Table 1 Challenges associated with Ebola virus disease preparedness in a complex humanitarian setting - Republic of South Sudan

Coordination

Overlaps in the role of the incident management system and humanitarian health cluster

▪ Definition and delineation of Ebola virus disease (EVD) preparedness and response roles between the incident management system and health cluster. The cluster may assume the health partners’ coordination function of the incident management system.

▪ Regular orientation of health cluster partners on the incident management system and their respective roles and vice versa.

Challenges of effective coordination of a large number of humanitarian partners

▪ Definition and consensus on the coordination structure as part of the preparedness plan and refining it through simulations.

▪ Strengthen public health emergency operation centers and leverage their capacities to streamline coordination at national and sub-national levels.

▪ Establishment of a national unified all-hazard multi-sectoral coordination platform.

▪ Effective mapping of partner capacities and comparative advantage to inform assignment of partners to relevant IMS functions.

▪ Flexibility to scale the incident management structure and functions to suit the scope and response needs of the outbreak.

▪ Definition and agreement among all partners on regional and national standards for training, simulations, personal protective equipment and EVD isolation units, etc.

▪ Conduct after-action reviews to learn from each response and improve coordination of preparedness and response.

Programmes

Weak health systems (inadequate human resources for health, weak information management system, disrupted supply chain management system, poor health financing, etc.)

▪ Integration of health system strengthening approach into the development and implementation of EVD preparedness plans.

▪ Definition and incorporation of strategies aimed at bridging the humanitarian-development nexus into EVD preparedness planning and response processes and interventions.

▪ Strengthening and use of other existing systems such as the NAPHS and integrated diseases surveillance and response system as platform for EVD and other outbreak preparedness and response.

Community distrust and resistance to uptake of preparedness interventions

▪ Analysis of historical, political, cultural and social issues to understand factors and beliefs which influence community resistance to EVD interventions.

▪ Development and dissemination of tailored-made risk communication messages using existing community structures.

▪ Strong community engagement and participation in EVD preparedness and response interventions during the pre, intra and post epidemic phases.

▪ Regular assessments to rapidly identify and respond to changing communicaiton needs of the target populations.

Operations

Insecurity and attacks on response assets

▪ Integration of activities to advocate for and negotiate the security of EVD preparedness and response assets and access to EVD affected and high risk areas in EVD preparedness and response plans.

Lack of access to high risk areas due to poor roads and insecurity

▪ Use of innovative approaches such as digital health technologies where feasible.

▪ Decentralization of preparedness and response interventions to high risk areas.

High cost of operations due to humanitarian context (poor road infrastructure etc.)

▪ Phased approach to EVD preparedness through geographic and programmatic prioritization of EVD preparedness interventions.

▪ Continuous assessment and mapping of the EVD transmission risks to better classify high risk areas for targeted preparedness interventions.

▪ Engagement of relevant humanitarian clusters like the logistics cluster to prioritize outbreak prone locations for logistical support.