FEDERAL

DEMOCRATIC
REPUBLIC
OF ETHIOPIA

NATIONAL ANTHRAX
PREVENTION AND CONTROL
STRATEGIC PLAN
Joint Ministry of Health, Ministry of Agriculture and Livestock
Resources, Ministry of Culture and Tourism and Ministry of
Environment, Forest and Climate Change Implementation Plan

2018 – 2030

1
2
 TABLE OF CONTENTS
FORWARD IV
CONTRIBUTING AUTHORS V
LIST OF ABBREVIATIONS VI
LIST OF TABLES VII
LIST OF FIGURES VIII
ACKNOWLEDGEMENT IX

CHAPTER ONE – INTRODUCTION 1

1.1. INTRODUCTION 1
1.2. EPIDEMIOLOGY OF ANTHRAX 2
1.2.1. Etiology and Spore Persistence 2
1.2.2. Transmission 2
1.2.3. Clinical presentation 3
1.3. DIAGNOSIS 3
1.3.1. Clinical signs 4
1.3.2. Laboratory diagnosis 4
1.3.3. Differential diagnosis 6

1.4. PRINCIPLES OF ANTHRAX PREVENTION AND CONTROL 6

1.5. ANTHRAX SITUATION IN ETHIOPIA 6

1.5.1. Burden of Anthrax in Ethiopia 6
1.5.2. Availability of Anthrax Vaccine in Ethiopia 7
1.5.3. Anthrax Surveillance System in Humans in Ethiopia 8
1.5.3.1. Epidemiological surveillance 8
1.5.3.2. Laboratory surveillance 9
1.5.3.3. Outbreak investigation and response 10
1.5.4. Anthrax Surveillance System in Livestock in Ethiopia 10
1.5.4.1. Epidemiological surveillance 10
1.5.4.2. Laboratory surveillance 13
1.5.4.3. Outbreak investigation and response 14
1.5.5. Anthrax Surveillance System for Wildlife in Ethiopia 15
1.5.5.1. Epidemiological surveillance 15
1.5.5.2. Outbreak investigation and response 15
1.5.6. Current Anthrax Prevention and Control Activities in Ethiopia 16
1.5.6.1. Core Stakeholders for Anthrax Control in Ethiopia 17
 1.5.6.2. Prevention and Control Activities in Humans in Ethiopia 17
1.5.6.3. Prevention and Control Activities in Livestock in Ethiopia 17
1.5.6.4. Prevention and Control Activities in Wildlife in Ethiopia 18
1.5.6.5. Policy, Legal and Institutional Framework supporting prevention

and control of Anthrax 18

1.6. CHALLENGES IN ANTHRAX CONTROL IN ETHIOPIA 19

1.6.1. Inadequate Laboratory Capacity and Biosecurity 19
1.6.2. Inadequate Surveillance 19
1.6.3. Lack of Prevalence and Burden Estimates 19
1.6.4. Inadequate Inter-Sectoral Collaboration and Partnerships 19
1.6.5. Lack of Educational and Awareness Materials for Anthrax Prevention 19
1.6.6. Limited Supply and Distribution of Anthrax Vaccine and management of
Anthrax vaccines 20
1.6.7. Funding Constraints and Competing Priorities 20
1.6.8. Lack of Integrated national guidelines and standard operating procedures
(SOPs) on anthrax prevention and control 20

1.7. OPPORTUNITY FOR ENHANCING ANTHRAX CONTROL AND PREVENTION IN ETHIOPIA 20

1.7.1. Establishment of One Health Coordination Structures 20
1.7.2. Increased Interest in Enhancing Anthrax Control and Prevention 20
1.7.3. In-Country Anthrax Vaccine Production 20

CHAPTER TWO 21
2. THE STRATEGIC FRAMEWORK 21
2.1. GUIDING PRINCIPLES OF THE STRATEGY 21
2.2. VISION 21
2.3. MISSION 21
2.4. GOAL 21
2.5. GENERAL OBJECTIVES 21
2.6. STRATEGIC FRAMEWORK FOR THE PREVENTION AND CONTROL OF ANTHRAX 22
2.7. COMPONENTS OF THE ANTHRAX PREVENTION AND CONTROL STRATEGIC FRAMEWORK 23
2.7.1. Surveillance and Reporting Systems 23
2.7.2. Outbreak investigation and response 24
2.7.3. Prevention and Control of Anthrax 24
2.7.4. Anthrax Diagnostic Laboratory Capacity 25
2.7.5. Information, Education and Communication 26
2.7.6. Multi-Sectoral Collaboration 27
CHAPTER THREE
3. IMPLEMENTATION PLAN 28
3.1.PHASE 1: PLANNING, PREPARATION AND ASSESSMENT PHASE (2 YEARS) (2017-2019)
3.1.1. Specific activities to be completed in the stipulated timeframe 28
3.1.1.1. Surveillance and reporting 28
3.1.1.2. Outbreak investigation and response 29
3.1.1.3. Disease prevention and control 29
3.1.1.4. Anthrax Diagnostic Laboratory Capacity 29
3.1.1.5. Information, Education and Communication 30
3.1.1.6. Multi-Sectoral Collaboration 30

3.2. PHASE 2: IMPLEMENTATION PHASE IN TARGET AREAS (4 YEARS) (2020-2023) 30

3.2.1. Specific activities to be completed in the stipulated timeframe 31
3.2.1.1. Surveillance and reporting 31
3.2.1.2. Outbreak investigation and response 31
3.2.1.3. Disease prevention and control 31
3.2.1.4. Anthrax Diagnostic Laboratory Capacity 32
3.2.1.5. Information, Education and Communication 32
3.2.1.6. Multi-Sectoral Collaboration 33

3.3. PHASE 3: IMPLEMENTATION PHASE IN EXPANDED AREAS (7 YEARS) (2024-2030)

3.3.1. Specific activities to be completed in the stipulated timeframe 33
3.3.1.1. Surveillance and reporting 33
3.3.1.2. Outbreak investigation 33
3.3.1.3. Disease prevention and control 34
3.3.1.4. Anthrax Diagnostic Laboratory Capacity 34
3.3.1.5. Information, Education and Communication 34
3.3.1.6. Multi-Sectoral Collaboration 34

3.4. WORK PLAN FOR IMPLEMENTING PHASES-ONE 35

3.5. Monitoring and Evaluation 45

4. BUDGET SUMMARY 52

5. ANNEXES 54
5.1. Budget Narrative 54
 FORWARD
The Government of Ethiopia is showing encouraging commitment to the livestock and public
health sectors. The Ministry of Health and Ministry of Livestock and Fisheries, has been dedicating

emerging disease epidemics including neglected zoonoses, that is diseases that are transmitted

burden on human health and livelihood.

Anthrax is an immediately reportable disease in Ethiopia. Anthrax outbreaks have been reported
from Ethiopia to the World Organization for Animal Health (OIE) every year from 1996 through

per year in cattle, sheep, goats, camels and horses. Human cases are also reported, but not always
from districts reporting animal cases. Recent work to prioritize zoonotic diseases for inter-sectoral
engagement ranked anthrax as one of the top 5 zoonotic diseases of major public health concern
in Ethiopia.

We therefore need to work together to plan and prepare ourselves to deal with epidemics of all

of One Health in prevention, combating and control of zoonotic diseases, the tripartite ministries,
Ministry of Livestock and Fisheries, Ministry of Health and Ministry of Culture and Tourism (through
the Ethiopian Wildlife Protection Authority), in collaboration with development partners (CDC,
FAO, USAID, Ohio State University, WHO and other partners) established a national One Health
Platform (OHP) with various technical working groups.

This National Strategy for the Prevention and Control of Anthrax, therefore, is drafted by the
Ministry of Health (through Ethiopian Public Health Institute (EPHI)), the Ministry of Livestock and
Fisheries (through the Veterinary Public Health Directorate, Epidemiology Directorates, Disease
Prevention and Control Directorate, National Animal Health Investigation and Diagnostic Center
(NAHDIC) and National Veterinary Institute (NVI)), and Ministry of Culture and Tourism (through
Ethiopian Wild Life Conservation Authority (EWCA)) and development partners. This strategic
document plans to prevent and control anthrax in humans and animals in Ethiopia using a
combination of the following strategic areas of focus: Strengthen Surveillance and Reporting
system, improving Outbreak Investigation and response, Prevention and Control, strengthen
Diagnostic laboratory capacity and Risk Communication. The strategic plans has three phases:

PHASE 1: PLANNING, PREPARATION AND ASSESSMENT PHASE (2 YEARS) (2017-2019)

PHASE 2: IMPLEMENTATION PHASE IN TARGET AREAS (4 YEARS) (2020-2023)
IV PHASE 3: IMPLEMENTATION PHASE IN EXPANDED AREAS (7 YEARS) (2024-2030)

control the public health impact of anthrax in humans and animals in Ethiopia through sustained
surveillance, laboratory diagnosis, prevention and control systems and community awareness. This
strategy will build upon and complement existing communicable disease prevention and control

public and animal health systems and enhancing their collaboration in areas of common interest
such as surveillance, early detection, diagnosis, rapid response, education and research.

_____________________________ _________________________________

Dr Kebede Worku Dr Gebregziabher G/Yohannes

State Minister State Minister
Federal Ministry of Health (MoH) Ministry of Agriculture and Livestock Resources
 CONTRIBUTING AUTHORS
The following experts are acknowledged for their contribution towards the production of
the first
edition of the national multi-sectoral anthrax prevention and control strategy in Ethiopia.
Dr. Musse Tadesse (Researcher, EPHI)
Dr. Mesfin zewdu (Senior Expert, MoLF)
Dr. Elias Walelign (National OH focal point and MERS CoV coordinator, FAO-ECTAD)
Dr. Antonio Veira (senior expert, US-CDC)
Dr. Matios Lakew (Associate Researcher, NAHDIC)
Dr. Biniam Tadesse (Associate Researcher, NAHDIC)
Mr. Negga Asamene (Researcher, EPHI)
Dr. Rediet Belayeneh (Associate Researcher, NAHDIC)
Dr. Abebe Wossene (Technical Advisor, USAID)
Dr. Assefa Deressa (Researcher, EPHI)
Dr. Baye Ashenafi (Researcher, EPHI)
Dr. Darsema Gulima (G/Manager, EVA)
Dr. Etsegenet Tekeba (Surveillance Expert, MoLF)
Dr. Feyessa Regassa (Researcher, EPHI)
Dr. Kassahun Amsalu (Disease Prevention and Control Expert, MoLF)
Dr. Lealemselam Negga (VPH Expert, MoLF)
Dr. Aklilu Tesfaye (VPH Expert, MoLF)
Dr. Takele Abayneh (Senior Researcher, NVI)
Mr. Temesgen Yadeta (Wildlife and Habitat Expert, EWCA)
Mr. Tesfahun Abeye (PHEM officer, EPHI)
Dr. Wondessen Bekele (Director of VPH, MoLF)
Mr. Behailu Gosheme (Expert, EWCA)
Dr. Scott Newman (ECTAD Team Leader – Ethiopia, FAO ECTAD)
V
Dr. Melissa Kadzik (Public Health Analyst, US-CDC)
Dr. Henry Walke (Chief, Bacterial Special Pathogens Branch, US-CDC)
Mrs. Susan Mugwe (Monitoring and Evaluation Expert, FAO-African Region)
Dr. Abiy Girmay (IHR Officer, WHO)
Dr. Jack Mortenson (Technical Expert, USAID)
Dr. Getnet Yiemr (Director, GOHI-East Africa)
 LIST OF ABBREVIATIONS
ADNIS Animal Disease Notification and Investigation System

CDC Center for Disease Control and Prevention

DOVAR Outbreak and Vaccination Report

ELISA Enzyme-linked Immuno-sorbent Assay

EPHI Ethiopian Public Health Institute

EWCA Ethiopian Wild Life Conservation Authority

FAO Food and Agriculture Organization of the United Nation

HSDP Health Sector Development Plans

LIMS Laboratory Information Management

MoCT Ministry of Culture and Tourism

MOH Ministry of Health

MoLF Ministry of Livestock and Fisheries

MoU Memorandum of Understanding

NAHDIC National Animal Health Diagnostic and Investigation Center

NVI National Veterinary Institute

OHP One Health Platform

OSU Ohio State University

PCR Polymerase Chain Reaction

PPE Personal Protective Equipment

SOP Standard Operating Procedure

TAD Trans Boundary Animal Diseases

VI TOR Terms of Reference

 LIST OF TABLES
Table 1: Distribution of human anthrax cases by region, 2014 – 2016, Ethiopia 7

Table 2: DOVAR output demonstrating cases and deaths of anthrax for 2012-2016 12

Table 3: Cases and Deaths of anthrax in animals from 2007 to 2009 13

Table 4: Record of the wild animals affected by the anthrax outbreak

at Mago national park 16

Table 5: National anthrax prevention and control strategic plan (two year work plan) 35

Table 6: Ethiopia - anthrax performance monitoring plan (Phase-one) 45

Table 7: Budget Summary by components of the Anthrax Prevention and Control

Strategic Framework (2018-2030)) 52

VII
 LIST OF FIGURES
Figure 1: Diagnostic tests and findings for B. anthracis 5

Figure 2: Flow of information and Timeline for immediately Reportable Diseases 9

Figure 3. Map of reporting and non-reporting woredas in 2016 (DOVAR) 11

Figure 4. Animal Disease Notification and Investigation System (ADNIS) pilot areas 11

VIII
 ACKNOWLEDGEMENT
The national Strategy for the prevention and control of anthrax in animals and humans
has been prepared by the anthrax Working Group (TWG) composed of participants from
Ministry of Health (MoH/EPHI), Ministry of Livestock and Fishery (MoLF/NAHDIC/NVI),
Ministry of Culture and Truism (MoCT/EWCA), Center for Disease Prevention and Control
(US-CDC/Ethiopia), Food and Agriculture Organization (FAO-ECTAD), Global One Health
Initiative (GOHI), USAID and World Health Organization (WHO).

The preparation of the national Strategy has benefited from the assistance and support of
many experts and representatives, including the following:

1. The participants in an Anthrax Stakeholders workshop “Anthrax surveillance,

prevention and control in Ethiopia” in March 2-3, 2017 at the Ethiopian Public Health
Institute in Addis Ababa, that was organized by US Centers for Disease Control and
Prevention (CDC) in collaboration with EPHI.

2. The participants in Stakeholders Meeting aiming at establishment of anthrax

Technical Working Group (ATWG) and development of TOR, in April 14, 2017 at
Food and Agriculture Organization country office (FAO) in Addis Ababa, that was
organized by US-CDC, FAO-ECTAD in collaboration with MoLF.

3. The participants in Anthrax strategic plan write-shop, in July 24-27, 2017 at Asham
Africa Resort in Bishoftu town, Ethiopia; that was organized by FAO-ECTAD in
collaboration with Ethiopian Public Health Institute (EPHI).

4. The participants in Anthrax strategic plan Monitoring and Evaluation write-shop,

in September 18-21, 2017 at Asham Africa Resort in Bishoftu town, Ethiopia; that
was organized by FAO-ECTAD in collaboration with Ethiopian Public Health Institute
(EPHI).

5. The participants in Anthrax strategic plan coasting exercise write-shop, in January

3-5, 2018 at Asham Africa Resort in Bishoftu town, Ethiopia; that was organized by
FAO-ECTAD and Global One Health Initiative (GOHI) in collaboration with Ethiopian
Public Health Institute (EPHI) and Ministry of Livestock and Fishery (MoLF).

6. E-conferences organized by CDC and FAO-ECTAD for the participants of ATWG.

The Ministry of Health under Ethiopian Public Health Institute (EPHI), the Ministry of
Livestock and Fishery, the Ministry of Culture and Tourism wish to thank all experts and
partners contributed to the successful completion of the strategic plan for the prevention
IX
and control of anthrax in Ethiopia.
 1
CHAPTER

INTRODUCTION
12
1.1. INTRODUCTION
Anthrax is a zoonotic bacterial disease of Health has been dedicating considerable
caused by Bacillus anthracis. It primarily resources to the response to Public Health
occurs in herbivorous wildlife and livestock, Emergencies: from epidemics of diseases
in which it is usually fatal. Anthrax causes to widespread malnutrition resulting from
four main clinical forms of disease in humans: drought.
cutaneous, gastrointestinal, inhalation
and injection anthrax. Humans contract Cognizant of the importance of One Health
cutaneous anthrax through direct skin in prevention, combating and control of
contact with B. anthracis infected animals or zoonotic diseases, the tripartite ministries,
during slaughtering animals or processing Ministry of Livestock and Fisheries, Ministry
animal by-products. Gastrointestinal of Health and Ministry of Culture and Tourism
anthrax results from consumption of raw (through the Ethiopian Wildlife Protection
or undercooked meat contaminated with Authority), in collaboration with UN agencies
B. anthracis. Humans develop inhalation (WHO and FAO) and development partners
anthrax through inhalation of spores (CDC, USAID, Ohio State University and
aerosolized during processing or contact other partners) established a national One
with contaminated hides, bones, hair or Health Platform (OHP) with various technical
wool. Of these forms, cutaneous anthrax working groups. Since the national OHP was
comprises >95% of the human infections. established, various activities have been
undertaken. One of the tasks was developing
Anthrax affects many domestic and wild a list of priority zoonotic diseases as an entry
animals and humans. The susceptibility for a multi-sectoral joint action to reduce
of different animal species to anthrax and combat the impact of zoonotic diseases
varies considerably. Most warm-blooded on public and animal health as well as on
vertebrate species (including reptiles and the national economy. The national zoonotic
amphibians that have been artificially disease prioritization was conducted using
warmed) have been infected, naturally or a tool developed by CDC and resulted in 5
experimentally. The disease is enzootic in priority zoonotic diseases for inter sectoral
several regions of the world and B. anthracis collaboration of which Rabies and Anthrax
has always been high on the list of potential are the two top priorities.
agents with respect to biological warfare
and bioterrorism. Following the development of the list
of priority zoonotic diseases, the three
The Government of Ethiopia is showing ministries, in collaboration with partners
encouraging commitment to the public planned to formulate strategies for the
health, livestock and wildlife sectors. A new control and elimination of dog-mediated
ministry dedicated to livestock, Ministry of
Livestock and Fisheries, has been established,
Rabies and for the prevention and control
of Anthrax through a One Health approach.
1
as part of a reform in the sector Investments This National Strategy for the Prevention
in public and animal health, production, and Control of Anthrax, therefore, is drafted
infrastructure, and facility development are by the Ministry of Livestock and Fisheries,
improving throughout the country. It is clear the Ministry of Health (through EPHI) and
that the livestock industry will continue to Ministry of Culture and Tourism (through
be a focus of the government at all levels. EWCA) and development partners.
Furthermore, Ethiopia has implemented
successive Health Sector Development Plans
(HSDP) since 2004, in four phases. During
this period the country has made huge stride
in improving access to health service and
improvement in health outcomes. Ministry
 1.2. EPIDEMIOLOGY OF neck, arm, or hands or wherever the spores
ANTHRAX came into contact with the skin
• Incubation period: up to 17 days, but most
1.2.1. Etiology and Spore Per- disease occurs in 1 to 7 days
sistence
• Exposure: butchering an animal that died
Anthrax is caused by Bacillus anthracis, a gram- of anthrax or contact with contaminated
positive, rod-shaped bacterium. B. anthracis animal products such as meat, hide, blood,
produces a toxic complex comprising three or hair
factors: oedema factor, protective antigen
and lethal factor. Together, these factors • Scratches or cuts on skin may increase risk
kill phagocytes, damage capillary walls and • Hand washing may decrease risk
interfere with blood clotting, leading to
oedema, shock and death. Protective antigen Inhalation anthrax
provides the mechanism for lethal factor to
• Initially- fever, chills, and fatigue may be
enter cells. Once outside the host and exposed
accompanied by cough; slightly later-
to air, B. anthracis starts sporulation. Spores
chest discomfort, headache, and nausea/
are extremely resistant to heat, cold, pH,
vomiting occur; finally- shortness of breath
desiccation, chemicals, irradiation and other
and confusion
adverse conditions, and can survive for years in
soil, wool, and hair of infected animals. • Incubation period: up to 60 days, but most
disease occurs in 1 to 7 days
1.2.2. Transmission
• Exposure: working with spore-
Bacillus anthracis can be found naturally in contaminated hides in an industrial setting
soil and commonly affects domestic and wild or bioterrorism
animals around the world. The animals can
become infected when they ingest spores from Gastrointestinal anthrax
contaminated soil, plants, or water. Spores
form when bacilli in blood or bodily fluids from • Development of fever/chills, fatigue,
carcasses are exposed to air, or when carcasses nausea/vomiting, and abdominal pain
are opened by scavengers. The spores begin are common; diarrhea, headache, and
to form soon after death, and the process confusion occur in about a quarter of
of sporulation is complete within 24 to 48 patients; swelling of neck, sore throat, or
hours. These spores are very hardy and they painful swallowing suggest pharyngeal
contaminate the soil, where they can survive for disease
many years, before being ingested by animals
• Incubation period: up to 16 days, but most
and re-starting the cycle. Vegetative cells within
disease occurs in 1 to 7 days
2 an intact carcass will be outcompeted by other
bacteria and die within 2 to 3 days. Biting flies • Exposure: eating meat from an animal that
may serve as mechanical vectors after feeding died of anthrax
on a carcass, contaminating vegetation.
Injection anthrax
1.2.3. Clinical presentation • Similar to cutaneous anthrax, but injection
Anthrax has 4 clinical presentations in humans: anthrax has the potential to spread more
rapidly throughout the body
Cutaneous anthrax • Incubation period: up to 20 days, but most
• A clump of small blisters or lumps that may disease occurs in 1 to 7 days
itch, swell, and eventually develop into an • Exposure: injecting spore-contaminated
ulcer with a black center; the lesion may be illicit drugs
painless and is often located on the face,
1.3. DIAGNOSIS expensive and the test is more a research
tool than of practical day-to-day value in the
Suspicion of anthrax arises from the field.
observation of clinical symptoms, the
anatomic-pathological findings and Animals
epidemiological data.
Rapid diagnostic methods require testing
1.3.1. Clinical signs the carcass while it is still fresh. Once the
carcass is putrefied or scavenged, culture
Clinical manifestations vary from species to is required to isolate B. anthracis. Samples
species, presumably reflecting differences in should be collected without opening the
susceptibility. Sudden death in apparently carcass, to prevent further environmental
healthy animals which may be accompanied contamination. Specimens can include
by bloody discharges from natural orifices, blood, tissue, exudates, other fluids, and
rapid bloating of the carcass, incomplete nasal turbinates.
rigor mortis and the absence of clotting of
the blood are the common characteristics
of anthrax in susceptible animals. In
Humans
more resistant species, local signs such as
swellings of the oral and pharyngeal region Specimens can include blood, skin
are seen. In wildlife, sudden death is the lesion exudates, pleural or ascitic fluid,
invariable sign, often (but not always) with cerebrospinal fluid, or stool. Specimens
bloody discharges from natural orifices, should always be collected prior to antibiotic
bloating, incomplete rigor mortis and the therapy. Culture and Gram stains will likely
absence of clotting of the blood. Cutaneous be negative if specimens are collected
anthrax accounts for > 95% of human after antibiotic therapy has been initiated,
cases worldwide. The lesions (eschars) are regardless of the form of disease. The
generally found on exposed regions of the likelihood that antigen or molecular testing
body almost invariably accompanied by methods will be positive decreases with
marked oedema extending some distance the length of antibiotic treatment prior to
from the lesion. sample collection. All samples (except sera
for serology) must be collected prior to the
1.3.2. Laboratory diagnosis initiation of antibiotics.
The simplest, quickest and best on-site
diagnostic method is examination of a
polychrome methylene blue-stained blood
smear for the capsulated bacilli supported,
where possible, with confirmation by
culture. Genetically-based confirmation 3
by the polymerase chain reaction (PCR) is
highly accepted on a stand-alone basis for
many types of specimen and is increasingly
available worldwide through commercial
kits. Retrospective diagnosis by enzyme-
linked immunosorbent assay (ELISA) in
animals that have survived infection is
possible, but specific antigen for this is
 Available tests Findings
Gram stain Gram-positive rods, square-ended, in
pairs or short chains

Polychrome Dark blue square-ended rods surrounded

by pink capsule. Rods are in pairs or
methylene blue stain
short chains, sometimes as single rods
(M’Fadyean stain)

Direct antigen Detection of antigen (usually protective

antigen, but test will specify)
detection

Serology Seroconversion (use as a retrospective

diagnosis, as need paired sera collected

at least 2 weeks apart)

PCR Detection of toxin and capsule DNA

Culture (Gold Identification of B. anthracis by: colonial

morphology, non-motile, non hemolytic,
standard)

4 gamma phage and penicillin-sensitive,

and capsule producing

Figure 1- Diagnostic tests and findings for B. anthracis (source: Framework for enhancing anthrax prevention and control,
August, 2016)
1.3.3. Differential diagnosis 1.5. ANTHRAX SITUATION IN
ETHIOPIA
Anthrax should be differentiated from other
causes of sudden death such as: lightning 1.5.1. Burden of Anthrax in
strike and accidental electrocutions, Ethiopia
pasteurellosis, piroplasmosis, blackleg,
malignant oedema, food intoxications, Ethiopia has a large livestock population and
botulism, peracute babesiosis, chemical many rural communities depend on animals
poisoning (heavy metal and other for food, income and draught power. Disease
poisoning), plant poisoning, snake bite, is one of the major constraints preventing
metabolic disorders (lactic acidosis), these large livestock resources from being
magnesium deficiency, bloat and others. fully exploited. Anthrax is an endemic
disease which occurs in May and June every
1.4. PRINCIPLES OF ANTHRAX year (‘anthrax season’) in several farming
PREVENTION AND CONTROL localities of the country, causing disease
both in humans and livestock. In 2000, it
Control of anthrax begins with control of
was reported that hundreds were affected
the disease in livestock, and vaccination of
in the Afar region of Ethiopia, many with
livestock has long been the hub of control
oral and gastroenteric infections. It is still a
programs. Anthrax is also responsive
significant risk in most regions in Ethiopia
to antibiotic therapy provided this is
and outbreaks frequently occur in humans
administered early in the course of the
and animals.
infection. In addition to antibiotic therapy
and vaccination, specific control procedures The diagnosis of reported anthrax cases
are necessary to contain the disease and in humans were based on clinical signs
prevent its spread. In particular: with epidemiological features and all
the reported cases were not laboratory
• Proper disposal of dead animals (burial
confirmed due to limitations in laboratory
and/or incineration);
capacity in public and animal health sectors.
• Not opening the carcass, since exposure Recent surveillance data (2009 to 2013)
to oxygen will allow the bacteria to form shows, a total of 5,197 human and 26,737
spores; animal anthrax cases (human to animal
ratio 1:5) were reported with 86 human
• Quarantine of infected premises; anthrax deaths (Case Fatality Rate:1.7 %).
• Cleaning and disinfection of infected The national human prevalence was found
premises and fomites; to be 1.3 per 100,000 populations per five
years, zero human case was reported from
• Control of insects and rodents. pastoralist regions with 55-216 animal cases.
The human prevalence was high in May
followed by February (0.20 and 0.15 per
5
100,000 populations per year respectively).
The burden of human anthrax cases was high
in the Amahara and Tigray regions. From
2014 -216, a total of 2,218 human anthrax
cases with a case fatality rate of 3.16 were
reported from five regions. Off which the
most cases were reported from the Amahara
region followed by Tigray and SNNP regions
(table1, below).
 Table 1: Distribution of human anthrax cases by region, 2014 – 2016, Ethiopia.

Region 2014 2015 2016

Cases % AR Cases % AR Cases % AR
Amhara 609 76.03% 3.04 428 55.80% 2.10 395 60.77% 1.90
Oromia 65 8.11% 0.20 73 9.52% 0.22 32 4.92% 0.09

SNNPR 30 3.75% 0.17 151 19.69% 0.83 0 0.00% 0.00

Somali 0 0.00% 0.00 0 0.00% 0.00 112 17.23% 2.00
Tigray 97 12.11% 1.96 115 14.99% 2.27 111 17.08% 2.15
Grand Total 801 100.00% 0.91 767 100.00% 0.85 650 100.00% 0.70

Even if the existing surveillance data in infected animals. The vaccine is administered
humans indicates the magnitude of anthrax subcutaneously or intradermally at a dose
by place and time, there is a limitation on the of 1ml and can effectively confer protection
type of anthrax, the risk groups and personal against anthrax for a year.
characteristics. The previous studies indicate
that the disease is well recognized by rural The final product is available in a vial of 100
communities but little is known about its doses (100ml) in freeze dried form and must
prevalence, epidemiology and public health be kept at + 2oC to + 8oC protected from light.
These conditions should be maintained from
significance (Teshale Seboxa et al., 1989; Esser
production until utilization. Currently, NVI has
et al., 2003).
a capacity of producing 36 million doses per
1.5.2. Availability of Anthrax year, however, the current production capacity
Vaccine in Ethiopia needs to be increased to cope up with the
increasing trend in Anthrax vaccine demand
Anthrax livestock vaccine is being produced at and for an effective implementation of future
National Veterinary Institute (NVI) for the last anthrax control and prevention programs.
50 years. NVI is the sole supplier of the vaccine
in Ethiopia and the availability of the vaccine 1.5.3. Anthrax Surveillance System in
provides favorable opportunity in the control Humans in Ethiopia
and prevention of Anthrax in Ethiopia.
1.5.3.1. Epidemiological surveillance
The vaccine is prepared from live spores of
a non-encapsulated but toxigenic variant of Implementation of anthrax surveillance
Bacillus anthracis 34F2 Sterne strain. This seed activities at all levels of health system with
strain is used worldwide for animal anthrax prompt laboratory confirmation of circulating
vaccine production since it is stable and has pathogen is an essential strategy for early
lost virulence, but is still immunogenic, due detection of anthrax outbreaks. Anthrax is a
6 to its incapability of forming a capsule, a rare, epidemic prone disease and one of the
characteristic coded by the pXO2 plasmid. The twenty priority diseases under the Public Health
vaccine produced is PANVAC certified for its Emergency Management system that should
safety and protective efficacy. be reported immediately when encountered.

The vaccine produced at NVI is composed of Routine flow of surveillance data is carried out
Bacillus anthracis (Sterne strain) containing107 from reporting sites to the next level up until
spores/dose, Saponine (0.1%), Stabilizer (4% the information reaches the central level. The
skimmed milk). The vaccine is indicated for use community and health facilities, especially
in cattle and sheep but can also be used for health posts, are the main source of information.
all susceptible domestic animals which are at The information collected from these sites is
risk of acquiring anthrax due to contact with compiled in standard forms, analyzed and then
the contaminated soil, forages, or carcasses of forwarded, to the WHO. The first 5 suspected
anthrax cases are reported using the Case- Woreda (DERF-W). The line list is completed
Based Reporting Format (CRF). If more for all cases and kept at the health facility
than 5 suspected cases are seen within one and woreda levels. Zones and Regions: use
month, use the Line list to report daily. After the Daily Epidemic Reporting Format for
100 cases report, the summary of the line list Regions (DERF-R) to report the summarized
using Daily Epidemic Reporting Format for suspected outbreak.

Figure 2: Flow of information and Timeline for immediately Reportable Diseases

1.5.3.2. Laboratory surveillance through commercial kits. PCR depends

on the unique specificity of the toxin
The prevention and control of outbreaks and capsule and their genes. B. anthracis
requires rapid identification of the pathogen cultures are easy to grow on nutrient agar
and the source of infection. Anthrax is medium. Specimens or cultures can be
diagnosed by growing the bacteria from grown overnight on Sheep Blood Agar (SBA)
blood or other tissues. Final identification at 35-37oC. Colonies should be observed
of the bacteria must be done by a public for hemolysis. Confirmation of identity
health laboratory under strict biosafety and and differentiation from near relatives is
biosecurity precautions. There are several generally easy with both traditional and
types of specimen samples for human molecular techniques.
anthrax testing. All potential B. anthracis
specimens should be documented and In Ethiopia, in all health institutions except
properly labeled upon arrival. To increase health posts, though the level of complexity
traceability, samples should be assigned is different, laboratory services with limited
a unique specimen identification number. facilities are available. Due to various
This number should be clearly labeled on reasons such as lack of properly designed
both the testing forms and the specimen laboratory rooms, laboratory personnel
container. with awareness of public health threat from

The simplest, quickest and best on-site

epidemic prone diseases and response
mechanisms, shortage of equipment and
7
diagnostic method is the one established supplies, absence of effective laboratory
in the early 1900s – examination of a equipment maintenance and management
polychrome methylene blue-stained blood system, and weak follow up and supervision,
smear for the capsulated bacilli supported, many of these laboratories are not in a
where possible, with confirmation by culture. position to carry out their responsibilities
Modern on-site anthrax-specific antigen to the level of standard expected. Currently
tests are being developed and validated but neither regional nor national Public Health
are not currently available commercially. reference laboratories are performing
Diagnosis by polymerase chain reaction Anthrax diagnosis either presumptive or
(PCR) is becoming increasingly accepted as a confirmatory.
stand-alone test for many types of specimens
and is increasingly available worldwide
 1.5.3.3. Outbreak investigation Passive surveillance
and response
Animal health Information system plays an
Twenty one immediately notifiable disease important role in surveillance and provides
and conditions were identified in Ethiopia information for economic assessment of
under IDSR system for immediate outbreak diseases in addition to fulfilling international
investigation and response. Anthrax is one reporting needs. The passive surveillance
of the immediately notifiable diseases and system mainly depends on a paper based
a single case of anthrax is considered as an system from woreda to the regional veterinary
outbreak. A cluster of animal deaths or unusual laboratory covering the respective woredas
events resembling the clinical sign of anthrax that laboratory is mandated to cover. The
in humans reported to the health offices at monthly disease outbreak reports received
different level followed by verification and from woreda level are entered in a web-based
outbreak investigation activities. Disease Outbreak and Vaccination Activity
The purpose of an investigation is to verify Reporting (DOVAR-II) system. This reporting
the outbreak, recognize the magnitude system is designed to collect information of
of the outbreak, diagnose the etiological any kind regarding animal health related issues
agent, identify the source and the route of such as diseases occurrences or vaccination
transmission as well as the people at risk, and activities performed in the woreda, including
recommend measures so that the outbreak can anthrax. Currently the proportion of woredas
be controlled as well as prevented in the future. reporting is around 50%, which is below the
The outbreak investigation in case of anthrax international standard of 80% (Source: DOVAR-
is based on the epidemiological findings (risk II database, 2016).
based and clinical findings). Up on notification Figure 3. Map of reporting and non-reporting
of suspected anthrax cases the health office woredas in 2016 (DOVAR)
immediately investigate the cases and carry out
the possible case management and outbreak
investigation steps.

Currently there is limited joint investigation

mechanism b/n the animal health, human
health and other relevant sectors. This might
affects the early detection and preparedness
for prompt response any upcoming epidemics
of anthrax and associated health impacts in
humans.

8 1.5.4. Anthrax Surveillance System in

Livestock in Ethiopia
Syndromic surveillance is practiced in some
1.5.4.1.Epidemiological surveillance selected areas using a mobile based daily
notification system known as Animal Disease
Active and passive surveillance systems are Notification and Investigation System (ADNIS).
being implemented nationally by the Ministry This system is mainly intended to serve the
of Livestock and Fisher for the animal health pastoral areas with a very low or poor reporting
related information’s. The implementation rate. It serves for immediate notification
of the surveillance system with its passive and early detection of some selected animal
and active components as well as additional diseases. Currently there are around 300 sites
surveys have led to a good understanding of practicing this reporting system, and there is a
the disease dynamics in the country including plan to reach 3600 sites at the end of GTP-2 as
status of anthrax (Source: Epidemiology a national plan.
Directorate, 2017).
 Active surveillance
Active surveillance is an essential tool for
early detection of diseases and introduction
of exotic diseases. Additionally, it provides
information for declaring a country or a zone
disease free. Currently there are 15 regional
veterinary laboratories conducting active
surveillance, in addition to NAHDIC.
Figure 4. Animal Disease Notification and
Annual sero-surveillance is being conducted
Investigation System (ADNIS) pilot areas
for priority diseases and trade sensitive
Major gaps of passive surveillance system diseases

Low return rate and poor quality of the Regarding introduction of exotic diseases,
reports received, as most of the outbreak annual risk based sero-surveillance is
reports are not confirmed or not supported by conducted around border areas of the
laboratory diagnosis. Hence, mapping of the country and other areas with the risk of
distribution of confirmed clinical outbreaks introduction of exotic diseases.
is only partially practiced due to the low
For other endemic diseases annual
reporting rate of lab confirmed outbreaks.
surveillance is conducted to know their
Lack of good quality internet connection both status and gathering information for
at regional veterinary labs for the purpose of national control program.
accessing semi-web based system, DOVAR-
In order to detect areas with active disease
II server and for the immediate notification
transmission, participatory disease
system server from field sites.
surveillance (PDS) is conducted for some
Lack of post-assessment evaluation to selected diseases.
quantify the clinical and the socio-economic
impact of disease outbreaks.

Another gap in the national surveillance

system is that it is not able to capture events
in wildlife.

Table 2: DOVAR output demonstrating cases and deaths of anthrax for 2012-2016.

Year No of cases No of Deaths Animal at risk Control Prophylaxis

vaccination vaccination
2016
2015
788
1,486
222
478
541,319
742,041
541,319
407,023
941,719
351,370
9
2014 2,297 931 1,223,180 585,021 251,727
2013 4,471 1,270 1,605,727 1,605,727 1,605,727
2012 5,311 1,372 1,927,238 713,241 147,689
Total 14,353 4,273 6,039,505 3,852,331 3,298,232

Table 3: cases and deaths of anthrax from 2007 to 2009 adapted from veterinary epidemiology year
book

Year Outbreaks Cases Deaths PAR Vaccine production Vaccine

in dose distribution
2007 927 7,781 3,002 2,081,755 8,467,600 6,467,000
2008 801 44,703 3,170 1,883,647 5,258,450 4,924,100
2009 681 4,523 1,772 1,761,990 7,083,200 3,809,500
 1.5.4.2. Laboratory surveillance The national laboratory also needs to conduct
specific risk assessment and prepare SoPs
To deliver effective animal health diagnostic regarding the specific biosafety and biosecurity
service through outbreak investigation, requirements for anthrax sample handling and
export testing and to conduct national disease analysis.
surveillances, the country has established
laboratory system with 15 regional veterinary 1.5.4.3. Outbreak investigation
labs working in collaboration with the national and response
referral veterinary laboratory, the National
Animal Health Diagnostic and Investigation The rapid detection of the introduction or
center (NAHDIC). NAHDIC is also a supporting sudden increase in any disease of livestock
laboratory for trans-boundary animal which has the potential of developing to
diseases for east Africa. NAHDIC has 11 BSL II epidemic proportions and/or causing serious
laboratories; including general bacteriology, socio-economic consequences or public health
bacterial serology and molecular diagnostic concerns are the points to be considered in
laboratories, as well asa BSL-3 laboratory livestock outbreak investigation in the country.
facility for the diagnosis of zoonotic & highly The investigation embraces all initiatives and is
contagious diseases like Bovine tuberculosis, mainly based on disease surveillance, reporting
HPAI and planned for the future to diagnose and epidemiological analysis. These lead to
anthrax. The laboratory has implemented improved awareness and knowledge of the
quality management system (QMS) and it is distribution and behavior of disease outbreaks
ISO/IEC 17025:2005 accredited laboratory by and infection, allows forecasting of the source
SANAS. and evolution of the disease outbreaks, and
monitoring of the effectiveness of disease
To date in the animal health sector, outbreak control campaigns.
reports of anthrax are based on history and
clinical signs and there is no laboratory Whenever livestock disease outbreak occur
confirmed cases at either the regional or anywhere in the country, the forefront
national level. NAHDIC’s experience for the veterinarians investigate the reports to come
diagnosis of anthrax is limited to polychrome up with a diagnosis whose result is largely
Methylene blue staining techniques dependent on tentative judgment made by the
(M’Fadyean stain), that is through staining clinician himself.
blood smears from peripheral blood vessels The veterinarian will put his/her utmost effort
and observing the square ended, blue rods to find out the real culprits behind the problem
in short chains surrounded by pink capsule to diagnose and ultimately control the disease.
through direct microscopy. Apart from this, Whenever the case is beyond the capacity of
confirmatory diagnostic capacity either with the district veterinarian, more help is called
molecular techniques (PCR) or through culture up from the next veterinary command chain,
10 using gamma phage is not yet established. the regional veterinary laboratory. Regional
In addition to limitations in confirming anthrax, veterinary laboratories are responsible for
biosafety and biosecurity issues are also of immediate outbreak investigation in their
major concern for culture and identification respective operational areas.
of Bacillus anthracis at the regional veterinary If the case is above the capacity of regional
laboratories. There is no harmonized SoP for laboratories it is referred to NAHDIC. NAHDIC
collection, transportation and handling of has experience of establishing an immediate
samples from anthrax suspected cases and outbreak investigation team incorporating
confirmatory test protocol for Bacillus anthracis experts from the national and regional
diagnosis at laboratory level. In addition, laboratories as well as national, regional and
laboratory staff’s at regional and national district veterinarians. Regarding anthrax
level are not well experienced and trained on outbreak investigation most of the diagnostic
confirmatory diagnostic techniques of anthrax. attempts were based on seasonal occurrence,
epidemiological survey, clinical signs and not specific to anthrax. On top of this for any
history. Appropriate tissue and dry swab death occurrence to wild animals, the scout
samples from anthrax suspected cases automatically reports the death to the park
can be collected for further identification office, and then the park office further reports
at NAHDIC. All the potential B. anthracis to the Ethiopian Wildlife Conservation
suspected samples should be documented Authority (EWCA). The EWCA veterinarians
and properly labeled upon arrival. It was will assess the situation and if necessary
only in few outbreak cases where the appropriate samples from diseased animals
organism was detected from blood smears can be collected and submitted to the
using M’Fadyean staining technique. Ethiopian Public Health Institute (EPHI)
or National Animal Health Diagnostic
In order to improve the current anthrax
and Investigation Centre (NAHDIC) for
outbreak investigation capacity, there is a
identifying the cause of disease outbreaks
need to address skill and knowledge gaps
among the wild animals. Apart from this
and improve laboratory capacity like through
effort there is no well-organized national
organizing specific training for regional and
surveillance system assisting the immediate
national staff on handling anthrax suspected
notification, investigation and response of
cases both at field and laboratory (on sample
disease outbreaks among wildlife.
collection, transportation, storage and
anthrax diagnostic and confirmatory tests). 1.5.5.2. Outbreak investigation and
response
1.5.5. Anthrax Surveillance System
for Wildlife in Ethiopia Anthrax outbreak has been observed in
southern parts of Mago national parks
Ethiopia has around 320 species of mammals
and spread to the northern part within
(36 are endemic), 862 species of birds (18
two months beginning from September
are endemic), 201 species of reptiles (9 are
1999. Moreover, another anthrax outbreak
endemic), 63 species of amphibians (24 are
from September to October 2000 has also
endemic), more than 180 species of fishes
been observed in this park. In the former
(40 are endemic) and over 6,500 species of
outbreak more than 1,600 wild animals
plants (more than 700 are endemic). Their
were dead from 21 different species (Table
distribution and occurrence normally vary
4, below). Of all the species Lesser kudu was
with elevation which starts at -110 meter
severely affected, which accounts for 95%
at Dalol depression up to 4,543 meter at
of mortality and as a result more than 65%
Ras Dashen Mountain peak, encompassing
of Lesser Kudu’s population within the park
major ecosystems such as afro-alpine,
died. Similarly during the second outbreak
savanna, desert and wetlands. To conserve
even though the extent of the death was
biological diversity in the different ecosystem
not as previous, Lesser kudu was again the
49 different protected area categories have
been established within the country. Of
most susceptible species. During the second 11
outbreak further spreading of the anthrax
these protected areas 20, 4, 7, 3, and 18 are
was controlled by early detection and proper
national parks, sanctuaries, wildlife reserves,
carcass disposal.
community based conservation area and
controlled hunting areas respectively.

1.5.5.1. Epidemiological surveillance

Survey of the presence or absence of
wild animals’ disease is conducted in the
protected areas once a year but this survey is
 Table 4: Record of the wild animals affected by the anthrax outbreak at Mago national park

Common name Scientific name In 1999 G.C In 2000 G.C In 1996G.C

(% male) (% male) population estimate
(CV)*
Ungulates
Lesser kudu Tragelaphus imberbis 1531 (44.9) 526 (41.4) 2268 (20)
Gerenuk Litocranius walleri 19 (68.4) 6 (67)
Warthog Phacochoerus africanus 16 (62.5) 1 (0) 161 (37)
Common bushbuck Tragelaphus scriptus 7 (71.4) 20 (55) 198 (29)
Lelwel hartebeest Alcelaphus buselophus lelwel 7 (42.8) 0 451 (46)
Dik-dik Madoqua guentheri 6 (66.7) 5 (50)
Bush duiker Sylvicapra grimmia 4 (50) 2 (100)
Tiang Damaliscus lunatus 4 (25) 3473 (47)
Oribi Ourebia ourebi 3 (67)
Waterbuck Kobus ellipsiprymnus 2 223 (31)
African buffalo Syncerus caffer 2 (50)
Grant’s gazelle Gazella grand 2 (50) 1228 (28)
Aardvark Orycyteropus afer 1
Elephant Loxodonta africana 1
Primates
Eastem black-and-white Colobus guereza 1
colobus
Olive baboon Papio anubis 3
Carnivores
Caracal Felis caracal 1
Mongoose Species not recorded 3
Rodents
Porcupine Hystrix cristata 1
Birds
Marabou stork Leptopilos crumeniferus 2
Hooded vulture Necrosyrtes monachus 1

1.5.6. Current Anthrax Prevention sectoral coordination framework to harmonize

and Control Activities in Ethio- the existing efforts to bring the required result
pia in preventing and controlling anthrax and
Even though anthrax is a reportable disease its impact on animal and human health. The
in Ethiopia, poor diagnostic capacity and technical, administrative and financial system
unreliable reporting make it difficult to estimate as well as multi-sectoral and multi-disciplinary
12 the true incidence in the country. However, coordination, collaboration and harmonization,
therefore, requires a strategic approach that
anthrax is enzootic in most of the regional
states in the country and has been reported should be agreed by all stakeholders.
from nearly every corner of the country with
1.5.6.1. Core Stakeholders for Anthrax
highest frequency from the highland mixed Control in Ethiopia
farming areas but precise incidence among
animals is unknown. Improving the coordination and collaboration
of various actors - federal, regional, state and
The fragmented efforts by many actors, woreda level sectoral (animal and human
including the livestock and public health health) institutions will improve the prevention
sector at the different administrative levels and control of anthrax through a One Health
(federal, regional) Approach. The necessary partners include:
employed so far were lacking of a central multi- • MoH (EPHI/PHEM, Regional and Woreda
 Level Bureaus of Health) is limitations in the coordination system.
• Ministry of Livestock and Fisheries • The National Veterinary Institute is the
(Federal, Regional and Woreda livestock one producing and supplying anthrax
bureaus and Veterinary Structures, vaccine.
National Animal Health Diagnostic and
• Regional States have their own annual
Investigation Center, National
plans for preventive vaccination that
Veterinary Institute, regional veterinary they submit to the NVI for production
laboratories) planning.
• Ministry of Culture and Tourism • Vaccination is usually done during the
(Ethiopian Wildlife Conservation Anthrax outbreak season (May and June)
Authority) once a year and involves all animals
at risk. However its implementation is
• International Development Partners
not uniformly practiced due to limited
(USAID funded EPT-2 program, FAO,
coordination, challenges in the cold
USAID P&R,
chain management, trained man power,
PREDICT, OHWF/OCHEA, CDC, WHO, OIE, and limitations in vaccine supply chain
OHIO University) system
• Local and national organizations (private • When an outbreak of Anthrax occurs
sector actors, sectorial and professional (suspected or confirmed) in a certain
associations eg. Veterinary Professional area, regional states or woredas buy
Associations, Public Health Associations, the vaccine from the NVI and conduct
local universities) ring-vaccination supported by routine
sanitary measures to contain the
1.5.6.2 Prevention and Control
Activities in Humans in outbreak.
Ethiopia • Movement control is an option
• Anthrax is one of 21 immediately implemented to control an anthrax
notifiable disease in the country outbreak but there is limitations in the
implementation.
• In 2003 alone, some 1,096 suspected
human cases were reported with a case • Community awareness creation is
fatality rate of 1.5% from four regions a common practice at village levels
(Tigray, Oromiya, Amhara and SNNPR) but there is limitations in formal
communication and information
• There is no guideline for the prevention dissemination system.
and control of anthrax disease in Ethiopia
1.5.6.4. Prevention and Control
• PHEM unit of EPHI has established a
system that enables identification of
Activities in Wildlife in Ethiopia 13
suspected human anthrax cases. Although there are cases encountered in
wildlife, the Ethiopian Wildlife Conservation
1.5.6.3. Prevention and Control Authority doesn’t have any prevention or
Activities in Livestock in Ethiopia control plan for the country. This is also
• There is animal disease reporting partly due to lack of skilled manpower and
mechanisms (ADNIS, DOVAR) and facilities within the EWCA to identify or
accordingly acts to control the disease diagnose the disease. Recently there was
in collaboration with concerned regional system for coordination and collaboration
and district level animal health offices. between the MoLF and EWCA. Vaccination
only involves domestic animals. The only
• Vaccination is widely practiced measure of control practiced for wildlife is
preventive measure all over the country the disposal of carcasses of suspected cases.
where the disease is endemic but there
 1.5.6.5. Policy, Legal and Institutional 1.6. CHALLENGES IN ANTHRAX
Framework supporting prevention and CONTROL IN ETHIOPIA
control of Anthrax
• Currently, the prevention and control 1.6.1. Inadequate Laboratory
Capacity and Biosecurity
of anthrax is managed separately by
institutions under three Ministries (MoLF, • Lack of regional and national laboratory
MoH and MoCT) mostly at the level of capacity on anthrax confirmatory diagnosis
regional bureau of Livestock/Agriculture (human and livestock)
and/or Health. The national disease
• Limited supply of diagnostic materials
prevention and control is guided by the
(human and livestock)
“Animal Diseases Prevention and Control
Proclamation no. 267/2002”. • Limited biosecurity and biosafety in
• Health Sector Transformation Plan (HSTP) laboratories (human and livestock)
provides strategic guidance for programing 1.6.2. Inadequate Surveillance
and service provision, and recognized the
current and persisting gaps in community • Potential under-reporting of anthrax cases
health and has put significant emphasis in and outbreaks (human and livestock)
promoting health service delivery through • Limited laboratory-based surveillance
improving access, coverage, continuity and (human and livestock)
coordination.
• No SOPs/guidelines for anthrax outbreak
• Livestock Master Plan (2016-2020) informs
response
targets set out in GTP2 for the livestock
sector. The LMP document aspires for 1.6.3. Lack of Prevalence and Bur-
the reduction of the impact of zoonotic den Estimates
diseases on human health (consumers) by
controlling zoonotic diseases and ensuring • No clear picture of prevalence since human
the safety of animal products. disease high in areas where animal disease
is not reported and vice-versa
• Ethiopian National Health Care Quality
Improvement Strategy 2016-2020 Reflects • Lack of anthrax burden and health-cost
the common concern in healthcare and it related studies
gives recognition to non-governmental
1.6.4. Inadequate Inter-Sectoral
organizations’ role on the issue
Collaboration and Partnerships
• EPHI Strategic Plan (2015/16-20/21)
promots a study on priority zoonotic • Poor joint anthrax investigation and
diseases at human animal ecosystem response
interface. It emphasized on OH approach • No data sharing and surveillance linkage
14 as a mechanism to implement the strategy.
The SP also indicated the development,
between sectors

institutionalization and implementation • Lack of One Health/multi-sectoral approach

of OH approach for strengthening cross- to address anthrax
sectoral collaboration and partnership on 1.6.5. Lack of Educational and
public health research. Awareness Materials for Anthrax
Prevention
• Poor public information on importance of
livestock vaccination
• Poor public education and awareness on
anthrax prevention and control
• Lack of training materials for health care • Development of multi-sectoral
providers and animal health workers zoonotic diseases Memorandum of
Understanding
• Poor notification guidance for public
health and animal health workers • Government commitment to anthrax
prevention and control
1.6.6. Limited Supply and Distri-
bution of Anthrax Vaccine and 1.7.2. Increased Interest in En-
management of Anthrax vaccines hancing Anthrax Control and
Prevention
• The amount of vaccines that can be
produced in the country is limited • Anthrax has been identified as one of
the top five priority zoonotic diseases for
• Potential disruption in the cold chain
inter-sectoral collaboration.
• Lack of national plan/strategy/calendar
for anthrax vaccine distribution • Increased commitment to joint
surveillance and response activities with
• Lack of strong national regulatory body
regards to prevention and control of the
for vaccine quality assessment
disease
1.6.7. Funding Constraints and • An inter-sectoral technical collaboration
Competing Priorities
has been initiated by the government,
• Existence of competing priorities – resulting in establishment of an Anthrax
other livestock/zoonotic diseases in the Technical Working Group.
country
1.7.3. In-Country Anthrax Vaccine
• Lack of long term funding for activities Production
for enhancing anthrax control and
• Anthrax livestock vaccine is
prevention
manufactured in Ethiopia by the National
1.6.8. Lack of Integrated national Veterinary Institute (NVI).
guidelines and standard operat-
ing procedures (SOPs) on anthrax • The 2016 production is about 25 million
prevention and control doses of the vaccine, based on demand.
NVI has the capacity to produce up to 36
• No SOPs on laboratorial procedure for million doses of the vaccine.
anthrax diagnosis
• Vaccine is distributed to regional
• No SOPs on anthrax outbreak veterinary bureaus and sold
investigation and response internationally.
• No national guidelines on anthrax
prevention and control
• The production target is determined by
the requests from the regional veterinary
15
1.7. OPPORTUNITY FOR EN- offices on a yearly basis. The vaccine is
HANCING ANTHRAX CON- bought by the regional governments
TROL AND PREVENTION IN not the federal government.
ETHIOPIA
• Vaccination is recommended once a year
1.7.1. Establishment of One for livestock and for ring vaccination
Health Coordination Structures during an outbreak.

• Establishment of National One Health

Steering Committee
• Establishment of Anthrax Technical
Working Group (ATWG)
 2
CHAPTER

THE STRATEGIC
FRAMEWORK
2.THE STRATEGIC • Generate scientific evidence to inform
decision and policy changes on anthrax
FRAMEWORK prevention and control

2.6. STRATEGIC FRAMEWORK

2.1. GUIDING PRINCIPLES FOR THE PREVENTION AND
OF THE STRATEGY CONTROL OF ANTHRAX
• Prevention and control of anthrax in
Anthrax is a World Organization for Animal
animals effectively reduces its impact on
Health (OIE)-listed animal disease that has
public health and the national economy
the potential to affect many animals within a
• A multi sectoral collaborative approach herd. It is important in the trade of livestock
and capacity building are essential for and livestock products and is a significant
successful prevention and control of public health issue. Anthrax is a notifiable
anthrax disease in both the livestock and public
health sectors in Ethiopia. A major outbreak
2.2. VISION of anthrax would cause severe production
losses to affected producers, with potential
To ensure anthrax is no longer a significant
dislocation and financial losses to the
public and animal health problem in Ethiopia
livestock producers from effects on exports
by 2030.
and a significant potential fatality in humans.
2.3. MISSION The foundation of anthrax control is
To significantly reduce and ultimately vaccination of livestock accompanied
control the public health impact of anthrax by rapid outbreak response to limit
in humans and animals in Ethiopia through environmental contamination and human
sustained surveillance, laboratory diagnosis, exposures. Animal outbreak response relies
prevention and control systems and heavily on effective surveillance and the
community awareness. availability of rapid and reliable laboratory
diagnostics. The proposed strategic
2.4. GOAL framework includes specific objectives and
activities to be performed under each one of
To prevent and control anthrax in human
the eight main components of the anthrax
and animals in Ethiopia
Prevention and Control Strategic Framework.
2.5. GENERAL OBJEC- Chapter Three has the implementation Plan,
TIVES subdivided into three phase, listing specific
activities to be completed in the stipulated
• Strengthen sectoral and multi-sectoral timeframe.
anthrax surveillance systems for effective
preparedness and response; This strategic document plans to prevent 17
and control anthrax in humans and animals
• Improve laboratory capacity for anthrax in Ethiopia using a combination of the
diagnosis at national and regional level following strategic areas of focus:
• Sustain inter-sectoral collaboration • Enhancing surveillance and reporting
among all stakeholders systems
• Undertake anthrax prevention and • Implementing outbreak investigation
control activities and response
• Enhance prevention capacity in terms • Improving community awareness on
of trained personnel and community the risks, transmission and prevention of
awareness anthrax
 • Enhancing anthrax vaccine production, Activity 1.3. Review and develop animal and
safety, quality, efficacy and distribution in human anthrax case definition (community
animals and international standards) and update
surveillance forms to ensure proper information
• Planning and implementing vaccination
is collected
campaigns
Activity 1.4. Develop anthrax surveillance
• Improving sanitary measures (carcass
guideline/ SoP
disposal, disinfection, avoid contact with
livestock) Activity 1.5. Provide trainings to address
surveillance capacity gaps and awareness
• Improving anthrax diagnostic laboratory
for animal and public health surveillance
capacity
officers and the community (case definitions
• Developing information, education and (community, suspected, probable and
communication materials confirmed) reporting, notification, data
management, data analysis and mapping and
• Strengthening multi-sectoral collaboration reporting etc).

2.7. COMPONENTS OF THE Activity 1.6. Provide resources (mobiles,

ANTHRAX PREVENTION laptops…) to improve timely and quality
AND CONTROL STRATEGIC reporting
FRAMEWORK
Activity 1.7. Strengthen national and regional
2.7.1. Surveillance and Report- Epi-lab networking (4 way linking)
ing Systems
Activity 1.8. Establish a wildlife anthrax
Surveillance is a critical element in the control surveillance system and link with the national
and prevention of anthrax. Effective anthrax system
surveillance in humans and animals enhances
Objective 2: Establish a mechanism for
early detection and reporting of cases, vital
reporting, feedback and information sharing of
for initiating timely responses and enabling
anthrax surveillance data among stakeholders
informed decisions about when and where
and relevant sectors
to intensify anthrax control efforts. Once
interventions are implemented, surveillance is Activity 2.1. Develop SOP and a mechanism for
essential in generating data to monitor progress inter sectoral information sharing (surveillance
or impact of the control efforts, which is data, risk mapping, hotspot identification)
essential for their sustainable implementation.
Activity 2.2. Review and strengthen standard
Specific objectives and activities of surveillance anthrax reporting format and channels
18 and reporting
Activity 2.3. Conduct a regular ATWG meetings
Objective 1: Assess and enhance the existing
surveillance system including data collection, Activity 2.4. Prepare and share regular joint
reporting and analysis (Case definition in anthrax national surveillance reports and
humans and animals, develop a reporting provide feedback to the regions and woredas
formats in human and animals and notification Activity 2.5. Perform retrospective analysis
and investigation/verification system) and publication of surveillance data at regional
Activity 1.1. Evaluate the existing surveillance and national level
system and databases to identify gaps, strength Activity 2.6. Develop a plan (SOP) for public
and barriers of epidemiological and laboratory announcement/Public disclosure for anthrax
surveillance in animals and humans outbreak
Activity 1.2. Address challenges based on the
identified gap 2.7.2. Outbreak investigation and re-
 sponse chain management system and SOP for
monitoring of vaccine, production (GMP),
Objective 3: Joint planning of preparedness, distribution, handling, storage (cold chain)
investigation and response plan (Develop and administration
guidelines and SOPs for response of anthrax)
Activity 4.6. Establish a PPP system for
Activity 3.1. Develop a national guideline implementation of vaccination campaigns
and SOPs for outbreak investigation and
response (case management, infection Activity 4.7. Plan and implement vaccination
prevention, environmental sanitation, campaigns
field investigation forms, roles and
Activity 4.8. Establish a proper unused
responsibilities)
vaccines disposal system (expired, damaged,
Activity 3.2. Establish a joint national and and inappropriately stored)
regional rapid investigation and response
Activity 4.9. Conduct Post vaccination
team for anthrax outbreaks
evaluation (using effective method)
Activity 3.3. Prepare outbreak preparedness
Activity 4.10. Training to animal health
plan and ensure availability of supplies
professionals and technicians on
(vaccines, drugs, human resource, laboratory
vaccine handling, transport, storage and
consumables, and equipment) for anthrax
administration, cold chain maintenance and
outbreak investigation and response
calibration
Activity 3.4. Conduct simulation exercises
Objective 5: Improve sanitary measures
and/or training for outbreak investigation
(carcass disposal, disinfection, avoid contact
including sample collection, handling and
with livestock)
transportation, after action review and
revision of the plan/SoP Activity 5.1. Develop SOP for proper infected
carcass and fomite disposal, environmental
Activity 3.5. Conduct/implement joint
sanitation, animal movement control
outbreak investigation and response
system/isolation
2.7.3. Prevention and Control of Activity 5.2. Ensure availability of the
Anthrax
necessary supplies and equipment (PPE) for
Objective 4: Enhance anthrax vaccine disinfection/environmental sanitation
production, safety, quality, efficacy,
Activity 5.3. Conduct training for animal
distribution and rational use of the vaccine
health, environmental health and public
in animals
health workers on best environmental
sanitary practices (on proper disinfection,
Activity 4.1. Asses/estimate the national
demand production, distribution and case management, and carcass disposal and 19
storage capacity of anthrax vaccine quarantine techniques)

Activity 4.2. Improve NVI vaccine production 2.7.4. Anthrax Diagnostic Laboratory
capacity to meet the estimated national Capacity
demand
Objective 6: Improve national and regional
Activity 4.3. Conduct cost effectiveness and animal and public health laboratory capacity
feasibility of animal vaccination foranthrax diagnostic testing

Activity 4.4. Conduct test vaccine efficacy, Activity 6.1. Assess national and regional
safety, quality and a post market assessment/ public and animal health laboratory
evaluation of the vaccine capacity for anthrax diagnostic testing
(sample collection and shipment, biosafety,
Activity 4.5. Develop vaccine supply biosecurity, skill and knowledge, testing,
 availability of necessary equipment and 2.7.5.Information, Education and
supplies) Communication

Activity 6.2. Prepare a laboratory Objective 8: Improve awareness and behavioral

development plan based on identified gaps change in the community regarding the risks,
(sample collection, transport, submission, transmission and prevention of anthrax
processing and confirmatory testing, training,
Activity 8.1. Assessment of existing
consumables, and equipment)
communication activities and materials for
Activity 6.3. Review laboratory sample communities (situational analysis)
referral SOPs (biosafety, biosecurity, handling,
Activity 8.2. Conduct community survey
transport, processing and testing)
to assess KABP (Knowledge, attitude and
Activity 6.4. Organize trainings for public and behavioral practice) in targeted audiences
animal health laboratory professionals and
Activity 8.3. Develop an evidence based
field staff (sample collection, preservation
national and regional communication strategy
and transport, submission, reporting and
(identify different audience groups, appropriate
confirmatory diagnosis)
channels, materials and key messages)
Activity 6.5. Procurement of necessary
Activity 8.4. Develop appropriate anthrax
laboratory supplies and equipment
related messages and concept testing based on
Activity 6.6. Introduce anthrax rapid diagnostic survey findings for different audience groups
field tests; research on new testing methods
Activity 8.5. Train professionals on
Activity 6.7. Strengthen a laboratory quality communication strategy
management system; equipment maintenance
Activity 8.6. Produce, pre-test and disseminate
and calibration system
Information Education Communication (IEC)/
Activity 6.8. Build capacity of the National Social Behavior Change Communication (SBCC)
Veterinary Institute to manufacture diagnostic materials
materials
Objective 9: Improve the knowledge and skill
Activity 6.9. Establish a national germ bank to of health/veterinary professionals
preserve circulating isolates of B. anthracis
Activity 9.1. Review of the existing educational
Objective 7: Establish and enhance inter materials for health/veterinary professionals
sectoral inter laboratory networking (public
Activity 9.2. Assess the knowledge and skills
and animal health)
(KAP) of the health/veterinary professionals
Activity 7.1. Map and linking existing public
Activity 9.3. Perform field level testing of the
20 and animal health laboratories based on the
assessment
developed educational materials

Activity 9.4. Develop training manuals

Activity 7.2. Review compatibility of existing
and provide training to public, animal and
laboratory information management (LIMS
environmental health professionals
and LIS) systems
Activity 9.5. Distribute information and
Activity 7.3. Establish an inter-laboratory
educational materials to relevant sectors at all
resource sharing networking mechanism;
levels (woreda, regional, national)
MoU, ToR

Activity 7.4. Organize regular inter-laboratory 2

fora (networking, information sharing, joint
plan)
.7.6. Multi-Sectoral Collabora-
tion
Objective 10: Strengthen existing national
platforms (OHSC, Anthrax TWG) and support
the establishment of coordination platforms at
regional and woreda level

Activity 10.1. Review the existing TOR and

conduct regular meeting of ATWG

Activity 10.1. Support establishment of

regional and woreda level anthrax prevention
and control coordination platforms (Develop
TOR and work plan for all regional TWG)

Activity 10.3. Organize regular technical

discussions and meetings on data sharing,
analysis, risk mapping, recommendation to
inform prevention and control

Activity 10.4. Ensure regular communication

and reporting to the OH steering committee

Objective 11: Obtain buy in and secure

resources for implementation of the plan

Activity 11.1. Develop an advocacy plan to

obtain buy-in from governmental stakeholders
and engaging private sectors, international
partners in a national anthrax control plan

Activity 11.2. Develop a budget for

implementation of plan and secure potential
source of funding for implementation of the
plan

Activity 11.3. Obtain official endorsement of

anthrax plan from all relevant ministries to
ensure a sustainable public funding mechanism

21
 3
CHAPTER

IMPLEMENTATION
PLAN
3. IMPLEMENTATION • Provide resources (mobiles, laptops…) to
improve timely and quality reporting
PLAN • Review and develop animal and human
3.1. PHASE 1: PLANNING, PREPA- anthrax case definition (community and
RATION AND ASSESSMENT international standards)
PHASE (2 YEARS) (2017-2019) • Develop anthrax surveillance guideline
During the first phase of the anthrax • Establish a wildlife anthrax surveillance
prevention and control strategy, the Ethiopian system and link with the national system
anthrax technical working group will focus on
• Develop SOP and a mechanism for inter
working together in a One Health approach
sectoral information sharing (surveillance
to work on activities related to assessment
data, risk mapping, hotspot identification
of current situation of anthrax surveillance,
outbreak, laboratory and vaccination • Conduct a regular review meeting,
systems in the country and defining overall workshops with stakeholders
responsibility for implementing anthrax
• Prepare and share regular joint anthrax
control strategies, resource mobilization,
national surveillance reports and provide
training and capacity building. At the end
feedback to the regions and woreda
of Phase 1, the country will have a well-
established Anthrax TWG, have fully assessed • Develop a plan (SOP) for public
surveillance systems, developed guidelines announcement/Public disclosure for
and SOPs to enhance anthrax surveillance and anthrax outbreak
control, and improved technical capacity and 3.1.1.2. Outbreak investigation and
laboratorial capacity to provide confirmatory response
diagnostic for anthrax. At this point, Ethiopia
• Develop a national guideline and
will be ready to start implementation
SOPs for outbreak investigation and
activities in selected target areas.
response (case management, infection
3.1.1. Specific activities to be com- prevention, environmental sanitation,
pleted in the stipulated time- field investigation forms)
frame • Prepare outbreak preparedness plan and
ensure availability of supplies (vaccines,
3.1.1.1. Surveillance and reporting
drugs, human resource, laboratory
• Evaluate the existing surveillance system consumables, and equipment) for anthrax
and databases to identify gaps, strengths outbreak investigation and response
and barriers to epidemiological and • Conduct simulation exercises; training
laboratory surveillance in animals and (outbreak investigation, on sample

•
humans
Address challenges based on the
collection, handling and transportation,
after action review, revise the plan
23
identified gap • Conduct/implement joint outbreak
investigation and response
• Provide trainings to address surveillance
capacity gaps and awareness for animal • Establish a joint national and regional
and public health surveillance officers rapid investigation and response teams
and the community (case definitions for anthrax outbreaks
(community, suspected, probable and • Prepare outbreak preparedness plan and
confirmed), reporting, notification, data ensure availability of supplies (vaccines,
management, data analysis and mapping drugs, human resource, laboratory
and reporting etc). consumables, and equipment) for anthrax
outbreak investigation and response
 • Conduct simulation exercises; training • Prepare a laboratory development plan
(outbreak investigation, on sample based on identified gaps (sample collection,
collection, handling and transportation, transport, submission, processing and
after action review, revise the plan confirmatory testing, training, consumables,
• Conduct/implement joint outbreak and equipment
investigation and response
• Organize trainings for public and animal
3.1.1.3. Disease prevention and control health laboratory professionals and field
staff (sample collection, preservation
• Asses/estimate the national demand and transport, submission, reporting and
production, distribution and storage confirmatory diagnosis
capacity of anthrax vaccine
• Procurement of necessary laboratory
• Conduct cost effectiveness and feasibility of supplies and equipment
animal vaccination
• Review laboratory sample referral SOPs
• Conduct test vaccine efficacy, safety, quality (biosafety, biosecurity, handling, transport,
and a post market assessment/evaluation of processing and testing)
the vaccine
• Organize regular inter-laboratory fora
• Develop vaccine supply chain management (networking, information sharing, joint plan)
system and SOP for monitoring of vaccine,
production (GMP), distribution, handling, 3.1.1.5. Information, Education and Com-
storage (cold chain) and administration munication
• Establish a PPP system for implementation • Assessment of existing communication
of vaccination campaigns activities and materials (situational analysis)
• Training to animal health professionals and • Review of the existing educational materials
technicians on vaccine handling, transport, for professionals
storage and administration, cold chain
maintenance and calibration • Assess the knowledge and skills (KAP) of the
profession
• Develop SOP for proper infected carcass and
fomite disposal, environmental sanitation, • Develop appropriate anthrax related
animal movement control system/isolation messages and concept testing based on
survey findings for different audience groups
• Ensure availability of the necessary supplies
and equipment (PPE) for disinfection/ 3.1.1.6. Multi-Sectoral Collaboration
environmental sanitation
• Review the existing TOR and conduct regular
24 • Conduct training for animal health,
environmental health and public health
meeting of ATWG

• Organize regular technical discussions

workers on best environmental sanitary
and meetings on data sharing, analysis,
practices (on proper disinfection, case
risk mapping, recommendation to inform
management, and carcass disposal and
prevention and control
quarantine techniques)
• Ensure regular communication and
3.1.1.4. nthrax Diagnostic Laboratory reporting for the OH steering committee
Capacity
• Develop an advocacy plan to obtain buy-
• Assess national and regional of public and
in from governmental stakeholders and
animal health laboratory capacity for anthrax
engaging of private sectors, international
diagnostic testing (sample collection and
partners in a national anthrax control plan
shipment, biosafety, biosecurity, skill and
knowledge, testing • Develop a budget for implementation
 of plan and secure potential source of • Provide resources (mobiles, laptops…) to
funding for implementation of the plan improve timely and quality reporting

• Obtain official endorsement of anthrax • Establish a wildlife anthrax surveillance

plan from all relevant ministries and system and link with the national system
ensuring sustainable public funding • Conduct a regular review meeting,
mechanism workshops with stakeholders
3.2. PHASE 2: IMPLEMENTA- • Prepare and share regular joint anthrax
TION PHASE IN TARGET national surveillance reports and provide
AREAS (4 YEARS) (2020- feedback to the regions and woreda
2023)
3.2.1.2. Outbreak investigation and
During Phase 2, Ethiopia will start response
implementation of the priority activities
• Prepare outbreak preparedness plan and
identified in this Strategic Plan. The
ensure availability of supplies (vaccines,
implementation will be phased and will
drugs, human resource, laboratory
start in selected target (high burden)
consumables, and equipment) for anthrax
areas, depending on the proposed activity.
outbreak investigation and response
Activities to be implemented during Phase 2
include pilot Projects, operational research, • Conduct simulation exercises; training
systems enhancements and development (outbreak investigation, on sample
of mechanisms for enhanced anthrax collection, handling and transportation,
prevention and control. At the end of after action review, revise the plan
Phase 2, in addition to the outcomes from • Conduct/implement joint outbreak
Phase 1, target regions will have enhanced investigation and response
surveillance systems, joint outbreak
response, improved anthrax control • Establish a joint national and regional
measures, improved laboratorial capacity, rapid investigation and response teams
improved inter-sectoral collaboration and for anthrax outbreaks
communication. At this point, Ethiopia will • Prepare outbreak preparedness plan and
be ready to re-evaluate the strategic plan ensure availability of supplies (vaccines,
and extend the implementation area to drugs, human resource, laboratory
additional areas, with a goal of extending consumables, and equipment) for anthrax
activities to a national level. outbreak investigation and response
• Conduct simulation exercises; training
3.2.1. Specific activities to be com-
pleted in the stipulated time- (outbreak investigation, on sample
frame collection, handling and transportation,

3.2.1.1. Surveillance and reporting

action review, revise the plan 25
• Conduct/implement joint outbreak
• Strengthen national and regional Epi-lab
investigation and response
networking (4 way linking)
3.2.1.3. Disease prevention and con-
• Provide trainings to address surveillance trol
capacity gaps and awareness for animal
and public health surveillance officers • Improve NVI vaccine production capacity
and the community (case definitions to meet the estimated national demand
(community, suspected, probable and • Conduct test vaccine efficacy, safety,
confirmed), reporting, notification, data quality and a post market assessment/
management, data analysis and mapping evaluation of the vaccine
and reporting etc).
 • Plan and implement vaccination campaigns • Establish an inter-laboratory resource
sharing networking mechanism; MoU, ToR
• Establish a proper unused vaccines
disposal system (expired, damaged, and 3.2.1.5. Information, Education and Com-
inappropriately stored) munication
• Conduct Post vaccination evaluation (using • Conduct community survey to assess
appropriate method) KABP (Knowledge, attitude and behavioral
practice) in targeted audiences
• Training to animal health professionals and
technicians on vaccine handling, transport, • Develop an evidence based national and
storage and administration, cold chain regional communication strategy (identify
maintenance and calibration different audience groups, appropriate
channels, materials and key messages)
• Ensure availability of the necessary supplies
and equipment (PPE) for disinfection/ • Develop appropriate anthrax related
environmental sanitation messages and concept testing based
on survey findings for different audience
• Conduct training for animal health,
groups
environmental health and public health
workers on best environmental sanitary • Train professionals on communication
practices (on proper disinfection, case strategy
management, and carcass disposal and • Develop training manuals and provide
quarantine techniques) training to public, animal and environmental
3.2.1.4. Anthrax Diagnostic Laboratory health professionals
Capacity
• Produce, pre-test and disseminate
• Organize trainings for public and animal Information Education Communication
health laboratory professionals and field
• Perform field level testing of the developed
staff (sample collection, preservation
educational materials
and transport, submission, reporting and
confirmatory diagnosis) • Distribute information and educational
materials to relevant sector
• Procurement of necessary laboratory
supplies and equipment 3.2.1.6. Multi-Sectoral Collaboration
• Build capacity of the National Veterinary • Review the existing TOR and conduct regular
Institute to manufacture diagnostic meeting of ATWG
materials
• Organize regular technical discussions
• Organize regular inter-laboratory fora
and meetings on data sharing, analysis,
(networking, information sharing, joint plan)
risk mapping, recommendation to inform
26 • Introduce anthrax rapid diagnostic field prevention and control
tests; research on new testing methods
• Ensure regular communication and
• Strengthen a laboratory quality management reporting for the OH steering committee
system; equipment maintenance and
calibration system • Support establishment of regional and
woreda level anthrax prevention and control
• Establish a national germ bank to preserve
coordination platforms (Develop TOR and
circulating isolates of B. anthracis
work plan for all regional TWG)
• Map and linking existing public and animal
health laboratories based on the assessment
• Review compatibility of existing laboratory
information management (LIMS and LIS)
systems
3.3. PHASE 3: IMPLEMENTA- (outbreak investigation, on sample
TION PHASE IN EXPANDED collection, handling and transportation,
AREAS (7 YEARS) (2024- after action review, revise the plan
2030) • Conduct/implement joint outbreak
During Phase 3, Ethiopia will extend the investigation and response
implementation area to outside the target • Establish a joint national and regional
areas, aiming at extending activities to rapid investigation and response teams
a national level. Activities implemented for anthrax outbreaks
at Phase 3 include selected activities
• Prepare outbreak preparedness plan and
successfully implemented during Phase
ensure availability of supplies (vaccines,
2, applied to areas where the activity is
drugs, human resource, laboratory
relevant. At the end of Phase 3, Ethiopia will
consumables, and equipment) for anthrax
achieve its goal of substantial reduction of
outbreak investigation and response
the public health and economic burden of
anthrax in the country. • Conduct simulation exercises; training
(outbreak investigation, on sample
3.3.1. Specific activities to be com- collection, handling and transportation,
pleted in the stipulated time- after action review, revise the plan
frame
• Conduct/implement joint outbreak
3.3.1.1. Surveillance and reporting investigation and response

• Provide trainings to address surveillance 3.3.1.3. Disease prevention and

capacity gaps and awareness for animal control
and public health surveillance officers • Conduct test vaccine efficacy, safety,
and the community (case definitions quality and a post market assessment/
(community, suspected, probable and evaluation of the vaccine
confirmed), reporting, notification, data
management, data analysis and mapping • Plan and implement vaccination
and reporting etc). campaigns

• Provide resources (mobiles, laptops…) to • Establish a proper unused vaccines

improve timely and quality reporti disposal system (expired, damaged, and
inappropriately stored)
• Establish a wildlife anthrax surveillance
system and link with the national system • Conduct Post vaccination evaluation
(Sero monitoring)
• Conduct a regular review meeting,
workshops with stakeholders • Training to animal health professionals

• Prepare and share regular joint anthrax

and technicians on vaccine handling,
transport, storage and administration,
27
national surveillance reports and provide cold chain maintenance and calibration
feedback to the regions and woreda
• Ensure availability of the necessary
3.3.1.2. Outbreak investigation supplies and equipment (PPE) for
disinfection/environmental sanitation
• Prepare outbreak preparedness plan and
ensure availability of supplies (vaccines, • Conduct training for animal health,
drugs, human resource, laboratory environmental health and public health
consumables, and equipment) for anthrax workers on best environmental sanitary
outbreak investigation and response practices (on proper disinfection, case
management, and carcass disposal and
• Conduct simulation exercises; training
quarantine techniques)
 3.3.1.4. Anthrax Diagnostic Laboratory • Specific activities and how they will be
Capacity prioritized within the stipulated timeframe
of the specific phase
• Organize trainings for public and animal
health laboratory professionals and field • Stakeholders that will take responsibility for
staff (sample collection, preservation specific activities
and transport, submission, reporting and
confirmatory diagnosis) • Key indicators that will result in an activity
being considered as “accomplished”
• Procurement of necessary laboratory
supplies and equipment

• Build capacity of the National Veterinary

Institute to manufacture diagnostic
materials

• Organize regular inter-laboratory fora

(networking, information sharing, joint plan)

3.3.1.5. Information, Education and

Communication
• Produce, pre-test and disseminate
Information Education Communication

• Perform field level testing of the developed

educational materials

• Distribute information and educational

materials to relevant sectors

3.3.1.6. Multi-Sectoral Collaboration

• Review the existing TOR and conduct regular
meeting of ATWG

• Organize regular technical discussions

and meetings on data sharing, analysis,
risk mapping, recommendation to inform
prevention and control

28 • Ensure regular communication and

reporting for the OH steering committee

3.4. WORK PLAN FOR IMPLEMENTING

PHASES-ONE
The implementation of each Phase’s activities
will be based on a phase-specific action
plan that will be developed by the Ethiopian
anthrax multi-sectoral technical working
group. The phase-specific action plans will be
composed of documents that will supplement
the national strategy by providing detail on the
following items:
 Table 5: NATIONAL ANTHRAX PREVENTION AND CONTROL STRATEGIC PLAN (TWO YEAR WORK PLAN)
Vision: To see Anthrax is no more a significant public and animal health problem in Ethiopia by 2030
Mission: To significantly reduce and ultimately control the public health impact of anthrax in humans and animals in Ethiopia through sustained
surveillance, laboratory diagnosis, prevention and control system and community awareness.
Goal: To prevent and control Anthrax in human and animals in Ethiopia

Note: The detailed work plan for implementation of Phase-one activities are listed on the table below (Table 5),

Strategic Plan
Owner- EPHI/MoLF
Phase 1: Planning,
Preparation and
Assessment Phase
(2018-2019)
Monitoring- For Completed
Quarterly Progress:
Select one of the On Progress
Option in the Drop
Down Menu Not Started
Outcomes

Outcome1.1. The strength,

Weakness/gap, Opportunity
Strategy
and Threat in the existing Specific Activities Detail activities
surveillance system will be
identified and Addressed
challenges/gaps 2018 2019
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Responsibility
St 1: Enhancing Evaluate the existing Review of the existing surveillance system and data base EPHI/MOLF
Surveillance and surveillance system
Reporting Systems and databases
Prepare checklist to evaluate existing surveillance systems EPHI/MOLF
Evaluate the process of case reports (sensitivity, completeness EPHI/MOLF
and timeliness of data flow; and association with animal and
human case)/surveillance evaluation on selected sites
Forward recommendations based on assessment result(Writing
a report)
EPHI/MOLF 29
Develop anthrax Review existing local and international anthrax surveillance EPHI/MOLF
surveillance guideline guidelines
Prepare a concept note EPHI/MOLF
Review of literature and other relevant documents EPHI/MOLF
Preparation of draft guideline (write shop) EPHI/MOLF
Finalize the guideline EPHI/MOLF
 Organize a validation workshop EPHI/MOLF
printing and dissemination EPHI/MOLF
Formulate a team of surveillance in EWCA EWCA/ MOLF
Establish a wildlife Prepare a plan/guidance to establish surveillance system EWCA/MOLF
anthrax surveillance
system and link with
the national system Fulfill the necessary supplies/requirements EWCA/MOLF
Initiate surveillance activities EWCA/MOLF
Identify the necessary supplies/material EPHI/MOLF
Provide resources
Procurement of the materials EPHI/MOLF
(mobiles, laptops…)
to improve timely and EPHI/MOLF
quality reporting
Distribution of the materials
Prepare training materials (presentations, participants guide and EPHI/MOLF
instructors guide)
Outcome 1.2: Information Provide trainings to Preparation for the training (prepare the Agenda, Venue, Hotel EPHI/MOLF
sharing mechanism among address surveillance accommodation, invitation of participants etc…)
sectors will be established capacity gaps
Deliver the training EPHI/MOLF
Write training report/evaluation report EPHI/MOLF
Review and modify Review existing anthrax reporting formats/channels and identify EPHI/MOLF
standard anthrax the limitations
reporting format/
Prepare a draft SOP and reporting formats EPHI/MOLF
channels and SOP
for inter sectoral EPHI/MOLF
Share the draft work to TWD members to be reviewed and
information sharing
commented
Compile the suggestions/comments and finalize the document EPHI/MOLF
Printing and dissemination EPHI/MOLF
Review and Monitoring of surveillance data (regularly) EPHI/MOLF
Give feedback for reporting sites EPHI/MOLF
Prepare and share
regular joint anthrax Sharing of the finding/surveillance data (MoLF and EPHI on a EPHI/MOLF
national surveillance regular basis/Monthly)
reports
Plan and implement the possible actions EPHI/MOLF
Summarizing and writing report (regularly) EPHI/MOLF
30 Plan to conduct a Meeting/Panel/workshop (Identifying the
agendas, venue, involved stakeholders etc...)
EPHI/MOLF

Conduct a regular
review meeting, Official communication with the stakeholders (invitation letter) EPHI/MOLF
workshops with Preparation on presentations for each stakeholders (CDC, EPHI, EPHI/MOLF
stakeholders MoLF, NVI, NAHDIC)
Meeting,/Panel/Work shop EPHI/MOLF
 Perform retrospective Collection and analysis of retrospective anthrax surveillance data EPHI/MOLF
analysis and
writing a manuscript EPHI/MOLF
publication of
surveillance data Publish the materials EPHI/MOLF

Outcome 2.1: Strengthened Develop a national Prepare a concept note EPHI/MOLF

St 2: Strengthening the outbreak investigation guideline and
Outbreak and response system SOPs for outbreak
investigation and through development of investigation and
response System joint preparedness plans response
and activities
Review of literature and other relevant documents EPHI/MOLF

Preparation of draft guideline, SOP (write shop) EPHI/MOLF

share the document for TWG members and Conduct a meeting/ EPHI/MOLF
workshop to discuss on the draft document
Finalize the guideline and dissemination EPHI/MOLF
Prepare a concept note EPHI/MOLF
Prepare outbreak Review of literature and other relevant documents EPHI/MOLF
preparedness
Preparation of preparedness plan (write shop) EPHI/MOLF
plan and ensure
availability of share the document for TWG members and Conduct a meeting/ EPHI/MOLF
necessary supplies workshop to discuss on the draft document
Finalize the EPRP and dissemination EPHI/MOLF
Prepare for stakeholders meeting EPHI/MOLF
Establish a joint
national and regional Stakeholders meeting (identify the expertise from each sector EPHI/MOLF
rapid investigation and prepare a roster)
and response teams Formulate a team of RRT EPHI/MOLF
for anthrax outbreaks
Develop SOP for RRT activities EPHI/MOLF
EPHI/MOLF
Prepare training materials (presentations, participants guide and
instructors guide)

Conduct simulation EPHI/MOLF

Preparation for the training (prepare the Agenda, Venue, Hotel
exercises; training accommodation, invitation of participants etc…)
Deliver the training EPHI/MOLF
Write training report/evaluation report EPHI/MOLF 31
Prepare for field work (meeting, identify all the necessary EPHI/MOLF
Conduct/implement supplies)
joint outbreak
investigation and Deploy RRT to the affected area EPHI/MOLF
response
Implementation of joint investigation and response EPHI/MOLF
 Outcome 3.1: Improved NVI/MOLF
vaccine production,
St. 3: Enhancing distribution, storage/
Prevention and handling and administration
Control of Anthrax system that meets the Asses/estimate the
demand at national and national demand
regional level production, Develop a concept note
distribution and
storage capacity of Review of the existing situation NVI/MOLF
anthrax vaccine
Writing a proposal for estimation of vaccine demand NVI/MOLF
Conduct a baseline survey (Onsite/field) NVI/MOLF
Writing a baseline survey report and share with TWG NVI/MOLF
prepare a concept note and proposal NVI/MOLF
Share the concept note and proposal to TWG and finalize the NVI/MOLF
proposal (work plan)
Conduct cost Identify the most sustainable vaccination programs and degree NVI/MOLF
effectiveness and of public-private shared responsibilities
feasibility of animal
vaccination Modeling of the coast effectiveness with government NVI/MOLF
perspective and producers perspective
Writing a report NVI/MOLF
Share the report for the relevant sectors NVI/MOLF
Support VDFACA to NVI/MOLF/
undertake vaccine Writing a concept note VDFACA
efficacy, safety,
NVI/MOLF/
quality and a post
Meeting with VDFACA officials and identify SWOT VDFACA
market assessment/
evaluation NVI/MOLF/
Address the identified gaps VDFACA
Review existing anthrax Vaccine management system (local and NVI/MOLF/
international practices) VDFACA
Prepare a draft SOP NVI/MOLF/
Develop vaccine
VDFACA
supply chain
management Share the draft work to TWD members to be reviewed and NVI/MOLF/
system and SOP for commented VDFACA
monitoring of vaccine
NVI/MOLF/
chain,
Compile the suggestions/comments and finalize the document VDFACA

32 Printing and dissemination

NVI/MOLF/
VDFACA
 Review existing PPP and vaccination activities/plan (local and NVI/MOLF/
international practices) VDFACA
Prepare a draft Vaccination plan (Workshop) NVI/MOLF/
VDFACA
Establish a PPP and
implementation Share the draft plan to TWD members to be reviewed and NVI/MOLF/
of vaccination commented VDFACA
campaigns
NVI/MOLF/
Compile the suggestions/comments and finalize the document VDFACA
NVI/MOLF/
Conduct Vaccination on the selected areas VDFACA
Prepare training materials (presentations, participants guide and NVI/MOLF/
instructors guide) VDFACA
provide Training Preparation for the training (prepare the Agenda, Venue, Hotel NVI/MOLF/
to animal health accommodation, invitation of participants etc…) VDFACA
professionals and
technicians on NVI/MOLF/
vaccine management Deliver the training VDFACA
NVI/MOLF/
Write training report/evaluation report VDFACA
Review existing environmental sanitation practice (local and NVI/MOLF/
international practices) VDFACA
Develop SOP for
Prepare a draft SOP NVI/MOLF/
Outcome 3.2: Improved the proper infected
VDFACA
environmental sanitation carcass and
practice nationwide fomite disposal, Share the draft work to TWD members to be reviewed and NVI/MOLF/
environmental commented VDFACA
sanitation, animal
NVI/MOLF/
movement control
Compile the suggestions/comments and finalize the document VDFACA
system/isolation
NVI/MOLF/
Printing and dissemination VDFACA
Ensure availability Identify the necessary supplies/material ( access and demand) EPHI/MOLF
of the necessary
Procurement of the materials EPHI/MOLF
supplies and
equipments (PPE) Distribution of the materials EPHI/MOLF
Prepare training materials (presentations, participants guide and EPHI/MOLF
instructors guide)
Conduct training on Preparation for the training (prepare the Agenda, Venue, Hotel EPHI/MOLF
best environmental
sanitary practices
accommodation, invitation of participants etc…)
Deliver the training EPHI/MOLF
33
Write training report/evaluation report EPHI/MOLF
 Review existing laboratory diagnostic capacity assessment tools/ EPHI/NAHDIC
checklists
EPHI/NAHDIC
Assess national and Adapt/prepare the checklists and include anthrax diagnostic
regional of public capacity assessment questions
and animal health
Organize review and validation workshops EPHI/NAHDIC
laboratory capacity
for anthrax diagnostic Conduct assessment of national and regional public and animal EPHI/NAHDIC
testing health laboratories anthrax diagnostic capacity and identify
limitations (on site visit)
Writing a report EPHI/NAHDIC
Compile sector specific assessment reports EPHI/NAHDIC
Prepare a laboratory Support preparation of the lab development plan based on EPHI/NAHDIC
Outcome 4.1: Improved Diagnostic capacity identified gaps
anthrax testing capacity of plan for anthrax
the national and selected (based on identified Organize a consultation meeting to review the development EPHI/NAHDIC
regional laboratories gaps) and SOP plan
Finalize the plan and disseminate to the relevant sectors EPHI/NAHDIC
St. 4: Improving
Anthrax Diagnostic Procurement of Identify the necessary supplies/material ( access and demand) EPHI/NAHDIC
Laboratory Capacity necessary laboratory EPHI/NAHDIC
Procurement of the materials
supplies and
equipment Distribution of the materials EPHI/NAHDIC
Prepare training materials (presentations, participants guide and EPHI/NAHDIC
instructors guide)
Organize trainings on Preparation for the training (prepare the Agenda, Venue, Hotel EPHI/NAHDIC
anthrax laboratory accommodation, invitation of participants etc…)
testing procedures
Deliver the training EPHI/NAHDIC
Write training report/evaluation report EPHI/NAHDIC
Review compatibility of existing laboratory information EPHI/NAHDIC
management (LIMS and LIS) systems
Map and linking EPHI/NAHDIC
Outcome 4.2: Enhanced existing public Establish an inter-laboratory resource sharing networking
inter sectoral inter and animal health mechanism; MoU, ToR
laboratory networking laboratories based on EPHI/NAHDIC
the assessment Organize regular inter-laboratory fora (networking, information
sharing, joint plan)
Reporting (regular meeting) EPHI/MOLF

34
 Assessment Collect available communication and information materials EPHI/MOLF
of existing (bulletins, posters, pamphlets, …) on anthrax prevention and
communication control
activities and
EPHI/MOLF
materials (situational Identify type and contents of communication materials which
analysis) can further be produced

St. 5: Enhancing Prepare a concept note EPHI/MOLF

Information, Outcome 5.1: Improved Prepare a proposal (questioners, identify sites) EPHI/MOLF
Education and Conduct community
awareness of the survey to assess KABP
Communication community on the risks and Conduct KABP survey (on identified sites) EPHI/MOLF
system prevention of anthrax Writing and disseminate a report EPHI/MOLF
Review of standard communication strategy EPHI/MOLF
Develop an evidence EPHI/MOLF
Review of the KABP assessment
based national
and regional Develop appropriate anthrax related messages EPHI/MOLF
communication
Pre-test of draft IEC/BEC materials EPHI/MOLF
strategy
Produce and disseminate IEC/BEC materials EPHI/MOLF
Review of the existing educational materials for professionals EPHI/MOLF
Assess the knowledge Prepare a proposal (questioners, identify sites) EPHI/MOLF
and skills (KAP) of the
professionals Conduct KABP survey (on identified sites) EPHI/MOLF
Writing and disseminate a report EPHI/MOLF
Outcome 5.2: Skilled health
Review of standard training manuals EPHI/MOLF
professionals on IEC system
Develop training Review of the KAP assessment EPHI/MOLF
manuals and perform
Develop draft training manuals (workshop) EPHI/MOLF
field level test of the
materials Finalize the training manual EPHI/MOLF
Printing and disseminate training manuals EPHI/MOLF
Prepare training materials (presentations, participants guide and EPHI/MOLF
instructors guide)
Provide training to
public, animal and Preparation for the training (prepare the Agenda, Venue, Hotel EPHI/MOLF
environmental health accommodation, invitation of participants etc…)
professionals Deliver the training EPHI/MOLF
Write training report/evaluation report EPHI/MOLF

35
 Review the implemented activities (reports, TOR..) EPHI/MOLF
Review the existing TOR and conduct regular meeting of TWG
Plan to conduct a Meeting/Panel/workshop on Anthrax EPHI/MOLF
surveillance system (Identifying the agendas, venue, involved
Regular stakeholders etc...)
Outcome 6.1: Strengthened communication and
existing national one health reporting for the Official communication with the stakeholders (invitation letter) EPHI/MOLF
platforms Anthrax TWG and OH Preparation on presentations for each stakeholders (CDC, EPHI, EPHI/MOLF
steering committee MoLF, NVI, NAHDIC, FAO...)
Meeting,/Panel/Work shop (Identifying SWOT) EPHI/MOLF
Prepare joint and sectorial activity/summary reports EPHI/MOLF
Avail the reports during OHSC meetings EPHI/MOLF
St. 6: Strengthening Develop an preparation of an advocacy plan EPHI/MOLF
Multi-Sectoral advocacy plan to Organize/use high level events/workshops to advocate and get EPHI/MOLF
Collaboration obtain buy-in from endorsement on anthrax prevention and control
governmental and
non-governmental Share the developed strategic plans, guidelines, SOPs and EPHI/MOLF
stakeholders materials for leadership approval
Organize a stakeholders validation workshop of the national EPHI/MOLF
Outcome 6.2: Endorsed/ anthrax prevention and control strategy
valid national anthrax Obtain official
prevention and control endorsement of
Finalize the document based on inputs from the validation EPHI/MOLF
strategic plan anthrax plan from all
workshop
relevant ministries
and Printing and dissemination for the relevant sectors and funding EPHI/MOLF
agencies
Secure potential Identify the possible source of funding EPHI/MOLF
source of funding for
Submit the strategic plan and financial plan to relevant funding EPHI/MOLF
implementation of
agencies
the plan

36
 Develop a monitoring and evaluation plan /check list EPHI/MOLF
Prepare for supervision (identifying the sites, date of supervision,
involved stuffs and prepare required materials) EPHI/MOLF
Onsite supervision EPHI/MOLF

Monitoring of each Writing compiled supervision report EPHI/MOLF

activity Share the report with the concerned body (TWG) EPHI/MOLF
Monitoring

Preparation for a review meeting (prepare the Agenda, Venue,

etc…) EPHI/MOLF

Review meeting (identify SWOT and put possible

recommendation to be implemented) EPHI/MOLF
Writing a report and dissemination EPHI/MOLF
Review of the planned activities and outcomes EPHI/MOLF
Prepare an evaluation plan/checklist EPHI/MOLF
Intreme evaluation of
the phase 1 Conduct an evaluation on the effectiveness of the implemented
Evaluation
activities (onsite visit) EPHI/MOLF
Writing a report EPHI/MOLF
Organize an evaluation workshop EPHI/MOLF

37
 3.5 Monitoring and Evaluation
Monitoring and evaluation is the routine and continuous tracking of planned activities using a set
of indicators to assess whether objectives are being achieved. The process can be used to measure
the effectiveness and feasibility of programs focused on proper prevention and control of anthrax in
humans and animals. The time frame for monitoring of each activity will be as described in the work
plan (Table 6, above). The effectiveness of each activities planned in Phase-one will be measured and
monitored using a measurable indicators as indicated in the table below.

Table 6: ETHIOPIA - ANTHRAX PERFORMANCE MONITORING PLAN

Strategy Output 1: Enhancing Surveillance and Reporting Systems

Activity Sub-activities Measurable

Means of
indicators of Deliverable Target
verification
achievement
Assess the Evaluate the existing Existing surveillance Gaps, 1 Assessment
existing Anthrax surveillance systems system and database Recommendations and report
surveillance and databases described Propose a solutions of
system the existing surveillance
system and database
documented
Develop anthrax Existence of anthrax Endorsed Anthrax 1 Anthrax
surveillance guideline surveillance guideline surveillance guideline surveillance
guideline
Establish a wildlife Existence of an wildlife anthrax 1 Wildlife anthrax
anthrax surveillance interoperable wildlife surveillance results Surveillance
system and share anthrax and national integrated in to MoLF reports
information with surveillance system national surveillance
MOLF system
Provide resources # of reporting Reporting equipment TBD Asset/hand over
(mobiles, laptops…) equipment distributed apportioned (After the registry, Timely
to improve timely and evaluation) and complete
quality reporting Surveillance
reports
Train professionals # of professionals Competencies anthrax 120 Training report
(from all sectors) to trained in anthrax surveillance acquired Participants
address surveillance surveillance
capacity gaps
Establish a Review and modify Existence of modified Modified anthrax 8 reporting Standardized
mechanism standard anthrax anthrax reporting reporting format and format and Surveillance
for reporting, reporting format/ format and SOP SOP in place 1 SOP reports; SOP
feedback and channels and SOP
information for inter sectoral
sharing information sharing
Prepare and share # of joint anthrax Joint anthrax national 8 Surveillance
regular joint anthrax national surveillance surveillance reports reports

38 national surveillance
reports
reports produced shared

Conduct a regular # of stakeholder Stakeholder meetings 4 Meeting minutes

review meeting, meetings Conducted convened
workshops with
stakeholders
Perform Joint Retrospective burden Retrospective burden N/A Submitted
retrospective analysis of anthrax described of anthrax documented Manuscript/
and publication of and published publication
surveillance data (Research paper)
 Strategy Output 2: Strengthening Outbreak Management system

Activity Sub-activities Measurable

Means of
indicators of Deliverable Target
verification
achievement
Develop a Joint Develop a national Existence of national National guideline 1 National guideline
preparedness, guideline and guideline and SOPs for and SOPs for outbreak and SOP
investigation and SOPs for outbreak outbreak investigation investigation and
response plan investigation and and response response in place
response
Prepare outbreak Existence of outbreak Endorsed Outbreak 1 Preparedness plan
preparedness plan preparedness plan; preparedness plan;
Establish a joint # of joint national Joint national and 3 RRT roster
national and regional and regional anthrax regional rapid
anthrax rapid rapid investigation investigation and
investigation and and response teams response teams for
response teams established. anthrax outbreaks in
place.
Conduct outbreak # of professionals Competencies on 120 Simulation
management/ trained in anthrax outbreak Participants training report
response simulation anthrax outbreak management acquired (>75% pass
exercises management competency
test)
Conduct/implement Proportion of Joint outbreak >90% of outbreak
joint outbreak suspected anthrax investigations and suspected investigation and
investigation and cases jointly response conducted anthrax response reports
response investigated cases jointly
investigated

Strategy Output 3: Enhancing Prevention and Control of Anthrax

Activity Sub-activities Measurable
Means of
indicators of Deliverable Target
verification
achievement
Improve Asses/estimate the National demand Gaps and N/A Assessment
anthrax vaccine national demand against production, recommendations of reports
production, production, distribution and production, distribution
safety, quality, distribution and storage of anthrax and storage of anthrax
efficacy, storage capacity of vaccine described vaccine documented
distribution and anthrax vaccine
rational use in
animals
Conduct cost Alternative Alternative vaccination N/A Study report
effectiveness and vaccination models/ models/strategies
feasibility study of strategies described documented
animal vaccination
Increase Anthrax Increment of National demand TBD NVI vaccine
vaccine production vaccination for anthrax vaccine production report
capacity production level production fulfilled
Improve vaccine
supply chain
management system
Presence of Updated
vaccine supply chain
management system
Vaccine supply chain
management system
improved
N/A Assessment
reports 39
Develop/Update # of SOPs developed Endorsed SOPs for TBD SOPs
SOP for production, for production, production, distribution,
distribution, storage distribution, storage storage and delivery
and delivery and delivery
Establish Sanitary Number of contractual Enhanced vaccination TBD Signed PPP
mandate contract agreements (PPP) coverage and efficiency contracts
(PPP) for vaccination with PPP involvement
campaigns
train animal health # of people trained Competencies on 80 Training report
professionals and on anthrax vaccine anthrax vaccine
technicians on management management acquired
vaccine management
 Improve sanitary Develop SOP for # of SOPs developed SOPs for infected TBD SOPs
measures proper disposal of for proper infected carcass and fomite
(Carcass disposal, infected carcass and carcass and disposal, environmental
disinfection, fomite, environmental fomite disposal, sanitation, animal
Avoid contact sanitation, animal environmental movement control and
with livestock) movement control sanitation, animal isolation in place.
system/isolation movement control
system/isolation
Ensure availability Proportion of high Sustainable PPE >75% of Procurement
of the necessary risk professionals supplies, in place identified records
supplies and equipped with PPE sites
equipment (PPE) received the
supplies
Conduct training on # of people trained Competencies on 80 Training report
best environmental on environmental environmental sanitary
sanitary practices sanitary practice practice
Strategy Output 4: Improving Anthrax Diagnostic Laboratory Capacity
Activity Sub-activities Measurable
Means of
indicators of Deliverable Target
verification
achievement
Improve national Assess national #, list of laboratories Gaps and 1 Assessment
and regional and regional public assessed for anthrax recommendations of reports
animal and public and animal health diagnostic testing anthrax diagnostic
health laboratory laboratory capacity capacity (16 Animal testing capacity
capacity for anthrax diagnostic health and 5 public documented.
for anthrax testing health labs assessed
diagnostic testing (including NAHDIC,
NVI and EPHI)
# of laboratory Endorsed Laboratory 1 Project report
development plans development plans
produced (1 for public
and 1 for animal
health sector
Prepare a laboratory # number of SOPs Endoresed SOPs 4 SOPs
development plan (Sample collection, available for use
and SOP (based on handling & biosafety,
identified gaps) preservation & cold
chain, transportation
and submission,
testing and reporting)
developed (for each
sector)
Procurement and # of laboratories Laboratory supplies and 4 Asset register
distribution of equipped with the equipment procured
necessary laboratory necessary supplies and distributed
supplies and and equipment
equipment procured
Train lab staff on # of professional staff Competencies in 120 Training reports
anthrax laboratory trained on anthrax anthrax laboratory
testing procedures laboratory testing testing procedures

40 Establish and Map and link existing

procedures.
#, list of public
acquired.
Public and animal health N/A Assessment
enhance inter public and animal and animal health laboratories mapped. report
sectoral inter health laboratories laboratories mapped.
laboratory based on the
#, list of public Interoperable/ 15 Laboratory
networking assessment
and animal health linked LIM and other reports
(public and
laboratories with communication systems
animal health)
interoperable(linked) LIMs
laboratory information
systems
Strategy Output 5: Enhancing Information, Education and Communication system
Activity Sub-activities Measurable
Means of
indicators of Deliverable Target
verification
achievement
Improve Assessment # of institutions Gaps in the existing 7 Assessment
community of existing assessed for existing communication and report
awareness of the communication communication and advocacy materials
risks, transmission activities and advocacy materials documented.
and prevention of materials (situational
anthrax analysis)
Conduct community Findings from Gaps and 1 KAPB Survey
survey to assess KABP the KABP survey recommendations reports
recommendations described. from the KABP survey
documented.
Develop an evidence Existence of Endorsed evidence 1 Communication
based national an evidence based national strategy
communication based national communication strategy document
strategy communication in place.
strategy.
Develop appropriate Proportion of Tested anthrax related 100% Field test report
anthrax related developed anthrax messages available
messages1 and related messages
concept testing for tested
different audience
groups
Disseminate # of disseminated IEC materials availed 5000 Dissemination
Information materials to target areas/ report
Education communities
Communication
(IEC)/Social
Behavior Change
Communication
(SBCC) materials
Improve the Assess the knowledge #, list of professionals Gaps and 150 Study report
knowledge and and skills (KAP) of the assessed recommendations of
skill of health/ professionals professional’s skills
veterinary documented
professionals
Develop training #, list of training Endorsed Training 2 Training Manual
manuals and perform manuals developed manuals developed
field level test of the
materials
Provide training to # of professionals Competencies on IEC 80 Training reports
public, animal and using the training acquired
environmental health manual
professionals
Distribute information # of information and Educational materials 200 Educational
and educational educational materials availed to targets materials
materials to relevant distributed (copies)
sectors

41
 Strategy Output 6: Strengthening Multi-Sectoral Collaboration
Activity Sub-activities Measurable
Means of
indicators of Deliverable Target
verification
achievement
Strengthen Regular communication Proportion of OH Recommendations N/A Steering
existing national and reporting for the OH steering committee implemented committee
platforms steering committee recommendations communique
(OHSC, Anthrax addressed
TWG)
Obtain buy Develop an advocacy plan Existence of an Advocacy plan in 1 Project report
in and secure to obtain buy-in from advocacy plan place
resources for governmental and non-
implementation governmental stakeholders
of the Anthrax
Obtain official endorsement Existence of endorsed EndorsemeD N/A Project report
prevention and
of the Anthrax prevention national anthrax of anthrax plan
control strategic
and control strategic plan prevention and obtained
plan
from all relevant ministries control strategic plan
and stakeholders
Secure potential source of Sum of resources Funding secured TBD Financial
funding for implementation mobilized agreement
of the plan

NOTE:
Endorsement of all the documents listed in the table will be by the director General of each
relevant sectors

The target stated in the table is only for Phase 1(Two years plan) activities and it doesn’t indicate
the target of all the three Phases (which will be determined based on the evaluation of Phase one
implementation statuses

All the assessment findings in Phase one will serve as a baseline data

Laboratory testing: including sample collection, transport, submission, lab analysis, interpretation
and reporting

Laboratory Information Systems; may include LIMS and other communication systems

Institutions assessed; Ministry of Health (EPHI), Ministry of Livestock and Fisheries, Ministry of
Culture and Tourism (EWCA), Ministry of Environment, Forest and Climate Change, Professional
associations (EVA, EPHA), Development partners (OSU, CDC, FAO, etc)

Message tools: posters, flyers, brochures, media messages, etc.

42
 4. BUDGET SUMMARY
An estimated birr 384,200,272.00 (14,125,010.00 USD) is required for the implementation of
activities under the three Phases (2018-2030). Of the total estimated coast 16.41% (63,052,864.00
birr/721, 2,318,120.00 USD) will be for the implementation of planned activities under Phase-
one of the strategic plan, the remaining 34.38% (45,233,491.20 birr/132,084,288.00 USD) and
49.21% (189,063,120.00 birr/6,950,850.00 USD) will be for the implementation of planned
activities under Phase-two and Phase-three aiming to expand at regional level. From the total
budget under Phase-one, the majority (85.2%) will be utilized for mass vaccination campaign
and laboratory capacity building at national level (NAHDIC and Microbiology laboratory in EPHI)
and the remaining 9.3% of the estimated coast also for the capacity building of professionals
through training and for development of relevant documents through workshops. The estimated
travel coasts (5.54%) will be for in-country travels for survey studies and Assessment activities
that involves additional stuffs for data collection in identified hot-spot areas. This assessment
activities will include evaluation of the surveillance system by conducting surveys in selected
areas, for a survey study on the awareness level of the community which will serve as a baseline
information. The allocated budget will help the national human health and animal health sectors
to strengthen the surveillance and outbreak investigation and response capacity for anthrax
in animals and humans in the next two year, through laboratory capacity building at national
level, improvement of workforce capacity in surveillance, Outbreak investigation and laboratory
testing knowledge and skills.

Table 7: Budget Summary by components of the Anthrax Prevention and Control Strategic Framework (2018-2030)

Phase 1 Phase 2 Phase 3

Strategy (by Total Costs
outcomes) Total Costs Total Costs Total Costs Total Costs Total Costs
(local
(USD) (local Currency) (USD) (local Currency) (USD)
Currency)
St 1: Enhancing
Surveillance and Reporting
Systems $1,806,624.00 $66,420.00 $4,669,696.00 $171,680.00 $6,718,944.00 $247,020.00
Outcome1.1. The
strength, Weakness/gap,
Opportunity and Threat in
the existing surveillance
system will be identified
and Addressed challenges/
gaps $1,421,472.00 $52,260.00 $3,899,392.00 $143,360.00 $5,563,488.00 $204,540.00
Outcome 1.2: Information
sharing mechanism among
sectors will be established
St 2: Strengthening
$385,152.00 $14,160.00 $770,304.00 $28,320.00 $1,155,456.00 $42,480.00
43
Outbreak investigation and
response System $961,248.00 $35,340.00 $1,754,944.00 $64,520.00 $1,012,928.00 $37,240.00
Outcome 2.1:
Strengthened the
outbreak investigation and
response system through
development of joint
preparedness plans and
activities $961,248.00 $35,340.00 $1,754,944.00 $64,520.00 $1,012,928.00 $37,240.00
St. 3: Enhancing Prevention
and Control of Anthrax $2,439,840.00 $89,700.00 $11,333,696.00 $416,680.00 $6,164,064.00 $226,620.00
Outcome 3.1: Improved
vaccine production,
distribution, storage/
handling and
administration system
that meets the demand at
national and regional level $1,671,168.00 $61,440.00 $5,803,936.00 $213,380.00 $3,619,776.00 $133,080.00
 Outcome 3.2: Improved the
environmental sanitation
practice nationwide $768,672.00 $28,260.00 $5,529,760.00 $203,300.00 $2,544,288.00 $93,540.00
St. 4: Improving Anthrax
Diagnostic Laboratory
Capacity $53,657,712.00 $1,972,710.00 $106,336,224.00 $3,909,420.00 $159,014,736.00 $5,846,130.00
Outcome 4.1: Improved
anthrax testing capacity of
the national and selected
regional laboratories $53,657,712.00 $1,972,710.00 $106,336,224.00 $3,909,420.00 $159,014,736.00 $5,846,130.00
Outcome 4.2: Enhanced
inter sectorial inter
laboratory networking
St. 5: Enhancing
Information, Education
and Communication
system $2,400,672.00 $88,260.00 $4,416,192.00 $162,360.00 $9,005,376.00 $331,080.00
Outcome 5.1: Improved
awareness of the
community on the risks
and prevention of anthrax $979,200.00 $36,000.00 $1,958,400.00 $72,000.00 $2,937,600.00 $108,000.00
Outcome 5.2: Skilled
health professionals on IEC
system $1,421,472.00 $52,260.00 $2,457,792.00 $90,360.00 $6,067,776.00 $223,080.00
St. 6: Strengthening Multi-
Sectorial Collaboration $285,328.00 $10,490.00 $570,656.00 $20,980.00 $570,656.00 $20,980.00
Outcome 6.1:
Strengthened existing
multi-sectorial
collaboration $285,328.00 $10,490.00 $570,656.00 $20,980.00 $570,656.00 $20,980.00
Monitoring $1,175,040.00 $43,200.00 $2,350,080.00 $86,400.00 $4,700,160.00 $172,800.00
Evaluation $611,728.00 $22,490.00 $1,223,456.00 $44,980.00 $2,446,912.00 $89,960.00
Total Budget $63,052,864.00 $2,318,120.00 $132,084,288.00 $4,856,040.00 $189,063,120.00 $6,950,850.00
Grand Total $384,200,272.00 $14,125,010.00

Note: The budget narrative for the implementation of Phase-I activities is presented in annex 5.1, below.

5. ANNEXES
5.1 BUDGET NARRATIVE
Note: the budget narratives described below is only for implementation of planned activities
under Phase-I of the strategic plan.
Justification:

44 A. Assessment Activities
Strategy 1: Enhancing Surveillance and Reporting Systems

Outcome 1.1: The strength, Weakness/gap, Opportunity and Threat in the existing surveillance system will
be identified and addressed challenges/gaps

1.1.3. Evaluate the process of case reports (sensitivity, completeness and timeliness of data flow; and association with
animal and human case)/surveillance evaluation on selected sites

Cost Average # Average # of Total Total Costs

Total
Strategy Items Per Day of Days Per Participants Rounds of (local
Costs USD
(USD) assessment Per assessment assessment Currency)

1 Participants Per Diem $20.00 10 20 1 $4,000.00 $108,800.00

Participants Trav-
2 el/ Transportation $100.00 10 20 1 $20,000.00
(Average) $544,000.00
Sub total $24,000.00 $652,800.00
 Justification

Evaluating the existing surveillance activities in the selected sites will provide the strengths and
weakness of the surveillance system. Underreporting and incompleteness of surveillance data
might leads to delayed response as a result of late detection of anthrax cases both in animals
and animals. Evaluating the sensitivity, flexibility, quality and other factors of the surveillance
and reporting system with respect to anthrax helps to identify the gaps. The evaluation will be
carried out on selected hotspot areas by using checklists and standard questioners. A total of 5
surveillance officers (EFLTP residents) and 15 data collectors will be involved in the evaluation.
The allocated budget will be used for perdiem and other logistics like transportation and
stationary.

Strategy 3: Enhancing Prevention and Control of Anthrax

Outcome 3.1: Improved vaccine production, distribution, storage/handling and ad-
ministration system that meets the demand at national and regional level

3.1.1. Asses/estimate the national demand production, distribution and storage capacity of anthrax vaccine
(baseline survey)
Total
Cost Average # Average # of Total
Total Costs
Strategy Items Per Day of Days Per Participants Costs
Rounds (local
(USD) assessment Per assessment USD
Currency)
S3 Participants Per Diem $20.00 10 5 1 $1,000.00 $27,200.00
Participants Travel/
S3 Transportation $100.00 10 5 1 $5,000.00
(Average) $136,000.00
Sub total $6,000.00 $163,200.00

Justification:

National veterinary institute have been producing and distributing anthrax vaccine for
animals. The exact animal population that requires anthrax vaccine provides the demand and
comparing the production capacity of NVI will help to identify the gaps in the demand and
production level of the vaccine. Currently such information is not properly documented and/
or further assessment will be necessary. Furthermore, the vaccine distribution and storage
capacity in various regions/areas were not adequately assessed. The allocated 163,200.00
birr will help to identify the strengths and gaps in vaccine production and distribution (the
overall vaccination system); used for perdiem and other logistics like transportation and
stationary.

3.1.2. Conduct cost effectiveness and feasibility study of animal vaccination

45
Cost Total
Average # Average # of Total
Per Total Costs
Strategy Items of Days Per Participants Costs
Day Rounds (local
assessment Per assessment USD
(USD) Currency)
S3 Participants Per Diem $20.00 10 5 1 $1,000.00 $27,200.00
Participants Travel/
S3 $100.00 10 5 1 $5,000.00
Transportation (Average) $136,000.00
Sub total $6,000.00 $163,200.00

Justification:

Understanding of the Coast effectiveness and feasibility of the existing animal vaccination
activities is better to strengthen and/or using better vaccination mechanisms adapted from
international experiences. The allocated 6,000 USD will help to assess cost effectiveness and
feasibility of currently used animal vaccination system.
 Strategy 4: Improving Anthrax Diagnostic Laboratory Capacity

Outcome 4.1: Improved anthrax testing capacity of the national and selected regional laboratories

4.1.1. Conduct assessment of national and regional public and animal health laboratories anthrax diag-
nostic capacity and identify limitations (on site visit)
Average # Average # of Total Costs
Cost Per Total Total
Strategy Items of Days Per Participants (local
Day (USD) Rounds Costs USD
assessment Per assessment Currency)

Participants Per
S4 $20.00 10 20 1 $4,000.00
Diem $108,800.00
Participants Travel/
S4 Transportation $100.00 10 20 1 $20,000.00
(Average) $544,000.00
Sub
$24,000.00 $652,800.00
total

Justification

The overall confirmation mechanism for anthrax in animals and humans case is based on the
clinical findings and simple staining practices. Such diagnostics practices will provide incomplete
evidence on the identification of anthrax and which might leads to false datas. Furthermore
absence of laboratory diagnostic capacity for anthrax in veterinary and human health sector
will affect the early response, prevention and control efforts towards anthrax. The allocated
652,800.00 birr will help to Conduct assessment of national and regional public and animal health
laboratories anthrax diagnostic capacity and identify limitations (on site visit). The assessment
will be conducted by four team (5 members in one team) in five selected regions. The assessment
of national and regional microbiology laboratories will be carried out using standard checklists
that helps to assess their capacity in terms of facilities, supplies, reagents and skilled laboratory
professionals. The identified gaps based on the assessment will be addressed and improved for
better confirmatory capability at least at national and some selected regional levels. The allocated
budget will be used to cover the logistics and perdiem cost of the participants in the assessments.

Strategy 5: Enhancing Information, Education and Communication system

Outcome 5.1: Improved awareness of the community on the risks and prevention of anthrax

5.1.2.Conduct KABP survey (on identified sites)

Cost Average # Average # of Total Costs

Total Total Costs
Strategy Items Per Day of Days Per Participants Per (local
Rounds USD
46 Participants Per
(USD) assessment assessment Currency)

S5 $20.00 10 30 1 $6,000.00
Diem $163,200.00
Participants Travel/
S5 Transportation $100.00 10 30 1 $30,000.00
(Average) $816,000.00
Sub total $36,000.00 $979,200.00
5.2.1. Conduct KABP survey (on identified sites for professionals)
Average # of
Cost Average #
Participants Total Total Costs Total Costs (local
Strategy Items Per Day of Days Per
Per Rounds USD Currency)
(USD) assessment
assessment

S5 Participants Per Diem $20.00 10 20 1 $4,000.00 $108,800.00

Participants Travel /
S5 $100.00 10 20 1 $20,000.00
Transportation (Average) $544,000.00
Sub total $24,000.00 $652,800.00
 Justification:

The allocated budget will be used for the assessment of the knowledge, skill and behavioral
attitudes in the community and also health professionals towards the risks of encountering
anthrax and the prevention measures. Standard questioners will be prepared and the
data collection will be done by trained data collectors. For this activity five teams will be
formulated having four data collector, one supervisor and one coordinator. Each team will
be assigned in selected one region and a total of five regions will be covered in the survey.
The finding will be published and documented. This will give a clear picture in the awareness
of the community and leads to develop appropriate IEC materials and systems for improving
the awareness of the community.
Monitoring and evaluation

7. 1 Monitoring of each activity (Onsite supervision)

Average # of
Cost Average # Total Costs
Participants Total Rounds of Total Costs
Strategy Items Per Day of Days Per (local
Per supervision USD
(USD) assessment Currency)
assessment
Participants Per
S7 $20.00 10 6 6 $7,200.00
Diem $195,840.00
Participants
Travel /
S7 $100.00 10 6 6 $36,000.00
Transportation
(Average) $979,200.00
Sub total $43,200.00 $1,175,040.00

8.1. Intreme evaluation of the phase 1/Conduct an evaluation on the effectiveness of the implement-
ed activities (onsite visit)
Average # of
Cost Average # Total Costs
Participants Total Rounds Total Costs
Strategy Items Per Day of Days Per (local
Per of evaluation USD
(USD) assessment Currency)
assessment
Participants Per
S8 $20.00 10 10 1 $2,000.00
Diem $54,400.00
Participants
Travel/
S8 $100.00 10 10 1 $10,000.00
Transportation
(Average) $272,000.00
Sub total $12,000.00 $326,400.00

Justification:

Monitoring of the implementation of the planned activities will help to assess the
47
effectiveness of the program towards achieving its objectives. Regular supervision of the
selected active sites will address the progress of the planned activities and planned to carry
out this activity every four months period. The allocated budget will be for transportation
and perdiem coast of the supervisors.

Training and others (workshop and meetings)

Strategy 1: Enhancing Surveillance and Reporting Systems
Outcome 1.1: The strength, Weakness/gap, Opportunity and Threat in the existing surveillance system
will be identified and addressed challenges/gaps
 1.2.4. Preparation of draft anthrax surveillance guideline (write shop)
Average Total
Average # of Total
Cost Per Day # of Days Total Rounds of Costs
Strategy Items Participants Per Costs
(USD) Per write workshop (local
write shop USD
shop Currency)
S1 Venue $100.00 2 1 2 $400.00 $10,880.00
Venue Package/
S1 $8.00 2 15 2 $480.00
Tea Break $13,056.00
S1 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants
Travel/
S1 $130.00 1 10 2 $2,600.00
Transportation
(Average) $70,720.00
Participants and
S1 $20.00 4 15 2 $2,400.00
Trainers Per Diem $65,280.00
Training Materials
S1 $10.00 1 10 2 $200.00
(Average) $5,440.00
S1 Stationery $10.00 1 10 2 $200.00 $5,440.00
Sub total $7,080.00 $192,576.00
1.2.5. Organize a validation workshop (Surveillance guideline)
Average Total
Average # of
Cost Per Day # of Days Rounds Total Total Costs (local
Strategy Items Participants
(USD) Per write of Costs USD Currency)
Per write shop
shop Training
S1 Venue $100.00 2 1 1 $200.00 $5,440.00
Venue Package/
S1 $8.00 2 15 1 $240.00
Tea Break $6,528.00
S1 Facilitators Fee $20.00 4 5 1 $400.00 $10,880.00
Participants
Travel/
S1 $130.00 1 10 1 $1,300.00
Transportation
(Average) $35,360.00
Participants
S1 and Trainers Per $20.00 4 15 1 $1,200.00
Diem $32,640.00
Training
S1 Materials $10.00 1 10 1 $100.00
(Average) $2,720.00
S1 Stationery $10.00 1 10 1 $100.00 $2,720.00
Sub total $3,540.00 $96,288.00

48
1.2.6. printing and dissemination of surveillance guideline

Amount Total Costs (local

Strategy Item Requested No. Needed Unit Cost
Requested Currency)
Printing of
S1 surviellance 1,000 $4.00 $4,000.00
guideline $108,800.00
Sub Total $4,000.00 $108,800.00

Justification:

Guidance for anthrax surveillance activities is important to ensure rapid detection, reporting
and effective response to emerging outbreaks of anthrax. This budget will be used to
develop a guideline for surveillance of anthrax both in humans and animals. The guideline
will incorporate detailed instructions, and protocols on reporting activities, active case
searches etc to deal with overall surveillance activities in the involvement of different sectors
including ministry livestock and fisheries and ministry of health. Two separate surveillance
guidelines will be prepared for veterinary sector and health sector. The guideline will be
prepared by the stuffs of each ministries and the allocated budget will cover the coasts for
the workshop (write shop and validation workshop). The remaining 108,000 birr will be for
printing and dissemination of the guideline.

1.3. Provide trainings to address surveillance capacity gaps

Average Total
Cost Average # of Total Total Costs
# of Days Rounds
Strategy Items Per Day Participants Costs (local
Per write of
(USD) Per Training USD Currency)
shop Training
S1 Venue $100.00 2 1 2 $400.00 $10,880.00
Venue Package/
S1 $8.00 2 40 2 $1,280.00
Tea Break $34,816.00
S1 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S1 Transportation $130.00 1 40 2 $10,400.00
(Average) $282,880.00
Participants and
S1 $20.00 4 45 2 $7,200.00
Trainers Per Diem $195,840.00
Training Materials
S1 $10.00 1 10 2 $200.00
(Average) $5,440.00
S1 Stationery $10.00 1 45 2 $900.00 $24,480.00
Sub total $21,180.00 $576,096.00

Justification:

Anthrax diseases is known to be shared problem among sectors, the collaboration remains
49
very weak. In this regard, the understanding and practice of joint surveillance fir anthrax
and other zoonotic diseases in Ethiopia has been lagging behind. Thus, sensitization and
awareness creation is very critical. Training for decision makers in public health and animal
health from across all regions, and also, animal and human health professionals in the
ground will strengthen collaborative efforts against emerging health threats. An estimated
45-45 health and veterinary professionals selected from each region will be trained on joint
anthrax surveillance system. This help will be used to cover the coast for the planned training.
 1.4. Conduct a regular review meeting, workshops with stakeholders
Cost Average # Average # of Total Total Costs
Total
Strategy Items Per Day of Days Per Participants Costs (local
Rounds
(USD) write shop Per write shop USD Currency)

S1 Venue $100.00 2 1 4 $800.00 $21,760.00

Venue Package/Tea
S1 $8.00 2 15 4 $960.00
Break $26,112.00
S1 Facilitators Fee $20.00 4 5 4 $1,600.00 $43,520.00
Participants Travel/
S1 Transportation $130.00 1 10 4 $5,200.00
(Average) $141,440.00
Participants and
S1 $20.00 4 15 4 $4,800.00
Trainers Per Diem $130,560.00
Training Materials
S1 $10.00 1 10 4 $400.00
(Average) $10,880.00
S1 Stationery $10.00 1 10 4 $400.00 $10,880.00
Sub total $14,160.00 $385,152.00

Justification:

This budget will be used to cover the coasts for conducting a regular review meeting, workshops
with stakeholders. The meeting will be held on a regular basis (every quarter) which will further
strength inter-sectoral communication and information sharing regarding surveillance findings
and other related activities.

Strategy 2: Strengthening Outbreak investigation and response System

Outcome 2.1: Strengthened the outbreak investigation and response system through
development of joint preparedness plans and activities

2.1.1. Develop a national guideline and SOPs for outbreak investigation and response (write shop)
Average
Average # of Total
Cost # of Total Total Costs
Participants Rounds
Strategy Items Per Day Days Per Costs (local
Per write of
(USD) write USD Currency)
shop Training
shop
S2 Venue $100.00 2 1 2 $400.00 $10,880.00
S2 Venue Package/Tea Break $8.00 2 15 2 $480.00 $13,056.00
S2 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S2 $130.00 1 10 2 $2,600.00
Transportation (Average) $70,720.00
Participants and Trainers
50 S2
Per Diem
Training Materials
$20.00 4 15 2 $2,400.00
$65,280.00

S2 $10.00 1 10 2 $200.00
(Average) $5,440.00
S2 Stationery $10.00 1 10 2 $200.00 $5,440.00
Sub total $7,080.00 $192,576.00
2.1.2. Prepare outbreak preparedness plan and ensure availability of necessary supplies
Average
Average # of
Cost # of Total Total Costs
Participants Total
Strategy Items Per Day Days Per Costs (local
Per write Rounds
(USD) write USD Currency)
shop
shop
S2 Venue $100.00 2 1 2 $400.00 $10,880.00
S2 Venue Package/Tea Break $8.00 2 15 2 $480.00 $13,056.00
S2 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S2 $130.00 1 10 2 $2,600.00
Transportation (Average) $70,720.00
Participants and Trainers
S2 $20.00 4 15 2 $2,400.00
Per Diem $65,280.00
Training Materials
S2 $10.00 1 10 2 $200.00
(Average) $5,440.00
S2 Stationery $10.00 1 10 2 $200.00 $5,440.00
Sub total $7,080.00 $192,576.00

Justification:

Absence of a standard guideline, preparedness plan and SOP for effective outbreak
investigation and response faces a great challenge for Ethiopia in outbreak management
activities. This budget will help ministries (MOH and MoLF) to develop a separate Outbreak
investigation guideline, outbreak preparedness plan and SOP for anthrax. The guideline will
be prepared by stuffs of the ministries or the TWG in a write shop. The guideline will provide
appropriate guidance on the steps and procedures of anthrax outbreak investigation and
response for the RRT members and other professionals that might facilitate early control
of the spread of the disease and further reduce associated public health impacts.

2.1.3. Conduct simulation exercises; training

Cost Average Average Total
Total Total Costs
Per # of # of Rounds
Strategy Items Costs (local
Day Days Per Participants of
USD Currency)
(USD) training Per training Training
S2 Venue $100.00 2 1 2 $400.00 $10,880.00
Venue Package/Tea
S2 $8.00 2 40 2 $1,280.00
Break $34,816.00
S2 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S2 Transportation $130.00 1 40 2 $10,400.00
(Average) $282,880.00

S2
Participants and
Trainers Per Diem
$20.00 4 45 2 $7,200.00
$195,840.00 51
Training Materials
S2 $10.00 1 10 2 $200.00
(Average) $5,440.00
S2 Stationery $10.00 1 45 2 $900.00 $24,480.00
Sub total $21,180.00 $576,096.00

Justification:

Limited knowledge and skill on outbreak investigation and response activities (joint
outbreak investigation and response) with regard to anthrax in humans and animals has be
the challenge for proper implementation of outbreak management activities. This budget
will help to provide a simulation exercise and training of veterinary and human health rapid
response teams selected from each region. The training is aiming to improve the knowledge
and skill of the stuffs/team members on proper management of anthrax outbreak in animals
and humans.
 Strategy 3: Enhancing Prevention and Control of Anthrax
Outcome 3.1: Improved vaccine production, distribution, storage/handling and administration
system that meets the demand at national and regional level

3.1.5a. Prepare a draft Vaccination plan (Write shop)

Cost
Average # Average # of Total Total Costs
Per Total
Strategy Items of Days Per Participants Costs (local
Day Rounds
write shop Per write shop USD Currency)
(USD)
S3 Venue $100.00 2 1 2 $400.00 $10,880.00
S3 Venue Package/Tea Break $8.00 2 15 2 $480.00 $13,056.00
S3 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S3 $130.00 1 10 2 $2,600.00
Transportation (Average) $70,720.00
Participants and Trainers
S3 $20.00 4 15 2 $2,400.00
Per Diem $65,280.00
Training Materials
S3 $10.00 1 10 2 $200.00
(Average) $5,440.00
S3 Stationery $10.00 1 10 2 $200.00 $5,440.00
Sub total $7,080.00 $192,576.00

Justification:

Absence of standardize anthrax vaccination plan addressing the seasonality, demand and all
geographic area with respect to the appropriate time had an impact on the effectiveness of
animal vaccination. This challenge might be addressed through development of a standardize
vaccination plan based on the assessment findings. This budget will be used to develop a national
animal’s vaccination plan for anthrax. The vaccination plan will incorporate detailed instructions
to deal with overall animal vaccination activities in the involvement of different sectors including
ministry livestock and fisheries and partners.

3.1.6. Provide Training to animal health professionals and technicians on vaccine management
Average Total
Cost Average # of Total Total Costs
# of Rounds
Strategy Items Per Day Participants Costs (local
Days Per of
(USD) Per training USD Currency)
training Training
S3 Venue $100.00 2 1 4 $800.00 $21,760.00
S3 Venue Package/Tea Break $8.00 2 40 4 $2,560.00 $69,632.00
S3 Facilitators Fee $20.00 4 5 4 $1,600.00 $43,520.00
Participants Travel/
S3 $130.00 1 40 4 $20,800.00
Transportation (Average) $565,760.00
52 S3
Participants and Trainers
Per Diem
$20.00 4 45 4 $14,400.00
$391,680.00
Training Materials
S3 $10.00 1 10 4 $400.00
(Average) $10,880.00
S3 Stationery $10.00 1 45 4 $1,800.00 $48,960.00
Sub total $42,360.00 $1,152,192.00

Justification:

Limited knowledge and skill on vaccine management has been the challenge for proper
implementation anthrax vaccination activities including planning, distributing, handling and
administration of the anthrax vaccine. This budget will help to provide training for veterinary
professionals selected from each region. The training is aiming to improve the knowledge and
skill of the stuffs on proper and effective management of vaccination campaign.
Outcome 3.2: Improved the environmental sanitation practice nationwide

3.2.3. Conduct training on best environmental sanitary practices

Cost Average # Average # of Total Total Total Costs
Strategy Items Per Day of Days Per Participants Rounds of Costs (local
(USD) training Per training Training USD Currency)

S3 Venue $100.00 2 1 2 $400.00 $10,880.00

S3 Venue Package/Tea Break $8.00 2 40 2 $1,280.00 $34,816.00
S3 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S3 $130.00 1 40 2 $10,400.00
Transportation (Average) $282,880.00
Participants and Trainers
S3 $20.00 4 45 2 $7,200.00
Per Diem $195,840.00
S3 Training Materials (Average) $10.00 1 10 2 $200.00 $5,440.00
S3 Stationery $10.00 1 45 2 $900.00 $24,480.00
Sub total $21,180.00 $576,096.00

Justification:

The best prevention and control measures of anthrax includes proper disposal of dead
animal body/carcass and environmental sanitation practices. Limited knowledge and
environmental sanitation practice has been one of the challenge that hinders the prevention
measures. The allocated budget will help to provide the best environmental sanitation
practices to the environmental health professionals selected from all regions. The training
will be held in two rounds and an estimated 80 individuals will be participated. This will
improve the knowledge of the health professionals on environmental sanitation methods
and practices.

Strategy 4: Improving Anthrax Diagnostic Laboratory Capacity

Outcome 4.1: Improved anthrax testing capacity of the national and selected regional laboratories

4.1.3: Organize trainings on anthrax laboratory testing procedures

Cost Average Total
Average # of Total Total Costs
Per # of Rounds
Strategy Items Participants Costs (local
Day Days Per of
Per training USD Currency)
(USD) training Training
S4 Venue $100.00 2 1 2 $400.00 $10,880.00
Venue Package/
S4 $8.00 2 40 2 $1,280.00
Tea Break $34,816.00
S4 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00

S4
Participants
Travel/
Transportation
$130.00 1 40 2 $10,400.00
53
(Average) $282,880.00
Participants
S4 and Trainers Per $20.00 4 45 2 $7,200.00
Diem $195,840.00
Training
S4 Materials $10.00 1 10 2 $200.00
(Average) $5,440.00
S4 Stationery $10.00 1 45 2 $900.00 $24,480.00
Sub total $21,180.00 $576,096.00
 Justification:

Laboratory based surveillance and outbreak investigation has a vital role in early detection and
response for anthrax suspected cases in animals and humans. Currently no laboratory confirmation
is done for any anthrax suspected cases due to limited laboratory capacity and trained laboratory
professionals on anthrax diagnostic tests. This budget will help to provide trainings on anthrax
laboratory testing procedures for laboratory professionals selected from all regions which will
improve their technical capacity and further strength the surveillance and outbreak investigation
activities.

Strategy 5: Enhancing Information, Education and Communication system

Outcome 5.2: Improved health professionals knowledge and skill on IEC system
5.2.2. Develop draft training manuals (workshop)
Total Total
Cost Average # Average # of Total
Rounds Costs
Strategy Items Per Day of Days Per Participants Costs
of write (local
(USD) write shop Per write shop USD
shop Currency)
S5 Venue $100.00 2 1 2 $400.00 $10,880.00
S5 Venue Package/Tea Break $8.00 2 15 2 $480.00 $13,056.00
S5 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S5 $130.00 1 10 2 $2,600.00
Transportation (Average) $70,720.00
Participants and Trainers
S5 $20.00 4 15 2 $2,400.00
Per Diem $65,280.00
Training Materials
S5 $10.00 1 10 2 $200.00
(Average) $5,440.00
S5 Stationery $10.00 1 10 2 $200.00 $5,440.00
Sub total $7,080.00 $192,576.00

Justification:
This budget will help to organize a write shop aiming to develop Information, Education and
Communication materials/documents. The training manuals will help to improve the health
professionals to properly deliver awareness regarding the risks and preventive measures of
anthrax to the community and other professionals. The gaps identified on the KABP assessment
will be addressed in the manuals and will serve as a national guidance comprising of all the
necessary contents and messages regarding anthrax in humans and animals.

5.2.3. Provide training to public, animal and environmental health professionals on IEC system

54 Strategy Items
Cost
Per Day
Average
# of
Days Per
Average
# of
Participants
Total
Rounds of
Total
Costs
Total
Costs
(local
(USD) Training USD
Training Per Training Currency)
S5 Venue $100.00 2 1 2 $400.00 $10,880.00
S5 Venue Package/Tea Break $8.00 2 40 2 $1,280.00 $34,816.00
S5 Facilitators Fee $20.00 4 5 2 $800.00 $21,760.00
Participants Travel/
S5 $130.00 1 40 2 $10,400.00
Transportation (Average) $282,880.00
Participants and Trainers
S5 $20.00 4 45 2 $7,200.00
Per Diem $195,840.00
Training Materials
S5 $10.00 1 10 2 $200.00
(Average) $5,440.00
S5 Stationery $10.00 1 45 2 $900.00 $24,480.00
Sub total $21,180.00 $576,096.00
 Justification:
Information, education and communication mechanism for delivering of appropriate
messages on the risks and preventive measures of anthrax plays a crucial role in improving
the awareness of the community. The content of the messages and the method of
delivery to the community require special skills and the training will improve the health
professionals on effective communication systems. Limited knowledge and skill of the
health professionals on the methods of community awareness affects the prevention and
control activities of anthrax. The allocated budget will cover the coasts for organize the
training aiming to improve knowledge and skill of the health professionals on IEC methods.
The training will be conducted in two rounds and an estimated 80 individuals will participate
on the training

Strategy 6: Strengthening Multi-Sectoral Collaboration

Outcome 6.2: Endorsed/valid national anthrax prevention and control strategic plan
6.2.2.Organize a stakeholders validation workshop of the national anthrax prevention and control strategy
Cost Average Average # of Total
Total Total Costs
Per # of Participants Rounds
Strategy Items Costs (local
Day Days Per Per of
USD Currency)
(USD) workshop workshop workshop
S6 Venue $100.00 2 1 1 $200.00 $5,440.00
Venue Package/Tea
S6 $8.00 2 40 1 $640.00
Break $17,408.00
S6 Facilitators Fee $20.00 4 5 1 $400.00 $10,880.00
Participants Travel/
S6 Transportation $130.00 1 40 1 $5,200.00
(Average) $141,440.00
Participants and
S6 $20.00 4 45 1 $3,600.00
Facilitaters Per Diem $97,920.00
S6 Stationery $10.00 1 45 1 $450.00 $12,240.00
Sub total $10,490.00 $285,328.00

Justification:

The national anthrax prevention and control strategic plan developed by the anthrax TWG
contains detailed activities that will be implemented in the stipulated timeframe with the
vision of significantly reducing and ultimately controlling the public health impact of anthrax
in humans and animals in Ethiopia through sustained surveillance, laboratory diagnosis,
prevention and control system and community awareness. The allocated budget will help to
organize a validation workshop aiming to present the drafted strategic activities and to get 55
approval and buy in from the authorized officials of each ministry for the implementation of
proposed activities on the strategic plan.
 8. EVALUATION
8.2. Organize an evaluation workshop
Cost
Average # Average # of Total Total Total Costs
Per
Strategy Items of Days Per Participants Rounds of Costs (local
Day
workshop Per workshop workshop USD Currency)
(USD)
S8 Venue $100.00 2 1 1 $200.00 $5,440.00
S8 Venue Package/Tea Break $8.00 2 40 1 $640.00 $17,408.00
S8 Facilitators Fee $20.00 4 5 1 $400.00 $10,880.00
Participants Travel/
S8 $130.00 1 40 1 $5,200.00
Transportation (Average) $141,440.00
Participants and Facilitaters
S8 $20.00 4 45 1 $3,600.00
Per Diem $97,920.00
S8 Stationery $10.00 1 45 1 $450.00 $12,240.00
Sub total $10,490.00 $285,328.00

Justification:
The proposed validation work shop is to evaluate the effectiveness of implemented activities on
phase-1 with respect to its objective. During the validation work shop the reports on all implemented
activities under phase-1 will be presented and the associated outcomes in preventing and control of
anthrax in humans and animals. Furthermore, the outcomes will be evaluated based on the identified
indicates. The strengths and weakness on the implementation of phase-1 activities will be identified
and further improved for phase-2 activities. An estimated 40 delegates from the relevant sectors will
be expected to participate on the two days validation workshop and the allocated budget is to cover
the coasts to organize a validation workshop.

Equipment’s and supplies

Strategy 4: Improving Anthrax Diagnostic Laboratory Capacity

Outcome 4.1: Improved anthrax testing capacity of the national and selected regional laboratories

4.1.3.Procurement of necessary laboratory supplies and equipment

Unit Total Costs
Total cost
Strategy Item Requested Unit Quantity price (local
(USD)
(USD) Currency)
S4 Thermocycler Pcs 10 10000 $100,000.00 $2,720,000.00
S4 Gel electrophoresis apparatus Pcs 10 10000 $100,000.00 $2,720,000.00

56
S4 Microfuge Pcs 10 2500 $25,000.00 $680,000.00
S4 UV trans illuminator and Polaroid camera Pcs 10 2500 $25,000.00 $680,000.00
S4 Micropipettes with volume range of 1-10 μl Pcs 10 300 $3,000.00 $81,600.00
S4 Micropipettes with volume range of 5-20 μl Pcs 10 300 $3,000.00 $81,600.00
S4 Micropipettes with volume range of 20-100 μl Pcs 10 300 $3,000.00 $81,600.00
S4 Clean Class II hoods Pcs 10 15000 $150,000.00 $4,080,000.00
S4 vortex mixer Pcs 10 1000 $10,000.00 $272,000.00
S4 Shaker Incubator Pcs 10 4000 $40,000.00 $1,088,000.00
S4 Centrifuge Pcs 10 8000 $80,000.00 $2,176,000.00
S4 Class II cabinet Pcs 10 15000 $150,000.00 $4,080,000.00
S4 Microscope Pcs 10 5000 $50,000.00 $1,360,000.00

S4 Autoclave Pcs 10 10000 $100,000.00 $2,720,000.00

S4 Incubator Pcs 10 3000 $30,000.00 $816,000.00
S4 Waterbath Pcs 10 1000 $10,000.00 $272,000.00
S4 Bunsen burner Pcs 10 30 $300.00 $8,160.00
S4 Permanent Masks Pcs 10 25 $250.00 $6,800.00
S4 Epindorf tube pack of 100 Pack 10 20 $200.00 $5,440.00
S4 Disposable face masks pack of 100 Pack 10 10 $100.00 $2,720.00
S4 Blood agar base medium, 500gram Bottle 10 150 $1,500.00 $40,800.00
S4 Nutrient Agar , 500gram Bottle 10 100 $1,000.00 $27,200.00
S4 Nutrient broth 500gram Bottle 10 100 $1,000.00 $27,200.00
PLET agar (polymyxin, lysozyme, EDTA
Bottle,
S4 [ethylene diamine tetra-acetic acid], thallous 10 200 $2,000.00
500gram
acetate) $54,400.00
Penicillin antimicrobial discs (One pack
contains 5 cartage each having 50 Pack /5
S4 10 100 $1,000.00
antimicrobial discs and each disc has 10 units Cartage/
concentration) $27,200.00
Vial of
S4 0.5% McFarland turbidity standard solution 100 10 $1,000.00
5-7ml $27,200.00
S4 Mueller Hinton agar, 500gram Bottle 20 150 $3,000.00 $81,600.00
S4 MacConkey Agar bottle 20 150 $3,000.00 $81,600.00
S4 Brain Heart infusion broth bottle 20 150 $3,000.00 $81,600.00
Ready made Polychrome methylene blue Bottle of
S4 20 100 $2,000.00
stain(MacFadyean’s stain) 500ml $54,400.00
Vial of
S4 Ready made Giemsa stain reagent 20 100 $2,000.00
500ml $54,400.00
S4 Sodium bicarbonate, 100gram Bottle 20 50 $1,000.00 $27,200.00
Catalase reagent /3% hydrogen peroxide
S4 liter 20 30 $600.00
solution/ $16,320.00
S4 Nutrient gelatin bottle 20 100 $2,000.00 $54,400.00
S4 Egg yolk agar bottle 20 100 $2,000.00 $54,400.00
S4 Motility medium with tetrazolium salt bottle 20 100 $2,000.00 $54,400.00
S4 Sterile swab, pack of 100 pack 20 80 $1,600.00 $43,520.00
S4 Peridish pack of 10 pack 5000 15 $75,000.00 $2,040,000.00
S4 Labeling markers pack of 10 pack 150 4 $600.00 $16,320.00
S4 Syringe and needles 24-26 gauge pack of 100 pack 1000 10 $10,000.00 $272,000.00
S4 Vacutainer needles pack of 100 pack 1000 10 $10,000.00 $272,000.00
S4 Vacutainer tubes pack of 100 pack 1000 10 $10,000.00 $272,000.00
S4 Test tubes/ bottle screw caps pack of 10 pack 1000 15 $15,000.00 $408,000.00
S4 Microscope slides pack of 100 pack 1000 5 $5,000.00 $136,000.00
S4 Slide cover slips pack of 100 Pack 1000 3 $3,000.00 $81,600.00
S4 immersion oil Bottle 1000 5 $5,000.00 $136,000.00
S4 lens paper pack of 100
Pasteur pipettes, preferably plastic disposable
Pack 1000 3 $3,000.00 $81,600.00
57
S4 Pack 1000 15 $15,000.00
pack of 100 $408,000.00
S4 Autoclavable discard bags pack of 100 Pack 100 15 $1,500.00 $40,800.00
S4 Disinfectant spray “gun” Bottle 100 4 $400.00 $10,880.00
S4 Inoculation loops pack of 10 Pack 160 3 $480.00 $13,056.00
Sodium hypochlorite (10,000 ppm) bottle of
S4 Bottle 50 100 $5,000.00
1 litre $136,000.00
Gamma phage of Bacillus anthracis (or cherry
S4 Vial 40 100 $4,000.00
phage) $108,800.00
Filter membrane of 0.45 μm pore size pack of
S4 Pack 100 100 $10,000.00
100 $272,000.00
S4 Sterne vaccine strain of B. anthracis (34F2) vial 200 100 $20,000.00 $544,000.00
S4 Primers Vial 1000 100 $100,000.00 $2,720,000.00
S4 Nucleotides(dNTPs) Vial 1000 100 $100,000.00 $2,720,000.00
 S4 Taq polymerase enzyme Vial 1000 100 $100,000.00 $2,720,000.00
S4 Agarose powder Bottle 1000 100 $100,000.00 $2,720,000.00
S4 PCR grade water Bottle 1000 100 $100,000.00 $2,720,000.00
S4 Positive Control DNA Vial 1000 100 $100,000.00 $2,720,000.00
S4 1kb DNA ladder 1000 100 $100,000.00 $2,720,000.00
S4 Microcentrifuge tube racks Pcs 1000 50 $50,000.00 $1,360,000.00
2.0ml microcentrifuge tubes with O-ring pack 1000 50
S4 Pack $50,000.00
of 500 $1,360,000.00
S4 1.5ml Microcentrifuge tubes Pack of 500 pack 1000 25 $25,000.00 $680,000.00
Total $1,927,530.00 $52,428,816.00

Justification: Currently in our country the national and regional laboratories do not confirm any anthrax
suspected cases this is mainly due to limited laboratory capacity and trained laboratory professionals
on anthrax diagnostic tests. Hence, these laboratory consumables will be used by the twob211 National
referral laboratories, that is bacteriology laboratories at Ethiopian Public Health Institute (EPHI) and National
Animal Health Diagnostic and Investigation Center (NAHDIC) for confirming anthrax suspected disease
outbreaks both in human and animals. The consumables will be used to collect sample from anthrax
suspected case from all over the country and then the collected samples will be cultured and identified
at laboratory using biochemical tests and gamma phages. Field level testing of smear samples will also
be made using MacFadyean’s stain from animal blood smear. Moreover, direct detection of the antigen
using PCR techniques will also be carried both from human and animal samples. After establishing and
strengthening the national laboratories capacity in diagnosing anthrax, then the experience will be shared
for regional laboratories.

List of hospital and regional public health laboratories

Ser. No Region Laboratory Assessed Level of laboratory

AA EPHI Bacteriology Lab National Reference Laboratory

AA EPHI Virology Lab National Reference Laboratory

Amhara Bahirdar Regional Lab Regional Laboratory
Amhara Dessie Regional Lab Regional Laboratory
Oromia Nekemt Regional Lab Regional Laboratory
Oromia Adama Regional Lab Regional Laboratory
Harar Harar Regional Lab Regional Laboratory
Afar Afar Regional Lab Regional Laboratory
Diredawa Diredawa Regional Lab Regional Laboratory
AA Aa Regional Lab Regional Laboratory
Tigray Mekele Regional Lab. Regional Laboratory

58 Somali
SNNPR
Somali Regional Lab
Hawasa Regional Lab
Regional Laboratory
Regional Laboratory
SNNPR Mizan Sub- Regional Lab Sub -Regional Laboratory
SNNPR Jinka Sub- Regional Lab Sub- Regional Laboratory
SNNPR Arbaminch Sub- Regional Sub- Regional Laboratory
Amhara Gondar University Teaching Hospital Hospital Laboratory
Benishngul-Gumuz Asossa Hospital Hospital Laboratory
Gambella Gambela Referal Hospital Hospital Laboratory
Oromia Jimma Specialized Hospital Hospital Laboratory
SNNPR Arbaminch General Hospital Hospital Laboratory
Tigray Humera Hospitsal Hospital Laboratory
SNNPR Hawasa Unive Teaching Hospital Hospital Laboratory
Ser. No Region Laboratory Assessed Level of laboratory
SNNPR Jinka Zonal Hospital Hospital Laboratory
SNNPR Wolayta Sodo University Teaching Hospital Laboratory
Hospital
Oromia Shasheme Referral Hospital Hospital Laboratory
Addis Ababa Yekatit 12 Hospital Hospital Laboratory
Somali Karamara Hospital Hospital Laboratory
Oromia Ambo Hospital Hospital Laboratory
Addis Ababa Alert Hospital Hospital Laboratory
Addis Ababa Armed Force Hospital Hospital Laboratory
Tigray Axum Zonal Hospital Hospital Laboratory
Tigray Haider Referral Hospital Hospital Laboratory
Amhara Tefera Hailu Hospital Hospital Laboratory
SNNPR Mezanaman Hospital Hospital Laboratory
Afar Dubti Hospital Hospital Laboratory
Amhara Debremarkose Hospital Hospital Laboratory
Oromia Metukarl Hospital Hospital Laboratory
SNNPR Mezanaman Hospital Hospital Laboratory
Addis Ababa Black Lion Hospital Hospital Laboratory
Addis Ababa Armauer Hanssen Research Institute Research Laboratory

List of animal health regional laboratories

s/ Name of National and Regional Regional Location Major activities

no Veterinary Lab states
1 National Animal Health Diagnostic and MOLF Sebeta Diagnosis, outbreak investigation, export
Investigation Center (NAHDIC) testing, research, surveillance and
capacity building
2 National Veterinary Institute (NVI) MOLF Debre Zeit Diagnosis, research and vaccine
production and capacity building
3 Mekele Regional veterinary Laboratory Tigray Mekele Diagnosis, outbreak investigation and
surveillance
4 Kombolcha Regional Veterinary Amhara Kombolcha Diagnosis, outbreak investigation and
Laboratory surveillance
5 Bahir Dar Regional Veterinary Amhara Bair dar Diagnosis, outbreak investigation and
Laboratory surveillance
6 Semera Regional Veterinary Laboratory Afar Semera Diagnosis, outbreak investigation and
surveillance
7 Shola veterinary Laboratory Addis Ababa Addis Ababa Diagnosis, outbreak investigation and
surveillance
8 Assosa Regional Veterinary Laboratory Benshangul Asosa Diagnosis, outbreak investigation and

9 Bedelle Regional Veterinary Laboratory

gumz
Oromia Bedelle
surveillance
Diagnosis, outbreak investigation and
59
surveillance
10 Asela Regional Veterinary Laboratory Oromia Arsi Diagnosis, outbreak investigation and
surveillance
11 Hirna Regional Veterinary Laboratory Oromia Hirna Diagnosis, outbreak investigation and
surveillance
12 Yabello Regional Veterinary Laboratory Oromia Yabello Diagnosis, outbreak investigation and
surveillance
13 Sodo Regional Veterinary Laboratory SNNPRS Wolayita Diagnosis, outbreak investigation and
Sodo surveillance
14 Mizan Regional Veterinary Laboratory SNNPRS Mizan aman Diagnosis, outbreak investigation and
surveillance
15 Jinka Regional Veterinary Laboratory SNNPRS Jinka Diagnosis, outbreak investigation and
surveillance
16 Jigjiga Regional Veterinary Laboratory Ethiopian Jijiga Diagnosis, outbreak investigation and
Somali surveillance
17 Dire Dawa Regional Veterinary Dire Dawa Dire Dawa Diagnosis, outbreak investigation and
Laboratory surveillance