EBOLA IN SIERRA LEONE
EBOLA IN SIERRA
LEONE, A CRISIS
OUT OF
CONTROL
CARE. ACT. SHARE. LIKE CORDAID.
MARIAN KRUIJZEN, CORDAID HEALTHCARE SIERRA LEONE
OVERVIEW OF THE PRESENTATION
Ebola in Sierra Leone, a crisis out of control
1.
Causes of the Ebola crisis being out of control
2.
Current situation
3.
Cordaid response
4.
Needs short, mid, long term
Ranking on Human Development Index of 187 countries:
Sierra Leone, 183; Guinea 179; Liberia 175
1: CAUSES OF THE EBOLA CRISIS
BEING OUT OF CONTROL
Two main causes:
1. Weak/Young health system
• Centralised management, decentralised
only on paper
• Mostly vertical inputs, young PBF
scheme
• HRH capacity insufficient and low
• Lack of infrastructure, communication,
transport, drugs ,laboratoty, equipment at
facilities
• Inmature HMIS and DHIS
• No ‘early warning’ or ‘epidemic response
system’
2. Social and cultural factors
• Lack of health information and
community involvement, traditional
healers
• Distrust towards officials, politicizing
• Cultural believes, habits
• Poverty and bushmeat consumption
2: CURRENT SITUATION
Still delayed international response and coordination
challenges. Little involvement local NGO’s
1.
Health system
•
•
•
•
•
2.
Health system collapsed, abandoned health
facilities;
increased mortality preventable conditions
Demotivated HWs, not paid in time, ill-equipped,
not fully trained, victims themselves and stigmatised
in society.
No protective gear and materials in most health
facilities
Huge transport and logistic challenges
Social and cultural
•
SL: Confirmed cases 3100; confirmed deaths 960;
people quarantined 17000; WHO: real figures 2-3
times higher. 22% children < 18 yrs
•
travel restriction to any district and neighboring
countries;
•
All schools closed; no gatherings
•
Distrust and denial
•
Stigma and food shortage patients and families
•
Economic decline
UNMEER targets of 1 October: “70-70-60 plan” : 70% safe
burials; 70% hospital-based isolation of suspected
cases within 60 days. by 1 December, the detection of
new Ebola cases could rise up to 10,000 per week.
QUARANTINED FAMILY IN BOMBALI
3: CORDAID RESPONSE
Goal: Emergency response; Prevention; Recovery health
services; Inclusion community health committees; Restore public
confidence in the healthsystem
1.
2.
3.
4.
5.
6.
Consortium project: Community prevention, sensitization, response: 15/8-15/11 by 3
healthcare partners (HPA-SL, PPA-SL and CB) in 3 Districts (Kenema, Bombali, Pujehun).
Total amount € 220.000. Total population 450.000 and 117 health facilities.
5 small grants: Lunsar hospital and 4 NGO’s
(radio messages, awareness, materials, door-to-door sensitization)
Mainstream Ebola prevention in 6 food security programs.
Shipment of 46 pallets with Ebola screening kits for 11 faith-based hospitals and 24
clinics. Challenges on procurement and transport.
Development and production Ebola Memory Game ‘STOP Ebola’
with the Dutch Web Foundation and local partners
Discussion with MoHS PBF-team on ebola indicators
In preparation:
1. Upscaling and expansion current and new initiatives
2. Two Cordaid staff to Sierra Leone for management, coordination and advise
4. NEEDS SHORT-TERM
UNTIL OUTBREAK IS UNDER CONTROL
1. Focus on health system:
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•
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Vaccines and medicine
Emergency input HRH, holding and treatment centers, diagnostic capacity, protective gear
and materials, ambulances/cars, etc, (air freight logistics)
Health System Strenghtening: Ebola indicators; HW’s motivation package; inclusion
community
Set up early warning system
2. Social and cultural involvement
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•
•
•
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Prioritize community involvement and capacitate Village Health Team (VHT) and
community health workers
Continued health education, focus on ‘community change agents’ like TBA’s and traditional
healers
Burial teams (training, logistics)
Dietary needs of discharged patients
Psycho-social support and stigma/discrimination control
Note: challenges at (inter)national coordination and response level should be dealt with by
Governments and UN-bodies.
4: NEEDS MID- AND LONG-TERM
Mid term
• Move from input to Output/Performance Based
Funding. Incorporate infection control indicators
• Technical Assistance to recover and strengthen
the health system
• Build a well-coordinated response system
operating at several levels but starting at the
Village Health Teams (VHT) and community
health workers (Uganda case).
• Focus on rural areas with health education
• Food security (no more bush meat!)
• Restore entrepreneurship and Investments
Long term
Build resilient health systems and
societies!