Ebola

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

eHA supports skill building of Sierra Leone’s Community Health Officers

By Sibongile Chikombore and Sahr Ngaujah

The Ebola Virus Disease (EVD) exposed the need for increasing human resource capacity in  Sierra Leone’s fragile health system. Prior to the launch of the Community Health Officers Management and Leadership Training Program (CHO-MLTP) in 2016, there was no formal training of that nature for health professionals in the country. The U.S. Centers for Disease Control and Prevention (CDC) collaborated with the Ministry of Health and Sanitation (MOHS), Njala University, Emory University, ICAP of Columbia University, and eHealth Africa (eHA) to develop a novel training program to address this need and ultimately improve health service delivery and health outcomes in Sierra Leone. CHOs working at Community Health Centers (CHCs) were targeted to be the first cadre to receive this public health management and leadership training, given their key role as first-line health service providers and chiefdom leaders.

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The aim of the MLTP is to emphasize public health systems thinking and basic management principles needed to run effective health facilities and outreach services. The emphasis of the project is also to strengthen interpersonal communication and engagement with community leaders in order to develop practical and sustainable solutions to longstanding public health challenges.

In Sierra Leone, the Peripheral Health Units (PHU) comprise of  Community Health Centres (CHCs), Community Health Posts (CHPs) and Maternal and Child Health Post (MCHPs). CHCs are headed by a Community Health Officer (CHO). The CHC is usually located at chiefdom headquarter level and provides services to a population ranging from 5,000-10,000 people. The CHP and MCHP are both usually located at smaller villages serving about 5000 or fewer people. They are manned by Community Health Assistants (CHAs) or Dispensers and Maternal and Child Health Aides (MCH-Aides) respectively.

CHO functions at the health center largely include administrative and clinical duties. The clinical responsibilities include treatment and appropriate referrals of medical, surgical and obstetric emergencies. They also supervise the activities of other PHUs in the chiefdom and report to the District Health Management Team (DHMT).

A total of ninety-nine (99) out of one hundred and seventy (170) CHOs across eight (8) districts (Bo, Kambia, Koinadugu, Bombali, Kenema, Kailahun, Western Area Urban and Rural) have been trained so far out of 12 targeted districts nationwide. The CHOs are trained in cohorts, comprised of CHOs from two districts.

As part of the effort towards sustainability and smooth transitioning of the CHO MLTP, selected staff from MOHS and Njala University are being trained as Trainers. Saidu Mansaray, CHO at Kroobay Community Health Center, is one of 99 CHOs who has been trained by eHA through the CHO-MLTP and was subsequently nominated to be part of the key individuals to form the Ministry of Health and Sanitation (MoHS), Training of Trainers (TOT) team. eHA conducted three TOT sessions for MOHS and Njala University staff who are the key MLTP implementing partners in Sierra Leone.

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I was part of the third cohort studies for the Sierra Leone CHO-MLTP. I was fortunate to be announced as one of the outstanding candidates in the CHO-MLTP Program.’
— Saidu Mansaray

The CHO MLTP has eleven (11) modules covered over a six-month period, with one of the key modules on Quality Improvement (QI). Before a CHO is eligible to graduate, he/she is expected to implement a QI project on either Improving Human Immunodeficiency Virus (HIV) or Hypertension Screening at their respective health facilities over a three month (minimum) period. The QI aims to address gaps or challenges in health service delivery at facility level on HIV or Hypertension during the MLTP, but the knowledge gained can be later used to apply the QI principles on other health challenges at the facility.

Through implementation of the QI, the CHO and PHU staff are able to work together as a team to brainstorm root causes of the health challenge being faced at the  facility, come up with interventions, and prioritize interventions (based on ease of implementation and how important they are on a scale of one to five). From the prioritization matrix, the QI team from each facility then implements the interventions (also known as “change ideas”) within their own capacity, using the limited resources available.

Saidu implemented an HIV screening QI project at his health facility, where HIV testing rates were low. Prior to the implementation of the QI project, only 26% of eligible persons over 15 years old were tested for HIV. Saidu recognized that increased HIV testing would be necessary to ensure that members of his community know their HIV status and could receive appropriate care. Since the implementation of the QI project at his health facility, the HIV testing rate of eligible persons over 15 years has increased to 81%, and patients found to be positive have also started receiving HIV management care.

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This training has further helped me to manage both logistics and human resources at the facility. I am now able to use the little resources I have in my facility to produce the best of results.
— Saidu Mansaray

Saidu was also nominated to be a TOT participant after showcasing good leadership skills during his MLTP training in cohort three, has attended 3 TOT sessions organized by eHA. In December 2018, Saidu and other CHOs participated in the 3rd ToT session and was captured actively participating during the TOT workshop facilitating and presenting group work assignments to colleagues - see pictures attached below. After the TOT, Saidu and other TOT participants are expected to mentor other CHOs undergoing the MLTP nationwide.

 
I am also currently being trained to pass on the skills learned from the CHO-MLTP Program to others.
— Saidu Mansaray

Post-Ebola Liberia: eHealth Africa strengthens laboratories in readiness for future infectious disease outbreak

Prior to the Ebola Virus Disease (EVD) outbreak in 2014, the Liberia public health laboratory system had weak capacity to detect, report and respond to public health emergencies. In order to fulfill our mission to build stronger health systems, eHealth Africa (eHA) supported Liberia’s laboratory system from 2014 - 2018. eHA’s lab support program has improved effectiveness of the laboratory system by providing human capacity support for four years, as well as improved electronic submission of lab reports by providing internet connectivity at priority labs (ELWA, Redemption, LIBR & Bong) since 2014.

Test samples in an eHA supported priority lab in Liberia

Test samples in an eHA supported priority lab in Liberia

The Bong lab is situated at the Phebe Hospital Compound, Bong County. In October 2014, it was one of the regional laboratories selected by Liberia’s Ministry of Health (MOH), the United States Navy (US Navy) and other partners for testing suspected Ebola samples as part of the fight against the 2014 West Africa EVD outbreak. The Bong lab and other identified priority labs faced a few similar capacity challenges, including the lack of skilled staff, lack of adequate equipment and poor internet connectivity. eHA provided lab support by developing technology for capturing of lab data, provided internet connectivity to enable the labs submit the data electronically and also provided human capacity support, including recruitment and training of lab desk officers.

Roberto Koimenee is one of the four lab desk officers that eHA worked with via the laboratory support program. He is deployed at Bong Lab to enter Ebola virus disease (EVD) data and report daily samples test results to the Liberia’s Ministry of Health and eHealth Africa.

From Roberto
‘’I got involved with eHealth Africa-Liberia through an application and CV submission during the Ebola outbreak in September, 2014 in Liberia. I was called by eHA for an interview which was followed by training as a Lab Desk Officer. I was assigned to Bong EVD Lab. I was motivated to work in the lab because I wanted to help in the fight against Ebola in Liberia. Since eHealth is a technology driven company, with my knowledge in data management, I decided to help in this fight against Ebola by entering data from samples tested and submit report for decision making at the National level.

I have more than eight years of experience as an Administrative staff and four years of experience as a data officer at eHealth Africa-Liberia, where I have won some performance awards. I love managing database and solving data issues. I am a person who thrives to work out things when it’s difficult to do and work independently to solve complicated problems”, he explains.  

I participated in a three-day training conducted by eHA and this training impacted my life and work by increasing my knowledge in the following topics: Sample handling storage, and processing; Confidentiality/Document control, Data entry and analysis. Today, I know how to control and secure patient information and report accurate and reliable results to requisite and identified individuals responsible to receive said information or results.

The part of the training I like the most was the off-line tracker although it has not been fully utilized by Bong Lab. The off-line tracker is so unique in that it tracks all data or information in all the four (4) regional labs in the country (Liberia). Each lab can see and access information including reports/results of specimen tested. This system can be used without internet. However, that training especially the off-line tracker needs to be fully utilized for the safety, reliable and secure of lab information/data.

Although I worked with other institutions before eHealth Africa came to Liberia, but life was not too good for me and my family. My salary was too small to cover all my expenses including undertaking house construction project. But after I was employed by eHA, my salary was encouraging that enable me and my family to live better life.’’

Roberto’s wife, Christiana Hne Koimenee, believes her husband made a good decision working for eHA in the fight against Ebola in Liberia, even though she expressed fear over her husband doing one of the riskiest jobs, and comes to the conclusion it was worth it.

‘’It was sad and worrisome for individuals like my husband to be at the frontline to test Ebola specimen. But it was also historical for him and those who stood firm to help in the process of fighting Ebola in Liberia.”
— Christiana Hne Koimenee
Roberto Koimenee and family

Roberto Koimenee and family