EPRP for COVID-19

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PREPAREDNESS AND RESPONSE PLAN FOR COVID-

19 SCENARIO 3

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Introduction Coronaviruses are a large family of viruses that cause illness ranging from common cold to more severe

diseases such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome

(SARS). A novel coronavirus was identified in December 2019 in Wuhan City, China among people who

had exposure to seafood market. This is a new coronavirus that has not been previously identified in humans.

This virus has been named by the World Health Organization (WHO) as COVID-19.

The disease has affected many countries and territories in Western Pacific, South-East Asia, Americas,

Europe and Eastern Mediterranean regions. The number of people infected and those who die of it, is

increasing every day. It has infected more people and already killed more as compared to the 2002 SARS.

On 30 January 2020, the WHO declared the 2019 novel coronavirus outbreak as a Public Health Emergency

of 1nternational Concern (PHEIC) with recommended actions for countries.

The Director General of WHO declared COVID 19 a global pandemic on 11th of March after the epicenter

moved from Wuhan China to rest of the globe and the number of cases increased 13-fold.

As the virus is new, there are many things that are not clear. It can be propagated in the same cells that are

useful for growing SARS-CoV and MERS-CoV, but notably, COVID-19 grows better in primary human

airway epithelial cells than in standard tissue-culture cells, unlike SARS-CoVor MERS-CoV.

Globally several pharmaceutical companies have embarked on research to develop vaccines/ treatments for

COVID -19. So far there are no licensed treatments or vaccines for the COVID-19 virus.

Rationale of the plan Since 13th of march when the first Covid-19 case was announced in Ethiopia, several cases have been

identified most of whom were imported, and the rest linked to imported cases (clusters). Ethiopia has also

been classified as one of the high-risk countries. All neighboring countries have also reported the confirmed

case.

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The number of expected cases for the response 34,068 per month and was calculated. The assumptions taken

were:

• 21% of the population is an urban population of whom are all considered at risk;

• 50% of the rural population was at risk given the sparse population distribution;

We then assumed that the total 66.5 million and assuming the herd immunity (R0 − 1)/R0 is 60%, 39m people

were expected to be infected with COVID 19.

In addition to this, according to a lancet publication, the risk of infection decreases by 60% if measures

including social distancing are put in place. Ethiopia has implemented a series of measures including

avoidance of mass gathering social distancing, and risk communication, including the advocacy for

handwashing, reduces the risk to 60%. However, since the measures are not stringent it was assumed that

the risk was 30%.

This plan was developed assuming that the expected number of COVID-19 cases amounted to on Average

34,000 confirmed case per months or approximately 102,000 cases within the next three months. With the

Estimation of 20% severe case 3.4% death.

2. Situation Analysis

As of 25th March 2020, a total of 414,179 confirmed cases, including 18,440 deaths (case fatality ratio

4.5%), were reported globally. The 10 countries with the highest number of cumulative cases included China

(81,848), Italy (69,176), United States of America (51,914), Spain (39,673), Germany (31,554), Iran

(Islamic Republic of) (24,811), France (22,025), Republic of Korea (9,137), Switzerland (8,789) and the

United Kingdom (8,091).

In the Africa, there has been a significant upsurge in the past week; the highest number of cases were

reported in South Africa 554 (0 deaths), Algeria 264 (17), Burkina Faso 114 (3), Senegal 8(0) deaths. In

Ethiopia, at the time of this update, the total number of confirmed cases recorded was 12; with a total of 342

contacts.

During the preparation Phase the following challenges were observed. Suboptimal coordination among

different Stakeholder in the overall Covid-19 preparation. In adequate preparation in contact tracing and

follow up team, challenge in training cascading to regions and lower level. Poor and un linked surveillance

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reporting system from lower level to higher level. in availability of isolation and treatments sites and in

adequate availability of supplies And Medical equipment. Poor Ambulance management system, shortage

of storage facility and poor supply chain management. Lack of information exchange and data

communication mechanisms from lower level to the central EOC at all Pillars.

3. Scenario-3: Assumptions Since 13th of March when the first Covid-19 case was announced in Ethiopia, several cases have been

identified most of whom were imported, and the rest linked to imported cases (clusters). Ethiopia has also

been classified as one of the high-risk countries. All neighboring countries have also reported the confirmed

case.

The following are working assumptions in preparing the worst-case scenario planning:

1. Ethiopia will have or already have (undetected yet) a ‘super-spreading’ event = Community transmission

2. The health system will be overwhelmed in few weeks once wide spread community happens

3. Death from other conditions will dramatically rise: After a month or two

4. Other emergencies will flare up: due to the healthcare system shifted to COVID-19 response

5. Significant number of patients with Acute Respiratory Distress Syndrome are expected which needs admission and ICU care

6. Exploit the existing system while exploring other options

7. Ethiopia will follow an offensive strategy

8. Limited testing capacity

9. Further considerations are made to mitigate the limitation of the estimate by limiting the scope of this plan for three months with an estimated monthly average of 34K confirmed cases per month.

Objectives and Strategies to prevent worst case scenario

General objectives • Maximally suppress communitywide transmission of COVID 19

o Suppression is a modified form of containment as we assume unknown level of community

spread which can lead to either direction i.e. to containment or mitigation.

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Specific Objectives • Detect, isolate and treat with enhanced contact investigation and increased laboratory capacity

o Enhance Health Facility Readiness

o Community and facility mobilization for active surveillance of RTI (risk communication)

• Reduce mortality

• Enhance leadership and governance platform for whole government response for primary and

secondary prevention of COVID-19 (i.e. protect people from getting the virus and allowing the

health care system to treat infected patients)

Strategies The strategies for the worst-case scenario in a phased manner

A) Phase I: Suppression measures

Suppression measures are steps taken to prevent the virus from spreading further or reducing the rate of

transmission in the soonest time possible so that the healthcare system can handle the circulation of the

virus for as long as possible, without overwhelming the capacity of the healthcare system. These measures

emphasize on preventing wider transmission, detecting early cases and tracing their contacts quickly

before spreading much in the community. Public health actions coupled with non-pharmaceutical

measures are expected to reduce spread of the virus and contain it to manageable size of affected people

and limited localities.

The suppression measures will inform the extent of the spread of COVID-19 in the community and inform

subsequent actions.

1. Public Health Measures to detect, isolate and treat COVID-19 cases:

The health sector needs to scale up its efforts of combating COVID-19 in both health facility and

community settings. Hence

➢ Scale up emergency response mechanisms by enhancing the incidence management system

at all level of the tier system and public health administrations

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➢ Active surveillance of Respiratory Tract infection in both health facilities and community

settings (chasing the symptoms than the virus to contain the spread)

➢ Increase testing capacity significantly to test as much suspects as possible in the earlier

phases (if epidemic worsens, consider the concept of epi-link)

➢ Enhance healthcare capacity to handle moderately ill and critical cases for COVID-19 to

reduce mortality

➢ Prepare designated non-COVID-19 hospitals for other health emergencies and delivery

services

➢ Determine alert and action thresholds of moving to either of the two classical strategies i.e.

Containment or mitigation measures

i. Intensive measures in two weeks with activity, output and outcome tracking

ii. Determine alert and action thresholds and take actions accordingly

2. Non-pharmaceutical measures:

The non-pharmaceutical measures are highly important to enhance primary prevention and accelerate the

pace and effectiveness of public health measures.

• Enforcement of the Social Distancing measures being taken

• The whole of government approach in response to pandemic

• Scale up the technical as well as political commitment at all level mainly for regional level preparedness and response

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Response Model and Governance (implementation Arrangement)

To address a challenge as significant and rapidly evolving as COVID-19, we need to work closely together,

as one.

At the heart of this initiative, we must have one response that is integrated initially across the health sector,

and ultimately feeds into one single multi-sectoral response including all relevant actors. This will ensure

we are unified in responding to the challenges we face – maximizing the value of our resources, avoiding

duplication of effort, and allowing all of us to play to our strengths and respective roles.

This is enabled by one plan,with an integrated view of all activities across the response. Both MoH and the

EOC have complementary roles to play in this – EOC will be the execution leader, and the MOH will

provide the strategic guidance and support.

This will all be enabled by one team. Regardless of where we sit in the system currently, we will all work

in a closely combined manner. The pillar structure of the EOC’s response is and remains the focal point of

our efforts – and across the MoH, EPIH the EOC, and other partners who are helping in this fight against

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COVID-19, we must all be aware and connected with the activities taking place within each pillar to avoid

duplication and ensure we make the most of the available resources.

The Ministry of Health leadership task force (Covid 19 command post) will provide overall guidance and

strategic support to the response execution led by the EOC.

The following are major activities of the MOH Covid 19 command post.

• Liaising with EOC for aligned decision making – providing a faster linkage between the EOC and

decisions required at the MoH, with a strongly-empowered team in the command post driving

decisions at pace

• Integration – ability to play a strategic role in ensuring there is one response and one plan, ensuring

a cohesive response across the various pillars in the EOC

• Troubleshooting – providing an escalation channel from the EOC to the MoH as required with a

view to faster resolution of issues and blockers

• Linkages –representing the MoH with partners and interventions across the health sector, and into

wider disaster management fora (such as the Disaster Risk Management Commission)

Federal/Regional Government

MOH/RHB

EOC (EPHI)

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Estimated cost per pillars

Pillar Total Cost (ETB) Total Cost (USD) Coordination and Leadership 214,286,960 6,533,139

Surveillance and contacting tracing 5,887,513,272 179,497,356

Laboratory 714,489,755 21,783,224

Case management and IPC 6,104,335,558 186,107,791

Points of Entry (POEs) 174,314,436 5,314,465

Risk Communication and Community Mobilization 895,242,000 27,293,963

Evidence generation and operational research (1% of total budget) 139,901,820 4,265,299

Grand Total 14,130,083,802 430,795,238

See Annex I for detailed Activities Budget, breakdown by pillars.

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Annex I

Operational plan for scenario 3

1. Coordination and leadership pillars

S/No. Proposed Intervention Activities

1 Strengthen national coordination

Revise stakeholders mapping Conduct biweekly meeting with stakeholder Conduct EOC inter-pillar weekly meeting Complete and disseminate operation plan Disseminate national guidelines and SOPs Conduct regular risk analysis (venerability Interface with NDRMC EOC

3 Support regional coordination

Conduct regional capacity assessment Review and support the preparation of regional EPRP and operational plan Conduct simulation exercise Support reginal EPRP activation/operationalization/ sub- regional PHEM structure

Strengthen resouce mobilization Conduct gap analysis interns of resource/forecasting Develop strategy for resource mobilization and disseminate it

Health workers capacity building

Map trained health workforce Develop a surge roster Conduct training and orientation Cheek the Deployment of health workforce

M&E framework

Develop KPIs strategy/plan Disseminate KPI plan to relevant stakeholder Develop and monitor reporting dashboard Prepare and disseminates periodic reports to relevant stakeholder Conduct need assessment for ICT interventions Help coordinate the selection of relevant technology and implement it/ Elaborate it

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2. IPC case management and facilities readiness

S/No. Proposed Intervention Activities

Expand isolation, treatment and quarantine sites Train and deploy adequate number of IPC and clinical team Develop and share IPC,CM and Facility Readiness support plan to regions and key stakeholders

Establish and support 300 Isolation centers with bed capacity of 200 for each Establish and support 34 Treatment centers with bed capacity of 400 for each Establish and support 100 quarantine centers with bed capacity of 500 for each

Train and deploy adequate number of physicians (1360), critical care specialists (204), and nurses (2720) Train and deploy adequate number of IPC experts (10000) Develop coasted plan with indicators Share the plan with all relevant stakeholders

Develop and implement M&E framework including digitization

Support and monitor the implementation

Develop and implement standardized data capturing and reporting formats Procure and distribute computers with database Develop and implement electronic data registration, monitoring and reporting system

Support the ME and Supplies forecasting, procurement and distribution task of the EOC

Support forecasting, distribution, and management of medical supplies and medical equipment Monitor and report consumption of medical supplies and medical equipment

Provide the required medical equipment, supplies and IPC materials Provide biomedical technical supports

Distribute all the procured supplies and equipment based on need Improve efficiency of supply utilization and management

Provide emergency biomedical technical supports through deploying a team of biomedical experts

Conduct ambulance need assessment and develop plan of action

Strengthen ambulance management Develop and implement health professional safety and support protocol

Procure and deploy 300 ambulances equipped with basic life support materials Distribute procured ambulance for regions based on their need Strengthen ambulance management system Hire, train and deploy personnel (sprayers (300), nurses (600)) working in ambulances Develop health professional safety and support protocol

Support and monitor implementation of health professional safety and support protocol

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3. Surveillance and laboratory Pillars

S/No. Proposed Intervention Activities

1

Have trained contact tracing team

Establish 33,334 contact tracing teams (each team with 2 people)

Training for 66,668 contact tracing experts

Avail logistics and PPEs for contact tracing team

Avail vehicles for each contact tracing team (33,334)

Face mask for contact tracing team (

Hand sanitizer for contact tracing team and driver (600,012 bottle)

2

Expand laboratory to peripheral level

Expanding the testing capacity to 19 sites throughout the country

Capacity building to facilitate sample Collection and transportation

Establishing sample transportation system at each woreda level

Training for laboratory technicians/technologists at least one from each woreda

3

Expanding call centers to regional level

Establish call center for 11 regions and city administration at least with a capacity of 20 lines

Avail 1320 call center experts for 11 regions and City Administrations

Enhance the capacity of EPHI's call center

Avail additional 24 call center lines in EPHI

Avail total of 288 experts for call center (EPHI level)

4

Have trained rapid response team

Establish 24000 rapid response team? For 4000 RRT per health facilities and 2000 RRT per/10000 woredas

Training for 28,000 RRTs (16,000RRT members in health facilities, 4000 RRT supervisor recruited per facilities and, 8000 RRT members per woreda)

Avail logistics and PPEs for RRTs Avail 2000 Ambulances and accompanying vehicles

Avail all PPEs used to manage 100,000 cases

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Use electronic reporting system 35,334 tablets/smart phone for RRTs and contact tracing and follow up trams

Avail one server at each region and one additional at EPHI (a total of 12)

Improve data management system

Avail 1182 computers for woredas and zones

Assign 1116 data managers

Supportive supervision

Regular data analysis and feedback

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4. Point of Entry

S/No. Proposed Intervention Activities

1 Engagement of regional higher administrative organs to give attention on the regional PoEs screening activities

Notify regional PHEM office via official letter to strength screening activities at land crossing POE

Give orientation/training for 68 land crossing POEs screeners & 18 domestic airports

Give training/orientation for all stake holders at POEs

Conduct supportive supervision for all POEs weekly

2 Engagement of Telecommunication higher administrative Official to solve the problem

Design a reporting mechanism from POEs to EPHI using ODK(avail tablet which can take Sim card) or using Wifi modem

Enforcement of the establishing of TIU and screening post at all PoEs (at Togo wuchale, Dawale, Lugdi, Moyale, and Kumruk) on the 1st phase

Establish 05Temporary isolation center at POE using fiber material as per design

Equip established temporary isolation unit with necessary supplies and equipment

Arrangement of the Ambulance linkage between PoEs and Treatment Units through discussion with Regional Heath Bureau

Assign at least 2- ambulance at international airports per shift for 24hrs POEs & 1-per domestic airport

Assign at least 2- ambulance at international airports per shift for 24hrs POEs & 1-per domestic airports

Assessing the gap and assignment of required man power at all PoEs& Gate/entrance of Regions, Industrial park, refugee camp, major cities & domestic airports

Assign a minimum of 2-screeners at each land crossing POEs, Gate/entrance of Regions, Industrial park, refugee camp, Gate/Entrances of major cities & 4-at domestic airports

Assign min of 30 staffs at BIA per shift

Procurement of more infrared thermometer for land crossing and Thermal camera for all International airports

Procure 286 infrared thermometer

Procure 20 thermal camera for airports

Strengthen filling of traveler’s health declaration form by passengers on board

Strictly follow the implementation of filling traveler’s health declaration form on board

Engagement of Ethiopian Airports enterprise higher officials & other stake holders at POEs to solve weak coordination between POEs and other stakeholders at all POEs

Continue virtual meeting with COVID-19 BIA command post members to solve all issues related with Screening activities and implement mandatory quarantine at hotel for passengers coming from abroad

Activate command meeting with stake holders at land crossing POEs stake holders

Identification of illegal PoEs and establishing of new PoEsby setting priority based on its potential risks.

Work with legal enforcement bodies (Federal police/army) to prevent illegal arrivals

Strengthen screening and establishing TIU activities different place

Establish 4-screening sites and TIU at Addis Ababa main Gate /entrance in four direction of AA

Establish Entry and exit screening and site at all regions

Establish screening sites and TIU at major industrial parks

Establish screening site and TIU at all domestic airports

Establish screening site and TIU at refugee’s camp

Establish screening site and Tiu at Major farms

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5. Risk Communication and Community Engagement

S/No. Proposed Intervention Activities

1 Train volunteers and link them to health and social services

Map community volunteers for training and deploy them to reach

Map key stakeholders working with volunteers to reach key population (vulnerable and at-risk communities)

To customize BCC materials to target the key population key population

Adapt RCCE strategy for scenario 3 to reach a key population

mobilize communication aids such as megaphones, mobile vans, etc.

2 Engaging and supporting regional health bureaus with a multi-sectoral approach

Partner with key stakeholders at zonal and woreda level to sensitize their existing networks

Provide RCCE guide orientation for various sectors and regional leaders

All developed guides should be signed and officially communicated

have a regional visit to promote trust and information sharing

Establish a telegram group communication platform with regional RCCE to increase collaboration

Conduct support supervision/ field visit to regional RCCE

Communicate ground feedback to the government for strict action

Communicate ground feedback to the government for strict action

Revision of community engagement guide to reflect the current COVID-19 situation

Revision of COVID-19 Government, Non-pharmaceutical intervention (NPI) community guide

Intensify public awareness and campaigns to various group

Customize, produce and disseminate NPI messages to target audience

Customize messages for targeted communities to engage them

Undertake perception assessment among the public

Develop short educational messages to reach communities

Empower community volunteer with information on how to reach targeted community groups

train volunteers to reach targeted community groups

Mobilize communication aids such as megaphones, mobile vans, etc

Equip volunteers with job guides/aids

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6. Logistics

S/No. Proposed Intervention Activities

1

Commodity Planning/Forecasting for COVID-19 Organize quantification exercise and follow procurement process by ESCM/Logistic team at EPHI

Commodity Planning/Forecasting for COVID-19

Resource mobilization for procurement of COVID -19 Supplies …at EPHI.

Consolidation of Donation supplies in items/ in kind from different partners.

Procurement orders follow up of COVID -19 Supplies …at EPHI.

Develop Distribution protocols/Strategy

Establish Emergency Distribution work process flow

Guide Self procurement protocol/strategy by Facilities

3 Developing Distribution protocols, and execute Distribution to Emergency sites(COVID-19 Trt centers, Isolation centers, quarantine centers

National Stock status monitoring excel sheet

ODK Mobile application for prioritized selected National stock monitoring

Conduct Weekly partner forum

Logistics Data Visibility Organize quantification exercise and follow procurement process by ESCM/Logistic team at EPHI

Resource mobilization for procurement of COVID -19 Supplies …at EPHI.

➢ For vulnerable populations (children, mental health. Women)

S/No. Proposed Intervention Activities

Tailored risk communication Develop tailored messages to the various groups

Communicate the messages using various channels including patient associations and help groups

Establish quarantine and isolation centers considering vulnerable groups

Establish adequate number of child friendly centers

Have separate quarantine and isolation centers for TB- COVID 19 co-infection and people with disabilities

Consider comorbidity in the development of case management

Consider the number of people with comorbidity in estimating the number of ICUs and ICU beds

Have a special treatment protocol for people with comorbid conditions

Coordinate with relevant sectors to address the disabled

Identify the relevant sectors and organizations to work with

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Performance Monitoring The key performance indicators will be used to monitor the implementation of the Plan. Planning monitoring and Evaluation team will assess the overall performance national and subnational levels, and with partners to monitor key performance indicators on a regular basis.

1. Leadership and coordination

S/No. Key performance indictors Frequency of data collection

Source of data

Number of sitreps disseminated Daily

% resource mobilize Monthly

% resource Utilized Monthly

Proportion of stakeholders mapped Monthly

Number of risk Assessment conducted

Number of capacities Assessment Monthly

Number of stakeholder meeting conducted

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2. Surveillance and laboratory pillars

S/No. Key performance indictors Frequency of data

collection Source of data

Daily

Number of alerts/rumors reported Daily

Number of Alerts investigated Daily

Number of Alerts discarded Daily

Number of Alerts pending Investigation Daily

Number of new suspected cases Daily

Number of deaths among suspected cases Daily

Number of confirmed cases Daily

Number of deaths among confirmed cases Daily

Contacts registered Daily

Contacts completed Follow-up Daily

Contacts lost to follow up Daily

Contacts symptomatic Daily

Contacts test positive Daily

Symptomatic contacts tested negative Daily

Number of samples collected Daily

Number of samples pending lab result Daily

Negative Daily

Positive Daily

Inconclusive Daily

Proportion of alerts/rumors investigated(verified) within 2 hrs Weekly

Proportion of suspected cases investigated within 2 hrs Weekly

Proportion of suspected cases isolated within 6 hrs Weekly

Proportion of suspected cases with sample collected within 6 hrs Weekly

Proportion of suspected cases with lab result within 6 hrs of specimen collection Weekly

Proportion of suspected cases discharged within 6hrs of a negative lab result Weekly

Number of regions with local transmission Weekly

% of death reported among reported case Weekly

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3. POE performance indictors

S/No. Key performance indictors Frequency of data collection

Source of data

Number of Travelers screened Daily Reports Number of Travelers under follow-up Daily Number of symptomatic travelers transferred to isolation facility Daily Number of Personnel (staff) conducting health screening Daily Proportion of land crossings & airports (excluding BIA) with screening sites Proportion of refugee camps & industrial parks with screening sites Bi weekly Reports, Proportion of land crossings & airports (excluding BIA) with TIU Bi weekly Reports, Proportion of refugee camps & industrial parks with TIU Bi weekly Reports, #proportion of screening sites with at least one infrared thermometer Monthly Reports, Proportion of international airports with at least one thermo scanner Monthly Reports, Number of screening sites equipped Monthly Reports, # of with full IPC as per the national guidelines # of POEs with hand washing and waste management facilities on site

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4. IPC Case management

S/No. Key performance indictors Frequency of data collection

Source of data

Total number of deaths related to COVID 19 in treatment center Daily Health facility log books

Total number of discharged cases from treatment center Daily Health facility log books Total number of newly admitted confirmed cases in treatment center Daily Health facility log books

Total number of critical patients on mechanical ventilator in treatment centers Daily Health facility log books Total number of critical patients in treatment centers Daily Health facility log books Total number of available (empty) beds in treatment center Daily Health facility log books Number of suspected COVID 19 cases admitted in isolation center Daily Health facility log books Number of discharged cases from isolation unit Daily Health facility log books Total number of available (empty) beds in isolation center Daily Health facility log books Total number of health professionals who tested positive for COVID 19 in isolation center Daily Health facility log books Number of suspected COVID 19 cases admitted in isolation center Daily Isolation centers log books Number of quarantined individuals in the quarantine center Daily Isolation centers log books Number of quarantined individuals who developed COVID-19 specific symptoms Daily Isolation centers log books Number of beds available in the quarantine center Daily Isolation centers log books

5. Logistics

S/No. Key performance indictors Frequency of data

collection Source of data

Logistic accuracy rate Monthly Logistics logs books

Emergency Procurement lead time Monthly Logistics log books

Line fill rate Monthly

Utilization of emergency Supplies Monthly Report

Emergency Vital Supplies Availability Monthly

Refill processing time Monthly

Average Delivery Time for Emergency Supplies Monthly

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SUMMARY BUDGETS

Coordination and Leadership

Activity Total Cost (ETB) Total Cost (USD)

PHEOC Functionalization at National Level 38,809,200 1,183,207

PHEOC Functionalization at Regional Level 99,768,600 3,041,726

Virtual Coordination Meetings -

Media briefing -

Monitoring and Evaluation 1,941,720 59,199

Provision of trainings 71967440 2,194,129

Production cost for virtual training materials 1800000 54,878

Sub-total 214,286,960 6,533,139

Surveillance and contacting tracing

Activity Total Cost (ETB) Total Cost (USD)

Printing, and dissemination of surveillance materials 19,764,072 648,261,553

Call center establishment and expansion 398,545,200 13,072,282,560

Contact tracing and follow up 2,669,580,000 87,562,224,000

Rapid response teams and health facility PHEM 2,580,990,000 84,656,472,000

Electronic surveillance and information management 218,634,000 7,171,195,200

Sub-total 5,887,513,272 193,110,435,313

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Laboratory

Activity Total Cost (ETB) Total Cost (USD)

Lab consumables 560,704,816 17,094,659

Laboratory HR Need 477,439 14,556

Sample transport/shipping 153,307,500 4,674,009

Sub-total 714,489,755 21,783,224

Case management and IPC Activity Total Cost (ETB) Total Cost (USD)

PPE for isolation and quarantine centers (300 Isolation Centers of 200 beds,) 512,183,332 15,615,345

Hand sanitizer 1,082,400,000 33,000,000

Medical Equipment 278,861,205 8,501,866

Medications 47,642,342 1,452,510

Procurement and Supply Management 490,153,860 14,943,715

WASH in isolation, quarantine, and treatment centers 2,488,661,000 75,873,811

Train and deploy adequate number of IPC and clinical team 610,920,460 18,625,624

Provide biomedical technical supports 4,050,000 123,476

Strengthen ambulance management 477,500,000 14,557,927

Develop and implement health professional safety and support protocol 4,050,000 123,476

Strengthen IPC practices at community level 60,000,000 1,829,268

Customize isolation centers to accommodate children (<18 yrolds) 4,713,360 143,700

Mental health and psychosocial support (MHPSS) provision 43,200,000 1,317,073

Sub-total 6,104,335,558 186,107,791

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Points of Entry (POEs) Activity Total Cost (ETB) Total Cost (USD)

Procurement of IPC materials 97566936.2 3200195507

Operational cost at POEs 76747500 2517318000

Sub-total 174,314,436 5,717,513,507

Risk Communication and Community Mobilization Activity Total Cost (ETB) Total Cost (USD) Volunteer mobilization (assuming 45 active work days in the 3 month period) 237,000,000 7,773,600,000

Interactive message communication targeting HEWs 162,800,000 5,339,840,000

1-day orientation of religious leaders and other key community figures like traditional healers (in 3 to 1 HEW group) 34,000,000 1,115,200,000

Print and distribute risk communication material 461,292,000 15,130,377,600

Risk communication targeted towards populations with limited abilities 150,000 4,920,000

Sub-total 895,242,000 29,363,937,600