Public Health Emergency

eHealth Africa supports Sierra Leone’s Public Health Services for better response to public health emergencies

The first-documented most widespread and deadly outbreak of the Ebola Virus Disease (EVD) in West Africa devastated three countries: Guinea, Liberia, and Sierra Leone. The outbreak started in May 2014 and by November 2014, during the height of the outbreak, Sierra Leone recorded over 500 new cases of Ebola a week. By October 2015, a total of 8,704 EVD cases had been diagnosed, and 3,589 people had died of Ebola in Sierra Leone.

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This disease caught the country’s Ministry of Health and Sanitation (MoHS) by surprise. The outbreak could not be effectively managed because the country did not have the requisite capacity (structure and staff) and systems -Standard Operating Procedures (SOPs), policies and plans, to effectively manage and mitigate the risks posed by the disease.

Ebola’s destruction on the peoples of Sierra Leone and the absence of appropriate structures to deal with future outbreaks, prompted the establishment of Public Health National Emergency Operations Center (PHNEOC) in  June 2015, as a coordination structure charged with the responsibility of providing public health emergency preparedness leadership, scientific and technical situational awareness and advice at a national level.

As Sierra Leoneans reflect on the atrocities of Ebola and other emergencies, this question becomes inevitable: Is Sierra Leone better prepared to address any future public health emergencies?

To better prepare for future outbreaks, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with the Ministry of Health and Sanitation and eHealth Africa, conducted successful trainings for health workers and other stakeholders on Public Health Emergency Management, Risk Communication,Threat and Hazard Identification and Risk Assessment (THIRA), Incident Management Systems and Public Health Operations and Management. These training sessions were done in Bo, Bombali districts and Western Area Urban with the involvement of health workers, district councillors, the national security agency and members of the agricultural sector. These trainings are geared towards improving the PHNEOC’s capacity to better prepare for health-related emergencies.

The PHNEOC/MoHS as beneficiaries have acquired increased knowledge on the method of approach in risk mitigation, analysis, preparedness, response, and recovery. For instance, EOC Focal Persons have been trained in all districts in Sierra Leone to decentralize command and control approach which has provided the necessary pace, efficiency, and structure for response efforts and foster real-time reporting and bridged the gap in communication from the districts EOC’s to the national EOC. eHA, with support from CDC, has embarked on introducing tools that seek to improve the coordination strategy of the PHNEOC such as the Virtual  Emergency Operations Center (EOC) communication platform tool. eHA has partnered with MoHS with support from CDC to train about 200 PHNEOC/MoHS staff on various public health emergency topics such as tabletop simulation exercises on Cholera and Lassa Fever; Executive Management training and Virtual EOC training.

I have participated in several trainings, I must confess that knowledge gained in this training is exceptional and can contribute meaningfully in any future outbreak and also benefit my District Health Management Team (DHMT) with management skills.
— Sahr Amara Moiba
Virtual EOC training participants

Virtual EOC training participants

Sahr Amara Moiba, District Surveillance Officer and EOC focal person in Kono district, is one of the 200 beneficiaries of the EMP training.

In 2018, there was a Measles outbreak in Pujehun and Kambia district. The EOC focal persons in these districts sent in a daily situational report to the national EOC which was presented to partners during the daily briefing meetings held at the EOC.

As part of the effort to strengthen the PHNEOC preparedness and response capacity, and also improve on the country’s Joint External Evaluation scores, eHA in collaboration with MoHS with support from CDC, developed SOPs for public health response. These SOPs will help improve on the response strategy of the PHNEOC in a coordinated way.

These SOPs will help foster a coordinated response in an event of any public health emergency.
— Mukeh Fambulleh, Program Manager of the PHNEOC

eHealth Africa and partners boost Sierra Leone’s surveillance capacity through 117 Call Center

Photo caption: Alexander Taylor, 117 Call Center Manager conducted a tour of the upgraded facility

Photo caption: Alexander Taylor, 117 Call Center Manager conducted a tour of the upgraded facility

Between 2018 and 2019, eHealth Africa (eHA) and the Ministry of Health and Sanitation (MoHS) worked together to ensure that Sierra Leone’s surveillance efforts were strengthened through the use of 117 Call Center.

The 117 Call Center is a Sierra Leone Ministry of Health and Sanitation initiative that was set up in 2012 as part of a wider support system to improve maternal and child health. In 2014, eHA partnered with the Ministries of Health (MOH) in Guinea, Liberia, and Sierra Leone to scale up existing universal toll-free numbers to become Ebola focused call centers. The 117 Call Center was scaled-up in response to the Ebola Virus Disease (EVD) outbreak - to serve as a tool to document, track and provide follow-up on suspected EVD cases and deaths. The 117 Call Center provides an early warning mortality and syndromic surveillance system tool that can detect, prevent and respond to disease outbreaks. Communities are sensitized to call the 117  line and report all deaths, suspicious illnesses, and events. In Sierra Leone, the 117 Call Center has helped to solve many issues like improving community death reporting through mortality surveillance; real-time alert reporting for infectious death, increasing alert and data support to the maternal & perinatal disease surveillance.

Recently, the 117 Call Center has seen major transformation-from extending the facility and giving it a facelift, to upgrading software for a more efficient system that the peoples of Sierra Leone can trust and utilize.

We have upgraded the call center software for a more accurate and precise data collection. Our community health workers play a very vital role in reporting cases to 117. We have added a new caller category of Community Health Workers. We also provided internet services for all the districts for real-time reporting and data collection for 117. We have also improved on our SMS software service that now provides a single text code to a caller to receive the burial code which confirms that they have indeed called 117.
— Sally Williams, 117 Project Manager, eHA.

In an effort to get the districts more engaged, 117 is not just centralized in Freetown. Alert desks have been set up in all 14 districts with District and Data coordinators there to manage the calls in real time.

The 117 Call Center is making positive strides in the country and the upgrade has taken it to international standard. 117 is easier to rebrand, given its popularity across the country.
— Dr. A.J. Moosa, Deputy Director - Health Security and Emergency.

Strengthening the surveillance system in Sierra Leone through the 117 Call Center is an unending quest.

We are planning on re-branding 117 and utilizing the social mobilization officers especially in the districts so that we can reach a greater number of our communities and encourage people to call 117 for any and all emergencies!
— Sally Williams

The 117 Call Center actively participates in the Surveillance Technical working group of the government of Sierra Leone’s One Health Approach Initiative, where the most updated information is shared as received via our call centers to guide interventions. Every day, the 117 Call Center is striving to produce better quality data to drive the evidence-based approach when handling public health issues in the country.