1. Humanitarian Donor Briefing 6 July 2011 Pakistan Cholera Update

2. Country-wide Outbreak Situation Avg 16 cholera outbreaks per week for 7 weeks Cholera update Week 20 – 26 (Dates 13 May – 30 June 2011) Epi-WeekAlertsOutbreaks Wk-20 (13-19 May)249 Wk-21 (20-26 May)4416 Wk-22 (27May-2 Jun)3819 Wk-23 (3-9 Jun)3413 Wk-24 (10-16 Jun)4515 Wk-25 (17-23 Jun)3215 Wk-26 (24-30 Jun)4111 Total25898

3. Khyber Pakhtunkhwa & Baluchistan ProvinceAlertsOutbreaksCasesDeathsTotal water samples tested % bacteria- unfit KPK5616735420090 Baluchistan10461358099 KPK 3 DTCs established to manage serious cases: RHC Havellian=87, DHQ Mansehra=247, DHQ Mardan=84: Total 428 cases. In Haripur outbreak, a medical camp was established in village Kellig by DoH and Save the Children; 307 patients. There was no death recorded after the response and DTCs establishment. 29 ORT corners established. WHO/UNICEF distributed 150,000 aqua-tabs, 15,000 soap, 4,000 jerry- cans and conducted hygiene promotion sessions. UNICEF brought safe water in water tankers to the Village Kellig and coordinated with Concern and HRDS in distribution of ORS, aquatabs, and hygiene messages. Baluchistan In all 4 outbreaks of AWD in last 7 weeks, DEWS team including EHE responded on time. Medicines, water filters, aqua tabs were distributed. Total 5 patients died before reaching health facilities After response from WHO team, 613 cases were treated and no death was reported. 13 ORT corners established.

4. Punjab & Sindh ProvinceAlertsOutbreaksCasesDeathsTotal water samples tested % bacteria unfit Punjab351718001415080 Sindh1495711401160098 Punjab Alerts investigated on time. Outbreaks managed in DHQ and Tertiary hospitals with trained DTC Rapid Response Teams. Two DTCs established for short periods in HFs near outbreak sites. Severely Dehydrated Cases were 30- 40 per day during outbreaks. 25 ORT Corners established. WHO distributed 100,000 Aquatabs, 15,000 soap, 1000 Jerry cans; and conducted hygiene promotion sessions. Sindh North (Sukkur): 11 ORT corners established. During week 26, 4 districts have ongoing AWD outbreaks; Khairpur, Larkana, N.Feroz and Shikarpur. AWD outbreaks were responded by respected district rapid response teams with DEWS, EHE, EM and logistic support. South (Hyderabad) : all 14 districts have had outbreaks, largest was 400 cases in Mirpurkhas, managed as DTC for one week. 18 ORT corners established. WHO in coordination with UNICEF, distributed 200,000 Aquatabs, 30,000 soap, 6000 Jerry cans; and conducted hygiene promotion sessions.

5. AJK & Islamabad (CDA & ICT) ProvinceAlertsOutbreaksCasesDeathsTotal water samples tested % bacteria- unfit AJK423802090 ICT4218013085 AJK Sporadic cases of AWD admitted to hospitals and managed without deaths. Field investigation carried out with DOH team and no other active cases of AWD were found. Kotli District with new outbreak this week. Investigation ongoing. WHO distributed 2,000 aqua-tabs, 1,000 soap, 6,000 and conducted hygiene promotion sessions ICT Outbreaks identified in sectors G6/1 and G7/2 last week and F6/1 and Barakhau this week; Alerts at Zia mosque Village and Saidpur Village. WHO/ NIH investigated alerts and CDA Health Directorate leading response with awareness messages in media and mosques. EDO-H in ICT organizing safe water for Barakhau. Hospitals responding PIMS 139 cases and Polyclinic 41 cases admitted. WHO distributed 100,000 aqua-tabs, 20,000 soap, 20,000 PUR-Sachets and conducted hygiene promotion sessions with 25 volunteers from PLAN Pakistan. UN-Habitat and UNICEF developed messages for mosques, churches and general public used in campaigns and given to CDA for printing.

7. Cholera Task Force Members CDA – Directorate of Health CDA – Directorate of Water Supply (incl. Simli Dam Authority Water Testing Laboratory of CDA PCRWR NIH – Public Health Division, Microbiology (Water) Lab NIH – Public Health Division, Epidemic Investigation Cell ICT Hospitals WHO –DEWS and Environmental Health team UNICEF – WASH Cluster for Emergency Response UN-Habitat Plan Pakistan FELTP

8. WHO Proposed Budget (5 month projection) 76 Surveillance Officers and 23 Environmental Engineers working in 96 districts More than 3000 health facilities reporting about 1,000,000 consultations per week About 130 alerts investigated weekly About 16 outbreaks of confirmed cholera controlled weekly in joint effort with UNICEF, since 13 May 2011 (7 weeks) Cost breakdownAmount (USD) A. Staff costs 1,104,000 DEWS - Environmental Health Response Teams854,000 DEWS - Environmental Health Managers and Support Staff 250,000 B. Operations 1,202,897 Transportation, communication, logistics, security of Field Teams 720,000 DTC support and logistics482,897 C. Training 244,000 Training on DEWS, hygiene and water quality in health facilities and communities 244,000 D. Acquisitions 2,122,000 Supplies for sample collection, transportation and laboratory testing; Medical supplies for case management - Diarrhoea Kits and PPE; Soap for hospital and household use; environmental health supplies for health facilities; Water quality testing kits 2,057,000 IT and data management tools65,000 E. Indirect program support 327,103 Total Cost: 5,000,000

9. UNICEF Proposed Budget Cost breakdownAmount (USD) A. Staff costs (salaries and other entitlements) 100,000 B. Travel- C. Contractual Services 500,000 -Water tankering of chlorinated water to the affected areas without piped water supplies as part of immediate response500,000 D. Operations 2,400,000 -Technical support, contracts and agreements150,000 -Sustained mass chlorination and repeated testing of all drinking water sources to achieve “zero” E-coli per 100 ml of water for all types of community water supplies 325,000 -Provision and installation of chlorinators on drinking water schemes75,000 -Sanitation clean-up campaigns for solid waste removal from the affected areas135,000 -Hygiene education and cleaning campaigns for vulnerable areas and distribution of IEC materials. Promotion of recommended hygiene behavior (sanitation and water use practices, disinfestations at the household level) at the household and community level in the affected districts /tehsils /provinces to improve access to safe and chlorinated water at point-of-use 215,000 -Distribution of NFIs i.e. aqua tab, PUR sachet, jerry cans, buckets, soaps etc. (Quantities: 143,000 hygiene kits and jerry cans) 1,500,000 E. Trainings- F. Acquisitions- G. Other- Subtotal project requirements3,000,000 H. Indirect program support costs (not to exceed 7% of subtotal project costs) 210,000 Total Cost: 3,210,000