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- 05/12/16--10:16: _World: Libérer le p...
- 05/12/16--12:35: _Sierra Leone: Ebola...
- 05/12/16--15:48: _World: Post-war rec...
- 05/13/16--03:52: _World: Political dy...
- 05/13/16--07:59: _Liberia: UNHCR Libe...
- 05/13/16--11:02: _World: Communicable...
- 05/13/16--12:07: _Sierra Leone: Water...
- 05/14/16--01:41: _World: Food Assista...
- 05/14/16--17:00: _Kenya: Kenya: Kakum...
- 05/16/16--06:29: _Guinea: OIM Guinée ...
- 05/16/16--06:42: _Guinea: IOM Guinea ...
- 05/17/16--07:10: _World: Will they, w...
- 05/17/16--19:57: _Sierra Leone: As Eb...
- 05/18/16--06:14: _Sierra Leone: Savin...
- 05/19/16--00:38: _Sierra Leone: Disas...
- 05/19/16--06:07: _Guinea: WHO Ebola S...
- 05/20/16--06:17: _World: Delivering C...
- 05/20/16--06:19: _World: Delivering C...
- 05/20/16--11:35: _World: Communicable...
- 05/21/16--19:02: _World: First-ever i...
- 05/13/16--03:52: World: Political dynamics and the effectiveness of aid programmes
There are a number of aggregated studies which identify political economy variables as key to explaining the effectiveness of aid programmes. These factors include the degree of political stability and cohesion in recipient countries, the presence of sound fiscal policies and institutions, and the strength of interest groups within parliament.
There is also a growing appreciation in academic and grey literature of the importance of political factors in accounting for the effectiveness of aid programmes in individual cases. There has been a tendency in this literature to focus on agential factors and in particular the role of elites engaging in corruption, clientelism and rent-seeking.
Aid projects can also be undermined by a lack of ownership on the part of recipient governments or the wider public, and through a failure on the part of donors to establish effective partnerships with local reformers.
Donors need to be alert to windows of opportunity to push through reforms. Notwithstanding the importance for donors of moving quickly enough to keep abreast of country-level political developments in recipient countries, micro-level features of the public administration can also frustrate the implementation of development projects.
- 05/13/16--07:59: Liberia: UNHCR Liberia Factsheet - March - April 2016
- 15,418 Ivorian refugees repatriated since 18 December 2015
- 2,646 Bales of clothing donated by UNIQLO to refugees in Liberia
- 1,763 Refugee children benefit from national polio immunization campaign 1973
- Alien and Nationality Law is being revised to prevent statelessness
- 05/13/16--11:02: World: Communicable disease threats report, 8-14 May 2016, week 19
- 05/13/16--12:07: Sierra Leone: Water crisis hits Sierra Leone capital
- 05/14/16--01:41: World: Food Assistance Outlook Brief, May 2016
Le 16 avril, l’OIM a pris part à la cérémonie officielle de fin du micro-cerclage de Koropara, en Guinée forestière, où étaient apparus les derniers cas d’Ebola en Guinée. Une délégation composée du Ministre de la Santé, M. Abdourahmane Diallo, du Coordinateur National, Dr Sakoba, de l’Ambassadeur de l’Union Européenne, M. Gielen, du Représentant du Chef de mission de l’OIM Guinée, Dr Blaise Bathondoli, et d’autres partenaires de la Riposte, avait fait le déplacement depuis Conakry.
Les 13, 14 et 15 avril, l’OIM Guinée a reçu la visite officielle de M. Charles Kwenin, Conseiller Afrique du Directeur Général de l’OIM. Durant son séjour, M. Kwenin, accompagné du Chef de mission, M. Amihere Kabla, s’est entretenu avec l’Ambassadeur des Etats-Unis, Son Excellence, M. Dennis Hankins, et le Point Focal des Nations Unies pour la Riposte Ebola. Il s’est également rendu à l’Ambassade du Japon, au Ministère des Affaires Etrangères et au Ministère de la Jeunesse pour promouvoir les activités de l’OIM. Le 9 Mars 2016, l’OIM a organisé une cérémonie au cours de laquelle elle a officiellement remis le Poste de Santé de Kamakouloun rénové et équipé par ses soins aux autorités de la Sous-Préfecture de Kamsar, Préfecture de Boké.
Le 18 avril, l’OIM, en coopération avec la George Washington University et CDC, a entamé une session de formation en Gestion d’urgences sanitaires des cadres de santé préfectoraux de la région de Mamou.
On April 16, IOM participated in the official closing ceremony marking the end of the micro-quarantine at Koropara, in the Forest Guinea, where the latest EVD cases in the country resurfaced in mid-March 2016. The Minister of health, Dr. Abdourahmane Diallo, the National Coordinator, Dr. Sakoba Keita, the EU Ambassador, Mr. Gielen, the IOM Chief of Mission Representative, Dr. Blaise Bathondoli, participated in the ceremony.
On April 13, 14, and 15, Mr. Charles Kwenin, IOM’s Senior Regional Adviser for Sub-Saharan Africa based in Geneva paid a working visit to IOM Guinea. During his stay, Mr Kwenin, accompanied by the Chief of Mission, Mr. Amihere Kabla and other IOM Guinea officials, paid a courtesy visit to the US Ambassador, Mr. Dennis Hankins and the UN Focal Point for the Ebola Response, Mr. Mark Wajnstok.
On April 18, in collaboration with the George Washington University and CDC, IOM began a training session on Health Emergency Management for prefectural health officials in the region of Mamou.
- 05/19/16--06:07: Guinea: WHO Ebola Situation Report - 19 May 2016
The Public Health Emergency of International Concern (PHEIC) related to Ebola in West Africa was lifted on 29 March 2016. A total of 28 616 confirmed, probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11 310 deaths.
In the latest cluster, seven confirmed and three probable cases of Ebola virus disease (EVD) were reported between 17 March and 6 April from the prefectures of N’Zerekore (nine cases) and Macenta (one case) in south-eastern Guinea. In addition, having travelled to Monrovia, Liberia, the wife and two children of the Macenta case were confirmed as Ebola cases between 1 and 5 April.
The index case of this cluster (a 37-year-old female from Koropara sub-prefecture in N’Zerekore) had symptom onset on or around 15 February and died on 27 February without a confirmed diagnosis. The source of her infection is likely to have been due to exposure to infected body fluid from an Ebola survivor.
In Guinea, the last case tested negative for Ebola virus for the second time on 19 April. In Liberia, the last case tested negative for the second time on 28 April.
The 42-day (two incubation periods) countdown must elapse before the outbreak can be declared over in Guinea and Liberia. This is due to end on 31 May in Guinea and on 9 June in Liberia.
Having contained the last Ebola virus outbreak in March 2016, Sierra Leone has maintained heightened surveillance with testing of all reported deaths and prompt investigation and testing of all suspected cases. The testing policy will be reviewed on the 30 June.
- 05/20/16--11:35: World: Communicable disease threats report, 15-21 May 2016, week 20
- It will insure the world’s poorest countries against the threat of a pandemic.
- In the event of a severe infectious disease outbreak, it will release funds quickly to the countries and/or to international responders, to accelerate the response—saving lives and reducing human suffering.
- By mobilizing an earlier, faster, better planned and coordinated response, it will reduce the costs to countries and their people for response and recovery.
- It will promote greater global and national investments in preparing for future outbreaks and strengthening national health systems.
- It will combine public and private resources to advance global health security, and create a new insurance market for managing pandemic risk.
Mercredi 10 – vendredi 12 février 2016 | WP1447
La pandémie de type Ebola qui a sévi en 2014-16 a mis en évidence le rôle crucial que jouent les agents de santé communautaires (ASC) dans la prévention et la réaction aux états d’urgence sanitaires et aussi à l’efficacité de leur prise en charge.
Alors que la région d’Afrique occidentale reconstruit ses systèmes de santé après Ebola, certains pays et communautés ont identifié le besoin de mettre au point des stratégies et des plans en vue d’intégrer le rôle des agents de santé communautaires (ASC) et en faire un système de services médicaux efficace.
Tout porte à croire que les agents de santé communautaires exercent une grande influence sur les résultats sanitaires de leurs communautés. Les investissements en matière d’agents de santé communautaires sont bien justifiés, mais il reste à résoudre la question de savoir comment trouver les ressources pour ces investissements. Les défis réels et pratiques que présentent la construction et le soutien d’un groupe robuste de travailleurs de santé communautaires sont toujours présents – et ces défis existaient avant le virus Ebola; or, très souvent, ils se sont multipliés.
Les systèmes sanitaires qui se remettent après l’impact de l’Ebola disposent de ressources limitées et de travailleurs en nombre réduit. Très souvent, les ressources nationales et internationales se limitent à des maladies particulières, et passer des contraintes d’intervention dans le cadre de projets verticaux à des programmes horizontaux ne se fait pas facilement. Les gouvernements, les donateurs et les organisations non-gouvernementales (ONG) s’efforcent de collaborer et d’adopter des moyens d’aborder l’ensemble du système, mais il faut pour cela énormément de compétences, d’efforts et de compromis. La direction des gouvernements au niveau national n’a jamais été plus importante. La façon dont chaque partie prenante soutient les agents sanitaires exige de nouveaux modes de réflexion et de nouvelles solutions. Ceci implique de réfléchir de manière systématique à ce qui motive et encourge l’agent sanitaire en tant que professionnel et en tant qu'’individu.
Compte tenu de cela, la réunion ayant pour thème “ La libération du potentiel des agents de santé communautaires suite à Ebola: quels sont les modèles et les stratégies qui vont s’avérer efficaces ?” avait pour objectif de mettre au point des solutions claires pour les pays affectés par Ebola en développant un groupe robuste de travailleurs communautaires qui se partagerait les leçons tirées des pays possédant des systèmes de santé communautaires; et qui harmoniserait les besoins des pays affectés par Ebola avec les efforts mondiaux déployés en vue de développer et de soutenir les programmes des ASC dans un ensemble complexe d‘environnements liés entre eux.
La réunion fait suite à la réunion sur les systèmes d’information sanitaires (SIS) organisée par l’Organisation ouest-africaine de la santé, qui s’est tenue en mai 2015 au Ghanai ; aussi bien que la réunion ‘Dans la (Re)construction des systèmes sanitaires en Afrique de l’ouest quel est le rôle des technologies de l’information et de la communication et des technologies mobiles?’ tenue à Wilton Park en juin 2015.ii Il est ressorti de cette réunion l’importance d'un vrai leadership de la part du gouvernement; le besoin de concevoir la technologie et les programmes axé sur l’utilisateur; le besoin d’assurer la formation de haut niveau pour les agents sanitaires; les mesures d’incitation alignées sur les besoins et les performances; et le rôle essentiel de la collaboration, surtout avec le secteur privé.
Cette conférence – qui réunissait une fois de plus les dirigeants des secteurs public et privé – cherchait particulièrement à favoriser une meilleure coordination; à développer une volonté trans-sectorielle de changement de paradigme; à établir des liens entre les communautés technologiques et ceux qui sont appelés à gérer ces systèmes au quotidien; et à placer l’agent sanitaire au centre de toutes les préoccupations de la partie prenante.
“ La phase critique d’Ebola est peut être résolue mais il existe encore un état d’urgence et de crise”
By Jennifer O'Mahony (Agence France-Press)
Dizzy and sweating, 15-year-old Isatu Koroma sits with her eyes closed in the maternity ward in Sierra Leone where she has spent the last 10 days, as her tiny little daughter begins to cry.
Koroma badly needs blood after a complicated delivery - relatives are expected to donate here but none has visited, also leaving the nurses to pay for her to eat.
Health workers in the west African country are battling a teenage pregnancy epidemic that peaked when the Ebola crisis was at its height late in 2014. They say it shows no sign of slowing.
Ward sister Josephine Samba describes the girl's pregnancy as "an accident", whispering that Koroma's own mother died two months after she was born as she cajoles her into breastfeeding the as yet unnamed baby.
Schoolgirls are so regularly admitted to Princess Christian Maternity Hospital (PCMH) in Freetown that they attract little attention.
Coyness about discussing sex in Sierra Leone veils the fact that during the chaos of the Ebola crisis many teenagers were raped or forced to have sex for money to contribute to household expenses, according to research by several children's charities and United Nations agencies.
"There were a lot more (teen pregnancies) during the Ebola breakout. Most of them were at home. There was no school, so everything was just upside down," Samba says.
After Sierra Leone announced its first Ebola cases in May 2014, schools were closed and movement severely restricted, leaving girls more vulnerable to abuse.
Since then the UN Population Fund (UNFPA) has counted more than 18,000 teenage pregnancies, with the number of pregnant girls up by 65% in certain districts.
Internationally recognised as the country with the world's highest maternal mortality rate, at 1360 deaths per 100,000 live births, Sierra Leone could ill afford the blow to its health system that Ebola dealt, diverting resources and staff away from maternal health.
The result is thousands of girls who will never live to become women, as UNFPA estimates that 40% of all maternal deaths occur among those under 18.
A lack of birth control and conservative abortion laws mean that many girls, upon realising they are pregnant and fearing they will be forced to drop out of school, attempt to abort with drugs or seek out backstreet providers who employ methods such as bicycle spokes to terminate pregnancies.
Louise Nordstrom, a Swedish midwife working on a UNFPA training programme for birth attendants at the hospital, described a recent, typical case of a young student who arrived at PCMH with severe stomach pains.
"You could see she was in agony. I asked her if she knew she was pregnant," Nordstrom said, keeping one eye on a screaming woman waiting to be taken to theatre for an emergency caesarian section.
"Soon after she went to pee in a bed pan and out came the dead foetus. It was very obvious she had been taking some drugs at home; she knew she was pregnant; she was afraid and didn't want to have the baby so she induced an abortion herself."
Many girls wait until it's far too late before seeking hospital care, says Alimamy Philip Koroma (no relation to the teenage mother), one of Sierra Leone's pre-eminent obstetric and gynaecology specialists.
"Some of them don't even come to the antenatal clinic, they stay at home because of fear of their (school) colleagues seeing them," he told AFP.
"Sometimes their pelvis is not prepared enough to have a child," he said, also referring to haemorrhage and septicaemia as particular risks for girls arriving after attempting unsafe abortions.
In this difficult context, Mohammed El Hassein, reproductive health specialist at UNFPA, said the three priorities were to improve progress in the uptake of family planning, bolster the image of midwives and ensure access to emergency obstetric care.
But the problem is particularly entrenched among young people.
"We are trying to train the (contraception) providers to be youth-friendly," he told AFP.
And for those who survive childbirth, life choices are restricted.
The government has only recently allowed school-aged mothers to go back to class and many of those who do lack the support they need.
"Before the reopening of school the child was very small and on breast milk. There was no one to take care of her except me," said Neima Foday, 19, speaking to AFP in the town of Kailahun with 13-month-old baby Ishmail on her knee.
"I'm a bit worried because my friends are attending school and I'm not," she said, adding that without an education she knew money would always be a problem.
Asked if Ishmail's father was contributing to his son's upkeep, Foday shook her head.
"I haven't seen him since I told him I was pregnant," she said.
© 1994-2016 Agence France-Presse
by Magdalena Mis, Thomson Reuters Foundation
Thursday, 12 May 2016 18:00 GMT
LONDON, May 12 (Thomson Reuters Foundation) - Reconciliation programmes to bring together communities divided by conflict can re-open old wounds and deepen problems such as depression and trauma by reviving war memories, researchers said on Thursday.
Read the story on the Thomson Reuters Foundation
What evidence is there that local political dynamics are explanatory factors for the success or failure of aid programmes? Provide examples, drawing on aggregated analyses of aid projects, where available.
There is an increasing recognition amongst development scholars and practitioners that the obstacles to effective change in developing countries are not only related to technical or financial issues, but are also bound with domestic politics and power relationships (DfID 2010a; DfID 2010b; Di John and Putzel, 2009; Leftwich: 2011; Parks and Cole, 2010; DFID 2016). As a result of the growing appreciation of the political barriers to development, donors and research organisations have developed a range of analytical frameworks and diagnostic tools to help navigate the political and economic conditions which can restrict the effectiveness of aid programmes.
Key findings include:
Population of concern
A total of 22,745 Persons of Concern
USD 23,860,907 requested
As the United Nations Mission in Liberia pursues the scheduled drawdown of its security forces by June 2016, Liberians are concerned about security. This especially whether Liberian security forces are adequately prepared and equipped to assume full the security of the State after the departure of UN peacekeepers. The issue has resulted in peaceful demonstrations requesting UNMIL to suspend its drawdown until after the elections take place in October 2017.
The 2015 Liberia Country Report on Human Rights Practices was released by the Bureau of Democracy, Human Rights and Labor, of the U.S. Department of State, in which Liberia was criticized over various governance and human rights abuses including corruption, deficiencies in governance, violence against women, police abuse, harassment and intimidation of detainees; arbitrary arrest and detention; sexual abuse and domestic violence, human trafficking; racial and ethnic discrimination; discrimination against lesbian, gay, bisexual, transgender and intersex (LGBTI) persons; mob violence; and child labor.
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 8-14 May 2016 and includes updates on Zika virus, Ebola virus disease, and yellow fever in Angola.
Freetown, Sierra Leone | AFP | Friday 5/13/2016 - 18:41 GMT
Sierra Leone's capital is in the grip of a fortnight-long drought that has forced residents to spend hours searching for water, often risking their lives by drinking contaminated supplies.
Activists have warned that schoolchildren are having to spend entire nights looking for water, with no end in sight for the crisis.
"The water crisis is worsening by the hour," Sao Lamin, chairman of Consortium of Civil Societies for Safe and Available Drinking Water told AFP on Friday in Freetown.
"We have put out monitoring teams throughout the city on a nightly basis to assess the extent of the crisis and have found out that many people, including schoolgirls, are not sleeping in their houses as they go in search of water from midnight to daybreak," he said.
One water company that typically provides 20,000 litres (4,400 gallons) of water to the capital every day blamed environmental problems and years of bills left unpaid by customers.
"We can link the current scarcity to delayed rainfall as well as massive deforestation and people constructing houses adjacent to the water catchment sites," said Joseph Musa, a spokesman for the Guma Valley Water Company.
"Millions of dollars covering over a decade or more are owed to the company," he said.
The government has called for calm and promised to do more to help, saying it was "disturbed" by reports of girls forced to roam the streets at night in search for water.
"The government is trying all possible means to alleviate the situation and has located 10,000-litre water tanks in strategic parts of the city to supply water to consumers," Information and Communications Minister Mohamed Bangura said this week.
"We are not making excuses but take full responsibility for what is happening," he added, saying the emergency distribution programme would continue for the next month.
The effects of the shortage may be severe in a country where deaths from waterborne diseases are common.
Local media have reported that dozens of water wells have already dried up in the western and eastern parts of the city, while an AFP journalist on Friday saw young women filling giant containers with water from a stagnant stream.
Bottled water manufacturers have cashed in on the crisis, reportedly doubling their prices to the equivalent of $1 (89 euro cents) per bottle in a country where the majority live on less than a dollar a day.
"It has never been like this," said Pastor Sammy Williams of the Life Brethren Church, who said he was praying for divine intervention as he gazed at the city's hilltop houses with dusty roofs scattered amongst parched brown trees.
© 1994-2016 Agence France-Presse
PROJECTED FOOD ASSISTANCE NEEDS FOR NOVEMBER 2016
This brief summarizes FEWS NET’s most forward-looking analysis of projected emergency food assistance needs in FEWS NET coverage countries. The projected size of each country’s acutely food insecure population is compared to last year and the recent five-year average. Countries where external emergency food assistance needs are anticipated are identified. Projected lean season months highlighted in red indicate either an early start or an extension to the typical lean season. Additional information is provided for countries with large food insecure populations, an expectation of high severity, or where other key issues warrant additional discussion.
Situation of the Ebola Virus Disease after its resurgence in Guinea
Following the Ebola Virus Disease resurgence at Koropara, in the prefecture of N’Zerekore, Forest Guinea on last March 17, the Guinean Government and the National Coordination of the fight against Ebola decided to quarantine the subprefecture through a micro-quarantine in order to contain the spread, identify contacts and search for new cases during twenty one days. IOM, through its sub-office in N’Zerekore deployed over twenty one agents and recruited about twenty local volunteers to take part in the micro-quarantine by ensuring health screening at entry and exit points of the village and by intervening along with other partners near households to detect symptoms appearance and sensitize inhabitants on good hygiene practices. During that period, 7 cases were confirmed and 1072 contacts were monitored.
On April 16, Koropara was declared “Ebola free” during an official ceremony led by the Guinean Minister of health, Mr. Abdourahmane Diallo.
According to the WHO situation report dated April 20, Guinea registered 3 814 cumulated, confirmed, probable and suspected Ebola Virus cases including 2 544 deaths, that is a 66.7% of death rate.
May 17 2016: Peace Direct's Local Peacebuilding Experts come together to discuss key issues in a new series of reports. In the first edition, they look at the phenomenon of 'third term' presidents in Africa.
Today we launch a new series of reports from Peace Direct’s Local Peacebuilding Experts. Focusing on five different countries around Africa, the first edition discusses what happens when presidents and prime ministers outstay their welcome.
In **DR Congo**, Maguy Libebele says, Joseph Kabila is making people nervous. He needs to make a clear statement of intent on when the next elections will take place, and if he will stand. The same uncertainty is making for a lively debate in **Sierra Leone**, according to Abdul Brima, while in **Burkina Faso**, Boris Somé discusses the key role civil society organisations played in overseeing a transitional government – but the risk that they might overstep the mark. In **Chad**, Bouyo Séverin speaks to campaigners about how Idriss Déby has managed to stay in power for 25 years, while in **Burundi**, our anonymous Local Correspondent paints in vivid detail a picture of what can happen when things go wrong.
Emerging from Crisis, Preventing the Next One
By Melanie Mayhew, World Bank Group
Every day for 27 years, in the early morning blackness that only fishermen know, John* and his crew dislodged their boat from Sierra Leone’s shore and paddled north toward Guinea, returning at sunset with nets flopping with fish.
Today John stands in a few inches of water in the port of Aberdeen, Sierra Leone, gazing at the colorful boats skirting the horizon, wishing he could return to the sea. It’s been a year since he captained a boat, a year since he fished.
“I would love to go fish but I can’t because I don’t have a boat,” John, 43, says.
John is landlocked by Ebola.
John doesn’t have a boat because the boats won’t hire an Ebola survivor—they’re afraid of contracting Ebola. Like the other former fisherman milling about the port, he is unemployed, unskilled to perform any job other than fishing. All are eager to work despite the blurry vision, body pain and headaches that they live with every day, reminders that they survived Ebola, but that Ebola never will go away for them.
The captains among them each made an average of $12 on a good fishing day. Now none of them can feed their families.
While much of the world has turned its attention away from Guinea, Liberia and Sierra Leone—which are just now emerging from the deadliest Ebola outbreak in history—the human and economic devastation endures. West Africa’s experience fighting Ebola is a lesson for the world, and for countries, as they prepare for the next pandemic.
With that lesson in mind, at the G7 later this month, world leaders will discuss a new mechanism, the Pandemic Emergency Financing Facility, which could help stop the next outbreak before it becomes the next Ebola crisis.
Rebuilding a life, block by block
Abdulai*, 34, sits in a flimsy plastic chair on the front porch of his home in Crab Town, Sierra Leone. He pushes his sunglasses to the top of his head so he can wipe tears from his eyes. Eight people in the house, including his parents, contracted Ebola. He was the only one to survive the disease.
Like John the fisherman, he was fired from his job when his boss learned that he was an Ebola survivor. He had a regular job in construction until late 2014, when he contracted Ebola. Now he lays concrete blocks, but the work is inconsistent. This week, he showed up for work five days, but was hired only one. He made $3 this week for a day’s work.
The family’s only other income is from his wife’s shop, which she runs from their home. She sells soap, cigarettes and garri. Sixteen cups of garri, a staple food that is made from cassava tubers, sells for about $4. The shop’s profits barely feed Abdulai, his wife and their children.
They haven’t paid rent in 18 months. They recently received a notice that they may be evicted from their home, which is made of concrete blocks, metal windows and doors, and a sturdy roof. If they’re evicted, they’ll move to a corrugated-metal shack with mud floors and no doors or windows. They say they’ll have to wash twice a night because of the heat. When the rains come, they’ll shiver when water streams through the roof and sides of the shack.
“We were not a wealthy family but we were coping,” Abdulai says. “Ebola was a setback for us.”
Stopping Ebola, and other diseases, at the source
The Ebola epidemic, which began in Guinea in December 2013, infected more than 28,000 people in Guinea, Liberia and Sierra Leone. It also rapidly exposed the paralyzing weaknesses in the countries’ health and public health systems.
Before Ebola, the countries were three of the poorest in the world, but had recently made significant health gains. However, when Ebola struck, the countries’ hospitals and clinics—overwhelmed by an influx of Ebola cases and the catastrophic loss of health workers to the disease— crumpled. Basic primary health care services, like maternal and child health care, were not available. A World Bank study found that the deaths of health workers may result in more than 4,000 deaths of women each yearacross the countries, as a result of complications in pregnancy and childbirth. These deaths are on top of the more than 11,000 people who died of Ebola.
The countries also had limited—and in some places, no—ability to detect and respond to infectious disease outbreaks as they spread in communities. Before Ebola, the country did not focus enough on disease surveillance and control, says Dr. Foday Daffae, the director for disease prevention and control for Sierra Leone.
If disease surveillance had been stronger, “we could have stopped Ebola,” Dr. Daffae says.
In addition to saving lives and building healthier communities, disease prevention and control efforts save the country money: Preventing diseases is much cheaper than caring for people when they get sick.
The Ebola crisis crippled the economies of Guinea, Liberia and Sierra Leone, costing them $2.8 billion in GDP losses, according to World Bank economists. Commodity prices collapsed; for example, the price of iron ore, which used to account for 60% of the Sierra Leone’s exports, crashed from $185/ton to $35/ton. Both of the country’s mines shut down and iron ore exports plummeted to zero. And donor funds, which helped the countries fight the Ebola crisis, now are drying up, leaving governments struggling to pay their bills and keep systems running.
Because of Ebola and its human and economic toll, countries like Sierra Leone are changing how they approach disease surveillance and control.
District surveillance officers now provide weekly and monthly reports on 47 diseases in communities, immediately reporting diseases like Ebola, Lassa Fever, Cholera and Measles. The country has focused on training health workers and surveillance officers, improving labs’ capacity to quickly test specimens, and collecting better data so they can analyze and address disease trends, Dr. Daffae says.
“This outbreak is over, but that doesn’t mean it won’t happen again,” says Dr. Daffae. “But we should detect it immediately and control it at the source the next time.”
The World Bank Group is working with nine countries in West Africa, including Guinea, Liberia and Sierra Leone, to improve surveillance and early reporting; strengthen laboratory capacity; bolster workforce training, deployment and retention; and enhance preparednes and rapid response. Because most contagious disease outbreaks cross borders, countries are working together to prevent and control diseases—no country can do this alone. This regional effort is part of the World Bank Group’s $1.62 billion commitment to help West Africa respond to and recover from Ebola.
In Liberia, the World Bank also is working with the Liberian government and many partners, including Gavi, the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and USAID, with resources from the International Development Association and the Global Financing Facility Trust Fund, to reconstruct and strengthen its health system to increase the use of services and enhance its resilience to shocks. The effort emphasizes emergency preparedness, surveillance and response, with a special focus on maternal and neonatal death surveillance and response.
Counting every death to save lives
It’s mid-morning in Sierra Leone, and someone has called 117, the country’s emergency hotline, to report a death in Kissy Public Works Development. The call is routed to the Western Area district surveillance team, which dispatches Tomeh Bangura, 53, a disease investigator, and Gibrilla Kabba, 29, a swabber—someone who collects laboratory specimens—to the home. The disease investigator asks the family for details of the death, while the swabber pulls on personal protective equipment, including a face mask, gloves and scrubs from head to toe. He enters the home with a test tube and swab in hand.
The baby’s father pulls the curtain aside and illuminates the room with his cell phone. The swabber bends to open and swab the three-day-old baby’s mouth. He places the swab inside of the test tube. Later, he’ll send the specimen to a lab.
Outside, the baby’s mother is crying on the porch. This is her first child. Family members and neighbors have started to gather to mourn the baby’s passing.
Although the swabber and disease investigator do not suspect Ebola or another infectious disease as the cause of death, the country’s new policy is to swab every person who dies, even if they die, for example, in a car accident.
If the swabber and disease investigator had suspected that the baby died of an infectious disease, they would have called an ambulance. The team follows the same procedure when they receive reports of diseases among the living: They send a swabber and disease investigator and request an ambulance if the case is serious or if an infectious disease is suspected. If Ebola is suspected, the person is sent to a holding center to await lab results.
Community-based surveillance guides also routinely check in on people in their communities, to ensure that all diseases and deaths are reported, which helps the district management teams collect and analyze data. Each team meets every day, Monday through Friday, to discuss these diseases and deaths, and where they need to deploy resources.
“If anything happens now we’ll be in a position to combat it,” says Tomeh, who has investigated more than 100 deaths since 2014.
These enhanced disease surveillance and control efforts have helped control recent flare-ups of Ebola in the countries. During a recent flare-up in Liberia, a case was suspected to be malaria until a lab test confirmed that it was Ebola. This allowed the district team to quickly contain and limit Ebola’s spread, ultimately saving lives, says Dr. Yatta Wapoe, the community health officer for Monserrado County.
“If we hadn’t had surveillance with the latest cases, it would have led to a huge outbreak,” she says.
Although the countries have made great strides, challenges remain. Some specimens can’t be tested at hospitals and clinics, even if they have a lab on-site. The labs lack functioning equipment, reagents and trained staff to run the labs and return timely results. C.H. Rennie Hospital in Liberia’s Margibi County—one of the counties hardest hit by the Ebola crisis—sees 100 patients a day, but there is only one functioning microscope. It can take 24-28 hours to get a lab result for deadly diseases like malaria.
Each country has just a few referral labs to test for Ebola, Lassa Fever, Measles, Rabies and Meningitis, but results are often delayed. However, there are signs of progress: In 2014, it took a week to get a result on an Ebola test, Dr. Wapoe says; now that test takes 24 hours. The previous weeklong delay thwarted health officials’ ability to prevent the spread of the disease.
“We were sitting on a time bomb,” Dr. Wapoe says.
Stopping diseases at the door
At C.H. Rennie Hospital in Margibi County, Liberia, construction workers sand and paint, in white and blue hues, cinder block walls. Days later, the hospital’s new triage unit will open, with sparkling white tile floors, two screening desks and a multi-bed isolation unit.
The new triage unit is meters from a memorial to the 14 health workers C.H. Rennie lost during the Ebola crisis.
During Ebola, infectious patients walked through the gates of the hospital with little or no screening. There was no area to keep them from infecting other patients, visitors and health workers. With the new triage unit, the hospital can immediately screen for infectious disease cases and then isolate people who may be contagious, ultimately delivering care more quickly to those who are infected, and decreasing the chance that they’ll infect others.
The triage unit is one of 27 that the United Nations Office for Project Service, with funding from the World Bank Group, is building in health facilities across Liberia.
Beyond these new triage units, health care workers are doing what they can to prevent the spread of disease, applying some of the infection prevention control measures they practiced at the height of the Ebola crisis, like wearing personal protective equipment and gloves, washing their hands and using hand sanitizer, and spacing hospital beds three feet apart to prevent the spread of disease.
Jackie*, a 41-year-old nurse midwife at Monserrado County’s Redemption Hospital, one of the busiest health facilities in the country, rolls an ultrasound cart through the hospital’s busy delivery ward, where five women are moaning as they wait to deliver their babies. After each ultrasound, she pulls sanitizer out of her pink fanny pack and squirts her hands.
Jackie has been working at Redemption Hospital for 25 years, first as a registrant, then as a nurse’s aide and now as a nurse midwife. She’s been delivering babies since eighth grade, when her midwife mother began training her.
“I love being a midwife,” she says. “I see the joy in the woman coming through labor and taking her baby home.”
Her job almost killed her. During the height of the Ebola crisis, Redemption Hospital was in the epidemic’s crosshairs. In September 2014 she was alone in the delivery ward, while other health workers stayed away, fearful of contracting Ebola.
A patient started bleeding. She didn’t stop until she was dead. The woman and two other patients died the next day of Ebola, and soon, Jackie learned that she had contracted Ebola from her patients. She was admitted to an Ebola treatment unit, and returned to work a few weeks later.
Although Jackie cheerfully says today that she no longer faces much stigma as an Ebola survivor, many are still struggling, like Lena*, 40, of Monrovia, Liberia. Despite great improvements in her life in the last year—she got married, was able to stay in her home despite a landlord threatening to evict her and is back in school—when she went to the hospital recently and disclosed that she was an Ebola survivor, the health workers refused to treat her.
“When you go to the hospital and they know you’re a survivor, no one is willing to touch you,” she says. Lena asked for water to brush her teeth and was given a bedpan filled with water.
Preparing for the next time
Everything Guinea, Liberia and Sierra Leone are doing to prevent the next outbreak is critical—however, infectious disease outbreaks are inevitable and can quickly overwhelm any health system, especially in the world’s most vulnerable countries.
The world sometimes comes to countries’ assistance only when a major outbreak, like the recent Ebola crisis, hits an explosive point. Without a strong system in place, the world will continue to move from crisis to crisis, killing thousands and destabilizing economies.
To respond to this, at the G7 later this month, leaders will discuss the Pandemic Emergency Financing Facility, a fast-disbursing financial mechanism that will make significant funds available the next time an epidemic hits. By stemming an outbreak before it reaches pandemic proportions, it could help save thousands of lives and keep the cost of outbreaks to millions, instead of billions or trillions, of dollars.
If Ebola had been stopped earlier, people like Umaru*, 39, who contracted Ebola in February 2015—14 months after the outbreak began—would still be fishing the seas of Sierra Leone.
“Things are pretty tough,” he says, “but I’m hopeful things will turn around. I’m a young man with a long life.”
*Ebola survivors have been identified only by their first names.
At the height of the Ebola crisis, Sierra Leone turned to mobile wallets to make fast, accurate, and secure payments to Response Workers. Before digitization, cash payments were slow, inaccurate, and open to graft and theft.
Digitization cut payment times from over one month to around one week, putting an end to payment-related strikes. In doing so, digital payments strengthened Sierra Leone’s capacity to contain the Ebola disease, treat those infected, and ultimately save lives.
In the process, digitizing payments also delivered cost savings of more than US$10 million by eliminating double-payment, reducing fraud, removing the costs of physical cash transportation and security, and cutting travel costs for Response Workers.
This case study sets out key lessons from Sierra Leone’s experience using digital payments to help combat Ebola. In particular, with health epidemics, natural disasters, and conflicts on the rise, governments need to take early action, in partnership with the humanitarian and development community and the private sector. Specifically, this case study shows how putting in place critical infrastructure and public education before a crisis hits can have a major impact in saving money, and more importantly, saving lives.
The Office of the National Security (ONS), in collaboration with all 14 District Councils, has completed training of three hundred and fifty five (355) members of District Disaster Management Committees (DDMCs) in Port Loko recently.
With support from the United Nations Development Programme (UNDP), the training workshops and consultations led to the re-activation and in some cases formation of DDMCs in all 14 districts. The Committees inter alia, are responsible for identifying, preventing and mitigating local disasters. The DDMCs will also engage in communicating risks of disasters at the national level.
In 2013, UNDP supported the Disaster Management Department (DMD) - the national body within the ONS that is charged with disaster preparedness and response – in collaborated with the Sierra Leone Police, National Fire Force, Ministry of Health and Sanitation, Sierra Leone Red Cross and others to provide training for DDMCs in 11 districts.
Western Area Rural District as part of the process of enhancing local level response to disasters. The training also took into account lessons learned from the Ebola crisis, during which the importance of local emergency response structures was fundamental.
Mammadi Kamara, a market woman from Kambia who is also the chairperson of the Bramaia Village Committee in the Kukuna Chiefdom, said that her district is prone to frequent bushfires and other disasters. She noted: “With this training, we no longer have to wait for the Government when there is a disaster. Whenever there is potential threat of disaster, with this training and the composition of the DDMC, we should be able to prevent it or respond quickly” she said.
The training covered orientation on basic disaster risk reduction concepts, community contingency planning, early warning systems, emergency first aid training, team work in tackling disasters and by extension disaster prevention mechanisms with emphasis on a community-based approach.
John Vandy Rogers, Director of DMD, said that “UNDP has boosted ONS-DMD in strategic areas like capacity building, technical and financial support, which has had an immense improvement in our overall performance.”
He continued that UNDP has had a long standing relationship with the Government of Sierra Leone especially in the area of disaster risk reduction and hoped for more collaboration in strategic areas aligned to the new global goals - Sustainable Development Goals (SDGs).
The committee comprises Paramount Chiefs, representatives of District Councils, representatives from the Office of National Security, Ministry of Health and Sanitation, Sierra Leone Police, District Immigration Officers, Republic of Sierra Leone Armed Forces, National Fire Force, Sierra Leone Red Cross, local community media, youths, and women groups.
UNDP works in vulnerable communities to reduce the impacts and risks of natural and other disasters in Sierra Leone by reinforcing and supporting stabilization of livelihood protection and empowerment of vulnerable people especially youth and women. UNDP also supports the DMD of the ONS to ensure that early warning modalities are put in place to avert, or at least, manage disasters.
UNDP Communications Unit. Email: email@example.com. Follow us on Twitter @UNDPSierraLeone and Facebook on UNDPSierraLeone, or log on to www.sl.undp.org
The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 15-21 May 2016 and includes updates on Zika virus, outbreak of yellow fever and Polio.
SENDAI, Japan, May 21, 2016—The World Bank Group today launched the Pandemic Emergency Financing Facility (PEF), an innovative, fast-disbursing global financing mechanism designed to protect the world against deadly pandemics, which will create the first-ever insurance market for pandemic risk. Japan, which holds the G7 Presidency, committed the first $50 million in funding toward the new initiative.
“Pandemics pose some of the biggest threats in the world to people’s lives and to economies, and for the first time we will have a system that can move funding and teams of experts to the sites of outbreaks before they spin out of control,” said Jim Yong Kim, President of the World Bank Group. “This facility addresses a long, collective failure in dealing with pandemics. The Ebola crisis in Guinea, Liberia and Sierra Leone taught all of us that we must be much more vigilant to outbreaks and respond immediately to save lives and also to protect economic growth.”
The announcement came a week ahead of the May 26-27 Summit of Group of Seven Leaders in Ise-Shima, Japan. G7 leaders had urged the World Bank Group to develop the initiative during their May 2015 summit in Schloss-Elmau, Germany.
“Japan is proud to support the Pandemic Emergency Financing Facility, which prevents pandemics from undermining important development achievements",” said Deputy Prime Minister and Minister of Finance of Japan Taro Aso. “Innovative financing for crisis responses by the PEF, together with financing for preparedness and prevention in peacetime including through IDA, are important to mitigate human and social losses and to help quickly recover in the event of a crisis. It is cost-effective and should be emphasized at all stages of economic development.”
The new facility will accelerate both global and national responses to future outbreaks with pandemic potential. It was built and designed in collaboration with the World Health Organization and the private sector, introducing a new level of rigor into both the financing and the response.
“Recent years have seen a dramatic resurgence of the threat from emerging and re-emerging infectious diseases,” said Margaret Chan, Director-General of the World Health Organization. “WHO fully supports the Pandemic Emergency Financing Facility as a critical contribution to global health security and a crucial line of defence against high-threat pathogens.”
The PEF includes an insurance window, which combines funding from the reinsurance markets with the proceeds of World Bank-issued pandemic (catastrophe, or Cat) bonds, as well as a complementary cash window. This will be the first time World Bank Cat Bonds have been used to combat infectious diseases. In the event of an outbreak, the PEF will release funds quickly to countries and qualified international responding agencies.
The insurance window will provide coverage up to $500 million for an initial period of three years for outbreaks of infectious diseases most likely to cause major epidemics, including new Orthomyxoviruses (e.g. new influenza pandemic virus A, B and C), Coronaviridae (e.g. SARS, MERS), Filoviridae (e.g. Ebola, Marburg) and other zoonotic diseases (e.g. Crimean Congo, Rift Valley, Lassa fever). Parametric triggers designed with publicly available data will determine when the money would be released, based on the size, severity and spread of the outbreak.
The complementary cash window will provide more flexible funding to address a larger set of emerging pathogens, which may not yet meet the activation criteria for the insurance window.
All 77 countries eligible for financing from the International Development Association, the World Bank Group’s fund for the poorest countries, will be eligible to receive coverage from the PEF. The PEF is expected to be operational later this year.
Recent economic analysis suggests that the annual global cost of moderately severe to severe pandemics is roughly $570 billion, or 0.7 percent of global GDP. A very severe pandemic like the 1918 Spanish flu could cost as much as 5 percent of global GDP, or nearly $4 trillion.
During the past two years alone, pandemic threats have included the devastating Ebola crisis in West Africa—which crippled the economies of Guinea, Liberia and Sierra Leone, and cost them an estimated $2.8 billion in GDP losses ($600 million in Guinea, $300 million in Liberia and $1.9 billion in Sierra Leone); the MERS outbreak, which took a toll on the South Korean economy; and the Zika virus that is spreading in the Americas and putting thousands of unborn children at risk.
Four global expert panels that were convened over the past year in the wake of the Ebola crisis concluded that the world must urgently step up its capacity for a swift response to outbreaks before they become more deadly and costly pandemics.
The PEF will do a number of important things to prevent another Ebola crisis:
The World Bank Group estimates that if the PEF had existed in mid-2014 as the Ebola outbreak was spreading rapidly in West Africa, it could have mobilized an initial $100 million as early as July to severely limit the spread and severity of the epidemic. Instead, money at that scale did not begin to flow until three months later. During that three month period, the number of Ebola cases increased tenfold. The Ebola epidemic has claimed more than 11,300 lives and cost at least $10 billion to date. International assistance has totaled more than $7 billion for Ebola response and recovery.