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Emergency For Cholera Outbreak In Yemen
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Emergency For Cholera Outbreak In Yemen
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Question:
Discuss about the Emergency Response for Cholera outbreak in Yemen.
Answer:
Introduction
In recent times, Yemen has faced one of the most severe cholera epidemics in the world. After coming into control in some time, the outbreak again resurged claiming the lives of a huge number of people and affect the health of few million people of the country. As a result, a project was authorized to provide emergency medical response to the cholera affected areas. The project based on setting up health camps, sending medical staff delegates in the regions to treat the patients and others. In addition to the appointment of medical stuffs, the project required a constant supply of medicines and medical equipments so that the medical staffs and nurses could be able to treat the patients and provide them with sufficient dosage of vaccination and medicines. Due to the large scale of the outbreak, the medicine supplies in the country was completely exhausted and hence, the medicines and vaccines were needed to be imported from other countries that resulted in the increase of the project costs and overall time.
In this report, a risk management plan has been developed based on the risks associated with the emergency response project.
Risk Management: Background of the Chosen Project
The chosen project is based on emergency response for Cholera outbreak in Yemen that took place within the period of May to October 2017. In the last quarter of 2016, a massive cholera outbreak took place in Yemen that reached an alarming level during April-May. As per an overall WHO estimated, nearly 900,000 people were affected with cholera with further rise in the value was projected for the next few weeks. The huge outbreak also claimed a large number of lives with almost 1% of the affected people reached fatality due to lack of timely and proper treatment of cholera. The outbreak was not limited to a single area – it spread over more than 150 districts of the country that were included in 16 Governorates of the country. While the cholera slowly came under control during March-April 2017, a resurgence of the cholera occurred in late April 2017 that claimed even more lives than the previous outbreak. The fatality rate also increased significantly to 1.6% of all the affected people and the cholera spread over an even bigger area – 180 districts in 18 Governorates.
In order to bring the cholera under control and treat the infected people, an emergency response project was initiated by appointing a large number of human resources including helpers, physicians, nurses, logistics assistants and others. The main objective of the project was to move from place to place and provide immediate medications to the affected people in the area. In addition to the healthcare support staffs, the medications and medical equipments were also needed to be carried from place to place in the areas of the outbreak. However, when the healthcare staffs were carried from place to place, it was needed to be ensured that the staffs are healthy and do not catch cholera during the treatment processes. Hence, sufficient amount of medical protection was to be provided to the patients as well as the healthcare staffs sent there for treatment of cholera. The project also required regular supply of medicines and medical equipments so that the physicians could be able to treat the patients and provide them with sufficient dosage of vaccination and medicines. Due to the large scale of the outbreak, the medicine supplies in the country was completely exhausted and hence, the medicines and vaccines were to be imported from other countries that resulted in the increase of the project costs and overall time. The project also required setting up field hospitals and health camps where the cholera struck most severely. The staffs in these camps did not need to move from place to place for providing services. Medicines, food and water had to be supplied from outside as the existing water sources were contaminated with cholera bacteria. The emergency response drive was continued till October 2017 when the outbreak slowly came within control and there were ample supply of cholera vaccine in the country.
Identification of Associated Risks
Due to the severity of the case and the epidemic situation of the country, there are a huge number of risks associated with the project. These risks are discussed as follows.
Health Risk – By far the most serious risk associated with the project is the health risk of the support and medical staff. Cholera is one of the most contagious diseases and hence, in spite of taking suitable amount of precautions and medications, the disease can easily spread from the patients to the physicians. This risk is further aggravated by the fact that it has taken the form of an epidemic and can easily spread on the healthcare staffs. Other support staffs like logistics assistants, health camp managers and others may also catch the disease easily. If the healthcare staffs are affected by the disease, the project cannot be continued further and emergency evacuation will be required for the healthcare and support staffs.
Supplies – Another major risk associated with the project includes the supply of food and medicines for patients as well as the medical staffs. While the Government is entitled to provide safe food and water to the common people, the food and water for the medical staffs and medicines for the patients are to be delivered from outside. Due to extensive nature of the epidemic, all the cholera vaccines are used up and most of the water sources are contaminated with the cholera bacteria. Any person coming in contact with these water sources can easily catch cholera. Hence, the medical staffs are strictly banned from eating local food and coming in contact with the local water. Their food and water are to be delivered through supply vans that travel from place to place for delivery in the health camps. During the delivery as well, the food, water and medicines can get contaminated and hence, extra-precautions like anti-germ delivery vaults, disinfectants and hand sanitizers are to be used to prevent contamination during delivery.
Budget – Budget is one of the major risks associated with the project. Due to the nature and scale of the project, no proper budget can be estimated accurately. The treatment processes depend on the extent of the disease in the patients, number of patients in the area, availability of the medicines and others. Due to the repeated recurrence of the disease in Yemen within a period of few months, all the stocks of medicines and vaccines are completely exhausted and hence, it is needed to import the required medicines from other countries. As a result of the epidemic, the prices of the medicines and vaccines have also sky-rocketed and this solely makes a huge negative impact on the project itself.
Inaccessibility – Another risk associated with the project is the inaccessibility of certain cholera affected areas of the country. Some of the extreme rural areas of Yemen are affected by cholera and the medical staffs depend on the land transport to reach these places and deliver healthcare measures. Furthermore, there will be also significant inconvenience of delivery of food, water and medicines in these areas that may delay the treatment processes of the affected people.
Dumping of Dead Bodies – Due to the outbreak of cholera, many people have already died and some more people are expected to die in the near future as well. However, in the rural areas, the dead bodies are simply dumped anywhere near water sources and other locations from where the cholera spreads as well. Hence, the medical staffs need to ensure the bodies are dumped at a suitable place that is far from water or food sources in order to avoid further contamination.
Outrage from Local People – This is a possible risk that might be faced from the medical and healthcare staffs especially in the rural areas. Due to continuous infections of cholera without sufficient treatment and prompt healthcare services provided by the governments resulting in deaths of the patients, the local people may turn hostile against the healthcare staffs when they arrive at the sites for providing treatment. It is needed ensure that the local people are calmed down and treatment is provided to the patients as fast as possible.
Risk Evaluation and Risk Ranking
The risk evaluation is done for this project using what-if analysis as follows.
Division: Yemen Healthcare Division
Description of Operation: Emergency Response to Cholera Affected Areas
By: PLEASE FILL
Date: May 2017-October 2017
What if?
Answer
Probability
Consequences
Recommendations
The healthcare staffs and nurses catch cholera during treatment
The affected staffs will have to be immediately evacuated from the area for treatment
9
8
Some additional medical staffs are to be kept as back up and sent to the sites in place of the affected staffs.
Contamination occurs during delivering food, water and medicine packets
All the packets should be tested before receiving delivery, in case there are signs of contamination, they should dumped away far from the site
7
8
Sanitizers, hand gloves, anti-contamination vaults, disinfectants and others are to be used by the delivery staffs
The project is out of funds due to complete exhaustion of budget
Request to be sent to higher authority for additional funding or leave the camps if the requests are not granted
10
9
The project should not depend upon a fixed budget value; the periodic increases and additional expenses are to be considered
Some epidemic affected areas are inaccessible by regular transport
Use drones for supply of med kits and food, use air transport
6
7
All areas should be surveyed for accessibility before allocating healthcare staffs
Dead bodies are dumped near camp locations and contamination occurs from those
Help the local people to dump the bodies far away from residential area
8
9
Dig a graveyard far from the residential area
Local people show hostile behavior towards healthcare staff
Raise awareness regarding habits that cause the spread of cholera and the effectiveness of the vaccines against cholera
7
8
Provide ample food, water and medicine to the people living in the affected areas
Mitigation Strategies and Contingency Plans
The mitigation strategies and contingency plans are determined using risk register matrix as follows.
Risk Name
Chance of Occurrence
Effect on Project
Mitigation Strategy
Contingency Plan
Contagion
Extreme
Very High
Avoid direct touch with the patients, avoid drinking local water and eating local food
Use sanitizers, gloves, disinfectants and others
Contamination
Extreme
Extreme
Avoid holding local food or water during delivery of the medicines
Use sanitizers, gloves, disinfectants and others
Budget
Very High
Very High
Avoid too much additional costs
Send request to government to provide additional funding
Schedule
Medium
Medium
Follow the schedule as provided
Prepare a feasible schedule for the health camps
Accessibility
High
Medium
Survey the areas before setting up camp
Deliver the medicines, food and water using drones
Dead Body Dumping
High
High
Help the local people to dump the bodies far away from residential area
Petition to government for creating a graveyard far from the living areas
Hostile Behavior
Medium
High
Raise awareness regarding habits that cause the spread of cholera and the effectiveness of the vaccines against cholera
Provide ample food, water and medicine to the people living in the affected areas
Lack of Treatment Facility
High
Very High
Set up medical camps using available facilities
Request government to provide better temporary facilities
No Effect from Provided Medicines
Medium
Extreme
Try new medicines
Import other similar medicines for treatment
Insufficient Supply of Medicine
Very High
Very High
Ask government to provide more medicines
Contact private agencies to provide medicines
Risk Monitoring and Control Plans
For the risk monitoring and control plan, an estimated time schedule has been prepared as shown in the following table.
Task Name
Duration
Start
Finish
Risk Management and Control
233 days
Mon 01-05-17
Wed 21-03-18
Project Initiation
17 days
Mon 01-05-17
Tue 23-05-17
Initial Discussions
1 day
Mon 01-05-17
Mon 01-05-17
Initial Planning for Project
4 days
Tue 02-05-17
Fri 05-05-17
Preparation of the Proposal Document
2 days
Mon 08-05-17
Tue 09-05-17
Sending a copy of proposal documents to government
2 days
Wed 10-05-17
Thu 11-05-17
Getting Feedbacks from Employees
2 days
Fri 12-05-17
Mon 15-05-17
Selection of Health Camp Sites
1 day
Tue 16-05-17
Tue 16-05-17
Getting Approval from Government
5 days
Wed 17-05-17
Tue 23-05-17
Finalization of the Project
0 days
Tue 23-05-17
Tue 23-05-17
Project Preparations
13 days
Wed 24-05-17
Fri 09-06-17
Survey of all Cholera Affected Areas
4 days
Wed 24-05-17
Mon 29-05-17
Risk Assessment
5 days
Tue 30-05-17
Mon 05-06-17
Prepare Risk Register Matrix
2 days
Tue 06-06-17
Wed 07-06-17
Preparation of Risk Management Plan
1 day
Thu 08-06-17
Thu 08-06-17
Preparation of Final Plan
1 day
Fri 09-06-17
Fri 09-06-17
Proceed for Execution
0 days
Fri 09-06-17
Fri 09-06-17
Project Execution
201 days
Mon 12-06-17
Mon 19-03-18
Procurement of Initial Budget from Government
10 days
Mon 12-06-17
Fri 23-06-17
Purchase of Medical Equipments and Medicines
10 days
Mon 26-06-17
Fri 07-07-17
Gather Vehicles for Relocating to Camp Locations
5 days
Mon 10-07-17
Fri 14-07-17
Set Up Camps
10 days
Mon 17-07-17
Fri 28-07-17
Take Risk Management Measures
15 days
Mon 31-07-17
Fri 18-08-17
Start Providing Healthcare Services
30 days
Mon 21-08-17
Fri 29-09-17
Providing food and water
15 days
Mon 02-10-17
Fri 20-10-17
Provide medicines
15 days
Mon 23-10-17
Fri 10-11-17
Prevent Contamination of Water
10 days
Mon 13-11-17
Fri 24-11-17
Take Suitable Safety Measures
15 days
Mon 27-11-17
Fri 15-12-17
Update Reports to Government
10 days
Mon 18-12-17
Fri 29-12-17
Study on Progress of the Healthcare
10 days
Mon 01-01-18
Fri 12-01-18
Send Requests for More Food and Medicine
2 days
Mon 15-01-18
Tue 16-01-18
Continue Treatment
5 days
Wed 17-01-18
Tue 23-01-18
Spread Disinfectant
5 days
Wed 24-01-18
Tue 30-01-18
Receive additional funding
5 days
Wed 31-01-18
Tue 06-02-18
Receive more medicines
5 days
Wed 07-02-18
Tue 13-02-18
Relocate Staffs
10 days
Wed 14-02-18
Tue 27-02-18
Evacuate ill staffs
2 days
Wed 28-02-18
Thu 01-03-18
Check reduction of contamination levels
10 days
Fri 02-03-18
Thu 15-03-18
Check on healths of patients
2 days
Fri 16-03-18
Mon 19-03-18
Return the staffs
0 days
Mon 19-03-18
Mon 19-03-18
Project Closing
2 days
Tue 20-03-18
Wed 21-03-18
Post Project Review
1 day
Tue 20-03-18
Tue 20-03-18
Survey in the Selected Areas
1 day
Wed 21-03-18
Wed 21-03-18
Stakeholder Sign Off
0 days
Wed 21-03-18
Wed 21-03-18
The costs are estimated based on the following resource usages.
Resource Name
Type
Max. Units
Std. Rate
Ovt. Rate
Cost/Use
Accrue At
Base Calendar
Project Manager
Work
100%
$250.00/hr
$0.00/hr
$0.00
Prorated
Standard
Medical Supervisor
Work
100%
$175.00/hr
$0.00/hr
$0.00
Prorated
Standard
Project Planner
Work
100%
$150.00/hr
$0.00/hr
$0.00
Prorated
Standard
Logistics Manager
Work
100%
$175.00/hr
$0.00/hr
$0.00
Prorated
Standard
Finance Manager
Work
100%
$125.00/hr
$0.00/hr
$0.00
Prorated
Standard
Local Guide
Work
100%
$65.00/hr
$0.00/hr
$0.00
Prorated
Standard
Support Staff
Work
100%
$600.00/hr
$0.00/hr
$0.00
Prorated
Standard
Food
Material
$75,000.00
$0.00
Prorated
Water
Material
$15,000.00
$0.00
Prorated
Medicines
Material
$12,000.00
$0.00
Prorated
Medical Equipments
Material
$20,000.00
$0.00
Prorated
Camp Setup Costs
Material
$10,000.00
$0.00
Prorated
Other Costs
Material
$5,000.00
$0.00
Prorated
Additionally, the total costs for the risk management process will incur costs as shown in the following table.
Task Name
Resource Names
Cost
Risk Management and Control
$905,800.00
Project Initiation
$57,600.00
Initial Discussions
Project Manager, Project Planner
$3,200.00
Initial Planning for Project
Project Manager, Medical Supervisor
$13,600.00
Preparation of the Proposal Document
Project Manager, Medical Supervisor
$6,800.00
Sending a copy of proposal documents to government
Project Manager, Medical Supervisor
$6,800.00
Getting Feedbacks from Employees
Project Manager, Medical Supervisor
$6,800.00
Selection of Health Camp Sites
Project Manager, Medical Supervisor
$3,400.00
Getting Approval from Government
Project Manager, Medical Supervisor
$17,000.00
Finalization of the Project
$0.00
Project Preparations
$24,200.00
Survey of all Cholera Affected Areas
Medical Supervisor
$5,600.00
Risk Assessment
Project Manager
$10,000.00
Prepare Risk Register Matrix
Project Manager, Project Planner
$6,400.00
Preparation of Risk Management Plan
Finance Manager
$1,000.00
Preparation of Final Plan
Project Planner
$1,200.00
Proceed for Execution
$0.00
Project Execution
$820,600.00
Procurement of Initial Budget from Government
Finance Manager
$10,000.00
Purchase of Medical Equipments and Medicines
Finance Manager
$10,000.00
Gather Vehicles for Relocating to Camp Locations
Logistics Manager, Medical Supervisor, Project Planner
$20,000.00
Set Up Camps
Logistics Manager, Medical Supervisor, Project Planner
$40,000.00
Take Risk Management Measures
Logistics Manager, Medical Supervisor, Project Planner
$60,000.00
Start Providing Healthcare Services
Logistics Manager, Medical Supervisor, Project Planner
$120,000.00
Providing food and water
Project Planner, Logistics Manager, Medical Supervisor
$60,000.00
Provide medicines
Project Planner, Logistics Manager, Medical Supervisor
$60,000.00
Prevent Contamination of Water
Project Planner, Logistics Manager, Medical Supervisor
$40,000.00
Take Suitable Safety Measures
Project Planner, Logistics Manager, Medical Supervisor
$60,000.00
Update Reports to Government
Project Planner, Logistics Manager, Medical Supervisor
$40,000.00
Study on Progress of the Healthcare
Logistics Manager, Medical Supervisor, Project Planner
$40,000.00
Send Requests for More Food and Medicine
Project Planner, Logistics Manager,Medical Supervisor
$8,000.00
Continue Treatment
Project Planner, Logistics Manager, Medical Supervisor
$20,000.00
Spread Disinfectant
Project Planner, Logistics Manager, Medical Supervisor
$20,000.00
Receive additional funding
Logistics Manager, Medical Supervisor, Project Planner
$20,000.00
Receive more medicines
Project Planner, Logistics Manager, Medical Supervisor
$20,000.00
Relocate Staffs
Medical Supervisor, Logistics Manager, Project Planner
$40,000.00
Evacuate ill staffs
Logistics Manager, Medical Supervisor, Project Planner
$8,000.00
Check reduction of contamination levels
Logistics Manager, Medical Supervisor, Project Planner
$40,000.00
Check on healths of patients
Support Staff, Food[1]
$84,600.00
Return the staffs
Finance Manager, Support Staff, Project Manager, Project Planner, Local Guide, Logistics Manager, Medical Supervisor
$0.00
Project Closing
$3,400.00
Post Project Review
Project Manager
$2,000.00
Survey in the Selected Areas
Medical Supervisor
$1,400.00
Stakeholder Sign Off
Finance Manager, Support Staff, Project Manager, Project Planner, Local Guide, Logistics Manager, Medical Supervisor
$0.00
Conclusion
Finally, it can be concluded that there are a number of risks and issues that are associated with the project. While this project is based on emergency response to the cholera affected areas in Yemen, the most serious risk associated with the project is the health risk of the support and medical staff. In addition to the existing medical staffs, the support staffs like logistics assistants, health camp managers and others may also catch the disease easily due to extreme contagious nature of the disease. The main problem is that if the healthcare staffs are affected by the disease, the project cannot be continued further and emergency evacuation will be required for the healthcare and support staffs. Another major risk identified for the project includes lack of the supply of food and medicines for patients as well as the medical staffs. Again, due to the extensive nature of the epidemic, all the cholera vaccines are used up and most of the water sources are contaminated with the cholera bacteria. This also spreads disease among the medical staffs. Finally, budget is one of the major risks discussed in this report and also associated with the project. Due to the nature and scale of the project, no proper budget can be estimated accurately. The treatment processes depend on the extent of the disease in the patients, number of patients in the area, availability of the medicines and others and for these cases, the budget can significantly vary. Hence, all plans are to be made before proceeding with the project.
Bibliography
Binder, J. (2016). Global project management: communication, collaboration and management across borders. Routledge.
Boud, D., Cohen, R., & Sampson, J. (Eds.). (2014). Peer learning in higher education: Learning from and with each other. Routledge.
Fleming, Q. W., & Koppelman, J. M. (2016, December). Earned value project management. Project Management Institute.
Harrison, F., & Lock, D. (2017). Advanced project management: a structured approach. Routledge.
Heagney, J. (2016). Fundamentals of project management. AMACOM Div American Mgmt Assn.
Kerzner, H., & Kerzner, H. R. (2017). Project management: a systems approach to planning, scheduling, and controlling. John Wiley & Sons.
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