United States Africa Command Office of the Command Surgeon UNCLASSIFIED//FOUO Force Health Protection & Readiness Seamless Health Service Support Strengthen Partner Nation (PN) Military Health Prepare and Respond to Crises COL Appenzeller, AFRICOM Command Surgeon Col Gillen, AFRICOM Command Deputy Surgeon Overview Mission / Vision Operational Environment Structure and Who We Are Program Development African Partner Outbreak Response Alliance (APORA) 22 Nov 2016 UNCLASSIFIED//FOUO

Mission Vision: Sustain the health of our force, UNCLASSIFIED//FOUO Mission Sustain the health of our force, Support ongoing operations, and Strengthen partner nation medical capability Vision: Shaping medical stability operations through partnership building UNCLASSIFIED//FOUO

The Operational Environment UNCLASSIFIED//FOUO The Operational Environment Northern Africa 4,885 Miles Western Europe Western Africa Eastern Africa Argentina United States 4,365 Miles Middle/Central Africa Southern Africa Tyranny of Distance Diversity of Population 100’s of ethnic groups 2,000 languages/dialects Wide variety of religious traditions Health Status China Five Regions UNCLASSIFIED//FOUO

US Africa Command Structure UNCLASSIFIED//FOUO US Africa Command Structure Secretary of Defense President Services Africa Command US Horn of Africa CJTF Command Special Ops US Air Forces *USAFE US Army US Navy Marine Forces Established 1 OCT 08 CJTF-HOA: Camp Lemonier, Djibouti SOCAFRICA: Stuttgart, Germany AFAFRICA: Ramstein AB, Germany *USAFE USARAF: Vicenza, Italy NAVAF: Naples, Italy MARFORAF: Stuttgart, Germany Title 10 Man Train Equip Subordinate Combined JTF/Unified Commands Service Component Commands UNCLASSIFIED Command Title 10 Authority UNCLASSIFIED//FOUO

UNCLASSIFIED//FOUO

J004 Command Surgeon Command Surgeon Deputy Command Surgeon UNCLASSIFIED//FOUO J004 Command Surgeon Command Surgeon COL Ned Appenzeller Deputy Command Surgeon Col Jeff Gillen Senior Enlisted Advisor CPO Oscar Alvarenga Executive Director Mr. John Sanders Individual Mobilization Augmentees (IMAs) Medical Operations and logistics (MOB) (J43) LtCol John Venegas CDR Byron Wiggins LTC Johnny Dennis Force Health Protection (FHP) LTC Sueann Ramsey LtCol Pete Mathews LTC Gregory Laughlin Maj Antonio Leonardi Medical Plans, Engagements & Exercises (PLEX) LTC Dominick Ivener Maj David Seelen Maj Jason Morrow Mr. Jack Hannon (Exercises) Medical Support to Operations Patient Movement Crisis OPTs / JOC Coverage FHP Message/Guidance Travel Readiness Support Medical Intelligence SME – Vet, ID, MIO, PH, Env Hlth Campaign Plans/CONPLANs/TCP/CCP/ Regional Alignment/ Global Health/ TSC Engagement/Exercises TSC-Theater Security Cooperation CONPLAN=Contingency Plan JOC=Joint Operations Center SME=Subject Matter Expert ID=Infectious Disease MI= Medical Intelligence TCP=Theater Campaign Plan CCP=Country Cooperation Plan

AFRICOM Command Surgeon Plans & Exercises (PLEX) Medical Specialists UNCLASSIFIED//FOUO AFRICOM Command Surgeon Plans & Exercises (PLEX) Medical Specialists How We Help Provide country access through medical Synchronize/synergize medical engagements Information exchange focused on self-assessment and gap analysis/priorities to provide greater understanding and improve Partner Nation Military capacity/capability to respond or assist civil authorities or even other countries in region Promote effective military-civilian partnerships in the health and security communities Provide technical assistance through identifying, documenting, and disseminating tools and guidance such as lessons learned, best practices, and research results Identify areas for applied research to address gaps in a pandemic response Identify and align best practices from African Partners Utilize current partners and mobilize new partners and additional financial resources for health programs for the military services, and continued engagement with current partners Branch Chief, PLEX LTC Dominick Ivener DSN: 421-4595 Dominck.j.ivener.mil@mail.mil Maj David Seelen International Health Specialist East Region DSN: 421-5628 David.j.Seelen.mil@mail.mil Maj Jason Morrow International Health Specialist North Region DSN: 421-4400 Michael.j.morrow.mil@mail.mil Mr. John “Jack” Hannon Exercise Medical Planner DSN: 421-4363 John.e.hannon2.civ@mail.mil UNCLASSIFIED//FOUO

Program Considerations

NG State Partnership Program Health/Medical Stakeholders Economic Community of West African States African Union Interagency Services African Partner Nations Office of the Secretary of Defense NG State Partnership Program State Partner Year New York South Africa 2003 Utah Morocco North Dakota Ghana, Togo, Benin 2004 Wyoming Tunisia California Nigeria 2006 North Carolina Botswana 2007 Vermont Senegal Michigan Liberia 2009 Massachusetts Kenya 2015 Kentucky Djibouti “Stability Through Health”

Capacity / Capability Building Strengthen Partner Nation (PN) Military Health - Strong PN military health capability and capacity supports PN national and regional military missions. Objectives: With PNs and other stakeholders, focus medical activities (operations, engagements, exercises) to achieve common goals. Strengthen PN defense medical institutions Four USAFRICOM principles for Medical Stability Operations activities with African partners: 1. Linked Events 2. Partnering 3. Measures of Effectiveness 4. After Action Reporting DODI 3000.05 DODI 6000.16 Stability Operations Military Health Support to CCP TCP Annex Q

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED Summary: Senior African military led medical strategic initiative to address African Partner Nation military capability to effectively respond to and support civil authorities for disease outbreak response. Where: Accra, Ghana When: 12-15 September 2016 Who: 10/13 African Nations work in outbreak response.

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED Partner Nation Representatives: Benin, Burkina Faso, Cameroon, Coted’Ivore, Gabon, Ghana, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, Togo. Prior APORA Nations invited / not in attendance: Cameroon, Niger, Senegal USG Participants: USAFRICOM, AFAF, US Embassy-Ghana, CGHE

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED OBJECTIVES Advocate for role of military in outbreak response Promote military-civilian partnerships Encourage regional and national program coordination Provide technical assistance Identify best practices from regional Africa Partners Self-assessment and gap analysis

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED OUTCOMES Self-assessment survey complete African Union (AU) identified for leadership role 5 New countries added to alliance 18 month plan development Next meeting requested for April/May 2017, location TBD

African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED OBSTACLES Program Transition Plan Global Health Engagement Organization

PROGRAM CONSIDERATIONS African Partner Outbreak Response Alliance (APORA) UNCLASSIFIED PROGRAM CONSIDERATIONS Maintaining Momentum Regional leadership and economic communities Medical Readiness Training Exercise (MEDRETE) concept

Questions? UNCLASSIFIED

Medical Central African Nation Growing Regional Operability UNCLASSIFIED//FOUO Casualty Evacuation Medical Central African Nation Growing Regional Operability Niger Long-term/Sustainable Capacity $1.3M – TSCTP multi-year, interagency regional program funds 2 x Cessna 208B Aircraft 5 Phase CASEVAC Training Program FY14 ~ $3M Additional Investment (pending approval) Deployable Forward Surgical Capability – Next Phase Trained 6 Medevac Crews 23 Flight hours flown Additional 45 flight hours projected-Jan 14 Trans Sahara Counterterrorism Partnership (TSCTP) Established in 2005, TSCTP is the U.S. Government’s (USG) multi-year, interagency, and regional program to build the capacity and resilience of the governments and communities in the Sahel and Maghreb regions of Africa to contain, degrade, and ultimately defeat the threat posed by al-Qa’ida, its affiliates, and other VEOs in the Trans-Sahara region.  TSCTP also provides a means to improve regional and international cooperation and information-sharing, including between the Sahel and Maghreb regions, to counter shared threats. The Trans-Sahara Counterterrorism Partnership (TSCTP) is a multi-faceted, multi-year US Government program aimed at defeating terrorist organizations by: strengthening regional counterterrorism capabilities, enhancing and institutionalizing cooperation among the region’s security forces, promoting democratic governance, discrediting terrorist ideology, and reinforcing bilateral military ties with the United States. The overall goals are to enhance the indigenous capacities of governments in the Pan-Sahel region of Africa (Mauritania, Mali, Chad, Burkina Faso and Niger, as well as Nigeria and Senegal) to confront the challenge posed by terrorist organizations in the region. Additionally, TSCTP will facilitate cooperation between the Pan-Sahel countries and Maghreb partners (Morocco, Algeria, and Tunisia) in combating terrorism. TSCTP is a sustaining program of counterterrorism, democratic governance, and military assistance and includes a public diplomacy component. Counterterrorism programs create a new regional focus for trans-Saharan cooperation, including use of established regional organizations like the African Union and its new Center for the Study and Re-search on Terrorism in Algiers. These programs include training to improve border and aviation security and overall counterterrorism readiness. TSCTP also continues specialized Counterterrorism Assistance Training and Terrorist Interdiction Program (TIP) activities in the Trans-Sahara region and possible regional expansion of those programs. TSCTP conducts public diplomacy programs that expand outreach efforts in the Sahel and Maghreb regions, Nigeria, and Senegal and seek to develop regional programming embracing this vast and diverse region. Emphasis is on preserving the traditional tolerance and moderation displayed in most African Muslim communities and countering the development of extremism, particularly in youth and rural populations. The Program also engages in governance programs that strive, in particular, to provide adequate levels of US Government support for democratic institutions and economic development in the Sahel, strengthening those states' ability to withstand internal threats. Lastly, the TSCTP conducts military programs intended to expand military-to-military cooperation, to ensure adequate resources are available to train, advise, and assist regional forces, and to establish institutions promoting better regional cooperation, communication, and information sharing. Support for these programs is provided through the Department of Defense's Operation Enduring Freedom Trans-Sahara (OEF-TS). That mission works with partner nations to provide training and support to partner nations with an emphasis on preventing terrorism and helping to enhance the stability of OEF-TS countries.   Flintlock ‘14 – Primary Operational Objective Planned CASEVAC Missions 18 of 21 days/42 flight hours Real World CASEVAC Response Platform UNCLASSIFIED//FOUO

State Partnership Program Current State Partnerships WY South Africa (2003) LOE 5 UT New York Morocco (2003) LOE 2,5 Utah Ghana (2004) Togo-Benin (2014) LOE 4,5 IN North Dakota VT KY Tunisia (2004) LOE 2 Wyoming CA ND MI Nigeria (2006) LOE 3,4,5 California MA Senegal (2008) LOE 4,5 Vermont Botswana (2008) North Carolina The National Guard State Partnership Program (SPP) links US states with partner nations for the purpose of supporting the bilateral security cooperation objectives of the Combatant Commander. The program’s goals reflect an evolving international affairs mission for the National Guard using the unique nature of the National Guard to interact with both active and reserve forces of foreign countries. The State Partners actively participate in a host of engagement activities ranging from bilateral familiarization and could lead to training exercise opportunities, fellowship-style internships, and civic leader visits and medical events. All activities are coordinated through the Theater Combatant Commander and the US Ambassadors’ country teams and other agencies as appropriate to ensure the State Partnership Program and the National Guard is tailored to meet both US and country objectives. Liberia (2009) Michigan Djibouti (2015) LOE 1 NC Kentucky Kenya (2015) LOE 1,5 NY Massachusetts Niger (2016) LOE 2,3,5 Indiana