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Global Review of Water, Sanitation and Hygiene (WASH) Components in Rapid Response Mechanisms and Rapid Response Teams in Cholera Outbreak Settings

In recent outbreak settings, the use of rapid response teams (RRTs) to support the WASH sector has increased.
RRTs have been used as part of the response to cholera outbreaks in countries such as Haiti, Yemen, Somalia, South Sudan and the Democratic Republic of the Congo, with the scope of these teams varying widely. As the presence of RRTs becomes more common in outbreak settings, it is important to better understand and document the different types of models in use.

UNICEF’s WASH in Emergencies (WiE) team has conducted a global review of the WASH components of the different types of RRT models based on four country settings: Haiti, Nigeria, South Sudan and Yemen. The review used a mixed-methods approach that included qualitative and quantitative data-collection methods. A review of secondary data of published and grey literature was conducted, including 80 relevant documents from the countries in question. In addition, 28 in-depth key informant interviews were conducted with internal and external stakeholders, including partners in government and non-governmental organizations (NGOs). The review explored operational and performance aspects related to RRTs, along with challenges faced, best practice and lessons learned.

The review demonstrates that the RRT model is an indispensable mechanism for supporting cholera response and prevention activities in the different countries in which it has been used. Through the systematic use of surveillance systems and available epidemiological data, RRTs target affected households and at-risk populations in the community. Through early detection at the beginning of an outbreak and the prompt use of RRTs play a critical role in avoiding further spread of the disease. The RRT model is evidence-based and provides an integrated and harmonized package that specifically targets pathways for cholera transmission. It is essential to reducing the spread of cholera and the risks to affected and at-risk populations. RRT interventions provide an immediate and timely response, with the potential to reduce and/or ‘slow down’ transmission. The knowledge gaps associated with measuring the effectiveness and impact of RRTs are recognized as an area for future action.

The RRT model is embedded in a comprehensive alert-response strategy that includes multiple layers of engagement with households, communities and healthcare facilities, providing a wide range of complementary actions to support the control and prevention of cholera transmission. The RRT model can be sustained when it is incorporated and supported by national control and elimination programs that focus on broader public health measures, such as community-based initiatives, with support and leadership from national authorities.

To support the replication of RRT models, the development of an operational guideline for different settings and contexts is strongly recommended. This should include tools and resources to support design, implementation, training and capacity-building, data collection, analysis and reporting, and monitoring and evaluation (M&E). Priority operational recommendations highlight the importance that coordination, surveillance, response, and M&E play in creating an enabling environment for the RRTs. The most significant factors are summarized in the main body of the report (see Table 7), and include:

• Interest and willingness among national and local authorities is required to ensure an effective response and facilitates systematic adherence to the comprehensive alert-response strategy, further reinforcing information- sharing, coordination and accountability.

• Strong coordination between stakeholders, including national and local level authorities, coordination mechanisms, such as the Health and WASH Cluster, and community leaders, facilitates timely information management and sharing.

• Strong information management, including a robust surveillance system and timely sharing of epidemiological data, based on a well-defined alert system to support the activation and deployment of teams.

• Early detection at the beginning of an outbreak and prompt use of RRTs plays a critical role in avoiding further spread of the disease, and is further reinforced through the support and leadership of national authorities.

• Availability of well-trained personnel in multi-sectoral teams, that include health, WASH and communication for development (C4D), with the flexibility to increase or decrease resources in response to cholera incidence and to remain agile in reacting to the ‘moving target’ of identified cholera hot-spots.

• Availability of materials and supplies, logistics support, and pre-positioning of items in secure and space-efficient warehouses, is required to support timeliness of interventions.

• Predictable, flexible and timely funding is essential for the RRTs and should be sustained over time. Contingency funding established with donors through a national mechanism for emergency funding is required in the absence of permanent funding sources.

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