Summary of major revisions made to emergency plan of action:

Malawi Red Cross Society (MRCS) is publishing this update to inform on the actions since the launch of the operation in September 2022 and update stakeholders on the changes resulting from the deterioration of the context on operational imperative.

This operation update is driven by the worsening of the cholera outbreak which has significantly spread over time in terms of magnitude and geographical area. There has been a 95% increase in the number of cholera cases in November (4,766 confirmed cases) compared to October (2434 confirmed cases). Based on this, on 5 December 2022, the State President declared the 2022 Cholera Outbreak a “Public Health Emergency”. As of 5 December, the epidemic included a cumulative total of 11,462 cholera cases with 332 deaths (CFR 2.9%) and 12,854 cases and 47 more deaths on 14 December 2022. This translates to urgent need to strengthen and expand the response engaged in September.

MRCS will continue to engage the Ministry of Health and DoDMA in implementing immediate and long-term cholera control, response, and preventive measures. The Malawi Government also plans to strengthen the roles of MoH and DoDMA in the next phase of the response. The MRCS additional support will help ensure that lives continue to be saved, and a resilient health system is maintained during and beyond the current outbreak.

The proposed revisions are as below:

1 . Increasing the target district to five to include Salima from the initial 4: Nkhatabay, Nkhotakota, Karonga and Mzuzu districts. Movement coordination also put in contribution to support Southern districts where outbreak is also spreading.

2 . Budget is increased from CHF 392,014 to CHF 748,286. Second allocation is CHF 356,272 considering that CHF 226,817 is already implemented by the National Society.

3 . Scale-up of the MRCS through this DREF include:

• Extension of the Emergency Response Team from 580 to 796 (580 volunteers and 216 HAS) to improve coverage for interrupting transmission and improving case management of Cholera at community and facility levels in the affected districts. support the MoH led Oral Cholera Vaccination campaign through social mobilization activities in high-risk districts,

• Deployment of 2 surge profiles to support the technical capacity at National Society and Delegation level, one supported under this DREF and another by regional surge unit.

• Improvement and extension of case management both at facility and community levels through a provision of oral rehydration therapy – support with the setup of 2 Oral Rehydration Points (ORPs) in each of the 5 districts (for a total of 10 ORPs), district versus 4 (one per four districts), initially planned.

• Support with the setup of a total of 10 CTUs. 4 already in place for which additional material will be provided and 1 new for Salima. This support includes provision of tents and temporary latrines, procurement of infection prevention control materials and provision of Personal Equipment (PPEs) for volunteers and HSAs; Task shifting in health facilities to support nurses to deal with the influx of patients.

• Reinforce the social mobilization and awareness activities by engaging more community leaders and through volunteers and mass communication activities extended to 4 months with more visual material, 15 painting, 50 Van publicity, 1500 airing jingles and IEC to be produced and diffused.

• As a new activity based on the need identified, MRCS will include promotion of the nutrition dietary diversification and breastfeeding for children under 2 as a safe fluid intake in cholera affected areas and safe continuation of breast feeding for mothers suffering from Cholera; infant and young child feeding practices

• Increased support to WASH activities and strengthened water management, access to water and WASH hygiene prevention toward the rainy season with:

• Ensuring rehabilitation of 25 boreholes instead of 9 initially planned.

• Support 3 boreholes construction by MoH with Drilling and materials.

MRCS will strengthen the response supervision with dedicated operation coordinator and wash officer to be mobilized to support community health response system strengthening.

Source: International Federation of Red Cross And Red Crescent Societies