VZCZCXRO4243
OO RUEHBZ RUEHDU RUEHMR RUEHRN
DE RUEHSB #0331/01 1101447
ZNR UUUUU ZZH
O 201447Z APR 09 ZDK
FM AMEMBASSY HARARE
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4401
RUEHSA/AMEMBASSY PRETORIA IMMEDIATE 5668
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHGV/USMISSION GENEVA 2076
RUCNDT/USMISSION USUN NEW YORK 1989
RUEHRN/USMISSION UN ROME
RUEHBS/USEU BRUSSELS
RHEHAAA/NSC WASHDC
RUEKJCS/SECDEF WASHDC
RHMFISS/JOINT STAFF WASHDC

UNCLAS SECTION 01 OF 04 HARARE 000331 
 
SIPDIS 
AIDAC 
 
AFR/SA FOR ELOKEN, LDOBBINS, BHIRSCH, JHARMON 
OFDA/W FOR ACONVERY, CCHAN, LPOWERS, KMARTIN 
FFP/W FOR JBORNS, ASINK, LPETERSEN 
PRETORIA FOR HHALE, PDISKIN, SMCNIVEN 
GENEVA FOR NKYLOH 
ROME FOR USUN FODAG FOR RNEWBERG 
BRUSSELS FOR USAID PBROWN 
NEW YORK FOR DMERCADO 
NSC FOR CPRATT 
 
E.O.  12958: N/A 
TAGS: EAID EAGR PREL PHUM ZI
SUBJECT:  ZIMBABWE CHOLERA - USAID/DART CLOSE OUT 
 
HARARE 00000331  001.2 OF 004 
 
 
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SUMMARY 
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¶1. In response to the cholera outbreak in Zimbabwe, USAID's Office 
of U.S. Foreign Disaster Assistance (USAID/OFDA) activated a 
USAID/Disaster Assistance Response Team (USAID/DART).  The mission 
of the USAID/DART was to identify humanitarian needs, target 
USAID/OFDA funding, evaluate response effectiveness, conduct field 
assessments, and participate in cholera-related meetings, including 
health and WASH cluster meetings.  The USAID/DART has ascertained 
that humanitarian organizations have continued to improve overall 
coordination and information management, case management capacity, 
and epidemiological analysis.  As of April 3, the UAID/DART has 
determined, in consultation with USAID/OFDA, that conditions have 
been met for USAID/DART close out operations. 
 
¶2. The USAID/DART has programmed more than USD7.3 million in 
response to the Zimbabwe 2008-09 cholera outbreak, including all of 
the USD6.8 million initially pledged.  Through nine UN and 
non-governmental organization (NGO) implementing partners, 
USAID/OFDA is supporting humanitarian coordination and health and 
water, sanitation, and hygiene (WASH) interventions in all ten 
provinces of Zimbabwe.  USAID/OFDA has procured 400 metric tons (MT) 
of soap, which was consigned to the UN Children's Fund (UNICEF) for 
provision to humanitarian organizations conducting hygiene materials 
distributions to at-risk populations.  These emergency WASH 
interventions complement USAID/OFDA's long-term WASH programming for 
the ongoing complex emergency.  In fiscal year (FY) 2008, USAID/OFDA 
provided more than USD4 million for WASH interventions prior to the 
cholera outbreak.  Following USAID/DART close out, USAID/OFDA staff 
based in Harare will continue to monitor the cholera response 
through discussions with partners, attending coordination meetings, 
and conducting additional health and WASH assessments as needed. 
END SUMMARY. 
 
---------- 
OVERVIEW 
---------- 
 
¶3. Beginning in August 2008, a cholera outbreak spread to all of 
Zimbabwe's provinces and affected 60 of Zimbabwe's 62 districts.  As 
of April 16, 2009, the cholera outbreak had caused 4,201 deaths with 
more than 96,000 cases reported, and a cumulative case fatality rate 
(CFR) of 4.4 percent, according to the UN World Health Organization 
(WHO).  According to WHO, weekly epidemiological data indicates a 
sustained decline in the rate of cholera cases and deaths over the 
past eight weeks.  The health and WASH clusters and the Ministry of 
Health and Child Welfare (MOHCW) have identified health and WASH 
programming, particularly social mobilization programs for cholera 
prevention coupled with hygiene materials distributions, as the most 
effective means to mitigate the spread of cholera.  Cholera cases 
originating in Zimbabwe have also been reported in neighboring 
countries, including South Africa. 
 
---------------------------- 
ACTIVATION OF THE USAID/DART 
---------------------------- 
 
¶4. On December 5, 2008 USAID/OFDA health and WASH technical 
Q4. On December 5, 2008 USAID/OFDA health and WASH technical 
specialists arrived in Zimbabwe to assess the cholera outbreak, 
supplementing the efforts of two USAID/OFDA staff based in Harare. 
On December 16, U.S. Charge d'Affaires, a.i. Katherine S. Dhanani 
declared a disaster due to the effects of the cholera outbreak.  As 
part of ongoing response efforts, USAID/OFDA activated a five-person 
USAID Disaster Assistance Response Team (USAID/DART) on December 10 
to identify humanitarian needs, evaluate response effectiveness, 
conduct field assessments, and participate in cholera-related 
meetings, including UN health and WASH cluster meetings.  USAID/DART 
health and WASH technical specialists conducted a number of 
assessments of the cholera response and USAID/OFDA-funded 
interventions in December, January, and early February. 
 
 
HARARE 00000331  002.2 OF 004 
 
 
--------------------------------------- 
USAID/OFDA CHOLERA RESPONSE PROGRAMMING 
--------------------------------------- 
 
¶5. The USAID/DART has programmed more than USD7.3 million in 
response to the cholera outbreak, including all of the USD6.8 
million pledged in early December 2008.  USAID/OFDA has provided 
approximately USD750,000 for health sector coordination and 
contributed nearly USD365,000 for the purchase and transport of 
hygiene commodities.  USAID/OFDA is also providing more than USD6.1 
million for WASH programming, including additional hygiene supplies 
and cross-border WASH support for South Africa's Limpopo Province. 
 
 
------------------------------------- 
USAID/OFDA EMERGENCY WASH PROGRAMMING 
------------------------------------- 
 
¶6. To provide for immediate WASH needs, USAID/OFDA provided nearly 
USD2 million to Oxfam/Great Britain (GB).  The NGO was already 
working on longer-term USAID/OFDA-funded WASH programming as part of 
the response to the ongoing complex emergency in Zimbabwe.  With the 
additional funding, Oxfam/GB scaled up WASH interventions for the 
cholera response, including participatory health and hygiene 
education (PHHE), sanitation interventions, the provision of safe 
water, and hygiene commodities distributions in seven districts in 
six different provinces, as well as the cities of Harare and 
Bulawayo.  The NGO is implementing the activities both directly and 
through local partners.  Oxfam is also supporting borehole 
rehabilitation in Mudzi District. 
 
¶7. Oxfam staff has reported improved access to safe water for 
approximately 200,000 people through emergency water tankering and 
water tank installation.  The organization has rehabilitated 45 
boreholes in Mudzi District and plans to repair an additional 75 
boreholes, supplying community members with training and providing 
spare parts.  Oxfam has also trained nearly 1,600 community 
volunteers, 75 percent of which are women, in basic hygiene, cholera 
transmission routes and prevention, and basic sanitation.  The NGO's 
community outreach has supported 18 drama groups and 396 awareness 
sessions.  Community volunteers have conducted more than 25,000 
household visits, distributing information, education, and 
communication (IEC) materials. 
 
¶8. USAID/OFDA staff have met frequently with Oxfam/GB and conducted 
visits to hygiene supply distributions in high-density areas in 
Kadoma, Norton, Bulawayo, and Harare.  In each case, USAID/OFDA 
staff noted that the NGO and local partners had recruited volunteers 
from the affected areas to carry out distributions, as well as 
house-to-house hygiene education.  USAID/OFDA staff also attended 
refresher training for community volunteers, participated in one of 
the daily district-level coordination meetings between Oxfam and 
local government, and questioned an informal focus group of 
beneficiaries from a hygiene supplies distribution.  The 
beneficiaries demonstrated a good knowledge of cholera prevention 
and identified issues including a lack of adequate waste collection 
Qand identified issues including a lack of adequate waste collection 
and poor drainage at the local water point.  The USAID/OFDA WASH 
specialist also assessed a number of rural boreholes recently 
rehabilitated by the NGO in Mudzi District. 
 
¶9. USAID/OFDA is also providing approximately USD2.8 million to six 
additional humanitarian partners for WASH interventions including 
PHHE, provision of safe drinking water, social mobilization, 
targeted sewer repairs, and the procurement and distribution of 
hygiene supplies to encourage household point-of-use water 
treatment.  The organizations will target cholera-affected districts 
in nine of the country's ten provinces, including high-density 
suburbs in Harare and Bulawayo, as well as mobile and vulnerable 
populations countrywide.  To date, USAID/OFDA staff have conducted 
monitoring visits of two Harare-area hygiene supplies distributions. 
 Both distributions were well organized, with prior registration of 
beneficiaries, nd included a review of proper hygiene practices and 
cholera prevention before each distribution took place. 
 
HARARE 00000331  003.2 OF 004 
 
 
 
---------------------------------------- 
USAID/OFDA-FUNDED CLUSTER COORDINATION 
---------------------------------------- 
 
¶10. USAID/OFDA provided approximately USD920,000 to UNICEF for WASH 
cluster coordination, the procurement of hygiene commodities, and 
PHHE.  The WASH cluster has improved data collection and 
dissemination, particularly through the deployment of a UNICEF 
information management officer funded by USAID/OFDA. 
 
¶11. To improve health cluster coordination, USAID/OFDA is providing 
USD750,000 to WHO, primarily to support the national cholera 
command-and-control center.  USAID/OFDA support of the 
command-and-control center has resulted in improved epidemiological 
reporting, case management training, early warning mechanisms, and 
rapid response to new cholera alerts. 
 
----------------------------------- 
USAID/OFDA-FUNDED HYGIENE SUPPLIES 
----------------------------------- 
 
¶12. Beginning January 12, 400 metric tons, or nearly 440,000 bars, 
of USAID/OFDA-procured soap began arriving at the UNICEF warehouse 
in Harare.  The soap, identified by UNICEF as a gap in needed 
hygiene supplies, was provided to humanitarian organizations 
conducting hygiene commodities distributions.  USAID/OFDA also 
funded UNICEF to procure 10 million water treatment tablets, 30,000 
water containers, and 30,000 buckets. 
 
--------------------------- 
USAID/OFDA REGIONAL SUPPORT 
--------------------------- 
 
¶13. Recognizing the trans-border impact of the cholera outbreak, 
USAID/OFDA provided approximately USD400,000 to the International 
Organization for Migration (IOM) in South Africa for WASH activities 
primarily targeting vulnerable populations.  The WASH interventions 
will focus on Limpopo Province, which as of March 16 accounted for 
approximately 43 percent of the more than 12,500 cholera cases 
reported in South Africa. 
 
----------------------------- 
USAID/DART CLOSE OUT STRATEGY 
----------------------------- 
 
¶14. On April 3, the USAID/DART determined, in consultation with 
USAID/OFDA, that conditions had been met for USAID/DART to close out 
operations.  The USAID/DART has ascertained that humanitarian 
organizations have continued to improve overall coordination and 
information management, case management capacity, and 
epidemiological analysis.  The cholera response is likely to 
continue until the end of the rainy season in April.  USAID/OFDA 
staff based in Harare will continue to monitor the cholera response, 
as well as ongoing complex emergency programming.  Cholera 
prevention interventions will be strengthened through complementary 
WASH interventions through ongoing complex emergency programming. 
 
¶15. USAID/OFDA's priority is the continuing provision of WASH 
support to vulnerable populations, both as part of the cholera 
response and to prevent future diarrheal disease outbreaks. 
USAID/OFDA provided more than USD4 million in WASH interventions in 
FY 2008 prior to the cholera outbreak. 
 
¶16. A USAID/OFDA-funded WASH program implemented by an NGO partner 
in the city of Bulawayo was initiated in 2007 in response to water 
Qin the city of Bulawayo was initiated in 2007 in response to water 
shortages and a diahheral disease outbreak in the city.  Prior to 
the cholera outbreak, the organization initiated WASH activities 
such as the installation of community water tanks, hygiene 
education, and hygiene supplies distributions, which may have 
contributed to the exceptionally low rate of cholera in Bulawayo 
during the current outbreak.  As of April 2, WHO reported a total of 
443 cholera cases in Bulawayo, Zimbabwe's second largest city.  In 
 
HARARE 00000331  004.2 OF 004 
 
 
contrast, Harare and nearby suburbs have accounted for more than 
18,000 cholera cases to date. 
 
¶17. USAID/OFDA staff will continue to monitor the cholera response 
through ongoing discussions with partners, attending coordination 
meetings, and requesting future TDY WASH technical assistance to 
monitor the effectiveness of WASH interventions.  USAID/OFDA-funded 
emergency interventions will help increase household-level coping 
mechanisms, both in the context of the current cholera outbreak and 
in the event of a future outbreak, complementing USAID/OFDA's 
longer-term complex emergency WASH programming. 
 
------------ 
APPRECIATION 
------------ 
 
¶18. The USAID/DART wishes to express appreciation for the 
exceptional support received from the U.S. Embassy in Harare and 
USAID/Zimbabwe.  The USG response to the cholera outbreak has helped 
to save lives among the affected populations.  By providing 
impartial, independent humanitarian assistance through 
assessment-based interventions that ensure an equitable and 
transparent distribution of assistance, the USG has demonstrated the 
concern and compassion of the American people for the citizens of 
Zimbabwe. 
 
MCGEE