Highlights
No EVD alert case detected during 20th to 26th July 2019 period.

WHO technical team travelled to Bukoba town, Kagera Region on 27th July 2019 to support the United Republic of Tanzania to conduct Ebola Virus Disease (EVD) Tabletop and field drills in two high regions of Kagera and Kigoma. The team was later joined by EVD Exercise Management Team (EMT) comprised of 35 officers from Prime Minister’s Office One Health Coordination Desk, Ministry of Health, FAO, USAID-Chemonics-HRH2030, Global Health Supply Chain, Tanzania Red Cross and MSF. The EMT held a two day preparatory meeting from 28th -29th July 2019 to discuss schedule of the week and assigning roles to EMT members. The team made a courtesy call to Regional Medical Officer and Regional Administrative Secretary to brief regional leaders on the objectives of the exercise program. The Kagera Regional Administrative Secretary Prof. Faustin Kamuzora officiated the launch of EVD simulation exercises on Tuesday 30th July 2019. In his remarks he emphasized multi-sectoral coordination and capacity building as key in EVD preparedness and response. During the opening remarks, the WHO team advised participants that, following declaration of Public Health Emergency of International Concern (PHEIC), Tanzania should recognize that the risk of EVD spreading to neighbouring countries is high hence need to; Scale up coordination of EVD preparedness activities with special focus on surveillance in communities, health facilities and at ports of entry, strengthen infection prevention and control in health facilities, scale up risk communication and community engagement. Consequently, participants were advised to pay keen interest in the simulations as they are meant to test the EVD Standard Operating Procedures (SOPs) and health systems, build response capacities, identify and address gaps, and promote good practices during EVD preparedness and response. The simulation exercises conducted where assessing various functions in EVD response namely; coordination, surveillance, laboratory, logistics, risk communication and community engagement, case management and infection prevention and control.

Tabletop Exercise (TTX)
One day TTX was conducted on Tuesday 30th July 2019 at Smart hotel Bukoba town in Kagera region. The exercise was attended by approximately 68 participants from Kagera Regional Health Management eam and district task force members from Bukoba Municipal Council, Bukoba District Council, Misenyi, Karagwe, Ngara, Biharamulo, Muleba and Kyerwa.

Drills at Health Facility Level and Points of Entry
Seven EVD drills were conducted at health facility level and points of entry in three districts of Bukoba Municipal, Misenyi and Ngara. The drills covered Rusumo One Stop Border Post and Kabanga One Stop Border Post, borders of Tanzania between Rwanda and Burundi respectively. The health care facilities that hosted EVD simulations exercises in Kagera region, three are designated Ebola Treatment Centres (Nshambya in Bukoba Municipal Council and Bunazi health centre in Misenyi district and Lukole HC in Ngara district), the other health care facilities that participated were Kagera regional referral hospital in Bukoba Municapality, Kyabyelile Health centre in Ngara a district that borders Rwanda and Burundi; the two facilities have designated isolation points.

Findings; Strength, Weakness and Recommendations.

Strengths

• Availability of trained health personnel in the regions
• Availability of EVD SOPs
• One designated Ebola Treatment Centers and Isolation points
• High commitment and leadership shown by the health care workers who participated in the exercises.
• Good notification and coordination of response.

Weakness

• Lack of adequate materials and equipment at the designated EVD treatment and isolation points. The structural designs of some of the facilities needs to be reviewed; no clear red and green zones, flow within the facility not adequate.
• Lack of adequate skills to conduct proper infection prevention and control at the facilities due to lack of materials and equipment and practice. Majority of staff trained have never worked together as a team and have not practiced the skills acquired. Case management components such as donning and doffing, decontamination, sample management was not ideal.
• Very few health personnel have been trained to cover the many health facilities and points of entry
• EVD SOPs have not been disseminated and they need review and re-validation. Health personnel are using old EVD SOPs.
• Staff did not use standard case investigation and notification forms.

Recommendations

• Revise EVD SOPs, print and disseminate the SOP.
• Conduct intensive EVD SOPs training at work stations combined with drills.
• Region to review number of designated Ebola Treatment Centers; majority do not meet minimum requirements.
• Provide adequate EVD materials and equipment to EVD isolation points and Ebola treatment centers
• Conduct regular simulation exercises at the designated isolation points and Ebola treatment centers
• Intensify surveillance activities including utilization of appropriate surveillance forms

The EMT travelled on Saturday 3rd August to Kigoma region to conduct similar simulation exercises from 5th to 9th August 2019 in four district of Kigoma municipal, Uvinza, Kigoma DC, and Mbugwe.

WHO Technical team briefing EVD Exercise Management Team

Drill at Health facility in Bukoba district, Kagera Region

WHO Team facilitating a drill at a health facility; simulated patient in a wheel chair

WHO Team giving Opening Remarks and Group Photo for simulation participants

Tabletop exercise to review EVD SOPs

Capacity building after drill