sierra Leone and implement it in all districts, thus developing long-term capacity for responding to future disease outbreaks. WHO will also support the establishment of a national all-hazards disaster management structure. This will build on the work of the NERC, and transition it towards a permanent Emergency Operations Center within the Ministry of Health and Sanitation. HEALTHCARE SAFETY
Sierra Leone’s Recovery and Transition Priorities
The importance of ensuring patient and healthcare worker safety cannot be overstated. Assuring effective IPC at healthcare facilities, and establishing triage and patient isolation procedures is a key goal that WHO will contribute to during this phase. Implementation of IDSR at the community, district and national levels will also be supported by WHO. This will help healthcare facilities to be better linked to epidemiological activity and anticipate patient arrival through effective referral systems. IPC requires well-functioning water sanitation and hygiene (including waste management and laundry services) in all healthcare facilities. WHO will work with the Ministry of Health and Sanitation, the Ministry of Water Resources, and UN agencies to address this issue throughout the recovery phase and beyond. ESSENTIAL HEALTH SERVICES The immediate objective is to support national authorities and civil society organisations to safely reopen health facilities and reactivate essential health services in both urban and rural settings. Such services must include maternal, child and reproductive health as well as vaccination programs. There will also be a strong focus on the reduction of adult morbidity and mortality due to HIV, tuberculosis and malaria, as well as the provision of healthcare to Ebola survivors. WHO will support Sierra Leone in the development and implementation of national plans aimed at building both resilience in the face of future outbreaks and emergencies and, in the longer term, the capacity to provide universal access to safe, high-quality health services.
RESILIENCE PHASE: ADVANCING SIERRA LEONE’S HEALTHCARE STATUS A resilient and effective health system is vital if Sierra Leone is to avoid future epidemics and continue progressing toward its development goals. There must be a shift away from vertical programs targeting specific diseases and resulting in limited investment in core health systems functions. A resilient health system in Sierra Leone is defined in terms of geographical and financial access to a defined Basic Package of Essential Health Services (BPEHS), which will be able to address different types of public health needs and challenges in the future. This phase of activity will focus on five components: patient and health worker safety; the health workforce; essential health services; community ownership; and information and surveillance. This phase is expected to start during Recovery, and extend into 2020. This phase aligns with the “agenda for prosperity” in the Government’s Recovery and Transition Priorities but is also informed by the longer-term Sierra Leone Health Sector Recovery Plan.
Sierra Leone Health Sector Recovery Plan With over 300 health workers infected and more than two-thirds dying from the Ebola virus in Sierra Leone, pre-existing shortages and maldistribution of the health workforce were further exacerbated. The resulting fear and distrust fuelled the mass attrition of health workers, strikes and disruptions to routine health services. Public sector labour expenditure caps have resulted in large numbers of vacancies despite substantial needs in Sierra Leone. Rapid workforce analysis, planning, deployment, capability development and management are essential preconditions to the reactivation of essential health services and core health systems functions. WHO is supporting Sierra Leone to assess emergency hiring needs, rebuild trust, coordinate efforts to identify and resolve employment and performance barriers, and strengthen health workforce information systems and accountability. For the short to medium term, these plans will focus on making every health district safe, functional and resilient. This will include ensuring that the population has geographical and financial access to a defined package of essential clinical and public health services. This package needs to ensure community systems are strengthened and linkages to the formal health system built. WHO is also providing technical expertise to rapidly implement IDSR systems and further develop capacities under IHR while ensuring these capacities are better integrated into local health systems. There are critical health workforce needs that will be addressed, taking into consideration a broader labour market lens, while governance, management, supply chain, information, health financing and accountability systems will also need to be strengthened.
WHO RESPONSE AND CONTRIBUTIONS TECHNICAL ADVICE The WHO will provide best practice, evidence based technical advice in key areas. Plans for sustained preparedness, future outbreak response capacity, and a return to essential health services will be developed at the request of the Sierra Leone government. WHO will support the transition from Ebola-focused healthcare delivery to the restoration of essential services including: reproductive, maternal, neonatal and child health; immunisation services; and HIV, TB and malaria treatment. Technical advice will also be provided on the five focus areas of the National Health Sector Recovery Plan, and the broader roll out of the BPEHS. STRATEGIC PLANNING AND MANAGEMENT Throughout the phases of transition described in this document, WHO will work with the government and development partners to support the development, review and evaluation of national plans and strategies for the Ebola response. WHO in Sierra Leone will build on the national and district based structures developed during the Ebola response. Nationally, the organization will be structured along areas of technical excellence in Ebola response, BPEHS and Health Systems Strengthening. This will involve a strong focus on district and operations support. At the district level, Ebola response teams will be transitioned towards longer-term roles, with field coordinators taking on broader public health advisory profiles. The WHO District Health Advisor will work closely with District Medical and Surveillance Officers from the Ministry of Health and Sanitation, and will be supported by WHO officers in key roles reflecting the structure at the national level. INFORMATION MANAGEMENT Critical to the response is transparent communication and reliable information management. Reporting systems have been established to analyse and track the epidemiological situation, and to monitor response activities. Regular analysis and reports on epidemiological activity at district, national and international levels will continue to be provided. Epidemiological forecasts and response projections need to continue to be developed to inform strategic and operational planning. Information systems and processes need to be further strengthened to improve accuracy, quality and timeliness of reporting. LOGISTICS AND OPERATI ONS SUPPORT Logistics and operations support remain essential. A reliable supply of consumables and equipment to bolster country and field operations must be maintained and long-term capacities established. The security of staff, accommodation and operational bases for country and field operations must also be maintained, including robust procedures and capacity for security risk assessments, and for dealing rapidly with threats to staff or facilities. This requires sufficient security staff, and the provision of radio, data and telecommunication facilities among other resources. Transportation to support country and field operations will remain critical especially during the wet season. To assist this process, WHO and the World Food Programme (WFP) are developing a joint operations platform. Under the terms of the agreement, WFP will provide field teams with the resources they need – computer equipment, phones, internet connectivity and vehicles – to carry out effective response operations.
WHO Sierra Leone Workplan May‐December 2015 OUTCOME 1: GETTING TO AND SUSTAINING ZERO Output
Activity
Q2 Q3 Q4
1.1.1 Support ongoing active surveillance with “zero weekly reporting” of suspected Ebola cases from key facilities and community leaders 1.1.2 Enable integrated epidemiological case investigations to identify transmission chains and identify contacts
1.1 Enhanced surveillance, contact 1.1.3 Support the systematic monitoring of contacts for 21 days, tracing and case across national and international borders where required investigation 1.1.4 Support the management of data systems to reliably record and share epidemiological data as part of monitoring the Ebola response 1.1.5 Support and ensure high quality laboratory diagnostic capacities for Ebola 1.2.1 Support the development and implementation of adapted community engagement strategies and messaging to address resistance and socio‐cultural barriers 1.2.2 Contribute to the training of response teams in trust building and communication skills so they are sensitive to and can adapt to the community context when responding 1.2.3 Enable local community engagement taskforces to support Ebola response activities including engaging community leaders 1.2 An engaged and traditional healers to carry out safe practices, case community identification and notification
1.3 Optimised case management
1.4 Strategic communication for getting to and sustaining zero
X
Proportion of new confirmed cases arising from known contact lists (over the past four weeks)
X
X
X
X
X
X
X
X
X
X
8.04
X
X
2.38
1.2.5 Support the development and implementation of strategies to address stigma affecting Ebola survivors at both healthcare X facility and community levels
X
1.3.1 Manage deployment of foreign medical teams
X
X
1.3.2 Support and coordinate the decommissioning/repurposing of Ebola Treatment Centres and Community Care Centres while maintaining contingency capacity
X
X
X
X
X
X
X
X
100%
Proportion of contacts seen daily by contact tracers
99%
100%
Proportion of the 7 border districts with functional community surveillance systems documented in a MOU
1
7
Percentage of Ebola laboratory test results released within 24 hours of receipt of sample
79%
100%
2
13
2
5
1
0
50%
100%
1 (as at Number of unsafe burials reported 10/05/15) 275 (Oct Number of psychosocial staff trained at the district 2014 to Jan level across Sierra Leone 2015) Number of Ebola Treatment Centres present in the 13 country Proportion of health facilities implementing the Minimum Standards for effective screening, triage, Pending and quality assured case management of suspected and probable Ebola cases Development and piloting of protocols and training package on Minimum Standards in Mainstream Pending Health Facilities, and roll out of train the trainers program in all districts
X
Case management mentors present in all districts supporting quality improvement in mainstream healthcare facilities and PHUs
X X
X X X X
1.4.6 Support public health advocacy and health campaigns in collaboration with MOHS
X
1.4.7 Improve media reportage on WHO and health events within Sierra Leone by conducting workshops with media partners
X
0 150 2
100%
13
2.88
X
1.4.5 Increase WHO's profile on different media platforms (website, Facebook, Twitter, and print) locally and internationally
Number of security incidents relating to health activity reported in any district in Sierra Leone in the past month Percentage of chiefdoms with community engagement taskforces in place per district
X
X
Baseline Target (May 2015) (Dec 2015) 41% (as at 10/05/15)
Number of district community engagement workplans that that specifically take into account social and cultural contexts Number of districts where training in communication and trust building skills was delivered to frontline staff
X
X
Subtotal
Indicator
X
1.2.4 Support national and district capacity to provide X psychosocial support to affected communities and Ebola survivors
1.3.3 Advsise on and promote the Minimum Standards in Mainstream Health Facilities to ensure that all health facilities maintain effective screening, triage, and quality assured case management of suspected and probable Ebola cases 1.3.4 Develop protocols to safely optimise the care of pregnant women and neonates recognising the protracted risk of transmission associated with pregnancy 1.3.5 Ensure case management quality improvement by supporting the training and mentoring of healthcare workers in mainstream healthcare facilities 1.3.6 Develop and support the implementation of best practices guidelines for managing the care of Ebola survivors 1.3.7 Develop a reporting framework for lessons learnt from Ebola FMT response 1.3.8 Contribute to the maintenance of referral services for Ebola cases 1.4.1 Recruit a crisis communication expert to manage and communicate critical outbreak response messages to the public and the international community 1.4.2 Implement interpersonal communication activities in communities and homes with ongoing EVD transmissions to combat challenges with interventions and diffuse stigma 1.4.3 Review EVD messaging in line with the current context of the outbreak response 1.4.4 Provide continuous messaging to the community using simulcast
Budget
13.66
0
13
OUTCOME 2: SUSTAINED ZERO & SAFE HEALTHCARE FOR PATIENTS AND HEALTH WORKERS Output
Activity
Q2 Q3 Q4
2.1.1 Support the strenghtening of national IPC structures through establishment of the National IPC Committee, monthly committee X meetings, and quarterly IPC Partners Coordination meetings 2.1.2 Support the process of finalization, validation, printing and distribution of the National IPC Guideline, training modules and educational materials 2.1 Ensured safety of 2.1.3 Facilitate effective IPC practices at healthcare facilities patients and healthcare through a continuous improvement program with asssessments, workers HCWs training, and the development of supply chain 2.1.4 Support the monitoring of the implementation of standardized triage and isolation in all healthcare facilities including referral capacity 2.1.5 Support local production of alcohol‐based handrubs in 5 government hospitals 2.1.6 Support IPC with improvements to WASH and waste management at healthcare facilities 2.2.1 Support the strengthening and implementation of IHR 2005 core capacities 2.2.2 Support the implementation of Integrated Disease Surveillance and Response (IDSR) guidelines at health facility, district and national levels (including CBDS) 2.2.3 Support the development of electronic tools for implementation of IDSR 2.2.4 Support the MOHS in the design, development and 2.2 Strengthened implementation of the Emergency Operations Centre emergency 2.2.5 Support the coordination, development and implementation preparedness and of cross border strategies for prevention and control of EVD and response capacity other priority epidemic prone diseases within the MRU framework 2.2.6 Establish a functional national laboratory network with adequate capacity for biosafety, quality assurance, information systems, and specimen referral 2.2.7 Support the development and implemetation of capacity building activities for emergency preparedness and response through training and supervision Subtotal
X
X
X
X
X
X
X
X
Indicator
Baseline
Target 2015
Number of IPC technical and coordinaiton meeting minute sahred with stakeholders and parnters
0
6
Assignment of international IPC advisor at MOHS
0
1
Validated , printed and distributed guideline
0
4000
0
5000
74%
90%
N/A
100%
0
5
0
25%
Budget
3.95
Number of trained health workers on validated guideline Proportion of ECCS scored above 80% Percentage of the assessed secondary and tertiary governmental hospitals which have a functional triage and referral system in place Number of Hospitals with supply of ABHR at point of care Proportion of facilities provided with WASH and waste management support
X
X
X
X
X
X
X
X
X
Number of districts which have functional IDSR systems
0
13
X
X
X
Number of districts which have access to and are reporting using the electronic IDSR tool
0
13
4.57
X
X
Percentage of laboratories scoring >80% in the national quality assurance programme
X
100%
8.52
OUTCOME 3: ESSENTIAL HEALTH SERVICES Output
Activity
Q2 Q3 Q4
3.1.1 Support the planning and implementation Polio and measles supplemental immunisation activities (SIA) 3.1.2 Support the RI acceleration plan 3.1.3 Support the introduction of inactivated Polio vaccine 3.1 Reestablishment of 3.1.4 Develop and update the Sierra Leone Nutrition Strategy, and essential health services commence a quarterly Nutrition Surveillance Report 3.1.5 Support the strengthening of reproductive, maternal and neonatal healthcare together with UNFPA and UNICEF 3.2 Adequate, well trained, and well distributed health workforce 3.3 Community ownership of health activity 3.4 Optimised Heath Information and Management Systems
Budget
X
X
Indicator Number of national immunisation campaigns held
X
X
X
X
X
X
2.19
Percentage of fully immunised children Inactivated Polio vaccine introduced in all districts Number of PHU staff trained on Growth Monitoring and Promotion Proportion of women delivering at a healthcare facility Number of districts with 60% healthcare workers trained in IMNCI Number of facilities with healthcare workers receiving refresher training on Life Saving Skills, Immunisation In Practice, and Injection Safety training
Baseline
Target 2015
0
4
31%
54%
4
8
0
125
3.2.1 Enable a skilled district/facility workforce with an emphasis on underserved areas and community based delivery
X
X
1.71
3.3.1 Ensure key policies, strategies and guidelines on community engagement are developed to support the implementation of the BPEHS
X
X
3.02
Availability of RI/SIA/new vaccine guidelines and vaccine communication strategies
0
1
3.4.1 Strengthen and develop Health Management Information Systems including HRMIS
X
X
0.38
Develop policies, guidance and standards for Emergency Preparedness and Response and surveillance
0
Complete
Subtotal
7.95
OUTCOME 4: PLANNING AND MANAGEMENT AT THE NATIONAL AND DISTRICT LEVEL Output
Activity
Q2 Q3 Q4
4.1 Effective leadership 4.1.1 Support National Health Sector strategic planning, engage and support of national Health Development Partners, and convene other technical UN X health sector agencies working on health coordination 4.2.1 Support District Health Management Teams with planning, X training, and service provision, reporting, and information management 4.2 Appropriately resourced and 4.2.2 Contribute to strengthening the operational capacity of the functioning District District Health Management Teams in rolling out the BPEHS Health Management Teams 4.2.3 Support effective management and coordination of health service delivery activities at the district level, together with District Health Management Teams Subtotal
X
X
X
X
X
X
X
X
Budget
1.32
4.42
Indicator Demonstrated leadership role in development partner coordination and advocacy within Sierra Leone at the national level Number of districts with agreed upon workplans Percentage of districts reporting on planned and implemented activities in a timely manner Monthly coordination meetings at district level with all partners, support the collation of meeting minutes and follow up actions, and assist the implementation of monthly meeting goals Number of monthly coordination meetings with action points documented and achieved
Baseline
Target 2015
Ongoing
Ongoing
13
13
0
100%
0
100%
0
100%
Baseline
Target 2015
6.28
OUTCOME 5: OPERATIONAL SUPPORT Output
Activity
Q2 Q3 Q4
5.1 Effective and 5.1.1 Monitor staffing by ensuring an adequate, qualified and efficient human motivated workforce in the country office resources management
Budget
Indicator
X
X
X
0.50
HR plan in place and updated and performance report submitted
5.2 Effective financial 5.2.1 Implement the finance control framework and ensure management and compliance with WHO’s administrative policies and regulations at X oversight the country level
X
X
0.45
Manage expenditure tracking and reporting at the country level in a timely manner
X
X
X
0.99
X
X
X
0.63
X
X
X
7.21
5.3 Provision of 5.3.1 Supplies and equipment operations and logistics 5.3.2 District and national office costs support for health activities 5.3.3 Vehicles and fuel Subtotal
Total (including programme support cost)
9.97
49.65
In progress Complete
Ongoing
Ongoing
Manage building maintenance works and establish In progress Complete functional amenities Ensure rational use of staff transport vehicles Ongoing Ongoing Maintain zero incidents affecting the security of 2 0 staff and their belongings while on duty
