Action by Churches Together (ACT) Appeal - El Salvador Dengue Epidemic Relief & Mitigation - LASA01 Appeal Target: US$ 119,513 Geneva, 25 October 2000
The Government of El Salvador has declared a national emergency due to an epidemic of haemorrhagic dengue that has affected a large area of El Salvador. Approximately 500 cases of dengue are reported every day including strains such as types II and III, as well as other cases of classic and haemorrhagic dengue. The haemorrhagic strain of dengue has so far produced 35 deaths, 33 of these being children. Haemorrhagic dengue is transmitted through the mosquito Aedes Aegypti which, in the ovarian state, can survive between 12 and 24 months and is resistant to any vaccine or other treatment currently available. The only way to control the illness is to organise and mobilise communities to stem the proliferation of the mosquitoes along with dengue mitigation programmes. The Lutheran World Federation (LWF - El Salvador Program), in co-ordination with 5 local NGO's and churches, proposes a national campaign to assist the affected population and to control and prevent dengue fever in El Salvador. The project comprises the following components: Pre-clinical treatment of the affected population Elimination of the infection sources Organisation of communities and training of community leaders in dengue mitigation procedures. Project Completion Date: 31 October, 2001 Summary of Appeal Targets, Pledges/Contributions Received and Balance Requested US$ Total Appeal Target(s) 119,513 Less: Pledges/Contr. Recd. Cash 0 In-Kind 0 Balance Requested from ACT Network 119,513 Ms. Genevieve Jacques Thor-Arne Prois Rev. Rudolf Hinz Director ACT Coordinator Director WCC/Cluster on Relations LWF/World Service REQUESTING ACT MEMBER Lutheran World Federation, Department of World Service (LWF-DWS) El Salvador Program IMPLEMENTING PARTNERS LWF/DWS will implement the project through "The Communal Network against the Dengue Epidemic," which was set up to combat the dengue crisis in El Salvador. The members of the Network are: The Lutheran World Federation - Department for World Service - El Salvador Program The Emmanuel Baptist Church (IBE) - carries out programs that promote change and integral development of the individual towards a more just and human society. IBE have 3 clinics with a doctor, and a team of 5 institutional promoters in the affected areas. The Institute for Research, Training and Development of Women (IMU) - was founded in 1986 and promotes awareness of the discrimination and subordination of women in Salvadoran society. It promotes measures that will improve the condition and position of women in society as well as strengthening women's organisations. In the health area IMU provides general information and assistance on sexual and reproductive health to young and adult women. They have two clinics operating in rural areas. The Foundation of Studies for the Application of Rights (FESPAD) - was created in 1988 and works on citizen participation in local development along with the application of human rights. FESPAD will advise in the effective organization of a community network and on the rights of that community. The United Communities from Usulutan (COMUS) - researches the development and strengthening of rural communities through conscious and active participation for their transformation. COMUS also specialises in the primary health of women during childbearing years and children under 5. COMUS will provide one doctor, two nurses and communal health promoters for the project. CREDHO (an Episcopal church based organisation) - is an institution linked to the Episcopal Church of El Salvador, founded in 1976, which contributes to the strengthening of capacities of impoverished communities including improving living conditions, income generation as well as management of the environment. CREDHO has experience in health work, environment and disaster relief. All organisations above have direct working relationships with rural communities in the country and have experience in emergency relief and inter-institutional co-ordination and will donate their services to implementation of the project. DESCRIPTION OF THE EMERGENCY SITUATION General situation: The Government of El Salvador has declared a national emergency due to an epidemic of haemhorragic dengue that has affected a large area of El Salvador. Approximately 500 cases of dengue are reported every day including strains such as types II and III, as well as other cases of classic and haemorrhagic dengue. The present epidemic is a combination of virus types II and III creating a strain which has not been detected previously. This haemorrhagic strain of dengue has so far produced 35 deaths, 33 of these being children. Haemorrhagic dengue is transmitted through the mosquito Aedes Aegypti which, in the ovarian state, can survive between 12 and 24 months and is resistant to any vaccine or other treatment currently available. The only way to control the illness is to organise and mobilise communities to stem the proliferation of the mosquitoes along with dengue mitigation programmes. To date the government has assumed a reactive attitude, carrying out a national campaign of cleaning and extermination of the adult mosquito but, very little has been done to eliminate the hatching of the mosquito eggs. Moreover, such assistance can not be successful without provision of professional assistance in health centres and such assistance has not been forthcoming from the authorities. However, a Cuban Brigade consisting of 37 doctors, technicians and nurses has assisted the Ministry of Health, along with voluntary specialists from Guatemala, Mexico, Costa Rica and the United States. This health team will support the Salvadorans in fumigation, treatment and studies on the Haemorrhagic Dengue. This health team has expressed concern that the greatest problem is the lack of health centres to provide medicine and care for the affected population. There is only one hospital in El Salvador which is prepared for this kind of illness, but it does not have any more available rooms. Latin America has long been affected by dengue fever and at present there are around 250,000 cases in all, with Brazil at the top of the league with 75,000 cases. It is felt that the epidemic in El Salvador offers an ideal opportunity to learn how to combat this new, resistant strain which could be repeated in other Latin American countries. But, specialists stress that the efforts of one country are not enough for preventative measures to work and it will also need a change in attitude of the population. Ministry of Health fumigation teams have found that many families refused to open their doors for the cleaning operation to take place and some do not use the little bag with insecticide that eliminates the mosquito larva. Furthermore, poverty and the quality of basic services (especially water) has a great influence on epidemic prevention. Emergency situation The current epidemic has produced 400 cases of haemorrhagic dengue and more than 4,000 of classic dengue. These figures do not include cases that are treated at community level and who do not have access to the health system or those who cannot afford treatment. In September and October 2000 El Salvador suffered heavy rain fall causing many rivers to burst their banks and consequently floods in both rural and urban areas. This has provoked the warm and damp conditions ideal for the development of the host-mosquito. In mid-October, the Benjamin Bloom Children's Hospital reported that 1,800 children were being treated for classic dengue and 284 for haemorrhagic dengue. Most of the data reflects the behavior of the epidemic in the urban areas, but in the rural areas it has been very difficult to carry out a census, given that in many cases there are no clinics or the patients do not attend the clinics. Currently, there is proliferation of the fever in various areas including the municipalities of Mercedes Umana and Berlin. In the municipalities of San Francisco Javier, San Agustin, Jiquilisco, 18 cases have been reported and other municipalities have reported the convergence of classic and hemorragic dengue. A Communal Network of local organisations, with hands-on experience working with local communities and experienced in health and emergency relief, has been formed to develop a plan of action against the dengue fever. Dengue General Data Dengue is a feverish illness caused by a virus and is manifested by daily fevers, headaches, muscular and joint pains and sometimes by skin outbreaks. Furthermore, it can be presented by serious haemorrhaging in different parts of the body that may cause death. The new strain, haemorrhagic dengue, is resistant to any known dengue treatment. Specialists from the Pan-American Health Organisation (PAHO), report that the virulence of the current dengue epidemic could be related to a virus combination, unique in the southern hemisphere. El Salvador is the first country where the strains II and III have converged. In the ovarian state it is very resistant and can survive between 12 and 24 months. In the inception phase it produces simultaneously 150 to 200 eggs. In the larva state it is sensible to light and does not rest on the water surface. Mature state: although it normally feeds within a radius of 100 square meters, it has the capacity to fly long distances. It prefers humid and dark places. GOAL & OBJECTIVES To develop a national campaign to assist the affected population and to control and prevent the expansion of the dengue epidemic in El Salvador. Objectives To provide pre-clinical treatment to families from communities where the epidemic exists - mainly in the rural areas To develop prevention and elimination activities aimed at the source of infection during the emergency phase. To educate community leaders in the treatment and destruction of infection sources. To promote and strengthen the inter-institutional co-ordination oriented to improve the conditions of the rural population's health, especially of vulnerable groups. BENEFICIARY INFORMATION AND TARGETED AREAS Targetted Beneficiaries 12, 600 families from rural areas, who have no access to potable water, no sanitation system and either have no access or difficult access to health centres. Women represent 61% of the participant families and men 39%; the majority population is less than 25 years old and the children under 14 years of age represent almost 50% of the population. Children 39,800 Women 7,710 Men 4,890 Geographical location: The epidemic covers practically the whole country but the project will be implemented in 112 communities in the following municipalities: DEPARTMENT MUNICIPALITIES CANTON COMMUNITIES # OF FAMILIES San Salvador Panchimalco San Isidro Divisadero Amayon Crucitas Troncones San Isidro Divisadero El Sillar Crucitas Troncones 120 100 83 101 77 Nejapa Nejapa El Llano-Anonal Los Naranjos 119 107 Santa Ana Texistepeque Costa Rica El Aguacatal 200 Cuscatlan Suchitoto Bermuda San Rafael Zacamil Montepeque 115 100 98 Sonsonate Cuisnahuat Apancoyo Rosales Clara 110 131 Nahuilingo Pushtan Pushtan 95 Sta Isabel Ishuatan Acachapa Acachapa 131 San Vicente Tecoluca, San Jose Llano Grande Francisco Angulo Cantarrana Los Milagros San Francisco Angulo 71 143 191 Usulutan, San Francisco Javier El Tablon La Pena Los Rios El Zungano Los Hornos El Palmo Los Horcones El Tablon La Pena Los Rios El Zungano Los Hornos El Palmo Los Horcones 121 110 103 100 98 99 125 Jiquilisco 14 de Julio El Carmen Taburete Claros 14 de Julio El Carmen Taburete Claros 113 94 129 Tecapan Las Queseras Gualache Chapetones Las Queseras Josseline Montecristo Unidos Somos Fuertes El Bongo La Quesera Loma Pacha 80 88 90 78 60 68 81 Ozatlan La Brena Joya de Pilar Nueva Guadalupe La Brena Joya de Pilar Nueva Guadalupe 100 121 113 San Agustin El Cantil Buenos Aires Galingagua Los Planes El Cantil Buenos Aires Galingagua Los Planes 80 101 138 106 Berlin Altos de Sn Lornzo Talpetates Corozal Altos de San Lorenzo Las Burras (Progreso) Carballo (Higueral) Mechotique Rio Los Bueyes 118 102 83 90 63 Mercedes Umana San Benito Horcones Jicaro San Benito La Barca San Simon Horcones Jicaro 98 108 92 123 148 San Dionisio San Dionisio Isla San Sebastian 173 Jucuaran Jucuaran El Zapote El Jicaro Las Pilas Santa Maria Santa Lucia Puerto Caballo 83 98 93 139 Usulutan Puerto Parada Las Salinas Capitan Lazo Buena Vista Los Desmontes Colonia Flores El Icaco Colonia Paniagua Los Tubos El Botoncillo Puertecito Ramirez Puerto Parada Colonia El Paraiso Colonia 27 de Agosto Colonia Melara El Flor Los Amayas El Limon El Lazo Las Conchas Buena Vista Los Desmontes 83 120 113 58 183 73 113 83 83 115 143 85 108 113 73 98 143 Puerto El Triunfo Corral de Mulas Nueva Ceiba 88 San Miguel San Rafael Oriente Canton Zelayas Santa Clara Rodeo de Pedron Piedra Azul Canton Zelayas Santa Clara Rodeo de Pedron Piedra Azul 113 100 143 163 San Jorge La Ceiba Candelaria Joya de Ventura La Morita La Ceiba Candelaria Joya de Ventura La Morita 143 163 153 133 Ahuachapan Jujutla Guayapa Abajo Guayapa Arriba El Naranjo El Mango El Zometa Cuilapa Hoja de Sal El Paraiso 203 98 143 108 87 San Francisco Menendez Cara Sucia Los Lirios 3 Reyes Magos Las Salinas Nueva Esperanza El Irayol 19 de Septiembre 98 71 75 120 115 108 San Francisco Menendez Garita Palmera El Palmo El Tamarindo Colonia ISTA El Chino Garita Palmera Bola de Monte Brisas del Mar 80 108 148 93 88 198 78 El Zapote La Hachadura Agua Fria La Ceiba Monte Hermoso San Benito El Zapote El Porvenir Los Monges Caserio San Marcos Rancho San Marcos El Castano Agua Fria Santa Rita Los Conacastes Monte Hermoso San Alfonso Miramar 212 213 98 103 113 198 120 100 120 101 118 112 communities 12,600 DESCRIPTION OF TARGETED ASSISTANCE Health attention Installation of 112 Local First Aid Kits (equipped with saline solution, acetaminophen, antibiotics, sphygmomanometers, stethoscope, thermometers, and bottles of Bacillus TURIGIENSIS SH-14), for initial treatment. Medical care and distribution of medicines - communal promoters/health committees and organised volunteers will carry out this activity. Permanent epidemiological vigilance, with the participation of the population through which all cases, clinically compatible with dengue fever, will be reported. 112 communal first-aid kits 278 diagnosis kits. 25,320 droppers of biological pesticide for 12,600 families The administration, handling of equipment and medicines will be the responsibility of the local communities Purchase of the materials All the relief items are available locally, with the exception of the biological pesticide. Prevention Taking into account the nature of the epidemic, it is necessary to carry out the cleaning campaigns, promoters' training, and training on the use of equipment in all the participating communities. The cleaning campaigns will be performed by the promoters through the organisation of the community into brigades; accordingly to geographical areas. This work will include collection of waste and refuse as well as fumigation. Permanent epidemiological vigilance, with the participation of the population will be carried out and supervised through visits by the communal promoters. Dengue mitigation activities will include the following: Sensibilisation campaigns in 112 communities. Organisation of communal development with other NGOs. 45 cleaning campaigns and vector controls in 112 communities (elimination of polluting containers and residue, fumigation, application of bio-larvicid) Publication of a manual for communal promoters (235 manuals) Publication of 2 popular educational books (17,800 copies) to use in the communal educational discussions. Training The promoters will be selected and trained in each participant community. The workshops will be carried out at local level. The technicians will develop a process of education, reflection and action in each one of the workshops, which will cover the following issues: illness history, conditions favourable to the development of epidemic diseases, the health situation in rural areas, prophylactics, clinical diagnosis, use of the first aid kits, etc. The material to be used in these workshops will be popular books and manuals for promoters, which will be designed, prepared, and printed specifically for this purpose. This means that all production of these materials will be the responsibility of two medical consultants, who will be contracted for this project. 14 training courses for institutional or communal promoters. 259 workshops for community members: 21 workshops with the participation of teachers and school students. 14 training courses for 210 communal promoters on diagnosis, prevention and treatment of cases of dengue. 280 educational discussions on diagnosis and dengue prevention for the communities. Due to the declaration of a national emergency, several governmental bodies have been involved in the cleaning of infection sources and gathering of waste, involving the resident population mainly in the urban areas, but giving little or no attention to the rural communities. IMPLEMENTATION & MANAGEMENT The members of "The Communal Network against the Dengue Epidemic" will carry out the strategic planning of the ACT/FLM-ES/Epidemic project; a co-ordination committee will be formed with institutional representatives. This committee will plan the development of each activity, emphasising the needs of the participant population. A Monitoring and Implementation Committee will be in charge of the implementation of the activities, in which technicians and/or community promoters will participate. All these activities will be defined in an Institutional Action Plan, which will guarantee the implementation and follow up of the activities. Implementation will be carried out by the personnel of the network members, many of whom are health service and health workers. A General Co-ordinator will be hired who will be responsible for joint plans, reports and general monitoring of the project. Two medical consultants will be hired in order to prepare the training materials. Plans for the implementation of the project will be elaborated quarterly and evaluations will be carried out at the end of each quarter. Monthly reports will be prepared by each implementing partner and quarterly reports will be sent to ACT Geneva. IMPLEMENTATION SCHEDULE The project will be carried out from October 2000 to October of 2001. COORDINATION There will be continuous co-ordination with different communal structures and with special attention to the rural communities. Likewise, co-ordination will be established with government bodies such as the Ministry of Health, local and municipal authorities involved in the project. BUDGET EXPENDITURE Description Type of No of Unit Cost Budget Budget Unit Units Colon Colon US$ COMMUNITY HEALTH Medicines for firs-aid kits Saline solution Unit 9,495 1.50 14,242.50 1,629 Acetaminopehn Bottle 633 10.00 6,330.00 724 Acetaminopehn Tablet 25,320 0.50 12,660.00 1,448 Medical equipment Sphygmomanometers Unit 278 175.00 48,650.00 5,563 Stethoscopes Unit 278 150.00 41,700.00 4,768 Biological larvicide Dropper 25,320 3.00 75,960.00 8,686 Thermometers Unit 278 10.00 2,780.00 318 Sub total 202,322.50 23,136 PREVENTION Cleanings campaigns Number 45 2,000.00 90,000.00 10,292 Popular educational books Book 17,800 10.00 178,000.00 20,354 Manuals for communal promoters Manual 235 60.00 14,100.00 1,612 Medical consultants (2) Lump sum 5,000.00 572 Sub total 287,100.00 32,830 TRAINING Community w/shops for promoters Workshop 14 2,000.00 28,000.00 3,202 Community educational w/shops Workshop 280 750.00 210,000.00 24,014 Sub total 238,000.00 27,216 COORDINATION Coordinator's fees Month 12 11,010.00 132,120.00 15,108 Communal network mobilization Trip 430 125.00 53,750.00 6,146 Sub total 185,870.00 21,254 PERSONNEL, ADMIN, OPERATIONS & SUPPORT Salaries and Benefits Prog Officer (10% monthly salary) Month 12 2,100.00 25,200.00 2,882 Operational Expenses Communications Month 12 750.00 9,000.00 1,029 Office rental Month 12 1,200.00 14,400.00 1,647 Staff Travel Month 12 4,375.00 52,500.00 6,003 Perdiem Month 12 1,500.00 18,000.00 2,058 Sub total 119,100.00 13,619 Audit & Evaluation Audit Lumpsum 12,750.00 12,750.00 1,458 TOTAL TARGET AND ESTIMATED EXPENDITURE 1,045,142.50 119,513 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Action by Churches Together (ACT) is a worldwide alliance of churches and their related agencies, meeting human need through co-ordinated emergency response. 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