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The Work of WHO in the African Region: Report of the Regional Director 2015 - 2016

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Executive Summary

The Regional Director is pleased to present this report on the work of WHO in the African Region for the period October 2015 to June 2016. The report outlines the significant achievements made under the six categories in the 12th General Programme of Work in supporting Member States in the African Region in health development. It reflects contributions from WHO country offices and the Regional Office, including the three Intercountry Support Teams.

Successful interruption of Ebola Virus Disease (EVD) transmission and improvement of health security

The longest and most severe EVD epidemic in known human history was stopped in West Africa in December 2015 after an intensive and sustained response by governments, civil society and development partners, including the UN system. At the height of the epidemic in August-September 2014, an average of 150-200 cases per week were being reported. By the end of 2015, only a few cases were being reported, with that plateau continuing into 2016. Based on the recommendations of the IHR Emergency Committee, the WHO Director-General lifted the declaration of the EVD epidemic as a Public Health Emergency of International Concern on 29 March 2016.
By then, a total of 28 616 confirmed, probable and suspected cases had been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.

Sierra Leone declared the end of Ebola human-to-human transmission on 17 March 2016 and Guinea on 1 June 2016, following the last flare-ups. Liberia first declared the end of Ebola human-to-human transmission on 9 May 2016, but thereafter new cases reemerged three more times in the country.

The end of the last flare-up of EVD in Liberia was declared on 9 June 2016. No cases subsequently emerged over a 90-day period of heightened surveillance which ensured that any new cases would be identified quickly and contained before spreading.

The swift containment of the flare-ups indicates that capacity has been built in these countries. Vigilance continues to be maintained in all three countries to prevent, detect and respond to suspected cases, as the risk of additional flare-ups from exposure to infected body fluids of survivors remains.

WHO and partners continue to work with the Governments of Guinea, Liberia and Sierra Leone to help ensure that survivors have access to medical and psychosocial care and screening for persistence of the virus, as well as counselling and education to help them reintegrate into family and community life, reduce stigma and minimize the risk of Ebola virus transmission. WHO is also collaborating with partners to support the countries to restore and strengthen key public health programmes, especially maternal and child health.

Continued focus on preparedness and swift response to epidemics

WHO continued to work with Member States and partners to improve national capacity for preparedness and response, notably by conducting a regional risk analysis and mapping exercise. The most vulnerable countries are receiving support to strengthen preparedness and to develop national plans and road maps towards achieving and sustaining the IHR core capacities. WHO is working with several global initiatives on health security, and there is ongoing advocacy for coordinated action among Members States and partners to improve preparedness, alert and response, and to strengthen crosscountry and cross-institutional collaboration.

Member States are expected to commit domestic resources to implement the priority interventions, since national health security is the primary responsibility of governments.

WHO has worked with the Governments of Angola, the Democratic Republic of the Congo (DRC) and Kenya to contain a yellow fever outbreak of unprecedented scale. The outbreak started in Angola in December 2015, and spread to the DRC and Kenya.

As of 30 June 2016, 3552 cases including 355 deaths had been reported in Angola, and 1399 cases with 82 deaths in the DRC. Uganda had also reported 60 cases and 7 deaths in an outbreak not related to the one in Angola. WHO and partners quickly supported the affected countries to implement control measures.

By the end of June 2016, the Organization had deployed 126 international experts to support vaccination campaigns and strengthen surveillance, risk communication, community mobilization, case management and integrated vector control.

Through the International Coordination Group mechanisms, WHO provided over 14 million doses of yellow fever vaccine to Angola, the DRC and Uganda. Funds amounting to approximately US$ 1.6 million were disbursed from the WHO Contingency Fund for Emergencies (CFE) and the African Public Health Emergency Fund (APHEF) to support national response efforts. The risk of yellow fever in the Region has changed, and a new yellow fever strategy is being developed in the Region with emphasis on immunization and health security.

The Regional Office also supported Cabo Verde and Guinea-Bissau to respond to outbreaks of Zika virus which were reported in October 2015 and June 2016 respectively. These outbreaks are linked to the Zika outbreak in the Americas, which was declared a Public Health Emergency of International Concern by the WHO Director-General on 1 February 2016.

By 30 June 2016, 7585 suspected cases of Zika including nine infants with microcephaly had been reported among newborn babies of Zika-infected mothers in the two countries, with 202 cases laboratory-confirmed. The number of reported cases in Cabo Verde has since declined with the last confirmed new cases reported in March 2016, while Guinea-Bissau had three confirmed cases by the end of June 2016.

WHO provided support for the initial investigation and confirmation of the diagnosis through the deployment of experts, while guidance and advice on Zika preparedness and response were provided to other Member States and partners.

Reducing childhood illness and mortality

WHO continues to promote immunization as the most cost-effective life-saving intervention, especially for children.
Coverage with the third dose of the diphtheria-pertussis-tetanus vaccine (DPT3) in the African Region has improved with 24 countries reaching coverage rates above 90% in 2015.

Countries also made significant progress in introducing new vaccines such as pneumococcal conjugate vaccines (PCV) and rotavirus vaccines into their immunization programmes. Thirty-eight countries are using PCV, while 31 are using rotavirus vaccines. The increasing use of these vaccines is already having a positive impact on disease prevalence.

For instance, Ghana, Rwanda and Togo have reported reductions of 45-65% of rotavirus hospitalizations in large referral hospitals for the period 2014-2015.

To further strengthen advocacy for immunization, ministers of health, parliamentarians and partners adopted a declaration on Universal Access to Immunization – “Universal Access to Immunization as a Cornerstone for Health and Development in Africa” – at the first ever Ministerial Conference on Immunization in Africa jointly organized with the African Union Commission and the Government of Ethiopia in February 2016. Implementation of the declaration will contribute to reducing child mortality within the context of the Sustainable Development Goals (SDGs).