West Africa Definition and Burden Wage Estimate

Appendix D. West Africa Definitions and Burden and Wage Estimates

West Africa Country Definition

The main goal of this information collection request (ICR) is to receive and maintain Paperwork Reduction Act (PRA) clearance in advance of any Ebola outbreak in West Africa, so that a CDC can respond without delay. Because it is impossible to predict when and where a new Ebola outbreak may occur, we make assumptions to estimate time and cost burdens based on West African country populations and official language. In order to generalize the utility of this ICR, we translated forms into four official languages (English, French, Portuguese, and Arabic).

We used the United States Agency for International Development (USAID) list of West African countries. West Africa is defined as the region including 21 countries.¹ Sorted by official language, they are:

• French - Benin, Burkina Faso, Cameroon, Côte D’Ivoire, Equatorial Africa, Gabon, Guinea, Mali, Niger, Senegal, and Togo.

• English – The Gambia, Ghana, Liberia, Nigeria, and Sierra Leone.

• Portuguese - Cape Verde, Guinea-Bissau, Sao Tome and Principe.

• Arabic – Chad and Mauritania.

Western Africa		Official Language2	2015 Population Estimates (in millions)3
			Country	By Official Language (%)
Benin		French	10.88m	146.05m (37.49%)
Burkina Faso		French	17.91m
Cameroon		French4	23.39m
Côte D’Ivoire		French	21.30m
Equatorial Guinea		French5	0.80m
Gabon		French	1.75m
Guinea		French	12.35m
Mali		French	16.26m
Niger		French	19.27m
Senegal		French	14.97m
Togo		French	7.17m
Gambia, The		English	1.97m	223.29m (57.32%)
Ghana		English	26.98m
Liberia		English	4.50m
Nigeria		English	183.52m
Sierra Leone		English	6.32m
Cape Verde		Portuguese	0.51m	2.50m (0.65%)
Guinea-Bissau		Portuguese	1.79m
Sao Tome and Principe		Portuguese	0.20m
Chad		Arabic6	13.60m	17.68m 4.54%
Mauritania		Arabic	4.08m
Total			389.52m	100%

West Africa Country Burden Estimates

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We assume 30,000 annual cases to ensure ample burden hours are requested for future outbreaks. The World Health Organization (WHO) case count for 11 months (March, 2014-Jan 2015) is rounded to 22,000.⁷ Assuming an average of 2,000 cases per month, an annual estimate is 24,000 which is adjusted to 30,000 cases. Based on the 2014 Ebola Virus Response, this estimate is not outside of the realm of possibility in an uncontrolled outbreak.

We make a simplifying assumption based on the population size in each country that 57.32% of the Ebola cases will arise from countries with English as the official language (n=17,196), 37.49% will be from French-speaking countries (n=11,247), 0.65% will be from Portuguese-speaking countries (n=195), and 4.54% will be from Arabic-speaking countries (n=1,362).⁸ We are aware that the affected countries will vary from outbreak to outbreak; therefore, the proportion of forms by language for each outbreak will also vary from our simplified estimation model. It is also possible that translations into native dialects will be necessary. However, we anticipate that the total burden for each type of form regardless of language will remain within the requested approval for 30,000 annual cases.

Case Investigation Forms: Short forms were originally developed as a resource- and time-saving aid if the number of cases is larger than MoH surveillance teams can handle using long forms. In the CDC experience of the first year of the 2014 Ebola Response, we noted that the majority of the Ministries of Health (MoH) preferred the short forms.

• For this information collection request (ICR), we assume that 90% of the 30,000 cases would be tracked with short forms (Attachments 1-4) and 10% would be tracked with long forms (Attachments 5-8).

  • For English-speaking cases (n=17,196), this amounts to 15,476 short forms and 1,720 long forms.

  • For French-speaking cases (n=11,247), this amounts to 10,122 short and 1,125 long forms.

  • For Portuguese-speaking cases (n=195), this amounts to 176 short and 19 long forms.

  • For Arabic-speaking cases (n=1,362), this amounts to 1,226 short and 136 long forms.

Based on our 12-month case estimate (n=30,000), our assumptions are anticipated to cover maximum annual requirements. In total, CDC is requesting burden hours for a total of 27,000 short forms (10 minutes each, or 4,500 hours total) and 3,000 long forms (20 minutes each, or 1,000 hours total) for four official languages spoken in West Africa.

Contact Investigation Forms: Based on response field experience in 2014, a conservative estimate of the number of household contacts per EVD case is 10. Therefore, we estimate 300,000 contacts to be listed (Attachments 9-12) and traced for follow-up (Attachment 13-16). For the Contact Tracing Follow-up Form, we assume the contacts will take 3 minutes each day to take their temperatures and record them; therefore, for 21 days of monitoring, it will take 63 minutes to complete the form. These contacts will be interviewed to assess their risk of exposure to the Ebola virus (Attachment 17-20). By language, the number of contacts for each type of contact investigation form is estimated as follows:

• For English-speaking contacts (n=171,960).

• For French-speaking contacts (n=112,470).

• For Portuguese-speaking contacts (n=1,950).

• For Arabic-speaking contacts (n=13,620).

Sex Transmission Case Investigations: To more fully understand sexual transmission factors, adult cases who are survivors will be administered additional questionnaires (Attachment 21-24). CDC anticipates that 20 percent of the respondents will be adults willing to take part in this interview (n=6,000). These are new forms, not previously reviewed and approved by OMB. By language, the number of adult cases for each sex transmission investigation form will be:

• For English-speaking adult survivors (n=3,439).

• For French-speaking adult survivors (n=2,249).

• For Portuguese-speaking adult survivors (n=39).

• For Arabic-speaking adult survivors (n=273).

Healthcare Worker Surveys: We assume that 15 percent of the 30,000 cases will be healthcare workers that may take part in additional exposure risk factor surveys (n=4,500) (Attachments 25-26 and country-customized forms for Liberia and Sierra Leone as Attachments 27-28). By language, the number of adult cases for the healthcare worker survey form will be:

• For English-speaking healthcare workers not in Liberia and Sierra Leone (n=2,455).

• For English-speaking healthcare workers in Liberia (n=52).

• For English-speaking healthcare workers in Sierra Leone (n=73).

• For French-speaking healthcare workers (n=1,687).

• For Portuguese-speaking healthcare workers (n=29).

• For Arabic-speaking healthcare workers (n=204).

Health Facility Surveys: For the Health Facility Assessment and Case Finding Survey (Attachments 29-32), we assume that such an assessment may be reasonably be conducted for 20% of the facilities caring for the annual 30,000 cases by MoHs, as resources permit (n=6,000). By language, the number of adult cases for the healthcare worker survey form will be:

• For English-speaking healthcare facilities (n=3,439).

• For French-speaking healthcare facilities (n=2,249).

• For Portuguese-speaking healthcare facilities (n=39).

• For Arabic-speaking healthcare facilities (n=273).

West Africa Country Wage Estimates

For purposes of estimating respondent hourly wages, we obtained minimum wages from the International Labour Organization (ILO) Working Conditions Law Database⁹) or internet news pages where published.

West Africa	Official Language	2015 Population Estimate	Minimum Wage Estimates				Source
			Country Wage Rate	US Dollar10
				Monthly	Daily	Hourly
Benin	French	10.88m	31,625 CFA francs/month	60.45		0.38	International Labour Organization
Burkina Faso	French	17.91m	30,684 CFA francs/month	58.65		0.37	International Labour Organization
Cameroon	French	23.39m	36,270 CFA francs/month	62.56		0.39	Internet News 2014
Côte D'Ivoire	French	21.30m	60,000 CFA francs/month	114.69		0.72	Internet News 2013
Equatorial Guinea	French	0.80m	95.400 CFA francs/month	165.75		1.04	International Labour Organization
Gabon	French	1.75m	80,000 CFA francs/month	138.99		0.87	International Labour Organization
Guinea	French	12.35m	440,000 G francs/month	60.17		0.38	Internet 2013
Mail	French	16.26m	28,460 CFA francs/month	54.40		0.34	International Labour Organization
Niger	French	19.27m	28,347 CFA francs/month	54.19		0.34	International Labour Organization
Senegal	French	14.97m	209.10 CFA francs/hour			0.40	International Labour Organization
Togo	French	7.17m	28,000 CFA francs/month	53.52		0.33	International Labour Organization
French West Africa		146.05m	Minimum Wage Weighted for Country Population			0.43
Gambia, The	English	1.97m	19.55 G dalasi/day		5.84	0.73	International Labour Organization
Ghana	English	26.98m	7 G cedi/day		2.09	0.26	Internet News 2015
Liberia	English	4.50m	6 USD/day or 75 cents/hour		6.00	0.75	Internet News 2013
Nigeria	English	183.52m	18,000 N naira/month	95.10		0.59	International Labour Organization
Sierra Leone	English	6.32m	500,000 SL leone/month	112.65		0.70	Internet News 2015
English West Africa		223.29m	Minimum Wage Weighted for Country Population			0.55
Cape Verde	Portuguese	0.51m	11,000 CV escudos/month	123.40		0.77	Internet News 2013
Guinea-Bissau	Portuguese	1.79m	19,030 CFA francs/month plus a bag of rice	36.38		0.23	International Labour Organization
Sao Tome and Principe	Portuguese	0.2m	750,000 dobras/month 11	34.32		0.21	Internet News 2014
Portuguese West Africa		2.50m	Minimum Wage Weighted for Country Population			0.34
Chad	Arabic	13.6m	147.00 CFA/hour			0.26	International Labour Organization
Mauritania	Arabic	4.08m	21,150 ouguiya/month	70.20		0.44	International Labour Organization
Arabic West Africa		17.68m	Minimum Wage Weighted for Country Population			0.30
Total Population		389.52m				0.50

West Africa Country Cost Estimates

The method for calculating a weighted hourly cost estimate for respondents from USAID West Africa Regional (all countries and official languages) and for the countries grouped by official languages is displayed below.¹²

Hourly minimum wage rate = USD per hour = or

Wage Weighted for Country Population (English, French, Portuguese, and Arabic)					Wage Weighted for Country Population (French)							Wage Weighted for Country Population (English)
(Country Popn/Total Popn)*(Hourly Wage) = Country Weight					(Country Popn/Total Popn)*(Hourly Wage) = Country Weight							(Country Popn/Total Popn)*(Hourly Wage) = Country Weight
10.88	389.52	0.38	0.010614		10.88	113.4	0.38	0.028308				1.97	223.29	0.73	0.006441
17.91	389.52	0.37	0.017012		17.91	113.4	0.37	0.045373				26.98	223.29	0.26	0.031416
23.39	389.52	0.39	0.023419		23.39	113.4	0.39	0.062459				4.50	223.29	0.75	0.015115
21.3	389.52	0.72	0.039372		21.3	113.4	0.72	0.105005				183.52	223.29	0.59	0.484916
0.8	389.52	1.04	0.002136		0.8	113.4	1.04	0.005697				6.32	223.29	0.70	0.019813
1.75	389.52	0.87	0.003909		1.75	113.4	0.87	0.010425				223.29	< SUM >		0.551259
12.35	389.52	0.38	0.012048		12.35	113.4	0.38	0.032133				Unskilled Workers				$0.55
16.26	389.52	0.34	0.014193		16.26	113.4	0.34	0.037853				Skilled Workers				$5.51
19.27	389.52	0.34	0.016820		19.27	113.4	0.34	0.044860				Highly Skilled Workers				$11.02
14.97	389.52	0.40	0.015373		14.97	113.4	0.40	0.041000
7.17	389.52	0.33	0.006074		7.17	113.4	0.33	0.016201
1.97	389.52	0.73	0.003692		113.4	< SUM >		0.429312
26.98	389.52	0.26	0.018009		Unskilled Workers					$0.43
4.50	389.52	0.75	0.008665		Skilled Workers					$4.29
183.52	389.52	0.59	0.277975		Highly Skilled Workers					$8.59
6.32	389.52	0.70	0.011358
0.51	389.52	0.77	0.001008		Wage Weighted for Country Population (Portuguese)							Wage Weighted for Country Population (Arabic)
1.79	389.52	0.23	0.001057
0.20	389.52	0.21	0.000108		(Country Popn/Total Popn)*(Hourly Wage) = Country Weight							(Country Popn/Total Popn)*(Hourly Wage) = Country Weight
13.6	389.52	0.44	0.009078		0.51	2.50	0.77		0.157080			13.6	17.68	0.44	0.200000
4.08	389.52	0.38	0.004609		1.79	2.50	0.23		0.164680			4.08	17.68	0.38	0.101538
389.52	< SUM >		0.496527		0.20	2.50	0.21		0.016800			17.68	< SUM >		0.301538
Unskilled Workers			$0.50		2.50	< SUM >			0.338560			Unskilled Workers			$0.30
Skilled Workers			$4.95		Unskilled Workers				$0.34			Skilled Workers			$3.02
Highly Skilled Workers			$9.93		Skilled Workers				$3.38			Highly Skilled Workers			$6.03
					Highly Skilled Workers				$6.77

Healthcare Worker Surveys: The CDC and WHO worked collaboratively to develop the “Healthcare Worker Ebola Virus Disease Exposure Report (Attachments 25-26). Two English-speaking countries, Liberia and Sierra Leone, chose to customize this form (Attachments 27-28). To estimate burden and cost estimates, we calculated average wages for English-speaking countries, excluding Liberia and Sierra Leone, For Liberia and Sierra Leone, we used their published hourly minimum wages.

West Africa	Official Language	2013 Population Estimate	Minimum Wage Estimates				Source
			Country Wage	US Dollar13
				Monthly	Daily	Hourly
Gambia, The	English	1.97m	19.55 G dalasi/day		5.84	0.73		International Labour Organization
Ghana	English	26.98m	7 G cedi/day		2.09	0.26		Internet News 2015
Nigeria	English	183.52m	18,000 N naira/month	95.10		0.59		International Labour Organization
English West Africa, excluding Liberia and Sierra Leone		212.47m	Minimum Wage Weighted for Country Population			0.52

Wage Weighted for Country Population (English without Sierra Leone or Guinea)
(Country Popn/Total Popn)*(Hourly Wage) = Country Weight
	1.97	212.47		0.73	0.006441
	26.98	212.47		0.26	0.031416
	183.52	212.47		0.59	0.484916
	212.47	< SUM >			0.522772
	Unskilled Workers					$0.52
	Skilled Workers					$5.23
	Highly Skilled Workers					$10.46

1 Source: USAID West Africa Regional at http://www.usaid.gov/west-africa-regional. List of countries provided by email communication with USAID contact listed on webite on 06/18/2015.

2 Source: The CIA World Factbook. Accessed 06/18/2015 at https://www.cia.gov/library/publications/the-world-factbook/fields/2098.html

3 Source: World Population Review. Accessed 06/18/2015 at http://worldpopulationreview.com/countries/

4 Cameroon official languages are English and French. French assumed for purposes of this estimation.

5 Equatorial Guinea official languages are French and Spanish. French assumed for purposes of this estimation.

6 Chad official languages are Arabic and French. Arabic assumed for purposes of this estimation.

7 Source: CDC Ebola (Ebola Virus Diease). Accessed 02/02/2015 at http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/case-counts.html

8 Source: World Population Review. Accessed 06/18/2015 at http://worldpopulationreview.com/countries/

9 Source ILO database: ILO Working Conditions Laws Database. ILO, Geneva. Available at: http://www.ilo.org/dyn/travail

10 USD conversion performed 06/20/2015 at eXchangeRate.com at http://www.exchangerate.com/currency-converter/XOF/USD/60,000%20/?XR-200Plus_Converter=convert&calc_short_from_iso=59&calc_short_to_iso=239

11 Sao Tome and Principe has no national minimum wage but has this minimum wage for civil servants. Available at http://www.refworld.org/docid/53284a7914.html.

12 Assume 8 hours/day; 40 hours/week; 4 weeks/month; 160 hours/month. Assume minimum wage applies to unskilled workers. Assume due to lack of documented information from existing sources, wages for skilled workers (e.g., healthcare workers, laboratory, and environmental services personnel) are 10 times minimum wage. Assume due to lack of documented information from existing sources, wages for highly skilled workers and executives (e.g., clinicians and health directors) are 20 times minimum wage.

13 USD conversion performed 06/20/2015 at eXchangeRate.com at http://www.exchangerate.com/currency-converter/XOF/USD/60,000%20/?XR-200Plus_Converter=convert&calc_short_from_iso=59&calc_short_to_iso=239

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