06 Apr 2015
‘GETTING TO ZERO’ STRATEGY FOR THE EBOLA RESPONSE IN KAMBIA DISTRICT
AIM
This document is designed to inform all stakeholders of the strategy in Kambia to coordinate priority
activities against known areas for improvement in the ongoing response, in order to strive for operational
excellence and so get to zero cases of Ebola.
BOTTOM LINE UP FRONT
The two main foci for activities in Kambia, in order of priority, are:
a.
Response Framework. This framework forms the cornerstone of the DERC’s approach to
coordination. It involves all pillars using a joint and comprehensive set of indicators across the
district in order to apply a discrete set of response mechanisms to each area.
b.
Cross-Border work. A Memorandum of Understanding between Forecariah Prefecture
and Kambia District is permitting collaboration on border health screening and the two sides are
beginning to share surveillance and response infrastructure through two Liaison Officers. This work
is crucial to protect Kambia District and Sierra Leone from cross-border transmission from Guinea.
INTRODUCTION
Over recent weeks there has been significant flux in both staff members and organisations working at the
DERC, and our indicators show that although the DERC is highly efficient in responding to events it could do
more to improve community acceptance of the response. For these reasons, and in response to the new
national strategy, Kambia DERC will coordinate its many partners and activities to focus on the highest
priorities in order to get to zero cases of Ebola.
PROGRESS SINCE JANUARY 2015 STRATEGY
Annex A details the strategy for Kambia as of January 2015. Activities have been graded either green for
complete, or orange for incomplete with comments about ongoing work to address shortfalls. It is clear
from this review that since the strategy was developed there has been a significant amount of progress
against planned objectives. In addition there have been a number of ‘surge’ activities which have delivered
resources and valuable lessons learned to the DERC, and cross-border collaboration with Forecariah
Prefecture in Guinea has delivered tangible protection against cross-border transmission, as well as ongoing
liaison and coordination in response to alerts and concerns along the border.
CURRENT ACTIONS
The DERC needs to respond to multiple drivers in its strategy which include: the National ‘Getting to Zero’
campaign; an influx of new partners and significant change in personnel; operational challenges in
improving community engagement; a need to work on transition issues such as schools re-opening and
health facility strengthening as CCCs close; and lastly the Kambia specific challenge of cross-border work.
The DERC and its partners have collaboratively identified these drivers, which in addition to a desire to
constantly improve processes have resulted in the activities in Annex B grouped by functional area. Each
Saturday these are reviewed with lead organisations, the output from which is reviewed and prioritised on
Sunday with the leadership before being briefed to all stakeholders each Monday. In this way the DERC is
able to coordinate an effective approach to getting to zero through ensuring operational excellence.
The Response Framework (at Annex C) illustrates how close coordination between partners, facilitated by
the DERC, is being used to utilise resources in a concerted fashion. It allows the DERC to pro-actively
identify specific areas of concern and assign appropriate response mechanisms to each.
FUTURE PLANS
The DERC intends to conduct a detailed planning assessment for the rainy season in order to identify
potential threats to Ebola Response operations and put in place steps to mitigate these threats.
CONCLUSIONS
Kambia DERC will get to zero by ensuring operational excellence in the district Ebola Response through the
mechanism explained above, with a focus on the Response Framework and Cross-Border collaboration.
ANNEXES
Annex A – Review of activities planned in January 2015 strategy
Annex B – Current activities in Kambia District grouped by functional area
Annex C – Kambia Response Framework
Annex A to
KAMBIA DISTRICT ‘GETTING TO ZERO’ STRATEGY
Dated 06 Apr 2015
REVIEW OF ACTIVITIES AND OBJECTIVES SINCE JANUARY 2015 STRATEGYOBJECTIVE 1
ACTIVITIES
100% of New Cases in Isolation within
24 hours
OBJECTIVE 2
100% of all known contacts visited and
reported on at least daily (for 21 days)
by contact tracers.
RESPONSIBLE /
LEAD
Complete construction and open Kambia
Holding Unit (KHU).
DMO
WHO/OFDA
Prepare DHMT / AU personnel to work in the
KHU, to ensure acceptable level of clinical care.
DMO
Partners in Health
Bring 12 Community Care Centres (CCCs) into
use on a phased basis.
UNICEF
- MARIE STOPES
- DHMT
DC
-Trocaire
Increase Ambulance fleet to ensure coverage of
CCC and expeditious transfers to treatment units
from KHU.
Providing maintenance for ambulances.
Decontamination area for abulances after
transportation of patients.
ACTIVITIES
RAG
STATUS
COMMENTS
All complete
To be determined
To be determined
RESPONSIBLE /
LEAD
Increase effectiveness of contact tracers (CT)
DMO
CDC
UNFPA
Marie Stopes
(training)
Increase communication and information flow
between contact tracers, supervisors, and data
manager and CT coordinator.
Perform quality control checks of contact tracers
and supervisors
DMO
CDC
DMO
CDC
RAG
STATUS
COMMENTS
All complete
OBJECTIVE 3
ACTIVITIES
RESPONSIBLE /
LEAD
100% of all bodies are buried within 24
hours in a safe and dignified manner.
Provision of Chiefdom Burial Liaison Officers
(CBLO)
DC / DMO
CAFOD
Use Boat based burial teams for riverine Area
community burials.
DMO
CAFOD
Reallocation of District Burial Supervisor (DBS)
role.
ACTIVITIES
DMO
Increase number of sample and swab takers.
DC / DMO
CAFOD
DMO
OBJECTIVE 5
Move lab samples processing area from Kambia
District Hospital to the Holding Unit. This will
remove all Ebola related activity from the
hospital, improve confidence amongst non-EVD
patients using the hospital and improve
efficiency.
ACTIVITIES
100% of homes be placed in quarantine
and decontaminated within 24 hours of
a positive result being received.
Implement a standardised process for
quarantine homes in Kambia and involve local
communities.
DC
Provide rapid decontamination of areas where
persons who are displaying obvious EVD
symptoms or have been confirmed positive.
Provide replenishment of items destroyed by
decontamination team.
Provide weekly food delivery to quarantined
homes to prevent sharing of food amongst
neighbors and provide support to families.
DC
OBJECTIVE 4
100% of all samples (from Holding Unit,
CCCs and burial swabs) to reach labs
within 16 hours of being taken, and to
be held at optimal temperature while
awaiting to be processed.
RESPONSIBLE /
LEAD
RAG
STATUS
COMMENTS
All complete
RAG
STATUS
COMMENTS
All complete
RESPONSIBLE /
LEAD
RAG
STATUS
COMMENTS
SOP complete to be
implemented week commencing
06 Apr once WFP store
construction finished
All complete
DC
DC
SOP to be implemented week
commencing 06 Apr once WFP
store construction finished, and
in addition new mechanism put
in place to coordinate security,
Provide security for quarantined homes
Ensure nutritional requirements of families and
infants in quarantine are met and advise on
nutritional status of surrounding community.
ACTIVITIES
DC
DC/ DMO
DHMT Nutritionist
100% of families are informed of the
condition of any family member who
has been admitted to a Holding or
Treatment Centre at least once every 48
hours.
Families liaison officer will provide psychosocial
support to families.
DC
UNICEF
OBJECTIVE 7
ACTIVITIES
RESPONSIBLE /
LEAD
100% surveillance throughout the
District (including active surveillance, on
the ground, in every Chiefdom at least
once per week)
OBJECTIVE 8
Increase number of surveillance teams to 9 (2 x
passive, 7 x active)
DMO
WHO
CDC
ACTIVITIES
RESPONSIBLE /
LEAD
Improve effectiveness of Social
Mobilisation capacity and capabilities to
ensure that Social Mobilisation activity
takes place in every Chiefdom, every
week
Set up a robust SocMob network
DMO & DC
UNICEF
Develop greater collaboration between Social
Mobilisation and Surveillance
DMO & DC
SocMob Pillar
Lead
OBJECTIVE 6
RESPONSIBLE /
LEAD
Improve community engagement through
setting up community meetings at Chiefdom,
Section and Town level, designed to encourage
communities to report sickness and death
DMO & DC
Surveillance Pillar
Lead
Design and activate a mass media campaign by
SocMob Pillar
Lead
UNICEF
(a) Designing, implementing and monitoring a
media campaign on radio
RAG
STATUS
decontamination and nutrition
simultaneously once quarantine
requirement identified on day
one
COMMENTS
Family Liaison Officer contract
and expansion under UPHR to be
confirmed with DEERF funding
and WHO support
RAG
STATUS
RAG
STATUS
COMMENTS
Training week commencing 06
Apr 15 to put in place new DSOs
under GOAL to fulfil this
objective
COMMENTS
Some elements of this complete.
Work ongoing to refresh SocMob
SOP, link into Response
Framework and ensure Comms
SOP tied into SocMob SOP. New
leadership from UNICEF
galvanizing this process.
OBJECTIVE 9
(b) Messaging through mobile phones
WHO
(c) Enhancing visibility of IEC material at
strategic locations
Various NGOs,
including Restless
Development,
Marie Stopes,
CaWEC
Develop a programme of street to street
engagement with community members
Develop a walk-through video on the Holding
Centre to dispel community resistance towards
using it.
ACTIVITIES
RESPONSIBLE /
LEAD
Improve confidence in the local health
care provision by ensuring no EVD case
admitted to Kambia District Hospital
Provide security and triage at Hospital.
DMO
Hospital
Superintendant
OBJECTIVE 10
ACTIVITIES
RESPONSIBLE /
LEAD
Optimise usage of DERC Vehicle
resources, and ensure optimal capacity
for EVD response
Coordinate all Vehicle assets at the DERC
DC
RAG
STATUS
RAG
STATUS
COMMENTS
Assessment of PHUs to complete
10 Apr 15 after which
donors/partners will be
encouraged to work together on
PHU strengthening as part of
transition work. Assessment of
District Hospital complete 04 Apr
15, ongoing work to sensitise DH
and DHMT staff to need for
partnership, partners and donors
also invited to collaborate on IPC
and whole system strengthening
at DH.
COMMENTS
All complete
Annex B to
KAMBIA DISTRICT ‘GETTING TO ZERO’ STRATEGY
Dated 06 Apr 2015
CURRENT ACTIVITIES IN KAMBIA DISTRICT GROUPED BY FUNCTIONAL AREA
Activity
Detail
Partners (Lead in bold)
Actions required
Transition Strategy
Written in early march
DERC, DHMT
Henry send round all partners
5 year DHMT plan
PHU Assessment
Written last week March
8 day exercise from 02 Apr
DHMT
MSSL, DERC, GOAL, IMC, WHO,
CDC, LSHTM, DHMT, UNICEF,
ACF
Send round if DMO happy
Final report – ID focal point
Review of assessment
Identification of findings and
opportunities/threats
PHU Safe triage, isolation and
referral
MSSL IPC training and supervision ongoing
MSSL, IMC, GOAL
Discussions with partners/donors once
assessment complete
Support to PHUs
WASH
ACF, AU
Implementation of WASH projects in PHUs (piped
water)
District Hospital IPC
Assessment
Assessment partially complete
CDC
Meeting with hospital leadership 04Apr2015
District Hospital IPC
partnership
Links to above to meet gaps ID’d
CDC, IOM, ACF, IMC, UNICEF,
GOAL, WHO, LSHTM, DHMT, AU
Send report to partners from CDC
Wider support to DH
To include all lines of health system
TBC
Meeting Sat 11Apr14 1400
MOHS hospital strategy for infectious disease Jess
DHMT IDSR centre
Legacy architecture required for IDSR
WHO, GOAL, ACF, AU
Partner/donor discussion
Health Systems Strengthening
Case Management
District SOP(s) on case
management
Do not exist, using national guidelines
ALL
Creation of SOPs which make clear the
delineation of live and dead case management
procedures
Holding Centre
IMC takeover and NERC list issue and ETC discussion
IMC, DERC, DHMT, AU, PIH
Confirm NERC list
Confirm re-opening
Discuss ETC function
Leadership of case
management meeting
Need for focal point for case management
Case management pillar
Patrick to lead meetings
Laboratories
Mobile laboratory
Systems
Need to resolve Nigerian vs Canadian lab and ensure
need for asset
AU, Nigerian Lab, Canadian Lab,
MSF (liaison), DHMT
Personnel, training, laboratory infrastructure, IPC
standards and transport review required
GOAL, PHE, WHO (IPC training),
DHMT, Holding Centre
DMO to confirm arrangements
DC is supporting
MOU for use of lab with Guinea
Await decision on new lab
Consider review of end-to-end process
Discuss with DMO
Future laboratory testing
function
Comparison of DHMT/Ebola lab and planning for longer
term – future testing capacity
DHMT, GOAL
Sam from GOAL to discuss future reference
laboratory network
Vaccine Trial
Cold chain
Evaluation of the existing cold chain for vaccine trial
purposes
LSHTM, DHMT, DERC, UNICEF,
CDC
Solar refrigerators in each PHU, and adequate
means and logistics for transportation
Order and place new cold chain elements in
selected PHUs
Detailed cartography at the village level
Data sharing
Collection of section-level population data
LSHTM, DHMT, WHO, CDC
Office space
Identification of office space in Kambia town
LSHTM, DHMT, DERC
Construction of office space in DHMT compound
Identification of cross-cutting
themes
Work with LSHTM and J&J to ensure vaccine trial meshes
with ongoing DERC strategy
LSHTM, DERC, DHMT
Discuss with Vanessa Vy
Quarantine
No reliable source of information below the
chiefdom level
Quarantine storage facility
MSU going up 04Apr2015
Pre-line listing
Has started
Strengthened when surveillance uplift occurs
Consider primary contact
removal
DHMT, DERC, WFP (CIDO),
KADDRO, TROCAIRE, AU, Action
Aid,
Review when MSU built
GOAL, CDC, WHO, KADDRO,
DHMT, UNFPA
Keep under review through
GOAL,
Get analysis from Port Loko and look to replicate
here – Sam
Requires rigorous assessment to ensure acceptable to
community, meaningful in view of epidemiology and
feasible
IPC assessment of home in
quarantine
Brenda to share quarantine assessment tool
WHO, ACF, MSF
WHO will lead the assessment development
Latrines
Security improvement
Enhanced coordination
Project nearly complete – only three latrines left,
UPHR/UNMEER, WHO, GOAL
Funding needs to be extended for project, ?DEERF
Once storage in place agreement that RSLAF will
coordinate initial quarantine
deployment/implementation
SLP, DERC, RSLAF
Col Conteh and DERC to coordinate
Review SOP
weekly quarantine meeting – needs scheduling by
Lt Kellie
Review progress on above inc pre-line listing
Surveillance
Response Framework
Complete but needs constant review for coherent
surveillance and response
WHO, UNICEF
Re-review and send round – regular meeting
Monday 1600 to do this
Case-based surveillance
Comprehensive investigation around each new case
DHMT, WHO, CDC, MSF, AU
Continue updating and revising all transmission
tree diagrams
Revised surveillance structure
Partnership with GOAL
DHMT, WHO, CDC, GOAL
Training weeks commencing 07 Apr 2015
Revised SOP
Surveillance SOP adopted by WHO and CDC
DHMT, WHO, CDC
Complete
Contact tracing
Change in partner
ACF taking over from MSSL
DHMT to recruit 3 additional supervisors, train
and equip with the Motorbikes
Major Sannoh and DERC team to operationalise
Live and death alerts process
combination
DERC, GOAL, CDC, DEST
Sam, Rebecca, Brenda and Stu to assist
Distribution of phones ongoing
CEBS
880 being trained from CHW pool
ABC, ACF, DHMT
Training finished
Now monitoring
Need to link with new surveillance structure
Presentation to DERC from ACF
Social Mobilisation
Response strategy
Weekly coordination meetings
Communications strategy
See above in surveillance
Led by UNICEF as pillar lead
SM pillar actors
Back to school plan exists
CDC, BBC Media Action,
UNMEER, UNICEF, Cross-Border
Task Force
CCC plan exists
Media plan exists
Social Mobilisation SOP
Traditional Healers, herbalists,
women, Soways, and TBAs
Chiefdom micro-planning
Faith leaders
SMAC Programme Strategy
Tuesday 1500
Number of communication plans to be shared by
Delphine
Delphine will share material with partners
After this schedule meeting to coordinate
development - Monday 1600 – pre-meet 1530 to
update this slide
Sharing what we have already and then developing
district specific SOP
UNICEF, UPHR, WHO, AJLC, (and
SocMob pillar partners)
Kadija putting together plan for linking with these groups
UNICEF, WHO
Kadija to share plan in order to source funding
and implementation
UNICEF led work
UNICEF
Helen to share with Delphine to then follow up
any future work
AJLC, CAFOD (part of SMART
consortium(
Consolidated message guide for SL updated every two
Restless Development, GOAL
weeks
Protection/Psychosocial
AJLC to share plan of action prior to 06Apr15
GOAL to share SMAC proposal (three pronged
approach) prior to Mon 06 Apr 2015
Family liaison / psychosocial
support proposal
New protection consortium
PSS strategy
Drafted, pending funding
UPHR, GOAL, DERC, AU
Brenda to follow up week commencing 06Apr15
with DEERF
Nationally led process and still awaiting confirmation on
lead partner for Kambia
MSWGCA, GOAL, ACF
Brenda to follow up funding confirmation from
DFID
MSWGCA, MOHS UNICEF, GOAL
(ISRaid)
Follow up with UNICEF Protection Specialist –
liaise with Delphine for dates
UNICEF, MSWGCA
Dependent on line above
National strategy on going:
1.Appropriate tools finalized and disseminated
2. Increase wellbeing and reduce stigma to Survivors and
EVD affected.
3. MHPSS monitoring and tracking tools
5. PSS services provided by community structures
6. Mental health and other health care services….
Protection Desk
To be aware that discussions ongoing about future
structure of protection desk, with above line
developments
Cross-Border Work
Liaison Officer development
Shared laboratory
Communications
Rations support for RSLAF
Expansion of BCP health
screening programme
One LO from each side
UNMEER, UNICEF, WHO
See detail in labs section
Frank and Ibrahim
Need SOP to map out communications and database
usage
WHO, Liaison Officers
Liaison Officers to report
Funding still required
IOM, CJIATF, DERC, RSLAF
Chase long term funds
Civilians
Increase number
Perhaps part of UNICEF discussion cross border
IOM, UNICEF, GOAL, CDC
IOM
CDC may be able to help with training
IOM involvement
Passes
Maintenance of MOU annexes
Joint epidemiology and
indicator development
Joint Social Mobilisation work
Possible funding for cross border work across region
IOM, DFID, CDC, DERC
Vehicle and individual passes for crossing
Chase IOM and DFID for latest
Henry to handover to Dauda
Liaison Officers
Ongoing
May not be feasible but work together towards some
consistency
ACF, WHO, UNICEF
Liaison officers to review prior to next meeting
Consideration of joint SocMob activities
UNICEF
Transition
Health Systems Strengthening
See separate section above
CCC decommissioning
Four CCCs being decommissioned
UNICEF, WHO, MSSL, DHMT
Await update from Delphine on dates / required
actions
CCC lessons learnt
Lessons learnt process being conducted by UNICEF
UNICEF, MSSL
Week commencing 06 Apr
CCC movement
Two CCCs (Kabaya and Bamoi Munu) are being moved
due to proximity to schools
UNICEF, WHO, MSSL, DHMT
Await update from UNICEF (Delphine) on
dates/required actions
Schools re-opening
Only schools with rigorous IPC can re-open
UNICEF
Meeting to be planned for Thursday 09 Apr
WASH Strategy
WASH strategy for district urgently needed as impending
gaps
District Council, ACF, Water ,
MinEducation, DHMT
Meeting with WASH partners for week
commencing 06 Apr 15
Logistics
Ambulances
Confirm how long ambulances are with DERC
CAFOD, Caritas, DERC
Ask NERC for length of stay for ambulances Henry
Annex C to
KAMBIA DISTRICT ‘GETTING TO ZERO’ STRATEGY
Dated 06 Apr 2015
KAMBIA DISTRICT RESPONSE FRAMEWORK
Aim
This aim of this document is to provide a framework for the Kambia DERC and partners to redefine the
focus of EVD response efforts in the district. Recognising that the only way to achieve the elimination of
Ebola in Kambia is to identify and isolate every single case of EVD in a timely manner, there is a need to
improve the scope and efficacy of current response efforts and ensure that the right areas are being
targeted with appropriate activities in a coordinated way.
This framework therefore aims to:
1.
2.
3.
4.
Define common response objectives and agreed indicators for measuring improvement
Agree criteria for identifying target communities for response efforts
Map out appropriate response activities for different issues and key partners
Outline a process for decision making and tasking of teams to ensure a coordinated approach to
activities in target communities
Background
As of March 2015, Kambia District continues to experience active EVD transmission. The district has a long
shared border with Guinea (Forecariah Prefecture), with multiple crossing points. Both sides of the border
are experiencing on-going active transmission chains. While the district surveillance system is functioning
well in response to known transmission chains, the alert system remains a concern. The number of daily
live alerts is low and the number of death alerts appears to be decreasing in some Chiefdoms, indicating
that community burials are practised in many areas. Pockets of community resistance to response efforts
remain, presenting challenges to containing the outbreak.
Key Response objectives
A logframe is attached as Annex A. The overall district goal is to get to zero and eliminate EVD from the
district. Desired results:




Strengthened alert system that is better able to detect suspected EVD cases (live and dead)
More efficient surveillance system with appropriate reactive and proactive capacity
Strengthened community engagement in response activities
Safe and effective case management system in place
Key Community Engagement Issues in the EVD Response in Kambia District

Under reporting - remains a significant concern. The number of daily live alerts is low and the
number of death alerts remains below the expected number of all-cause deaths for the district,
with a recent decline in reporting in some Chiefdoms;

Unsafe Burials – Awareness that Ebola can be transmitted by washing or touching dead bodies is
high, 1 however under reporting of deaths and specific reports of secret burials indicate that unsafe
burial practices continue. Resistance to and mistrust of burial teams continues to be reported.
While much effort has gone into making safe burials more dignified, messaging has focused solely
on the importance of safe burials, not on what improvements have been made to the process;

Community denial – in some areas, communities and stakeholders continue to deny the existence
of Ebola, attributing symptoms to other causes, such as witchcraft. Encouraging reporting and
ensuring effective case management and surveillance in such communities is challenging;

Community resistance to response efforts – rejection of burial teams, surveillance/contact tracing
efforts, and decontamination teams have been reported in some areas of the district, indicating a
need to increase community engagement and trust in response efforts;

Community distrust in the response system – ongoing fears about the condition of holding centres
and ETUs continue to be reported in communities and, in some cases, has led to reluctance to
report suspect cases. While the number of deaths in quarantined homes has decreased, some cases
still occur. Community members also report fears that ambulances and treatment centres are
spraying patients with chlorine and killing them.

Weak political engagement – the engagement of village taskforces varies considerably between
different areas, with some Chiefdoms yet to establish taskforces in problem areas. Similarly, the
engagement of Paramount Chiefs in response efforts is variable across the district, with
opportunities for increased engagement and leadership on the response at Chiefdom, Section, and
Village levels;

Cross border transmission – an estimated 10,000 people cross between Guinea and Kambia District
each week. Active EVD transmission continues in Forécariah Prefecture across the border. Ongoing
efforts to establish cross border screening and surveillance are underway;

SocMob Messaging – to date, messaging has not focused on recognising symptoms of Ebola that
may occur in the early stages of the disease, such as headache, joint pain, nausea and weakness.
Redefining the District’s Response Efforts
In order to broaden the scope and efficacy of response efforts, there is a need to proactively identify target
communities, based on agreed criteria, target response efforts effectively to address specific challenges,
and coordinate partner activities in target locations.
Identifying target locations
1. All DERC partners to agree a list of selection criteria (see Annex A);
2. WHO will use these criteria to develop a weekly list of target communities to be shared each
Monday in the evening DERC brief. These locations –in addition to any emerging concerns during
the week - should form the focus of all DERC response activities;
1
Nationwide, 94% percent of respondents accept that Ebola can be prevented by avoiding funeral or burial rituals that
require handling the body of someone who has died of Ebola. Foucs 1000, UNICEF, CDC, Follow-Up Study on Public
Knowledge, Attitudes and Practices relating to EVD Prevention and Medical Care in Sierra Leone (Ebola KAP-2),
December 2014
Agreeing appropriate response activities
3. All DERC partners to agree a set of surveillance and SocMob approaches which, based on examples
of best practice, are most effective to address (see Annex B);
4. DERC to carry out a mapping of effective approaches for different issues and appropriate partners
for implementation (see Annex B)
Decision making and tasking process
5. A weekly planning meeting will be held on Mondays at 4pm. The list of target communities will be
shared and a coordinated response plan developed for each community, incorporating both
proactive surveillance and SocMob activities;
6. Plans will
7. Daily Joint Surveillance and SocMob Meeting will be held each morning at the DERC to define
reactive activities as needed;
8. Daily SocMob meeting will be held after the surveillance meeting to define any additional
community engagement activities needed, depending on issues that arise.
Kambia District Response Framework - Logframe
GOAL
To get to zero in Kambia District
INDICATORS
Primary
Objective
Outcome 1
Outcome 2
Outcome 3
2
To improve the efficiency and
effectiveness of the district
surveillance and response system
Strengthened community
engagement in response activities
SOURCE OF
VERIFICATION
100% of confirmed EVD
cases come from a contact
list
Number of confirmed cases coming
from a contact list
All suspect cases transferred
to appropriate health facility
within 24 hours of an alert
being raised
Number of suspect cases transferred
to appropriate health facility within
24 hours of an alert being raised /
total number of suspect cases in
given time period
Number of live alerts
Number of live alerts reported to
the DERC
Number of death alerts
# of corpse alerts / expected district
death rate of at least 116 deaths
per week2
The number of reported
deaths approximate the
expected number of allcause deaths
100% of credible alerts are
investigated within 24 hours
Number of credible alerts
investigated within 24 hours / total
number credible alerts within same
period
All cases require 2 tests at
72h interval
100% of confirmed EVD
cases come from a contact
list
Number of confirmed cases coming
from a contact list / all confirmed
cases
All cases fall along a
known transmission
chain
Time between symptom
onset and alert report is less
than 48 hours
Number of cases presenting prior to
48 hours / total number of cases
reported in given time period
The majority of credible
alerts (alive, dead) are
reported by the
community
Strengthened alert system that is
better able to detect suspected
EVD cases (live and dead)
More efficient surveillance
system with reactive and
proactive capacity
NUMERATOR/DENOMINATOR
(based on crude mortality rate for SL – CIA World Factbook)
RISKS AND
ASSUMPTIONS
All positive swabs come from
known contact lists
100% of suspected cases
accept to travel to the HC or
CCC
100% burials are conducted
in a safe and dignified
manner with community
input
100% lab results are
returned to patient/family
members <24h from
publication
100% of samples arrive at
the PHE lab <24h from
collection
Outcome 4
Safe and effective case
management system in place
0% nosocomial infections
100% of survivors receive
follow -up support
Number of deaths (swab positive)
among known contacts / total
number of deaths that are swab
positive in given time period
Number of HC/CCC patients matches
number of suspected cases (no
escapes) / total number of suspect
cases in given time period
Number of safe and dignified burials
that incorporate traditional
elements / total number of burials
including unsafe in given time period
Number of families informed within
24 hours / total number of families
informed from same lab result 24
period regardless of length of time
of reporting
Number of samples delivered to the
lab on the same day as
collection/number of samples
delivered in total from given 24 hour
diagnosis period regardless of length
of time of reporting
Number of healthcare workers who
are EVD+ / total number of EVD+
cases in given time period
Number of registered survivors
provided with a survivor support
package / total number of survivors
in given time period
Contacts voluntarily
report illness to CT upon
symptom onset
In-take registry at
HC/CCCs
Burial teams' report
Family Liaison Office's
report
Chain of custody
Medical records
Psycho-social support
pillar records
Kambia District Response Framework - Defining Target Areas
Issue
Hotspot
Definition / Indicator
Three or more suspected EVD cases (incl. at least one confirmed case) over a 10 day period from more than one HH in a single
village
Two confirmed cases over a 10 day period from separate HH within a village
Positive Swab
New case not on a contact
list
Death in a quarantine home
Cross-border transmission
Under reporting of deaths
Unsafe burial
Community
resistance/mistrust
Two or more cases (including one confirmed case) from a single HH in a village over a 10 day period if either the two cases have a
common source of infection or 20+ people in the village were exposed to the two cases after they became ill
Positive swab result confirmed
Positive result confirmed (live or dead) where the source of infection is not known
Death of a contact of a confirmed case during the quarantine period
Villages with a known epi link to areas in Guinea with positive cases
Areas in close geographic proximity or porous crossing point to areas in Guinea with known transmission
Areas where the difference between expected and actual death alerts in greater than 20 over a three week period. Need section
level population estimates to better calculate exact target locations. Liaise with LSHTM.
Specific report of a community burial
Any incidence of resistance (e.g. verbal or physical confrontation) to a response team
Refusal or resistance to any case management activity (e.g. referral to Holding Centre)
Community denial
Remote/hard-to-reach areas
Areas not reached by social
mobilisation activities
Silent Cluster
Refusal or resistance to any quarantine-related activity (e.g. food delivery)
Linked to the above but where specific feedback is received that communities or stakeholders do not believe in the existence of
Ebola and attribute symptoms to other causes (e.g. witchcraft)
Communities not reachable by four wheel vehicles (e.g. motorbike or bicycle only)
Communities which become inaccessible in the rainy season
Communities with no known socmob presence (i.e. based in the community)
Areas from which there are reports of cases or a chain of transmission , but which have not reported cases themselves
Kambia District Response Framework - Toolkit of Approaches for Community Engagement and Surveillance
ACTIVITY
Case Investigation
Active Surveillance
WHO
9 teams (based out of DERC),
comprising a DSO, SocMob,
Sprayer/Line List Officer, Swabber,
Technical support from partners.
10 chiefdom level DSOs supporting the
above teams on investigation
Case Investigation Teams (as above)
when there are no alerts to
investigated
WHAT
Investigate all alerts – live and dead
Full investigation of positive cases,
incl. line list
Visit community to investigate
rumours and look for potential
triggers:
Speak with key stakeholders (village
leaders, taskforce, traditional
healers, women’s groups etc.)
Active Case Search
Contact Tracing
DERC/DO meeting with
Paramount Chief and/or other
key leaders
Surge team comprising DSO/
Surveillance and SocMob and liaises
with
Review medical records in PHUs and
CCCs
Pre-Engagement with key
stakeholders followed by house to
house visits by contact tracers and
community members to identify sick
or recently dead people.
Contact tracer based at or near
community, working with a supervisor.
Technical support provided from
partners
Contact tracers visit daily all contacts
from confirmed cases over a 21 day
period and report all illnesses or
deaths for further investigation.
District Coordinator and District Officer
DC and DMO engage Paramount
Chief directly to discuss particular
issues
WHEN
LEAD AND PARTNERS
Hotspots
Positive Swabs
New case not on a contact list
Death in a quarantine home
Cross-border transmission
Central teams – DHMT
Hotspots
Positive Swabs
New case not on a contact list
Death in a quarantine home
Cross-border transmission
Under reporting of deaths
Silent clusters
Secret burials
Community Denial (following
socmob)
Hotspots
Positive Swabs
Central teams – DHMT
Technical support:
WHO/CDC/MSF/GOAL/AU
Technical support:
WHO/CDC/MSF/GOAL/AU
DHMT
Technical support: WHO
This is a more intrusive
method for selective use and
requires an active community
taskforce and strong
community engagement prior
to activity
All contacts of positive cases
Lead: WHO/UNFPA
Supervision: Marie Stopes
Secret Burials
Community resistance –
response to specific
incidences or issues
Personnel: UNFPA
DO to contact PC
ACTIVITY
Community visit from DO and
Paramount Chief
WHO
District Officer, SocMob Pillar Lead,
DHMT Social Mobiliser and PC for
Chiefdom
WHAT
Inform community of visit ahead of
time
Visit community to engage key
stakeholders - e.g. town chief
Meetings with individuals involved in
any specific incidences.
Community meetings with key
stakeholders
DHMT Social Mobiliser/SMAC
Engage community mobilisers if
appropriate.
Other partners (UNICEF, WHO) as
appropriate.
Needs careful handling as this
approach can exacerbate volatile
situations
Decide on messaging appropriate to
the issue(s) to be addressed
Inform community of visit ahead of
time.
Engage key stakeholders in
discussion – communicate agreed
messages but also listen to key
concerns.
Participants could include: Ward
Councillors (if appropriate), Section
Chief (if appropriate)Town Chief,
religious leaders, opinion leaders
identified by the community
Based on community feedback, team
to provide practical
recommendations to DERC for follow
up.
Recommendations to be directed to
the appropriate pillar for action.
WHEN
LEAD AND PARTNERS
Under reporting of deaths
Community resistance/
distrust
Secret burials
Silent clusters
Hotspots
Positive Swabs
SocMob Pillar Lead to
decide on need for meeting
Under reporting of deaths
Community resistance/
distrust
Community Denial
Secret burials
Silent clusters
Hotspots
Positive Swabs
Remote/hard-to-reach areas
Areas not reached by socmob
activities
SocMob Pillar/UNICEF to
develop messages
DO to contact PC
SocMob Pillar/UNICEF to
develop and brief on
messages
ACTIVITY
Community meetings with
particular target groups (e.g.
women, youth)
WHO
DHMT Social Mobiliser/SMAC.
Appropriate local partner with either
presence in the geographic area or
experience working with specific target
groups (e.g. mother feeding groups,
CHWs, youth taskforce etc.)
Engage community mobilisers
Other partners (UNICEF, WHO) as
appropriate.
WHAT
Decide on messaging appropriate to
the issue(s) to be addressed and
groups to engage
Visit community to identify specific
groups, working through appropriate
leadership and arrange an
appropriate time and venue for
discussion.
WHEN
LEAD AND PARTNERS
Under reporting of deaths
Community resistance/
distrust
Community Denial
Secret burials
Ongoing engagement
activities
Remote/hard-to-reach areas
Areas not reached by SocMob
activities
SocMob Pillar/UNICEF to
develop messages
Community resistance/
distrust
Community Denial
Under reporting of deaths
Secret burials
Community resistance
Community denial
DHMT SocMob
Hold focus group discussions with
community mobilisers and members
of the selected group to discuss
issues, gather concerns, and agree
actions
Based on community feedback, team
to provide practical
recommendations to DERC for follow
up.
Community Sensitisation
through EVD survivors
DHMT
Meetings with religious leaders
DHMT Social Mobiliser
Focus 1000, Access to Justice, ISLAG,
CHRISTAG-depending on geographic
area and denomination.
Recommendations to be directed to
the appropriate pillar for action.
Project design underway
Decide on messaging appropriate to
the issue(s) to be addressed and
groups to engage
Working through appropriate
structures, identify appropriate
religious leaders. Arrange an
appropriate time and venue for
discussion.
Hold discussions to understand
DHMT Social Mobiliser
Pillar Lead to decide on
most appropriate partner
Focus 1000, Access to
Justice, ISLAG, CHRISTAG
ACTIVITY
WHO
WHAT
WHEN
LEAD AND PARTNERS
constraints/issue (depending on
context), discuss potential solution
and agree on culturally sensitive
messages and actions (e.g. special
dispensations to allow safe and
dignified.
Meetings with traditional
healers and Soways
DHMT Social Mobiliser/SMAC.
Agree on appropriate times and
venues for message dissemination.
Project design underway
Appropriate local partner with
experience working with target groups
– SHADE, Access to Justice,
Direct Household Engagement
DHMT Social Mobiliser, local
community mobilisers, key community
stakeholders
Visit to specific household(s) with
identified concerns (e.g. quarantined
home resistant to surveillance team)
House to House mobilisation
DHMT Social Mobiliser, local
community mobilisers, key community
stakeholders
Radio messaging
Three main radio stations with
messaging provided by SocMob Pillar
House to house visits across a
community to engage in dialogue and
disseminate key messages – with a
particular focus on marginalised or
more vulnerable groups who may not
attend or be excluded from
community meetings.
Radio stations to broadcast agreed
messages through presenters. Topics
to be decided in SocMob pillar
Under reporting of deaths
Community Denial
Community resistance/
distrust
Any case linked to traditional
healers
Positive Swabs
New case not on a contact list
Death in a quarantine home
Secret burials
Community Denial (linked to a
particular HH)
Community resistance/
distrust (linked to a particular
HH)
Secret burials
Community Denial
Community resistance/
distrust
Cross border transmission
DHMT Social Mobiliser
Pillar Lead to decide on
most appropriate partner
depending on context
Under reporting of deaths
Secret burials
Cross border transmission
Community Denial
Community resistance/
distrust
To be completed
To be completed
To be completed
ACTIVITY
Radio interviews with key
spokespersons
WHO
WHAT
Three main radio stations with
appropriate spokespersons: DMO, DC,
NGO staff, Family Liaison Officer,
Religious Leaders etc.
SocMob staff to provide
training/messaging to spokespeople.
Paramount Chief tour of
chiefdoms
Paramount Chief, District Officer,
District Coordinator, SocMob Pillar
Lead
IEC material distribution
Community mobilisers
Support to chiefdom and village
level taskforces
Jingles
To be completed
UNICEF to share latest material with
partners through SocMob Pillar
Radio stations to run interviews and
panel discussions on particular topics
defined by SocMob Pillar
To be completed
Messaging to be defined by SocMob
Pillar and disseminated to key
partners
To be completed
For use on radio shows
Not to be relied on as a standalone
tool, but can be useful to draw
attention to key issues in a
community, provided that thorough
community engagement and
dialogue are ongoing in target
communities.
WHEN
LEAD AND PARTNERS
Cross-border transmission
Under reporting of deaths
Secret burials
Community Denial
Community
resistance/distrust
Under reporting of deaths
Community Denial
Community
resistance/distrust
Community denial
To be completed
To be completed
To be completed
To be completed
To be completed
District Officer
To be completed