Intervention Summary:
On 25 May, the worst known outbreak of the Ebola Virus Disease spread to Sierra Leone. By 24 June, 163 cases and 46 deaths were reported. Since this is the first Ebola outbreak in West Africa, the health systems have been in urgent need of technical support to control the epidemic. Widespread fear and misunderstanding has made education and public awareness critical for prevention measures and encouraging people to seek treatment.
Four Start Network agencies responded in 10 districts across the country and worked closely with health officials to support the government’s Ebola response plan. The agencies implemented projects in areas with confirmed cases and in neighbouring at-risk districts. Two projects focused on Freetown to prevent transmission in a densely populated urban area. Overall, the prevention interventions reached an estimated 13.7% of the population.
The responses focused on supporting the Ministry of Health and Sanitation, training community health workers and volunteers, procuring medical equipment and widely disseminating Ebola control and prevention messaging.
Coordination proved essential for partnering with community groups on sensitisation strategies and to gain access to vulnerable populations. A variety of methods were used to raise awareness, including door-to-door visits, street campaigns, film screenings, trainings of trainers and posters and fact sheets. These activities directly reached over 820,000 people, not including an estimated 1.5 million additional people indirectly reached through radio broadcasts. In coordination with the District Health Medical Teams, 3,027 health workers and volunteers received trainings on outbreak control measures and use of personal protective equipment. To increase coverage quickly, training of trainers sessions facilitated cascading learning at the community level. In addition, responses emphasised reaching young people through schools and children’s clubs, and a two day training of trainers workshop on child protection during the outbreak was held for 23 NGOs.
About 69% of the budget was spent on health inputs, and 55% of total funds were implemented through seven different local partners. A decentralised project selection process was successfully made at the country level for the first time. All the agencies involved are scaling-up their Ebola response following the Start Fund grants with other funds totaling at least £340,000. This will reach an estimated 997,167 people at a similar rate, or 17% of the population.
Lessons from the Response:
Communication of project plans allowed prevention efforts to reach more people more consistently but coordination could have gone even further.
- Regular coordination with existing partners and WaSH consortia members increased coverage of the Freetown area and helped implement a standardised model to cover all 59 city sections.
- Focusing coordination efforts on existing partners limited the effectiveness of sharing lessons learned.
One agency learned that sharing with a larger community of NGOs would have filled more gaps.
- Project selection at the national level allowed local humanitarian staff not only to select the best-placed projects but also to continue coordinating after selection. A Learning Review meeting after the response, for example, identified that coordination of KAP survey methodology would have improved aggregate impact analysis.
- Too many coordination meetings on the same day sometimes competed with time for implementation.
Coordination with the Ministry of Health and Sanitation improved effectiveness and support of NGO efforts.
- Collaboration with MoHS officials at the district and national levels made the responses more focused and in-line with the government’s revised Ebola response plan.
- Coordinating with the District Health Medical Teams helped identify gaps in the Peripheral Health Units, minimized overlaps in training health workers and even allowed sharing of personnel.
- Knowledge transfer in campaigns that involved motorcades was more effective when MoHS staff were present to answer questions of people passing by rather than the conventional broadcast approach.
Empowering the community to lead the sensitisation increased reception of Ebola advisory messages.
- Monetary incentives increased speed of mobilisation. The WaSH consortium in Freetown agreed a standardised one-time model of payment of 10,000 Le to CHWs because of the urgency required.
- People were more receptive to known community members, whether volunteers or health workers. In door-todoor visits, more households answered the door when the community leaders were placed in the front.
- Door-to-door sensitisation was more effective in the evenings because it was the farming season.
- One project found that reaching more young people required carrying out more activities around schools, cinemas, football pitches and other public places where they hang out.