Liberia Experience:
National Level
Coordination and
Partnership in Cholera
Control.
14-16 May 2008
Dakar, Senegal
Background Situation
• 15 counties and 88 districts
• Estimated 3 million people
- Sparse Pop - density, 84 per sq mile except
Monrovia (1 million people)
- Infrastructures destroyed by war
- Access to safe water - 24% (UNDP 2006),
sanitation nationwide - 26% - (UNICEF,
2006)
- Low households incomes. ¾ pop on less
than US$1 a day (iPRS, 2007)
- Infant mortality rate, 102/1000 & crude
morality estimate 1.1/10,000/day (CFSN,
2006).
- Diarrhea 2nd cause in morbidity/mortality
- Seasons– Wet –April – Oct, Dry Nov-March.
Cholera hot spot areas
• Occurrence
(slides line
graph)
Trends :2005 -2007
1400
1200
1000
800
2005
2006
2007
600
400
200
0
jan
feb
mar april may
jun
jul
aug sept
oct
nov dec
Liberia cholera trend in 2008
Cases and Deaths
250
231
200
150
Cases
107
100
Deaths
80
50
2
0
0
0
Januar y
Febr uar y
Months
M ar ch
LIBERIA MAP SHOWING CHOLERA
HOT SPOTS COUNTIES
Lofa
Gbarpolu
Grand Cape Mount
Bong
Nimba
Bomi
Margibi
Montserrado
Grand Bassa
Grand Gedeh
River Cess
River Gee
Sinoe
Grand Kru
Maryland
National Strategy
•
•
•
•
Coordination
Partnership
Surveillance / EWARNS
Institutional capacity
Coordination
• Multisectoral approach
• Decentralized epidemic task force
• Standardized case management,
surveillance & monitoring
• Partners mapping & up dates.
• Leadership – MOH/CHT
• Annual integrated plans.
• Pooled contingency plans / stocks
Partnerships
• Relevant GOL Ministries / Depts
• CBOs Hygiene behaviors promotion
• UN agencies: UNICEF, WHO, UNMIL
- Tech. asst; Finance; Resources;
logistics.
• Health/WATSAN NGOs and WATSAN
CONSORTIUM
• Communities
Surveillance
• Standardized data collection
tools & analysis at county
levels.
• Pre-positioned investigation &
case detection teams.
Institutional capacity
• INGO – (9), LNGO) (26) & CBOs in 4
counties
• UN agencies –(WHO, UNICEF,
UNHCR)
• Community – ORT corners /
Treatment centers, trained
• Trained staffs & community own
resource persons (volunteers).
Successes
• Consistent reduction in attack rates
• Sustained multisectoral & integrated
approach to cholera control
• Availability of trained local
resources at community level.
• Sustained partners support.
• Decentralized chlorine stocks
• Response within 24hrs-48hrs
• Coherence approaches &Team work.
• Functional surveillance systems
OUR UNIQUE WAYS OF
WORKING.
• Merged GOL coordination &
WASH cluster.
• Innovations - Pooled funding
(DFID/ECHO) -WASH consortium
– 5 INGOs – services delivery &
capacity building through GOL.
- Pool funding from partners
Limitations/Challenges
• Deplorable infrastructure states
• High Poverty level
• Meager resources skewed towards curative
services.
• Low WASH coverage.
• Insufficient resources – human & materials
• Weak national systems / policies enforcement.
• Inadequate mid-level skilled health personnel to
manage cholera control
• Transition from humanitarian to development.
• Low access to health services
• Unreliable data for planning
LESSONS LEARNT
•
•
•
•
Pre positioning of stocks - chlorine
Routine Well chlorination.
HH water chlorination practice
Pre-mapping and identification of
resources at county levels.
• Community based hygiene education
• ORT corners / Treatment centers
• Sustained partnership & coordination
Our Needs
• Long-term funding from donors,
targeting AWD/Cholera / WASH.
• Support for Skill training on cholera
management.
• Expansion of decentralized cholera
confirmation laboratories - Counties
• Research on cholera to establish
evidences for intervention.
• Support for sustainable WASH
activities.