Main findings

Food Consumption: globally satisfactory except in the Lake Chad basin and in certain pockets of Niger, Mali and Senegal

Livelihood Change: livelihoods assets and strategies are sustainable and protected, nonetheless they remain eroded in conflict areas in the Lake Chad Basin, the north of Mali, and in the Liptako Gourma neighboring areas (Burkina Faso-Mali, Niger)

Nutritional situation: remains worrying in general following GAM rates above the crisis threshold in many regions in Mali, Niger, Nigeria, Chad and in Burkina Faso, and above the emergency threshold in Chad and in North-East Nigeria Mortality Mortality data for children under 5 years-old in the 3 North-East Nigeria States are very worrying and call for an immediate response.

Highlights

• 10% increase in cereal production compared to last year confirmed in West Africa. Third consecutive year of favourable production conditions.

• Restrictive exchange rates development of regional economies such as Liberia, Ghana and Nigeria affecting trade patterns in the region

• Difficult macro-economic conditions affecting commercial activities in Chad despite positive agricultural performances

• Drop of world cocoa prices has diminished export and budgetary revenues in Côte d’Ivoire

Author
Eric Osoro
Medical Epidemiologist , Washington State University

It’s 18 months since Sierra Leone was declared Ebola free after a two-year outbreak that left 4,000 people dead.

While the outbreak might be over, its effects will persist for many years. In the small nation with a population of just 7 million many lost relatives and friends to the disease. And its economy which was growing rapidly before the outbreak was devastated.

It will take time for Sierra Leone to rebuild. But there are valuable lessons learnt from the outbreak. The importance of engaging communities in outbreak response is one of the most important. The country’s commitment to public health awareness about the disease was critical in disease prevention and control. This was seen in the active participation of ordinary citizens in reporting the suspected cases.

The public health response to the outbreak was structured in three phases. In the first the government increased the treatment beds and encouraged behaviour changes like handwashing to prevent the spread of the disease.

In the second phase health workers engaged and worked in communities to identify infected people and those in close contact with them. Communicating with the community groups built trust and confidence in the response efforts.

In the third phase, the focus was on accurately defining and rapidly eliminating all new chains of Ebola transmission while restoring health services to normal.

I was a member of the response team as a consultant epidemiologist with the World Health Organisation during the third phase using my training on surveillance for diseases and management of outbreaks. We needed to address complex challenges such as the coordination of many actors in health and the way the disease was spreading through the community.

The field work

We had an immense task. Together with the local health teams, we established a monitoring system to detect infected people early and provide them with an effective response. Our daily routine included reviewing the number of cases reported, assessing the investigations and conducting field visits.

We also needed to ensure that hospitals’ health systems functioned normally. While Ebola was the most serious disease around, there were also cases of other common diseases such as malaria and pneumonia that also needed attention.

And we needed to implement a stronger surveillance system which would provide information on priority public health events like outbreaks as soon as they were detected. The Ebola outbreak had “surprised”, devastated and collapsed the health system. We wanted to avoid a repeat.

The outbreak was unanticipated and its magnitude overwhelming. In the initial phases, infection spread, killing many health workers which led to the closure of health facilities.

The power of public health education

With health facilities closed, communities were pushed to the forefront of the Ebola outbreak response. They became first responders. The Ebola treatment centres were few and community members had to initially attend to infected people.

The key messages from health authorities was that Ebola was incurable and sick people therefore needed to be taken to treatment centres. The message was factual but the citizens interpreted it as a death sentence.

Most stayed with their infected loved ones at home, fuelling the spread further and more aggressively. The community’s participation and response to the disease needed to be refocused urgently. And a massive public health awareness was rolled out.

The message development and deployment closely engaged local leaders and stakeholders to learn and address what influenced people’s decisions and their resistance to following advice on Ebola prevention.

Through the campaign, the residents realised their power in ending Ebola. Simple infection prevention and control lessons such as washing hands with soap regularly and avoiding contact with people likely to be infected with Ebola were key.

They learnt Ebola related symptoms and this triggered proactive reporting of suspected cases through a toll free line.

The road to recovery

When the outbreak was officially declared over, the country moved to maintaining a no-outbreak status (zero Ebola cases). The health facilities and the affected communities were recovering from the effects of the outbreak.

During this time, there were fears that Ebola would re-emerge but the strong reporting collaborations between the health workers and the community members was commendable.

For example, one Sunday afternoon, we received a call of a sick person. This description required a rapid response. A team was activated and dispatched within an hour. By the time we arrived the person had died after bleeding from the mouth and nose. But there were crowds, anxious to know whether Ebola had comeback.

They had isolated the body and closed contact. We urgently delivered samples for testing and when the results returned negative the following morning, there was a sigh of relief.

This was a powerful demonstration of health promotion from communities.

The way forward

The Ebola outbreak in Sierra Leone reflects the challenges facing health systems at local, national and international levels. When the national health system is inaccessible and unresponsive to community needs, alternative solutions outside the health system are sought. This makes it more difficult to identify acute health problems.

In 2005, the World Health Assembly foresaw an outbreak whose magnitude was closer to the devastation caused by Ebola and adopted a code of conduct, International Health Regulations.

This international protocol was signed by about 200 countries and is aimed at preventing, protecting, controlling and providing a public health response to the international spread of disease. These minimum capacities were to be achieved by 2004, but less than 30 countries have fulfilled. None of these are from Africa.

The code is a relevant and critical mechanism to help countries work together to prevent the spread of diseases and other health risks. It’s evident that gaps in early detection and rapid response to a disease outbreak leads to a public health crisis.

An efficient disease surveillance system rapidly detects and reports public health events. Disease outbreak preparedness should be in place before an outbreak, information shared and resources adequately determined.

Finally, winning the trust and confidence of communities plays a central role in the rapid control of an outbreak – it saves lives.

http://theconversation.com/ebola-virus-response-experiences-and-lessons-from-sierra-leone-75931

Projected food assistance needs for October 2017

This brief summarizes FEWS NET’s most forward-looking analysis of projected emergency food assistance needs in FEWS NET coverage countries. The projected size of each country’s acutely food insecure population (IPC Phase 3 and higher) is compared to last year and the recent five-year average and categorized as Higher (p), Similar (u), or Lower (q). Countries where external emergency food assistance needs are anticipated are identified. Projected lean season months highlighted in red indicate either an early start or an extension to the typical lean season. Additional information is provided for countries with large food insecure populations, an expectation of high severity, or where other key issues warrant additional discussion. Analytical confidence is lower in remote monitoring countries, denoted by “RM”. Visit www.fews.net for detailed country reports.

WaPOR: database dissemination portal and APIs

The FAO portal to monitor Water Productivity through Open access of Remotely sensed derived data (WaPOR) monitors and reports on agriculture water productivity over Africa and the Near East.

It provides open access to the water productivity database and its thousands of underlying map layers, it allows for direct data queries, time series analyses, area statistics and data download of key variables associated to water and land productivity assessments.  

The portal’s services are directly accessible through dedicated FAO WaPOR APIs, which will eventually be also available through the FAO API store

Water productivity assessments and other computation–intensive calculations are powered by Google Earth Engine.

The first, beta release of WaPOR is available as of 14 April 2017. The beta release publishes Level 1 (continental, 250 m resolution) data from April 2009 to December 2016. WaPOR will be increasingly improved during the course of 2017 and beyond.

WaPOR roadmap

WaPOR: a tool to monitor water productiovity

Overview

• This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 42 events: three Grade 3, six Grade 2, two Grade 1, and 31 ungraded events.

• This week, two new events have been reported: monkeypox outbreaks in Sierra Leone and Central African Republic. In addition, two events have been graded: the acute watery diarrhoea/cholera outbreak and the humanitarian crisis in Ethiopia have been elevated to grade 3 emergency while the meningitis outbreak in Nigeria has been graded as level 2 emergency. The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crisis in South Sudan, the grade 2 cholera outbreak in Democratic Republic of Congo and the meningitis outbreak in Niger.

• For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

• A table is provided at the end of the report with information on all public health events currently being monitored in the region. Major challenges to be addressed include:

• Timely laboratory confirmation of disease outbreaks in order to implement appropriate control measures.

• The prompt availability of sufficient doses of vaccines in order to implement effective reactive vaccination campaigns.

Preparations are currently underway for a vast bed net distribution campaign in Sierra Leone. Planned for June this year, the campaign aims to distribute nearly 4.2 million insecticide-treated bed nets to households nationwide to protect its population of seven million people from malaria, which remains one of the country’s leading causes of death and illness.

Every year malaria infects thousands of Sierra Leoneans, with children and pregnant women especially vulnerable. A recent national survey shows that, despite high levels of awareness, malaria prevalence among young children is as high as 40 percent, with devastating impacts for families, communities and development.

“Malaria can be both prevented and treated, which makes every malaria-related death even more tragic,” says Janet Kayita, Essential Health Services Coordinator at the World Health Organization in Sierra Leone. “Insecticide treated bed nets are one of the most cost-effective ways of preventing the disease, and we need to work together with Government, partners and communities to ensure that families both have access to and are using the nets every night, everywhere, alongside early treatment seeking behavior at the very first signs of the infection.”

Christy Berewa is a nurse at the Under Five Clinic at Kenema Government Hospital in the east of the country, and regularly treats young children presenting with malaria – often at a late stage when they can be vulnerable to complications. “Although people know and talk about it in communities and among families, malaria regrettably still remains the most common complaint we receive here on a daily basis. Even more upsetting is the fact that the disease can be prevented and treated at no major cost, yet it still continues to kill so many children”.

Preventive measures such as improved sanitation, and continued and consistent use of the treated nets remain a key focus for malaria interventions. With the pending mass distribution of nets, the Ministry of Health and Sanitation is therefore working with local partners to prevent leakages and misuse of the nets and has recently embarked on a mass awareness campaign to this effect.

“Achieving the full impact of this large scale intervention requires everyone including Government, health professionals, partners, communities, families and individuals to ensure improved preventive measures and timely treatment,” said Dr Samuel Smith, Manager of the National Malaria Control Programme in the Ministry of Health and Sanitation.

Towards a commitment to reduce new cases of the disease by 40 percent by 2020, the national bed net distribution campaign is being led by the Ministry of Health and Sanitation and supported by a range of partners including the Global Fund, the UK Government, WHO and UNICEF, as well as community and civil society partners

Related links: Sierra Leone Malaria Indicator Survey 2016

Overview

This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 41 events: two Grade 3, six Grade 2, two Grade 1, and 31 ungraded events.

This week, one new event has been reported: an outbreak of hepatitis E in Niger.

The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crisis in South Sudan as well as outbreaks of Lassa fever in 5 West African countries, measles in Guinea, acute watery diarrhoea/cholera in Ethiopia, and the food insecurity crisis in the Horn of Africa.
For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

A table is provided at the end of the bulletin with information on all public health events currently being monitored in the region.

Major challenges to be addressed include:

• Cross border spread of diseases and the need to build and maintain strong collaboration and corporation among State Parties, in line with provisions of the International Health Regulations (IHR 2005).

• Deliberate investment in preparedness activities in order to strengthen disease surveillance for early detection, verification and response to public health events; and minimize their impacts.

New event

Hepatitis E
Niger
72 Cases 17 Deaths
24% CFR

Event description

The Niger Ministry of Health notified WHO on 12 April 2017 of an outbreak of hepatitis E in Diffa region located in the east of the country. The outbreak emerged on 09 January 2017 when clinicians at the Centre Mere-Enfant de Diffa started admitting pregnant women with acute jaundice syndrome. The initial case-patients presented with headaches, vomiting, fever, conjunctivitis, pelvic pain, and memory loss. The initial differential diagnosis was yellow fever, however, hepatitis E was later considered in light of the preponderance of pregnant mothers to the disease and the ongoing outbreak of hepatitis E in neighbouring Chad.

According to the Regional Director of Public Health in Diffa, 72 cases of acute jaundice syndrome including 17 deaths (case fatality rate of 23.6%) were reported by 10 April 2017. All 17 deaths occurred among pregnant mothers. Over 70% (52/72) of the case-patients and 100% of the deaths were reported from the Centre Mere-Enfant de Diffa while 20 case-patients and zero death came from Diffa district health care.

On 11 April 2017, the WHO Country Office in Niger relayed laboratory results from the Institut Pasteur Dakar (IPD). The results indicated that 14 samples obtained from the initial cases of acute jaundice syndrome in Diffa tested negative for yellow fever virus while 4 samples tested positive for hepatitis E virus. These results led to the formal declaration of hepatitis E outbreak by the Ministry of Health on 12 April 2017.

Detailed outbreak investigation and risk assessment are currently being conducted and the findings will be provided in the next bulletin.

Overview

This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 42 events: three Grade 3, six Grade 2, two Grade 1, and 31 ungraded events.

This week, two new events have been reported: monkeypox outbreaks in Sierra Leone and Central African Republic. In addition, two events have been graded: the acute watery diarrhoea/cholera outbreak and the humanitarian crisis in Ethiopia have been elevated to grade 3 emergency while the meningitis outbreak in Nigeria has been graded as level 2 emergency. The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crisis in South Sudan, the grade 2 cholera outbreak in Democratic Republic of Congo and the meningitis outbreak in Niger.
For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

A table is provided at the end of the report with information on all public health events currently being monitored in the region.

Major challenges to be addressed include:

• Timely laboratory confirmation of disease outbreaks in order to implement appropriate control measures.

• The prompt availability of sufficient doses of vaccines in order to implement effective reactive vaccination campaigns.

New events

Monkeypox
Sierra Leone
1 Cases
0 Deaths
0% CFR

Event description

A single case of monkeypox has been confirmed in Pujehun district in the southern region of Sierra Leone. The putative index case, a 35-year old peasant farmer from Kpaku village, Galliness Perri chiefdom, Pujehun district, developed ill-health on 14 March 2017. He presented to a local health facility on 16 March 2017 with fever, body pains, malaise, dysphagia, and enlarged cervical lymph nodes; and was presumptively treated for malaria and sore throat as an out-patient. On 17 March 2017, he developed generalized vesicular skin eruptions in addition to the initial constitutional clinical features. The case-patient was admitted to Pujehun district hospital on 25 March 2017. Biological samples including blood and vesicular swabs were collected on 28 March 2017 and shipped to the National Reference Laboratory in Freetown. The samples were then transported to the Institut National de Recherche Biomedicale (INRB) in Kinshasha, the Democratic Republic of Congo. Laboratory results from INRB relayed on 17 April 2017 to Sierra Leone indicated that the vesicular swab tested positive for Orthopox virus by polymerase chain reaction (PCR) assay and monkeypox virus by GeneXpert technique. Based on these results, the Sierra Leone Ministry of Health notified WHO on 17 April 2017 of the outbreak of monkeypox. Part of the samples have been shipped to the Centres for Diseases Control and Prevention (CDC) in Atlanta, United States for further analysis.
Thirteen close contacts to the index case were listed and are being followed up. None of them have developed any febrile illness and/or skin lesions in the first 21 days since the last exposure.
The contacts are still being monitored for additional 21 days (twice the maximum incubation period of monkeypox). No other significant exposure risks have been identified except for the fact that the index case, being an occasional hunter, caught a squirrel (a known vector of the monkeypox virus) in the preceding days of his illness for domestic consumption.

West Africa can be divided into three agro-ecological zones or three different trade basins (West Basin, Central Basin and East Basin). Both important for understanding market behavior and dynamics.
The three major agro-ecological zones are the Sahelian, the Sudanese and the Coastal zones where production and consumption can be easily classified. (1) In the Sahelian zone, millet is the principal cereal cultivated and consumed particularly in rural areas and increasingly, when accessible, in urban areas. Exceptions include Cape Verde where maize and rice are most important, Mauritania where sorghum and maize are staples, and Senegal with rice. The principal substitutes in the Sahel are sorghum, rice, and cassava flour (Gari), the latter two in times of shortage. (2) In the Sudanese zone (southern Chad, central Nigeria, Benin, Ghana, Togo, Côte d'Ivoire, southern Burkina Faso, Mali, Senegal,
Guinea Bissau, Serra Leone, Liberia) maize and sorghum constitute the principal cereals consumed by the majority of the population. They are followed by rice and tubers, particularly cassava and yam. (3) In the Coastal zone, with two rainy seasons, yam and maize constitute the most important food products. They are supplemented by cowpea, which is a significant source of protein.
The three trade basins are known as the West, Central, and East basins. In addition to the north to south movement of particular commodities, certain cereals flow horizontally. (1) The West basin refers to Mauritania, Senegal, western Mali,
Sierra Leone, Guinea, Liberia, and The Gambia where rice is most heavily traded. (2) The Central basin consists of Côte d'Ivoire, central and eastern Mali, Burkina Faso, Ghana, and Togo where maize is commonly traded. (3) The East basin refers to Niger, Nigeria, Chad, and Benin where millet is traded most frequently. These three trade basins are shown on the map above.

Overview

This weekly bulletin focuses on selected public health emergencies occurring in the WHO African region. WHO AFRO is currently monitoring 44 events: three Grade 3, six Grade 2, two Grade 1, and 33 ungraded events.

This week, two new events have been reported: a cluster of acute illness and sudden deaths of an unknown aetiology in Liberia and outbreak of anthrax in Zimbabwe. The bulletin also focuses on key ongoing events in the region, including the grade 3 humanitarian crises in Nigeria and South Sudan, the grade 2 outbreaks of meningitis in Nigeria and necrotising cellulitis/fasciitis in Sao Tome and Principe, hepatitis E outbreak in Niger, and the food insecurity crisis in the Horn of Africa.
For each of these events, a brief description followed by public health measures implemented and an interpretation of the situation is provided.

A table is provided at the end of the report with information on all public health events currently being monitored in the region.

Major challenges to be addressed include:

• The capacity to undertake rapid analytical epidemiology studies as well as appropriate laboratory testing including toxicology in a timely manner in order to determine the aetiology of unknown events.

• The practical operationalization of the ‘One Health’ concept to all levels of the health system including communities in order to prevent avoidable morbidity and deaths linked to zoonosis.

New events

Cluster of undiagnosed illness and deaths Liberia

20 Cases
11 Deaths
55.0% CFR

Event description

On 25 April 2017, the Liberia Ministry of Health notified WHO of a cluster of acute illness and sudden deaths due to an unknown aetiology in Sinoe county located in the southern region. The event, linked to a funeral function, started on 23 April 2017 when the index case, an 11 year old girl from Teah town, Greenville district developed an acute onset illness. She presented to FJ Grante hospital with diarrhoea, vomiting and mental confusion; and died within one hour of admission. The following day (24 April 2017), the second case-patient, a 51 year old woman from Teah town, Greenville developed sudden onset of vomiting, abdominal pain and confusion.

She was admitted to FJ Grante hospital on 25 April 2017 and died the same day. On 25 April 2017 (the third day), a cluster of 13 case-patients from 5 communities in Greenville [Teah town - 6 cases,
Congo town – 3 cases, Red hill - 2, Down town - 1, and Johnstone street - 1] developed similar acute onset illness. Seven out of the 13 case-patients died the same day on 25 April 2017.

Between 23 and 27 April 2017, 20 case-patients presenting with similar illness were line-listed, 11 of those died, giving a case fatality rate of 55%. Over 80% (9/11) of the deaths occurred within the first 3 days (between 23 and 25 April 2017). Forty-two percent of the cases manifested with headache, 37% had vomiting, 27% had confusion, and 26% had abdominal pain and body weakness. Ninety five percent (19/20) of the cases came from Sinoe county. The first case outside Sinoe county (but linked to the funeral) occurred on 27 April 2017 in Montserrado county. Ten of the deaths took place in Sinoe and one in Montserrado. By 28 April 2017, 5 case-patients were admitted in F.J. Grant hospital in stable clinical condition. Fifty two close contacts have been listed and are being followed up on a daily basis for signs and symptoms of the illness.

A total of 20 biological specimens were collected: 7 oral swabs, 7 whole blood, 3 urine, 2 cardiac fluid, and 1 rectal swab. Of these, the 7 oral swabs, 6 whole blood and 2 cardiac fluid tested negative for Ebola virus. One whole blood sample is still being tested for Ebola virus.
Chemistry analysis on 3 urine specimens has not yielded any significant results. Further laboratory investigations for the pathogens including toxicological testing are ongoing. The first set of 11 samples have been shipped to Atlanta, United States. Another set of samples is being shipped to the WHO Reference Laboratory in South Africa.

Over 95% of the line-listed cases participated in at least one aspect of the funeral rites of the religious leader who reportedly died of a known cause. The aspects of the funeral activities include burial, “repass” and “wake keeping”.

Public health actions

• The national and county epidemic preparedness and response committees have been reactivated to coordinate response to the event.

• A multi-disciplinary national rapid response team has been deployed to Sinoe to conduct detailed outbreak investigation and support lower level outbreak response.

• Active case search has been initiated in the affected and surrounding communities. Outbreak case definition has been developed to facilitate active case search among those who attended the funeral functions and others. Investigation and compilation of line list of all cases including systematic identification of contacts are ongoing.

• Case management of patients currently admitted at the F.J. Grante Hospital is ongoing • County level advocacy meetings and community engagement have been conducted. The county health team has also embarked on mass public awareness.

• Infection prevention and control interventions have been re-enforced including hand hygiene practices, water points testing and safe burials.

Situation interpretation

An alarming and a rapidly evolving situation unfolded in Liberia, understandably so, coming in the aftermath of the Ebola virus disease outbreak.

While the dreaded Ebola virus disease has been ruled out in this event, there is still an urgent need to establish the ultimate aetiology of this cluster of acute illness and sudden deaths. The dramatic evolution of the event with very short course of illness and sudden death, and the clustering of the cases is indicative of a common source exposure to the pathogenic agent. All indications are pointing at the funeral functions of the religious leader. The likelihood of foods, drinks or water poisoning is high and the ongoing toxicology testing will be very critical to provide some answers. The overall risk of spread of the event is lowering with the sharp decline in the number of cases and deaths reported. No new cases and/or death have been reported since 28 April 2017.

The Ministry of Health has requested WHO and CDC to expedite the process of toxicological testing outside the country. WHO is currently supporting the deployment of an experienced pathologist to do autopsy on one dead body that is preserved.

The Government of Liberia and the Ministry of Health is being commended for the swift and effective response to this event, including the early detection and rapid deployment of response teams. The strong collaboration between WHO, CDC and the other partners in dealing with this event should set precedence for future response.

Key Messages
- Between Feb 7 and March 18, a series of joint market assessments were conducted across West Africa. These annual assessments were carried out under CILSS leadership, with active participation by FEWS NET, WFP, FAO, national Ministries of Agriculture and Market Information Systems. The findings from these assessments are key inputs to this report, which provides an update to the assumptions and analysis outlined in the West Africa Regional Supply and Market Outlook report published in December 2016. Some of the results were also presented at the March 2017 PREGEC meeting.
- At the regional level, production is above-average, driven by a third consecutive year of favorable production conditions in key surplus-producing areas and a large supply response in Nigeria to favorable production and marketing conditions (high prices and government support programs). There are nevertheless localized instances of below-average production within Niger, Mali, and Burkina Faso (due to erratic rainfall) and northeastern Nigeria (due to protracted conflict and displacement).
- As anticipated in December, major market anomalies in the region are driven by the direct and indirect impacts of macroeconomic shocks and conflict and are mostly concentrated in or emanating from dynamics in the eastern basin. National-level anomalies in Nigeria and Chad are both linked to low oil export revenues, which have reduced government and private sector spending and access to foreign reserves for essential imports. Demand in both countries is down due to lower purchasing power.
- In the Eastern Basin, the ongoing market disruptions in the northeast or Nigeria are driven by the protracted conflict (and related displacement). Nationally, macroeconomic conditions have resulted in relatively high local nominal prices, while export parity prices are relatively low. These trends are expected to persist in the short to medium term. In areas of Niger bordering Nigeria, prices have increased compared to 2016 due to local deficits and supply disruptions around Maradi and Zinder. This has led to increased reliance on imports from Nigeria at this point in the marketing year (usually this demand is stronger during the lean season) and higher prices in these key markets. In Chad, market activities are expected to remain below average, resulting in lower food prices.
- In the Central Basin market supplies are adequate, but trader restocking is at below average levels due to good household stocks. Households and traders are retaining stocks in anticipation of higher prices later in the year. By and large in the basin, prices are stable or below average, except in Ghana. Trade flows are below average for this time of year due to (1) adequate grain supply in importing countries and (2) reduced livestock demand from Nigeria (there are even instances of trade flow reversals, with Nigerian livestock traded in Burkina Faso and Ghana, which is atypical).

At the conference on, “Scaling-Up the Purchase for Progress (P4P) Model of Pro-Smallholder Market Development in Africa: The Vital Role and Impact of the Public Sector,” hosted by the African Economic Research Consortium (AERC) and the United Nations World Food Programme (WFP) in Nairobi, Kenya on 10-11 April, 2017, senior African policy makers and key stakeholders from the private sector, civil society, and wider development community adopted this declaration as an affirmation of their strong commitment to scaling up the demand-led model of support to smallholder farmers piloted in 15 African countries under the Purchase for Progress (P4P) initiative.

Declaration, Nairobi, April 11, 2017

We African senior policy makers and stakeholders at the conference on Scaling-Up the Purchase for Progress (P4P) Model of Pro-Smallholder Market Development in Africa: The Vital Role and Impact of the Public Sector, Acknowledging the desire set out in Africa’s Agenda 2063 for shared prosperity and well-being, for unity and integration, for a continent of free citizens and expanded horizons, where the full potential of women, youth, differently-abled persons, boys and girls are realized, and with freedom from fear, disease and want;

Embracing the vision articulated in the Malabo Declaration on Accelerated Agricultural Growth and Transformation for Shared Prosperity and Improved Livelihoods of a modern and productive agricultural sector in Africa driven by science, technology, innovation and indigenous knowledge;

Affirming the goal of a world free of hunger set out in Sustainable Development Goal 2 to End Hunger, Achieve Food Security and Improved Nutrition, and Promote Sustainable Agriculture;

Appreciating the African Development Bank’s Feed Africa Strategy and in particular the clear intention to build on existing successful efforts, bringing them to scale, while enhancing the capacity of key public and private actors;

Noting that recent rapid growth in many parts of Africa has not been sufficiently inclusive, with many people – especially women and youth – at risk of being left behind;

Recognizing that because agriculture will continue to underpin a majority of African livelihoods in the coming decades, inclusive growth in Africa cannot be achieved without a fundamental transformation of African agriculture – a transformation that must itself be inclusive;

Further recognizing that because smallholder farmers will continue to dominate African agriculture long into the future, a central challenge facing policy makers in Africa today is how to promote inclusive and self-sustaining processes of growth fueled by technological advances in smallholder agricultural production and trade;

Comprehending the large body of evidence generated by researchers in Africa and beyond showing that deeper market participation and engagement by smallholders are vital to agricultural transformation, but that such participation and engagement are constrained by a range of structural factors inherent to smallholder systems – e.g., the wide spatial dispersion of farms, lack of on-farm storage capacity, high risk, and thin and unstable input and output markets;

Noting that policy environments can combine with these structural conditions to generate behavior by smallholders that while economically rational, militates against deep and productive market engagement;

Recognizing that numerous promising initiatives in market-based smallholder-led agricultural development have been implemented across the continent, but few have been scaled-up;

Confirming the demand-led P4P approach as one such promising initiative that has been embraced by several governments across the continent;

Further confirming the relevance and effectiveness of the four components that underpin the P4P approach: (1) consistent demand for quality food (where quality relates mainly to food safety but can also include nutrition considerations); (2) targeted capacity strengthening of smallholders, typically through farmer organizations; (3) coordination and linkage support for providers of key supply chain services such as input, finance, and aggregation; and (4) an enabling policy and institutional environment;

Endorsing the gender transformative dimensions of the P4P approach that have delivered significant gains for hundreds of thousands of women farmers;

Acknowledging the rapidly expanding opportunities to use digital platforms to spur inclusive innovation across agricultural value chains, especially by spreading knowledge, boosting skills, improving monitoring and evaluation, and enhancing access to credit and financial services at scale;

Recognizing that strong Government ownership and engagement are critical to the success of the P4P approach, and that recent estimates suggest large and growing demand for quality food by a range of public programmes across Africa including schools, hospitals, prisons, and militaries; and

Appreciating the commitment in the Declaration by Senior Policy Makers at the AERC Senior Policy Seminar held in Maputo, Mozambique on 26-27 March, 2015 to undertake consultations within our own Governments to explore scope for employing pro-smallholder demand-led approaches within public food procurement programs, thereby promoting inclusive and sustainable growth and broader transformation;

1. Affirm that smallholders lie not only at the centre of Africa’s agricultural transformation agenda, but also at the core of the continent’s inclusive social and economic transformation agenda;

2. Commend the efforts of the 15 African governments that facilitated, supported, and successfully implemented P4P-inspired programmes and integrated them into national agricultural development strategies and food reserve systems;

3. Encourage these 15 governments to deepen and scale up these efforts;

4. Applaud the critical role of the African Economic Research Consortium (AERC) and its partner institutions, in capacity building for promoting evidence based policies and generating the knowledge basis for decision making to promote inclusive and sustainable agricultural transformation and broader social and economic transformation;

5. Appeal to African governments to boost investment in African institutions devoted to knowledge generation, capacity building, and policy dialogue to support scaling up of the P4P model of smallholder development and support;

6. Urge the World Food Programme to continue to support design and implementation of the P4P model in Africa, based on rigorous technical guidance material, emphasizing scaled-up efforts that adhere to the principles and priorities identified in this conference, including leveraged public sector procurement; and 7. Collectively commit to undertake consultations and planning within our own Governments and organizations to translate the Scaling-up Roadmaps developed at this conference into concrete Action Plans with the elements agreed, including, where appropriate, employing pro-smallholder demand-led approaches within public food procurement programs, thereby promoting inclusive and sustainable growth and broader transformation.

African countries represented at the meeting included: Burkina Faso, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Liberia, Rwanda, Sierra Leone, South Sudan, Tanzania, Uganda, and Zimbabwe.
Other countries represented at the meeting included: Belgium, Canada, China, France, and Russian Federation.
Organizations represented at the meeting included: ACDI/VOCA, African Development Bank, African Economic Research Consortium, African Center for Technology Policy Studies, Bank of Uganda, Bank of Ghana, Bill and Melinda Gates Foundation, Central Bank of Kenya, Citibank, HarvestPlus, International Center for Biosaline Agriculture, International Center for Tropical Agriculture, International Fund for Agricultural Development, Kenya Institute of Public Policy Research and Analysis, Mfarm, UN Food and Agriculture Organization, UN World Food Programme, Reserve Bank of Zimbabwe, Syngenta, University of Cape Town, University of Malawi.

Executive Summary

The West African Ebola Virus Disease (EVD) outbreak in 2014/15 posed a number of urban-specific challenges to humanitarians responding to the crisis. One of these related to controlling the rapid spread of the disease across the urban landscape. Guinea, Liberia and Sierra Leone used quarantine at various points, which was by and large ill received, particularly in urban centres. This paper focuses specifically on the use of quarantine in urban environments during the humanitarian response to the Ebola Crisis.

As part of ALNAP’s broader Ebola in Cities series, this paper identifies the following key messages to take forward into future public health crises in urban environments:

• Quarantine is a controversial and debated issue. While it has been used effectively to contain the spread of infectious disease, there are also significant risks related to human rights, creating fear and confusion as well as psychological impacts.

• International human rights law requires that quarantines, which restrict human rights in the name of public health or public emergency, meet certain requirements as laid out in the Siracusa Principle (Oxfam, 2014; Silva and Smith, 2015).

• Quarantine should be used as a last resort and, if possible, should be implemented in a partial and voluntary manner to minimise impacts on quarantined persons (CDC, 2014).

• Quarantine was used in a number of ways throughout the response in Guinea, Liberia and Sierra Leone. At times, entire areas were under quarantine, though often quarantine was applied just to individual households.

• Quarantines in urban areas are complicated by the size and density of their populations.

• Highly mobile populations make managing and enforcing quarantine more complex.

• Large-scale quarantines result in equally large waste disposal needs and other water, sanitation and hygiene (WASH) vulnerabilities.

• In a context where quarantine has been ordered, humanitarians have a role to address the basic needs of populations, including for food, water, hygiene items and information.

• Humanitarians also have a role in supporting the rights of quarantined people by monitoring the context, advocating for rights and reporting any violations of the Siracusa Principles.

Executive Summary

Population mobility is a critical area of concern in any infectious disease crisis, and particularly in those spread through human-to-human contact, such as Ebola. During the West African Ebola Virus Disease (EVD) outbreak in 2014/15, population mobility within and between urban and rural areas became a key challenge for humanitarian response. Despite restrictions at border crossings, attempts to control population mobility proved largely unsuccessful. This paper explores the urban dimensions of population mobility, including forces for and drivers of mobility as well as the implications for humanitarian response.

As part of ALNAP's Learning from the Ebola response in cities project, this paper identifies the following key messages to take forward into future public health crises in urban environments:

• Urban spaces see a high number of anonymous, untraceable interactions every day, and it is easy for people to disappear. This problematises contact tracing and surveillance efforts.

• People move across porous and fluid national and urban borders quickly and easily.

• The drivers of population movement are diverse, encompassing labour, livelihoods, social and familiar connections, cultural activity, legal differentiation and fear. Research about the drivers and motivations behind population mobility in urban areas could enhance future public health responses.

• The success of small-scale community-level surveillance and self-reporting suggests this may be a more effective area towards which to direct efforts. As such, we should pay more attention to ways of incorporating communities in surveillance and encouraging self-monitoring behaviour.

General Situation during April 2017

Forecast until mid-June 2017

The Desert Locust situation was calm during April due to poor rainfall and ecological conditions throughout most of the spring breeding areas in northwest Africa and the Arabian Peninsula. Low numbers of solitarious adults were present in Mauritania, Morocco, Algeria, Egypt and Iran. The situation continued to remain unclear in Yemen where surveys could not be conducted. During the forecast period, small-scale breeding could occur in parts of the interior in Saudi Arabia and Yemen, and in a few places in northeast Morocco, central Algeria and southeast Iran. Although this may cause locust numbers to increase slightly, they will remain below threatening levels and no signifi cant developments are likely.

Western Region.

The situation remained calm in the region during April. Low numbers of adults were present in parts of northern Mauritania, Western Sahara and northeast Morocco, and in central Algeria. Limited breeding occurred near irrigated farms in the central Sahara of Algeria where small-scale ground control operations were undertaken. A lack of rainfall and poor ecological conditions will severely reduce spring breeding this year. Consequently, no signifi cant developments are likely. In Mauritania, low numbers of adults will gradually move south towards summer breeding areas in the southeast.

Central Region.

The locust situation remained calm as no locusts were reported in the region during April except for isolated adults in southeast Egypt.

Nevertheless, ecological conditions were favourable in parts of the interior of Saudi Arabia and Yemen where small-scale breeding could occur during the forecast period and cause locust numbers to increase slightly.

Both countries should stay alert because the situation continues to remain unclear in Yemen as surveys cannot be carried out. Elsewhere, no signifi cant developments are likely.

Eastern Region.

Scattered adults were present in southeast Iran where small-scale breeding is likely to occur during the forecast period. No locusts were present in adjacent areas of southwest Pakistan where conditions remained dry and unfavourable for breeding. No signifi cant developments are likely.

Zero Ebola-related fatalities documented among the 59,000 sponsored children and family members supported by World Vision during the outbreak.

Summary

The unprecedented Ebola Virus Disease (EVD) outbreak in West Africa was first reported in Sierra Leone in March 2014 and rapidly spread as the response to the crisis failed, revealing the faults of the region’s chronically fractured and under-resourced healthcare system. However, a review of district level EVD records indicated that no Ebola-related deaths were documented among the 59,000 World Vision-supported sponsored children and their family members. World Vision, Inc. commissioned Johns Hopkins University Bloomberg School of Public Health to determine the effectiveness of specific strategies employed by World Vision in order to increase the evidence of what works in responding to similar disease outbreaks. The study also explored differences between households containing children sponsored by World Vision that had a documented case of Ebola and households without a case of Ebola.

EVD in Sierra Leone

Sierra Leone’s fragile healthcare system is a result of a civil war that ended in 2002, which severely damaged the health infrastructure and created a cohort of young adults with little or no education. Consequently, there was a severe shortage of healthcare workers as well as weak transportation infrastructure, making it difficult to transport samples to laboratories and patients to health centers. In August 2014, the World Health Organization (WHO) declared the EVD outbreak a “public health emergency of international concern.” Due to a lack of early warning systems, Ebola spread rapidly and the country’s health system lacked the capacity to address the overwhelming number of cases.
Studies demonstrated the critical role of isolation of Ebola patients and safe burials in controlling spread of the disease. But initially approaches, particularly quarantine and body collection, were designed with lack of bottom-up community engagement, and were therefore ineffective. Designed and implemented without buy-in and input from community leaders, they failed to address key infrastructure constraints and were culturally insensitive. This resulted in general distrust among community members, and, ultimately, underutilization, and underuse of these interventions. By March 2016, WHO had documented a total of 14,124 cases of Ebola, including 3,955 deaths, in Sierra Leone— more than any other country.