5. Coordination, responsibilities and
5.3. Stakeholder responsibilities related to cholera
thereby limiting information sharing, planning and response.
Delayed action by some key actors (including government, UN, donors,
•
NGOs) to take direct actions to control the outbreak, hence limiting funds available and actors involved in the early response.
Delay use of the media to inform communities.
•
Difficult cross-border communication because the disease is not
•
officially defined.
Lose early opportunities to reduce the spread of the disease.
•
(Note: It can be very difficult to determine, monitor, and share with relevant authorities the antimicrobial susceptibility of circulating V. cholerae strains if the government does not want cholera declared).
5.3 Stakeholder responsibilities related to cholera
The stakeholders outlined in the following table may be involved in cholera prevention, preparedness and response. The range of stakeholders involved will depend on the scale of the outbreak.
TIp
Co-ordination and communication when cholera is not declared.
Use UNICEF’s role in protecting the rights of children as an
•
advocacy tool with the government.
Proactively support co-ordination and action within the existing
•
limitations, e.g. by supporting efforts from organisations already working on development
programmes in the area.
Build relationships and trust with the medical, WASH and
•
other practitioner staff working on the response. Even when a government is not declaring the outbreak, practitioners on the ground are often working hard to do their best to respond within the limitations. If they trust that you will
not put them in a difficult or dangerous position with the political authorities, they will welcome support for improving the response.
Help to form a bridge between the government practitioners
•
and other organisations with significant experience in responding to cholera where the links do not already exist.
If there is reluctance to the use of the word ‘cholera’,
•
but there is acceptance of the term ‘AWD’ (or another term), do not waste time debating language but stress with both governments and populations the seriousness of the disease.
This includes the need to respond promptly and use mass media to inform large populations with key information.
Emphasize AWD prevention, and treatment and referral
•
systems in on-going development activities, particularly at community level.
Encourage senior representatives (for example, the
•
Humanitarian Co-ordinator or UN Resident Coordinator and Heads of Agencies) to lobby government officials to recognise the problem and explain why it is in their interest to use internationally accepted terminology.
Provide evidence, where available, to support lobbying efforts,
•
e.g., WHO written declarations that trade restrictions on seafood are no longer applicable, etc. Also, highlight the likely impacts if the outbreak becomes extensive, including the costs to the country, and share examples of other large outbreaks.r
5
Coordination, responsibilities
and information management
1
Stakeholder category
/ level of importance Description Possible responsibilities / actions
Primary stakeholders:
Household- and community-based Human Rights Based Approach (HRBA) - rights holders
Including: Girls, boys, women, men, i.e., all community members, including infants, youth, older persons, single heads of household, orphans, people with disabilities, persons living with HIV/AIDS (PLWHA), etc. children in and out of school; food and water vendors.
Community cholera preparedness planning and action, participating in
•
local task forces or working groups
Managing and maintaining household and community based water points
• and latrines and hand-washing facilities
Using safe water, undertaking safe excreta disposal and practising safe
•
personal and food hygiene
Practising safe infant feeding, hand-washing with soap at critical times
•
(after defecation or handling faeces, before preparing food, feeding a child or eating), and using and maintaining latrines
Using ORS for rehydration and helping others to reach a health facility
•
quickly when sick
Peer education on undertaking safe water, sanitation and hygiene practices
• and the importance of safe infant feeding and use of ORS
Selling and using safe water to prepare foods and beverages to be spent
•
Practising safe food hygiene in food outlets
•
Monitoring of new cases and informing health professionals.
•
Secondary stakeholders:
Community-based HRBA duty bearers
Including: Schools / teachers; Religious institutions / leaders; Village-level community health workers (and other extension workers); respected community members (leaders, traditional birth attendants, elders, etc.); community groups (women, youth, sports);
community-level private sector (shop keepers selling household water treatment products, ORS, etc.);
people who may be influential in the local area (staff of local colleges and well-known local people/celebrities);
women’s and youth groups and/or clubs (and other community groups); community media (such as community radio or TV stations, local theatre and mobile cinema/video groups).
Cholera prevention through supporting WASH interventions
•
Community cholera preparedness planning and action, including health
• and hygiene promotion
Mobilising community members to adopt healthy and safe behaviours and
• practices and engaging communities in cholera prevention activities and local cholera task forces
Providing education and motivating school children on measures for cholera
• prevention and response
Providing leadership and motivation for community members and religious
•
followers on measures for cholera prevention and response
Facilitating discussions within communities to de-stigmatise cholera
•
Providing feedback to authorities on the quality of services provided
•
to communities
Selling ORS, soap and water treatment chemicals or equipment.
•
Table 5 potential stakeholders in cholera prevention, preparedness and response and their
responsibilities / actions
5
Coordination, responsibilities
and information management
1
Stakeholder category
/ level of importance Description Possible responsibilities / actions
Tertiary stakeholders:
District, regional, national or international HRBA duty bearers
Including: Local government (departments including health, water, education, community development, agriculture15); ministries (health, water, communication, disaster preparedness, social welfare, community development); semi-autonomous institutions (with responsibilities for nutrition, medical research, etc.).
educational establishments (universities, colleges and other training establishments, e.g., those training epidemiologists, doctors, nurses, social workers, public health, environmental health, or water and sanitation professionals); private sector (providing supplies, supporting promotional efforts); influential national celebrities or sports stars; non-governmental organisations and the Red Cross Movement
(national and international UN agencies and partners, e.g., WHO, UNICEF, OCHA); and donors (bi-lateral, unilateral, embassies, private).
Cholera prevention through supporting WASH interventions and, where
•
appropriate, vaccinations
Preparedness planning and associated actions
•
Co-ordination at cross-border, national, regional and district levels
•
Surveillance and epidemiological studies
•
Outbreak investigation
•
Planning, prioritising actions and managing the outbreak response
•
Provision of technical guidance and standards
•
Laboratory confirmation of
• V. cholerae
Water quality testing and monitoring
•
Establishment of cholera treatment sites
•
Clinical assessment and case management
•
Logistic and supply chain support to prevent shortages of critical treatment
• materials
Psychosocial support for cholera patients and their families
•
Integrated communication (media and interpersonal communication)
•
Mobilising the community
•
Supporting, encouraging and monitoring of the work of community workers
•
Providing WASH services
•
Training at all levels
•
Monitoring of food safety at food outlets
•
Monitoring and reporting
•
Funding.
•
15 At local government level, sometimes cross-sectoral mobilisation teams work on projects outside of their own sector, and in larger outbreaks staff from outside of the usual sectors may be called in to support the response efforts
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Coordination, responsibilities
and information management
1 2 3 4
7 8 9 10
6
TOC