1. 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

2. 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

3. 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

4. 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

5. UNCLASSIFIED//FOUO

6. 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

7. 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:
Maj David Seelen
International Health Specialist
East Region
DSN:
Maj Jason Morrow
International Health Specialist North Region
DSN:
Mr. John “Jack” Hannon
Exercise Medical Planner
DSN:
UNCLASSIFIED//FOUO

8. Program Considerations

9. 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”

10. 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
DODI
Stability Operations
Military
Health Support to
CCP
TCP Annex Q

11. African Partner Outbreak Response Alliance (APORA)
UNCLASSIFIED

12. 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: September 2016
Who: 10/13 African Nations work in outbreak response.

13. 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

14. 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

15. 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

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

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

19. Questions?
UNCLASSIFIED

20. 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

21. State Partnership Program Current State PartnershipsWY
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