Dear colleagues,

In mid-May, PATH staff in the Democratic Republic of the Congo (DRC) began hearing unofficial reports of an outbreak of Ebola in the country. On May 12, following confirmation of the disease by the National Biomedical Research Institute, the DRC Minister of Health informed the World Health Organization (WHO) of an outbreak of Ebola virus disease in Likati health district, Bas-Uélé province. As of June 9, the outbreak is responsible for five confirmed cases and three suspected cases, including four deaths.

DRC is one of the countries in which PATH has been a key partner in global health security (GHS) efforts. Over the past 8 months, we’ve been working closely with the Ministry of Health (MOH) to establish an Emergency Operations Center.

When reports of the Ebola outbreak were confirmed, PATH rapidly responded to requests from the MOH to support emergency response efforts. PATH and our partners have been undertaking activities to address a variety of needs around the outbreak, including additional diagnostics, communication campaigns, transportation services, lab capacity, disinfection equipment, and telecommunications infrastructure. You can read more about PATH’s involvement in the outbreak response on the PATH blog.

On June 2, the Minister of Health of the DRC declared that the Ebola outbreak has been contained. However, two separate outbreaks of circulating vaccine derived poliovirus type 2 are also a potent threat to the security of the country and the region. These outbreaks are showing us in real time that strong country health systems are essential to prevent, detect, and respond to these incidents. And yet, funding for global health security is at risk, with large cuts being proposed by the White House to US-led global health and development programs. The investments in health security being made in DRC and elsewhere by the US government, private partners, and NGOs are critical and must continue, even after the crisis has passed.

PATH is working with our network of partners to respond to the Ebola outbreak in Bas-Uélé. During the first days of the outbreak, PATH provided support to the MOH to get surveillance teams to the epicenter. We helped mobilize a cross-sector group of international partners to support the government with high-resolution satellite imagery, geospatial mapping capabilities, and other tools to help investigate and respond to the outbreak.

DigitalGlobe had its satellites take new, high-resolution imagery of the affected area and made available some archived high-resolution imagery for mapping efforts. Coordinating with the University of California, Los Angeles (UCLA), DRC Research program, the OpenStreetMap DRC and the Humanitarian OpenStreetMap Team crowdsourced the mapping of the outbreak area using DigitalGlobe’s imagery. Hundreds of OSM volunteer contributors, both in the DRC and around the world, then collectively spent thousands of hours mapping the outbreak region. The large area was able to be mapped in a very short amount of time using crowdsourcing. The mapping is being verified and further completed using GPS coordinates sent from the smartphones we provided to responders now in the field. The government will be able to use that data to plan its response.

We are also partnering with Mountain Safety Research (MSR) to deploy the MSR Community Chlorine Maker, a portable device that can produce chlorine in just five minutes, in response to a lack of chlorine for disinfection in emergency clinics and mobile labs.

A coalition of rapid response organizations, including Médecins Sans Frontières, the World Health Organization, and the Centers for Disease Control and Prevention are actively engaged in supporting the government’s response. These organizations have decades of experience in responding to complex public health emergencies, and the GHSP team at PATH is honored to contribute our part to support these efforts. PATH’s activities in response to the outbreak are led by the DRC GHSP team: Trad Hatton, Matt Havlik, Leon Kapenga, Leguym Mvulanianga, Nancy Nzau, and Hermann Tchiyane.

Read more about PATH’s response to the outbreak on the PATH blog and in a Q&A with Trad Hatton, DRC country leader for PATH.

In addition to Ebola, there are now two separate outbreaks of circulating vaccine-derived poliovirus type 2 in southeastern DRC, which are a setback to global elimination efforts. WHO, the DRC MOH, and other partners including PATH are moving quickly to limit the spread.

Our work to support the development of the emergency operations center (EOC) is continuing and will be crucial to build DRC’s capacity to prevent, detect, and respond to future threats. In the coming quarter, the team in DRC anticipates the completion of the EOC operational plan, which will include determination of the model, selection of vendors for equipment, and solving network connectivity. PATH supported Dr. Gaston Tsiabenda, an epidemiologist with the MOH who will manage the new EOC, to participate in CDC’s Public Health Emergency Management Fellowship to enhance country capacity and the establishment of a fully functioning EOC.

Staffing updates: Nancy Nzau, Communications Officer, has joined the GHSP team in DRC to support communications for the project.

In February, PATH supported a one-day workshop to disseminate communications materials developed for integrated disease surveillance and response. Additionally, the team supported the 2017-2021 surveillance strategic plan by setting up a planning committee and validating the plan. The strategic plan will begin implementation in May.

In April, PATH supported the Medical Assistance and Emergency Service (SAMU) to improve the management of health emergencies in health facilities by adding new capacity for patient triage. This activity is included in the roadmap of the Direction of the Health Facilities to improve emergency care services at hospitals and implementation of emergency reception units at health centers. PATH organized the first of a series of trainings for triage nurses (also known as emergency organizer nurses). With PATH’s support, SAMU has trained 76 nurses in Dakar’s emergency care services. PATH and SAMU and the Direction of Health facilities will conduct a supervision mission to evaluate the trained nurses, and plan to scale up these emergency care services in other 13 regions of Senegal.

Also in this quarter PATH conducted training of surveillance staff in health information systems, data integration, and decision making. Additionally, the Senegal team conducted a training-of-trainers for the taskforce of the Division of Sanitary and Social Information Systems on International Disease Classification 10.

PATH conducted a supportive supervision mission of health facilities in all 14 regions of Senegal to evaluate the implementation level of the recommendations and practices for infection prevention and control (IPC) and patient safety. Additionally, the team provided technical assistance to the national program to fight healthcare-associated infections (PRONALIN) on the planned national prevalence survey by participating in a workshop to develop protocols and standard operating procedures for the survey. Using DHIS2 as a system for antimicrobial resistance (AMR) data notification was scaled up during the months of February and March; 24 out of 47 labs were trained in this system. PATH has continued progress in developing the national lab policy and 5-year strategic plan for laboratories, biosafety/biosecurity, and AMR.

In the area of immunization PATH is supporting technological solutions and innovations for strengthening the Expanded Program for Immunization (EPI) performance by developing a web platform (Open Data Kit Collect) for conducting the national inventory of all cold chain equipment in Senegal. Additionally, PATH is utilizing the e-learning platform, Moodle, for immunization training, and has supported the MOH in using this platform for EPI.

Staffing updates: Pape Birahim Ndiaye joined the Senegal team as an intern, supporting lab data collection and community-based surveillance.

The Tanzania team has continued planning for a water, sanitation, and hygiene (WASH) demonstration project. The project will accomplish the following goals: 1. evaluate health care facility implementation of national guidelines for water quality, storage, hygiene promotion, and waste management; 2. documenting use and maintenance of handwashing and drinking water stations; and 3. assessing changes in appropriate management of waste.

While WASH is not included in the Global Health Security Agenda action packages, there is a strong relation to health security. WASH is critical for preventing outbreaks of waterborne diseases such as cholera, as well as preventing spread of enteric diseases that can result in overuse of antibiotics and contribute to AMR. PATH has been coordinating with the Ministry of Health, Community Development, Gender, Elderly, and Children (MoHCDGEC)’s Environmental Health and Sanitation group to finalize details of the geographic scope of the project and target population. PATH is building a study protocol based on guidelines for WASH in health care facilities developed by MoHCDGEC, NIMR, and the University of Dar es Salaam.

PATH continued to support electronic integrated disease surveillance and response (eIDSR) systems in Arusha and Kilimanjaro. The team ensured that eIDSR materials are available in health facilities in the two regions and conducted quarterly supportive supervision missions. The team also assisted the regional health management team and council health management teams to conduct data quality assessments at 68 health facilities, and training of 290 health workers in order to improve reporting timeliness, completeness, data quality, and analysis.

Staffing updates: Abel Ngwalle, Senior WASH Technical Officer, has joined GHSP to finalize the protocol for the WASH demonstration project and begin the baseline assessment of facilities. Rehema Mageni has joined the team as Program Associate to support GHSP and the Data Use Partnership with PATH’s Digital Health Solutions team.

In January, PATH provided support to train hospital staff at 16 hospitals to use WHONET software, as well as to identify issues and data quality standards and for sharing antimicrobial resistance (AMR) data within the Vietnam Administration for Medical Services (VAMS) structure. PATH has also been working with VAMS on developing an electronic reporting platform for healthcare-associated infection (HAI) surveillance.

PATH supported the Ministry of Health (MOH) to organize and present at the Convergence Workshop to Strengthen Health Information Systems for Preventive Medicine in Vietnam in February. For this presentation, PATH demonstrated the value of interoperability between General Department of Preventive Medicine (GDPM) platforms and clinical and lab data to detect and respond to a hypothetical measles outbreak. This type of activity is critical to inform the Government of Vietnam’s public health leadership of the importance of a health information system and interoperability as electronic reporting of health information expands in Vietnam.

In March, PATH collaborated with CDC, GDPM, regional institutes, and four pilot provinces to prepare for and implement monitoring and evaluation for a pilot event-based surveillance (EBS) system. This support included development of protocols and tools as well as midterm progress checks to Pasteur Institute in Ho Chi Minh City, An Giang, and Ba Ria Vung Tau. Progress of EBS implementation in four pilot provinces was examined and lessons learned will be applied to inform the roll out of EBS in two new provinces.

PATH assisted VAMS and CDC in the process of developing three new national infection prevention and control (IPC) guidelines (hand hygiene; IPC in anesthesia and recovery departments; environmental hygiene) as well as three other guidelines supported by WHO (sterilization and disinfection of endoscope equipment; prevention of urinary tract infections; implementing HAI surveillance in hospitals). Additionally, PATH has actively participated in a newly formed joint coordination group on AMR/IPC activities involving CDC, WHO, Health Advancement in Vietnam, Oxford University Clinical Research Unit, and other partners. The group met to create and present a unified strategy for the government of Vietnam to promote progress in IPC/AMR related activities.

Staffing updates: The team welcomed Unarose Hogan, International Technical Advisor for Infection Prevention and Control, Sang Dao Dinh, Program Officer, and Amanda BenDor, Technical Program Manager.

PATH participated in the World Health Assembly, where advocating for epidemic preparedness and support of the Global Health Agenda was high on PATH’s list of priorities. In a statement from PATH’s Advocacy and Public Policy group, PATH applauded WHO for highlighting research and development (R&D) as a core component of addressing epidemic diseases. New tools and improved drugs, vaccines, and diagnostics must be appropriate, available, accessible, and affordable in low resource settings where outbreaks are likely to occur. PATH also urged WHO and Member States to focus on medical countermeasures, platform technologies, and high-quality surveillance systems in preparedness R&D. Member States must continue to make progress by prioritizing investments in and accelerating reform for strong health systems, in order to prevent, detect, and respond. Appropriate prescription and use of antibiotics joined with R&D are vital to battling antimicrobial resistance. PATH called on the Secretariat to support development and execution of country plans to prevent the rise of resistance, and to hold nations accountable to their commitments.

Staffing updates: The GHSP team in Seattle welcomed Joshua Klett, intern.