Between November 2014 and September 2015, FEWS NET worked with Mobile Accord (GeoPoll) to conduct thirteen rounds of SMS-based trader surveys in Liberia and Sierra Leone on the status of market activities and operating costs. Liberia and Sierra Leone are FEWS NET remote monitoring countries. In remote monitoring countries, analysts typically work from a regional office, relying on a network of partners for information. As less data may be available, remote monitoring reports may have less detail than FEWS NET presence countries. The SMS-based survey results serve to corroborate key informant and partner reports on market activities and serve as inputs to FEWS NET’s integrated food security analysis on the impacts of the Ebola outbreak. The first round of data collection identified a sample of traders to monitor fundamental market characteristics (Table 1). During the second through sixth rounds, the survey focused on market activities, while the subsequent rounds inquired about both market and agricultural activities. Data was collected on a bi-weekly basis for rounds 2-6 and on a monthly basis thereafter.

Key Messages

This report provides a summary of findings from a FEWS NET trader survey using a SMS-based platform through GeoPoll during the week of August 24th, 2015 (thirteenth round of data collection). The sample includes 276 small to large-scale traders across 14 districts in Sierra Leone (Figure 1).
Thirty-eight percent of respondents were local rice traders and 28 percent were imported rice traders, followed by palm oil (18 percent), and cassava (16 percent).

During the week of August 24th, 23 percent of survey respondents reported that the most important market in their area operated at reduced levels (Figures 2 and 3), and one percent of traders reported market closures.

Twenty-eight percent of traders indicated that market supplies of main commodities were lower than normal at this time (Figure 4).

High transport costs was the most frequently cited reason for reduced market supplies compared to normal at this time (Figure 5).

Forty-four percent of respondents indicated that the current primary agricultural activity is weeding (Figure 10). Thirty-nine percent of respondents reported normal and on-time agricultural activities (Figure 9).

Forty-nine percent of respondents reported reduced agricultural wage opportunities compared to normal at this time (Figure 8). Thirty-three percent of traders reported that they were not able to sell their cash crops as usual at this time of year (Figure 7).

NEW CASES

• New Confirmed cases = 0 as follows:
  Kailahun = 0, Kenema = 0, Kono = 0 Bombali = 0, Kambia = 0, Koinadugu = 0, Port Loko =0, Tonkolili = 0 Bo = 0, Bonthe = 0, Moyamba = 0 Pujehun = 0 Western Area Urban = 0, Western Area Rural = 0, Missing = 0

• DISCHARGED CASES = 4,051

• CUMULATIVE CASES = 8,704

• CUMULATIVE DEATHS =3,589

• Suspected cases = = 5,141

From a peak of over 500 cases a week in October 2014, with transmission in all 14 districts, Sierra Leone has reached the tail end of the Ebola outbreak with single digit cases in only one district as of mid-September 2015. Active case search, supervision and mentoring of contact tracers and contact tracing activities continue to be strengthened in all districts. As a result of a coordinated effort with partners and national authorities, 14 districts will have completed their 42-day countdown to become free of Ebola Virus Disease (EVD) transmission by 7 November 2015.

In order to consolidate these gains, preparedness in the event of reoccurrence remains crucial in getting to and maintaining a resilient ZERO.

The current outbreak has not only tested the existing health infrastructure, but has also overshadowed work in strengthening the health system services in the country.

While ending the current Ebola outbreak remains the primary objective of Sierra Leone and the sub-region, WHO is committed to assist in strengthening the country’s existing health system’s capacity to detect, respond to and recover from public health emergencies now and in the future.

Sierra Leone has entered Phase 3 of the response which has two key objectives: first; to define and rapidly interrupt all remaining chains of transmission and, second, to identify and manage risks in all locations that were previously affected. Towards this end, a rapid emergency operational plan has been initiated that provides support to assess the risks, trace, monitor and support each and every person linked to Ebola cases, and ensure that the best possible Infection Prevention and Control (IPC) standards are upheld in all healthcare facilities to protect Health Care Workers (HCWs) and those seeking care.

In light of behavioural challenges, social mobilization teams and anthropologists work alongside surveillance colleagues to address rumours, perceptions and harmful practices. In an effort to provide a comprehensive response, a multidisciplinary approach was adopted to ensure Sierra Leone not only achieves ZERO cases but sustains a resilient ZERO. To this end, operational management, integrated strategic planning and management (national and district level), protection for (HCWs) and patients through proper IPC, all the while revitalizing the Integrated Disease Surveillance Disease(IDSR) in the country to ensure preparedness. Interagency coordination with other UN Agencies, Funds, and Programmes (AFPs) has maximised response efforts, with a common goal to fully support the government with its national priorities and strategies.

New Freetown Declaration advocates for increased prioritisation of functional tiered laboratory networks to close gaps in global health security agenda

PRESS RELEASE: Freetown, Sierra Leone (11 November 2015) – The recent Ebola outbreak in West Africa highlighted the importance of early disease detection and response in preventing the rise of new global health threats. Early detection requires that rapid disease testing capacity reaches across countries and into rural communities where people live. Now the health experts in Africa are taking steps to strengthen laboratory networks in order to improve the early detection of outbreaks on the continent.

During a ‘Regional Global Health Security Consultation for Laboratory Strengthening’ convened by the African Society for Laboratory Medicine (ASLM) and the World Health Organization’s Regional Office for Africa (WHO AFRO) in Freetown, Sierra Leone, on 15-16 October 2015, high-level Ministry of Health officials from more than 20 countries in Africa, together with ASLM and WHO AFRO, have issued a “Freetown Declaration” calling for a new framework for tiered laboratory networks and implementation of a score card to assess readiness of these networks. The Declaration calls for laboratory networks to be integrated with public health institutes and surveillance systems to ensure early disease detection in Africa. This new framework and integrated approach of laboratory networks and surveillance systems is critical to meet the needs of the Global Health Security Agenda (GHSA). GHSA is a collaborative effort from governments, international organisations, and civil society to promote global health security as an international priority.

“Diagnostic services are a cornerstone of health systems and, if well-integrated with surveillance systems, are essential for robust detection and response to public health threats. There has been enormous progress made in Africa to strengthen laboratory capacity to meet the needs of HIV, malaria, and tuberculosis programmes. It is now imperative for Africa to take the next steps and improve our resilience to emerging threats, especially to prevent a resurgence of Ebola,” says Sierra Leone’s Minister of Health and Sanitation, Dr. Abu Bakarr Fofanah. “Like Ebola, emerging diseases and new threats are still being identified on the front lines in our communities. The newly released Freetown Declaration calls upon national governments, donors, and local partners to address existing gaps in global health security in Africa.”

United States Coordinator for Threat Reduction Programs, Ambassador Bonnie Jenkins, says, “GHSA is intended to accelerate progress by the global community to build capacity to prevent, detect, and respond rapidly to infectious disease threats, in support of global frameworks that set the standard for durable protection against these threats to health and welfare everywhere. ASLM’s close collaboration with WHO AFRO to strengthen laboratory systems, as expressed in the Freetown Declaration, will provide a strong impetus for implementation of the GHSA in Africa.”

“Given the growing role of laboratory networks in global health security and taking into account the International Health Regulations (IHR 2005) being implemented within the context of Integrated Disease Surveillance and Response (IDSR) in the African Region, the Freetown Declaration is a crucial opportunity to further strengthen and expand on public health laboratory networks,” affirms Dr. Matshidiso Rebecca Moeti, World Health Organization Regional Director for Africa. “The Declaration issues a call to action across Africa to establish resilient tiered laboratory networks, measure progress with a standardised score card, and integrate networks with public health institutes. Together, we must answer the call.”

Dr. Trevor Peter, Chair of the ASLM Board of Directors, says, “ASLM is working to tackle diagnostic and institutional weaknesses through a strategy that bolsters local capacity and builds strong partnerships across the continent towards the achievement of the GHSA targets. Countries need strong, functional tiered laboratory networks to ensure early disease detection and effective response. These networks need to be regularly assessed using a score card, as well as more effectively integrated into disease surveillance and public health institutes. No government or organisation can do it alone, so we must find ways to collaboratively build healthy communities now and for the long-term. The Freetown Declaration reasserts our commitment to strengthening local defences against future Ebola outbreaks.”

MEDIA CONTACT: Corey White, ASLM Senior Communications Officer, Email

To combat the Ebola outbreak in Liberia, Guinea, and Sierra Leone, UNDP provided hazard payments to Ebola Response Workers (nurses, doctors, contact tracers, ambulance drivers) who were risking their lives to combat the virus. Thousands of citizens, including medical professionals, mobilized to safely track Ebola cases, treat the sick, and bury the dead. By 2015, UNDP had supported governments to pay nearly 20,000 Ebola Response Workers to combat the virus in all three countries.

These are countries "coming out of conflict, with very poor infrastructure, very small, under-resourced and under-trained health workforces, overwhelmed by a crisis which even in Western countries would severely stress the system," said Peter Graaf, the UNMEER Ebola crisis manager for Liberia.

"One of the very challenging and complex areas was the Ebola response workers payments. The government really needed help to make sure they were paid so they could work," said Ghulam Sherani, Head of Payments for UNDP in Sierra Leone.

"Hazard pay had the most impact on getting the people in this country to come in and join the fight, regardless of how many medical doctors we would have had coming in, if the hazard pay wasn't around, (...) it would have been a very difficult situation". Raymond Kabya, District Coordinator for Ebola in Port Loko, Sierra Leone.

ALNAP and ELRHA will be looking at 15 different examples of humanitarian innovation funded by ELRHA’s Humanitarian Innovation Fund (HIF) grants. Each case study will explore the dynamics of successful innovation processes, culminating in a unique and in-depth study on innovation in humanitarian action.

Words of Relief is a Translators without Borders (TWB) project designed to provide local language translation services to non-governmental organisations (NGOs), UN agencies and other actors during humanitarian response.

Was this a successful innovation process? What lessons about innovation were found? Each case study is part of a broader research that seeks to define and understand what successful innovation looks like in the humanitarian sector, and improve understanding of how undertake and support innovative programming can work in practice.

HIF-ALNAP case studies on successful innovation

This study is one in a series of 15 case studies, undertaken by ALNAP in partnership with ELRHA’s Humanitarian Innovation Fund (HIF), exploring the dynamics of successful innovation processes in humanitarian action. They examine what good practice in humanitarian innovation looks like, what approaches and tools organisations have used to innovate in the humanitarian system, what the barriers to innovation are for individual organisations, and how they can be overcome.

About the case studies Case study subjects are selected from a pool of recipients of grants from the HIF, (£75,000-150,000).

The HIF awards grants for each stage of innovative practice: grants of up to £20,000 are available for the recognition, invention, and diffusion stages, and grants of up to £150,000 can be obtained to support the development and implementation stages. The HIF selects grantees on the basis of a variety of criteria designed to achieve a robust representation of the range of activity in humanitarian innovation.

The case study subjects are chosen to reflect innovation practice in the humanitarian system. They cover information communication technology (ICT) innovations and non-ICT innovations, and they offer a balance between innovations that have reached a diffusion stage and those that have not. They also reflect the wide geographic range of the areas where innovations are being trialled and implemented. (For more information on the methodology and criteria used to select case study subjects, see the forthcoming ‘Synthesis report’ for the case study series).

About HIF-ALNAP research on successful innovation in humanitarian action These case studies are part of a broader research partnership between ALNAP and Enhancing Learning and Research for Humanitarian Assistance (ELRHA) that seeks to define and understand what successful innovation looks like in the humanitarian sector. The ultimate aim of this research is to improve humanitarian actors’ understanding of how to undertake and support innovative programming in practice. This research partnership builds on ALNAP’s long-running work on innovation in the humanitarian system, beginning with its 2009 study, Innovations in International Humanitarian Action, and draws on the experience of the HIF grantees, which offer a realistic picture of how innovation actually happens in humanitarian settings.

Innovation is a relatively new area of work in humanitarian action, yet it is one that has seen exponential growth in terms of research, funding and activity at both policy and programming levels. While the knowledge base around innovation in the humanitarian sector is increasing, there remain a number of key questions for humanitarian organisations that may be seeking to initiate or expand their innovation capacity. The HIF-ALNAP research has focused on three of these:

Primary research questions

What does successful humanitarian innovation look like?

What are the practices organisations can adopt to innovate successfully for humanitarian purposes?

Secondary research question

What are the barriers to innovation in the sector and how can they be mitigated?

The case studies will be used to produce a synthesis document that addresses these three questions. The outputs of this research are aimed at humanitarian organisations interested in using innovative practices to improve their performance, as well as organisations outside the humanitarian sector, such as academic institutions or private companies, seeking to engage in innovation in humanitarian action

Introduction

Beginning in March of 2014, West Africa experienced the largest Ebola outbreak on record.
Unlike many smaller preceding outbreaks of Ebola virus disease (Ebola), this particular outbreak spread to multiple African countries and caused (as of July 2015) more than 27,000 suspected human cases. In August 2014, the first American citizen with Ebola was flown to the United States (U.S.) for treatment. Additional patients have subsequently been medically-evacuated to the U.S. and two returned travelers were diagnosed and treated in Dallas, Texas and New York City, New York. These experiences, as well as the secondary infections of two health care workers in a Dallas hospital, identified opportunities to improve preparedness for and treatment of suspected and confirmed patients with Ebola. In response, Congress appropriated emergency funding, in part to ensure that the health care system is adequately prepared to respond to future patients infected with Ebola. In doing so, Congress directed the Department of Health and Human Services (HHS) to develop a regional approach to caring for future patients with Ebola.

The funding provided through the Hospital Preparedness Program (HPP) Ebola Preparedness and Response Activities is intended to ensure the nation’s health care system is ready to safely and successfully identify, isolate, assess, transport, and treat patients with Ebola or patients under investigation for Ebola, and that it is well prepared for a future Ebola outbreak. While the focus will be on preparedness for Ebola, it is likely that preparedness for other novel, highly pathogenic diseases will also be enhanced through these activities. Assuring that patients with Ebola are safely and well cared for in the U.S. health care system and that frontline providers are protected and trained to recognize and isolate a person with suspected Ebola are the cornerstones of the HPP funding opportunity announcement (FOA).

Experience with patients with Ebola in the U.S. has shown that care of such individuals is clinically complex, requiring highly skilled health care providers and technologically-advanced care. This has led Congress, experts, and stakeholder groups to suggest that, to the extent possible, care of patients with Ebola should be concentrated in a small number of facilities.
At the same time, however, the nation’s hospitals must be prepared to handle one or more simultaneous clusters of Ebola. Further, all hospitals must be able to identify, diagnose, and treat a patient with suspected Ebola until they can be transferred to a facility that can provide definitive care. Ultimately, the HPP funding aims to ensure the health care system is well prepared in the event of future Ebola or other special pathogen outbreaks.

Overview

The goals of Ebola virus disease (EVD) surveillance during Phase 3 of the Ebola response are to promptly detect new, suspected EVD cases and deaths so as to trigger appropriate response, including rapid diagnosis, case isolation and management, contact tracing, safe burials, and the identification of transmission chains.

The proposed surveillance strategy needs to be reassessed in June 2016 and the systems in place and testing strategies adapted accordingly. Critical to this review will be the status of implementation and performance of national Infectious Disease Surveillance and Response (IDSR), the epidemiology, new knowledge in particular on the persistence of the virus in survivors and the transmission risk associated with this.

Background

The incidence of Ebola virus disease (EVD) in the three most affected countries in West Africa has fallen from a peak of 950 cases per week during September 2014 to less than 10 cases per week from August 2015 onwards. The risks presented by EVD are subsiding but not negligible, and changing in character. The continuing transmission of infection in Guinea and Sierra Leone into September 2015, plus the suspected reemergence of infection resulting from exposure to survivor body fluids in Guinea, Liberia and Sierra Leone, highlight the importance of maintaining surveillance across all three countries. While the risk of reemergence from survivors is not quantifiable, it is likely relatively low and does decline over time.

Phase 3 of the Ebola response builds upon capacity and knowledge gained during earlier phases, and has 2 objectives:

• Objective 1: To accurately define and rapidly interrupt all remaining chains of Ebola transmission

• Objective 2: To identify, manage and respond to the consequences of residual Ebola risks Against this background, this document presents an overview of the surveillance strategy required to achieve the above objectives of Phase 3 of the Ebola response.

The document displays a set of recommendations that must be understood as the minimal standard countries must implement. If resources allow and if operationally feasible, criteria to test live and dead individuals can be modified and made more sensitive.

The proposed surveillance strategy needs to be reassessed in June 2016 and the systems in place and testing strategies adapted accordingly. Critical to this review will be the status of implementation and performance of national Infectious Disease Surveillance and Response (IDSR), the epidemiology, new knowledge in particular on the persistence of the virus in survivors and the transmission risk associated with this.

Goals of the Phase 3 surveillance strategy The goals of EVD surveillance during Phase 3 (as in earlier phases of the Ebola epidemic) are to promptly detect new, suspected EVD cases and deaths so as to trigger an appropriate response, including rapid diagnosis, case isolation and management, contact tracing and safe burial, and the identification of transmission chains.

The activities carried out to achieve both objectives cover four distinct periods in each country. Periods A-C covers Phase 3. In period D the approach to surveillance is essentially given by IDSR.

A. From October 2015 until the last known opportunity for transmission (following discharge of the last patient from an Ebola treatment centre, or after burial of the last Ebola death), and for 42 days (end of the outbreak) (Objective 1)

B. After the end of the outbreak, a further 90-day period of heightened surveillance (Objective 2)

C. From 90 days up to one year (Objective 2)

D. After one year (after Phase 3)

Comments

Avec environ 20,000 cas, l’année 2015 se caractérise par une baisse substantielle du choléra par rapport à la même période l’année dernière (75% de réduction). Durant ces dernières semaines, la transmission demeure active dans 4 pays de la région. La situation en RDC reste préoccupante avec plus de 70% de cas de la région et une épidé- mie en cours dans la province du Manièma. Les données complètes des semaines 42 et 43 ne sont pas encore disponibles. Toutefois, 48 cas de cholera et 3 décès ont été rapportés à la semaine 43 dans une prison de la ville de Kisangani.

With approximately 20,000 cases, year 2015 is characterized by a substantial decrease in cholera cases compared to the same period last year (75% decline). In recent weeks, the transmission remains active in four countries of the region. The situation in DRC remains alarming with the highest burden of cholera in the region (70% of cases) and an ongoing epidemic in the Maniema province. Comprehensive data for weeks 42 and 43 are not yet available. However, 48 cholera cases including 3 deaths were reported during week 43 in a prison in the city of Kisangani.

Current epidemiological situation + country-specific information

There has been considerable development in slowing down the Ebola Virus Disease Outbreak in Guinea, Liberia and Sierra Leone. On 7 November 2015, the Government of Sierra Leone declared that the Ebola outbreak is over. This meant that no cases had been declared in Sierra Leone over the last 42 days.

Despite the World Health Organisation (WHO) declaration marking the end of the Ebola outbreak in Sierra Leone being well received, the world must remain focused on getting to, and sustaining, zero cases. Until there are zero cases in each affected country, there is still a risk to the people and economies in these previously badly affected countries in the West Africa region and beyond.

On 11 November, Liberia was on day 69 of 90 days of active surveillance after being declared Ebola free for the second time on 3 September 2015. Communities are being urged to remain vigilant and report all deaths. Most organisations that were involved in the EVD response are in the process of scaling down their operations and planning for the coming year.

On 3 September 2015, the WHO had declared the Government of Liberia free of the Ebola virus transmission in human beings. This was after the passage of 42 days since Liberia’s last laboratory-confirmed second negative test case (on 22 July 2015). Liberia is currently in a 90-day period of heightened surveillance and continues to intensify vigilance in the fight against the EVD epidemic. Both Liberia and Sierra Leone have now achieved objective 1 of the phase 3 response framework: to interrupt all remaining chains of Ebola virus transmission.

Guinea reported no confirmed cases in the week to 8 November. A total of 4 cases have been reported from Guinea in the past 21 days, all of whom are members of the same family from the village of Kondeyah, in the sub prefecture of Kaliah in Forecariah. All 69 contacts currently being followed in Guinea are located in Kaliah and are scheduled to complete their 21-day follow-up period on 14 November.

According to the 04 November WHO Ebola Situation Report, one new confirmed case of Ebola Virus Disease was reported from Guinea in the week to 1 November. The case is the new-born child of a 25-year-old woman who was confirmed as a case in the prefecture of Forecariah during the previous week. The child was delivered in an Ebola treatment centre (ETC) in Conakry, and is currently undergoing treatment. The mother died after giving birth. Her other two young children were also confirmed as cases during the previous week and are receiving treatment. The 3 confirmed cases reported the previous week generated a large number of high-risk contacts in Forecariah who are now entering the second week of their 21-day post-exposure follow-up period.

On 1 November there were 382 contacts under follow-up in Guinea (compared with 364 the previous week), 141 of whom are high-risk. Therefore there remains a near-term risk of further cases among both registered and untraced contacts. The WHO Situation Report observed that case incidence had remained at 5 confirmed cases or fewer per week for 14 consecutive weeks. Over the same period, transmission of the virus has been geographically confined to several small areas in western Guinea and Sierra Leone, marking a transition to a distinct, third phase of the epidemic. The phase-3 response2 coordinated by the Interagency Collaboration on Ebola3 builds on existing measures to drive case incidence to zero, and ensure a sustained end to EVD transmission. Enhanced capacity to rapidly identify a reintroduction (either from an area of active transmission or from an animal reservoir), or re-emergence of virus from a survivor, and capacity for testing and counselling as part of a comprehensive package to safeguard the welfare of survivors are central to the phase-3 response framework.

Concern’s burial workers face stigma from their communities every day. In response, three of them created a song they call “No Discriminate” that they eventually hope to record, and inspire widespread change. View it here first.

Saturday, November 7th marked 42 days since the last reported case of Ebola Virus Disease in Sierra Leone. This is twice the maximum incubation period of the virus, and, according to the WHO, it means that the country is now officially Ebola-free. “Zero + 42″ became the shorthand and rallying cry of the celebrations that have followed across the country and beyond, which were especially passionate because it is an achievement driven largely by Sierra Leoneans themselves, and not by external forces.

In spite of these celebrations, harmful legacies remain. One example is discrimination against burial workers, whose families and communities shun them because of their association with the disease. These workers should be celebrated as heroes and many of them continue to fight, only now they’re confronting stigma.

Mohamed Samba Kamara, Mohamed Rogers, and Mohamed Lamintoray were members of Concern Worldwide’s burial teams, and their weapon of choice against stigma is rap — in the form of a song they call “No Discriminate.” Ultimately, they intend to record it and inspire widespread change.

Beginning in late 2014, Concern’s teams, brave volunteers who accepted the risk of infection and death, stepped to the forefront of the effort in Freetown, by committing to give victims and safe and dignified burials. After intensive training in personal protection, the Concern team went to work. Each member was determined to ensure that burials were both safe and dignified, and that every grieving family would be treated with respect.

At the height of the effort, Concern was employing nearly 300 people and managing a fleet of 25 vehicles to ensure that upwards of 80 victims a day would be safely removed from their communities, transported to the cemetery and buried. At the burial site in Waterloo, near Freetown, more than 9,000 graves line the hillside. Across all sites, the teams ensured the safe and dignified burial of more than 17,000 people.

Today, a little more than a year after the burial teams went to work, the number of cases is zero. Heroes like Mohamed Samba Kamara, Mohamed Rogers, and Mohamed Lamintoray were instrumental in this achievement. It’s now the responsibility of organizations like Concern, the government, and community leaders, to make sure they and hundreds of other burial workers across the country receive the respect and admiration they deserve. “No Discriminate” is a powerful step in that direction.

Mike Denny is a nurse and Infection Prevention & Control specialist from Gallup, New Mexico, U.S. He served as the Infection Prevention & Control Manager for the Ambulance project in Sierra Leone from June to November, 2015. This was his first mission for Handicap International.

What are the services provided by Handicap International’s ambulance project?

It has several aspects. First, we transport patients from their dwellings to Ebola testing centers. Second, we decontaminate their dwellings. At the same time we inform the family and surrounding community about what we are doing and how they can protect themselves. Finally we bring the vehicles, both the ambulances and the decontamination vehicles, back to our base in Hastings for a final decontamination.

What is unique about the services Handicap International provides?

Before this project started an centralized ambulance service for Ebola patients did not exist in Freetown. The local ambulance services do not transport Ebola patients. Transporting Ebola patients requires highly skilled and highly trained professional ambulance drivers and attendants. The dwelling decontaminations must also be done under the strictest of standard operating procedures. The decontamination of the vehicles back at Hastings also requires special skills. We have detailed standard operating procedures for every task and each staff member must master the tasks they are assigned to perform through training and practice.

Because of the staff’s skill level we’ve transported almost 3,800 patients, did nearly 5,000 vehicles decontamination and 1800 dwellings decontamination without a single person being contaminated by the virus.

How are staff members protected from Ebola?

The primary safety factor that we use to ensure that workers remain safe is a team concept. Nobody enters a contaminated area alone and people are always supervised by observers not actively participating in the decontamination operations. By using this team approach we make sure that everybody remains safe and follows the protocols that we established for their safety.

The primary personal protective equipment (PPE) that we use is the coverall. It goes from the ankles to the wrist and then the neck, providing complete coverage of the limbs and torso. We then also use rubber boots, a facemask, goggles, and a hood. We cover it with an apron and three pairs of gloves, two pairs of soft nitrile gloves and a pair of heavy gloves over the top.

What happens on a typical intervention?

People report suspected Ebola cases by dialing 117, which goes to the Command Center in Freetown. The Command Center is where the Ebola response is coordinated. We take calls from the Command Center at our dispatch. When a call comes in, our dispatch manager will get the address and all necessary details to locate referred cases. The dispatch manager then chooses a team to respond, which includes an ambulance to transport the patient, a decontamination vehicle with our equipment, a “dirty car,” which will remove the contaminated belongings of the patient and a “clean car” that will distribute a replacement kit to the family.

Once we arrive on scene our health promoter and team leader will engage with the community, the family, and the patient to inform, explain and determine what type of intervention will be needed. Sometimes people will refuse to let us work, but our health promoter’s job is to convince them to allow us to proceed with the intervention.

In the meantime, the team leader does an assessment of the situation. He will determine if the patient can walk or if he needs to be carried from the site, and where we can set up our operations. This can be a real concern, especially in slum areas, where sometimes our preparation areas can be as far as 200 meters from the dwelling that we’re decontaminating. Once these issues are resolved, the team leader will brief his team and supervise them as they put on their personal protection equipment. Then two hygienists, one carrying a sprayer with a solution of 0.5% chlorine will proceed to the dwelling, followed by the ambulance attendant who will then escort the patient to the ambulance.

If the patient needs to be carried, the ambulance attendant and one of the hygienists will carry the patient on a stretcher. Often dwellings are very small and poorly lit, we have to be very cautious when the staff get inside to pick up the patient. Any rough edges or sharp objects can breach the PPE and expose our workers to the Ebola virus.

Once the patient is safely inside our ambulances and being transported to the Ebola Testing centers, the hygienist with the sprayer will proceed to systematically decontaminate the dwelling with the chlorine spray. The final act is to remove the patient’s mattress and other material, which can be soiled from body fluids. We’ll saturate the mattress with chlorine, and then take it to a dumping site. After the intervention, a “clean car” will bring a new mattress and others replacement items like pillows, mosquito net for when the patient returns to the house.

Tell me about the staff you work with.

I arrived here and they taught me how to fight Ebola. I’ve learned from them every day that I’ve been here. They come from a variety of backgrounds and they’ve all come together to fight Ebola.

I’ve served in the company of heroes. I’m so proud to have fought Ebola with these people. It’s been an honor to lead them. They’ve inspired me to work 10-12 hour days, seven days a week, for five months for this, I do it for them. It’s the best job I ever had. I’m so proud to be part of this effort. I want the world and my fellow Americans to know what these people here in Sierra Leone have done.

Please don’t forget them. They have faced serious consequences as a result of their work due to the stigma of Ebola in Sierra Leone. When they leave our camp after work, some have to hide their IDs, so that people don’t know what their job is. If they didn’t do this, they would not be able to get on a bus, nobody would pick them up. When they get home, they have to hide the fact that they work for Handicap International so their landlords don’t evict them. Many of their families will no longer associate with them. Their wives, parents, and other family members won’t see them anymore since they started working on the Ebola epidemic.

Now that the Ebola outbreak in Sierra Leone seems to be at its end, what is the plan for this project? Handicap International plans to maintain a staff of Ebola responders. We want to be ready so that if Ebola does come back, we will have trained professionals ready to deal with it.

Chinese President Xi Jinping announced a few days ago that China would provide the 5th-round emergency aid to African countries to fight against Ebola. On November 4, the Official of the Department of Foreign Assistance made a comment on the contents of this round of aid.

The official said that this is China’s 5th round of foreign assistance provided to African countries which were hit by Ebola including Sierra Leone, Liberia and Guinea. This round of assistance is mainly applied to the following three aspects:

1. Help the three countries in the epidemic area with the tail-in work and the consolidation of the achievements of combating Ebola in the previous stage, in order to push the countries to terminate Ebola completely. China will continue to dispatch the virus detection team to Sierra Leone and send personnel in turn to the observation and treatment center of China-Sierra Leone Friendship Hospital. China will run the Ebola Treatment Center of Liberia, and transfer it to Liberia after the completion of the tasks. China will continue to provide necessary medical care materials and do a good job in local training for prevention and curing Ebola virus. China will actively support the work of the UN, WHO and the African Union and provide necessary financial supports to the above organizations.

2. Support the post-Ebola economic and social reconstruction of the countries in the epidemic area, and bolster the economic recovery and social development of the countries. According to the requirements of the three countries for economic and social reconstruction, China will attach importance to the assistance projects relating to people’s livelihood, capacity building and infrastructure, which will be implemented gradually after the consultation with the countries.

3. Support Africa to build the public health system, and strengthen the ability and level of African countries to combat major epidemic disease. China will make full use of the current assistance material of medical care in Africa, combine the “hard input” of infrastructure construction and the “soft input” of talents training, and promote the implementation of the China-Africa cooperation plan on public health, in order to help Africa enhance the ability of public health and explore the building mode of public health system which works for the reality of Africa.

Since the West Africa was hit by Ebola in March 2014, China has provided 4 rounds of emergency humanitarian aid valued RMB750 million to African countries including Sierra Leone, Liberia and Guinea, which have been put into use timely. Together with the international community including the multilateral organizations like UN and WHO, China has made its contributions within its ability to combating Ebola, and has gained wide acclaim and high evaluation from African countries and the international community. The assistances fully reflected the sincerity, affinity and good faith of China’s cooperation concept with Africa,. At present, through the joint effort of the countries in the epidemic area and the international community, Ebola combating in the world has gained important achievements. The countries have stepped into a new stage of post-Ebola reconstruction.

I. Introduction

1. The present report is submitted pursuant to Security Council resolution 2056 (2012), in which the Council requested me to develop and implement a United Nations integrated strategy for the Sahel region. It is also submitted pursuant to the presidential statement of the Security Council dated 27 August 2014 (S/PRST/2014/17), in which the Council requested me to inform it of the progress towards the implementation of the United Nations Integrated Strategy for the Sahel through an oral briefing by 15 December 2014 and through a report and a briefing no later than 30 November 2015.

2. The present report summarizes the major developments in the Sahel region from 1 June 2014 to 30 October 2015 and provides an update on the status of implementation of the Integrated Strategy. It also provides information on efforts undertaken to strengthen regional ownership and consolidate partnership, as well as regional and international coordination initiatives and efforts undertaken to mobilize financial resources for the implementation of the Integrated Strategy. It builds on the analysis included in the oral briefing by my Special Envoy for the Sahel to the Security Council on 11 December 2014 (see S/PV.7335).

I. Introduction

1. Le présent rapport est soumis en application de la résolution 2056 (2012), dans laquelle le Conseil de sécurité m’a prié d’arrêter et de mettre en œuvre une stratégie intégrée de l’ONU pour la région du Sahel. Il est également soumis en réponse à la déclaration du Président du Conseil de sécurité datée du 27 août 2014 (S/PRST/2014/17), dans laquelle le Conseil m’a prié de le tenir informé de l’état d’avancement de la mise en œuvre de la Stratégie intégrée des Nations Unies pour le Sahel par la voie d’un exposé oral d’ici au 15 décembre 2014, et par la présentation d’un rapport et d’un exposé le 30 novembre 2015 au plus tard.

2. Le présent rapport rend compte des faits marquants intervenus dans la région du Sahel entre le 1er juin 2014 et le 30 octobre 2015 et de l’état d’avancement de la mise en œuvre de la Stratégie intégrée. Il renseigne également sur les efforts déployés en vue de renforcer l’appropriation régionale et de consolider les partenariats, ainsi que les initiatives de coordination régionale et internationale et l’action menée pour mobiliser des ressources financières aux fins de la mise en œuvre de la Stratégie intégrée. Il se fonde sur l’analyse contenue dans l’exposé oral que mon Envoyée spéciale pour le Sahel a fait au Conseil le 11 décembre 2014 (voir S/PV.7335).

By State House Communication Unit

As government continues to show commitment towards the relocation of flood victims, President Ernest Bai Koroma Friday 13 November completed a conducted tour to the temporary housing construction site for the affected families at Mile 6 Village on the outskirts of Freetown.

The president also made on the spot visit at the Freetown Central Lorry Park and the Hastings Airport. His visit at Mile 6 was in sync with government’s aspirations to provide a safe living environment for the September 16 flood victims in Freetown.

Briefing the president, Coordinator of the Office of National Security (ONS) Mr. Ismael Tarawally said a total of 1,209 flood affected families have so far been registered, clarifying that 108 families will be relocated to Mile 6. He said at the moment, 98% of the affected families have already been relocated. The security chief went on to state that for those families who have preferred to stay with their families will be given rent subsidy of Four Hundred Thousand Leones with a monthly package while those that will be relocated at Mile 6 would be given two months packages because of the new environment.

“All the families that will be relocated will receive packages and for those families that will be relocated at Mile 6 will receive two months packages,” the security chief explained.

In another development, President Koroma also visited the Hastings Airport in follow up on the issue of assigning land for the ministries of Health and Sanitation and Social Welfare, Gender and Children’s Affairs. The president stated that his visit was to help make an informed decision and to determine whether to continue with the operations of the airport and the two ministries altogether. He said in the fullness of time, he will visit the Sierra Leone Airport Authority to inspect ongoing rehabilitation of facilities at the Hastings Airport.

President Koroma also visited Clay Factory at the Freetown Central Lorry Park where he inspected facilities around the park.

INTRODUCTION

The scale of the Ebola crisis in West Africa in 2014 and 2015 challenged the national governments and international development and humanitarian agencies on multiple levels. It reverberated around the world, caused huge suffering for those affected, gripped the media and ultimately forced us all to examine how we responded, what we did well, and how we can do better.

Concern Worldwide, an Irish humanitarian international non-governmental organisation (INGO), has been at the forefront of the response to the Ebola outbreak in Sierra Leone and Liberia during 2014 and 2015. In this paper, we reflect on how politics affected our response as a medium-sized INGO and the national and international response.

We examine primarily politics with a small ‘p’, which is about people on the ground trying to do the best they can in a difficult situation and the challenges and obstacles that impede their progress.
We also touch on the big ‘P’ politics where the national and international governments and multilateral institutions are all thrown together with a common goal but often different and competing agendas where an initial lack of leadership and decisiveness transformed into a situation with arguably too many leaders.

WASHINGTON, D.C., Nov. 17, 2015 – The U.S. Government’s Millennium Challenge Corporation (MCC) and the Republic of Sierra Leone today signed a new $44 million partnership agreement at the Sierra Leone State House. MCC Vice President of Policy and Evaluation Beth Tritter joined U.S. Ambassador John Hoover, Chief of Staff to the President of Sierra Leone Mr. Saidu Conton Sesay, and Sierra Leone Minister of Finance and Economic Development Kaifala Marah.

The $44.4 million grant – known as an MCC Threshold Program – will support policy reforms, build institutional capacity, and improve governance in the water and electricity sectors, with a focus on Freetown. The program aims to create a foundation for the delivery of financially sustainable water and electricity services while limiting opportunities for corruption by establishing independent regulation, strengthening key institutions and increasing transparency and accountability.

“For many years, our governments have worked together to promote peace, security and democracy in Sierra Leone,” Tritter said. “Today, we celebrate another step forward, a new partnership that will lay the groundwork for sustainable economic growth at a critical moment in Sierra Leone’s history.”

The partnership comes as the country emerges from the devastating Ebola outbreak and complements the U.S. Government’s recovery efforts. It also represents MCC’s latest contribution to Power Africa, following recent investments in Liberia and Benin. MCC’s Threshold Programs assist countries to become eligible for MCC’s larger grants – known as compacts – by supporting targeted policy and institutional reforms.

Sierra Leone’s Threshold Program focuses on three key components: A Regulatory Strengthening Project that will build capacity at the newly formed Electricity and Water Regulatory Commission; a Water Sector Reform Project that aims to improve overall sector governance, performance, and accountability by building capacity at the Freetown water utility; and an Electricity Sector Reform Project that will help the Government of Sierra Leone operationalize a new framework and market structure for the country’s electricity sector. The program was approved by MCC’s Board of Directors at its quarterly meeting in September.

Read MCC’s Sierra Leone Threshold Program Fact Sheet to learn more.

The Millennium Challenge Corporation is an innovative and independent U.S. Government agency working to reduce global poverty through economic growth. Created by the U.S. Congress in January 2004, with strong bipartisan support, MCC provides time-limited grants and assistance to countries that demonstrate a commitment to good governance, investments in people and economic freedom. Learn more about MCC at www.mcc.gov.

Summary:

• March-April 2014: Ebola outbreak first detected in Guinea; National Ebola Task Force established in Sierra Leone

• May 2014: First Ebola case reported in Sierra Leone near the border with Guinea, with rapid caseload spread as a result of the movement of health care workers.

• June 2014: IFRC Field Assessment and Coordination team (FACT) deployed (rapid assessment);
  Emergency Appeal launched for CHF 880,000.

• July 2014: IFRC Appeal revision n° 1 issued for CHF 1.36m; Emergency Response Units deployed to establish the Ebola Treatment Centre in Kenema with extraordinary DREF allocation of CHF 1m.

• September-October 2014: with confirmed caseload spiraling out of control and twelve out of thirteen districts affected; IFRC issues Appeal revision n° 2 for CHF 12.85m, followed by revision n° 3 for CHF 41.1m.

• March 2015: Appeal revision n° 4 for CHF 56.8m.

• June 2015: Appeal revision n° 5 for CHF 94M to extend from emergency to recovery phase

• November 2015: The Government of Sierra Leone declared that the Ebola outbreak is over.

SECTOR OVERVIEW

Populations affected by natural disasters and complex emergencies experience diverse public health challenges, often complicated by displacement and the disruption of basic services. USAID’s Office of U.S. Foreign Disaster Assistance (USAID/OFDA) remains at the forefront of the humanitarian community’s efforts to mitigate mortality and morbidity during crises by supporting a wide range of health interventions. USAID/OFDA-supported initiatives include life-saving medical assistance, immunization campaigns, disease surveillance systems, vector-control activities, and capacity-building trainings for local health workers. Recognizing the inextricable link between health and other core humanitarian sectors, particularly nutrition and water, sanitation, and hygiene, USAID/OFDA supports integrated programs that simultaneously address multiple determinants of health in emergencies, such as access to health facilities, food security, and the availability of safe drinking water. In Fiscal Year (FY) 2015, USAID/OFDA provided nearly $704 million to mitigate and prevent adverse effects of natural and man-made crises on the health of affected populations. Assistance included nearly $700 million for health interventions in more than 20 countries and approximately $3.7 million for global and regional health initiatives.