Sierra Leone Ebola Response Getting To A Resilient Zero

Sierra Leone Ebola Response
Getting To A Resilient Zero
National Ebola Response Centre
The Context
• Mano River Union Declaration of zero infections by 16th April
• Need to answer the question – where are we on the journey?
• Need to document and monitor implementation of the diverse
plans, strategies and initiatives that are being pursued by
multiple players to Get to Zero
• Need to respond to on-going occurrence of EVD cases
• Need to secure broader and deeper community engagement
and ownership to Get to Zero
The Context
•
•
•
Downward
trend in cases
stalled since
late January
Complacency
and fatigue
setting in
Transition
activities
introduce
additional
risks
The Context
Number of days with no confirmed cases as at 17th March 2015
0
Western Urban
Western Rural
1
Port Loko
1
Moyamba
1
Kambia
1
Koinadugu
3
Bombali
3
Focus required on
high transmission
districts but not to
the detriment of low
transmission districts
Tonkolili
22
Kono
22
25
Kenema
63
Bo
88
Bonthe
94
Kailahun
110
Pujehun
0
20
40
60
80
100
120
The Context
Persistent Drivers of EVD Transmission
• Failure to isolate the sick on a timely basis
• Unsafe burials
• Inadequate identification and follow up of exposed persons
• Inadequate IPC and triage at non-Ebola Healthcare facilities
and in informal settings involving healthcare workers or
traditional healers
• Slow response times caused by operational obstacles
The Strategy
Critical
Interventions
EVD
Event
Management
Success = Closing the
Implementation Gaps
• DERC planned, NERC
supported
• “Zero Ebola” Campaign, National
coverage, Hotspot Districts focused
• Rapid Response Teams
• National Day of Remembrance
National
Campaigns
Critical Interventions
• The critical interventions are not new and have been
successful in reducing transmission
• Being implemented by Districts and by local and
international partners via District plans and other
strategies and initiatives
• But as we Get to Zero, there needs to be a national
overview of the quality of these interventions
• Critical interventions must be delivered with operational
excellence
Critical Interventions
QUALITY SURVEILLANCE AND COMPREHENSIVE CONTACT TRACING
•
INFECTION PREVENTION AND CONTROL
•
NEGOTIATED SAFE AND DIGNIFIED BURIALS
DEEPENING COMMUNITY ENGAGEMENT
•
CROSS BORDER COLLABORATION
•
MENTAL AND PSYCHOSOCIAL SUPPORT SERVICES
IMPROVED OPERATIONAL EFFECTIVENESS
First 3 relate to
identify, isolate
and safely bury
Remaining 4 are
cross-cutting
issues
Focus on Resilient
Zero
Success is
dependent on
closing the
implementation
gaps
EVD Event Management
•
Getting to zero requires the targeted and effective management of each
EVD event
•
Led by DERCs and supported by technical partners and NERC, key
features have been active case finding, comprehensive contact tracing and
targeted social mobilisation
EVD Event Management
Develop and
implement
actions for
critical
interventions
Lessons learnt
from the event
and fed back
into the critical
interventions
Respond to
EVD event
management
•
Every EVD event relates to the
failure of one or more of the 7 Critical
Interventions
•
Lessons learnt must be fed back into
Critical Interventions
•
Should result in Continuous Quality
Improvement
•
“Off-site quarantine” e.g. of effective
feedback into Critical Interventions
National Campaigns
•
To complement Critical Interventions and EVD Event Management, there is
merit in launching National Campaigns to:
•
– Counter complacency and fatigue in the fight against Ebola
– Create a sense of energy, urgency and community ownership in respect
of Getting to Zero
– Quickly isolate the remaining infectious in communities and identify
unknown transmission chains
National “Zero Ebola” Campaign
•
National Day of Remembrance
National Campaigns
“Zero Ebola” Campaign – National Coverage, Hotspot Districts Focused
Timing
Friday 27th – 29th March 2015, 4th April, 11th April and 18th April
National
Features and
Messaging
•
•
•
•
•
•
Hotspot
Features
•
•
Stay at home for 3 days followed by 3 Saturdays (21 days) of active case findings
Ebola epidemic not over and national case numbers now only slightly higher than July 2014
when State of Emergency Declared
Urgency and focus required to be Ebola free before rainy season
Messaging to be developed but more targeted to contacts and transmission chains
Timed so children can be safe when first phase schools re-open on 7th April
Women and local communities to be prominently featured
Door-to-door active case finding & engagement led by community taskforces
Community taskforces supported by skilled social mobilisers and community monitors
working with DERCs
National Campaigns
“Zero Ebola” Campaign – National Coverage, Hotspot Districts Focused
During Campaign, Hotspot
Districts
To Have:
•
•
•
Non-Ebola health care service delivery
Lab sample turnaround times operating at optimal levels
Skilled multi-disciplinary teams comprising Health Workers, Community
Taskforces, Trained Social Mobilisers in every ward and village across the
country
Success
•
•
Isolation of all sick in the four Hotspot Districts
Improvement in percentage of new cases from known contacts (to above
90%)
Increase in alerts across the country
Re-energizing of populace in national fight against Ebola
•
•
Zero Ebola Campaign – Nationwide
Main objective: Getting to and staying at Zero Ebola Infections
Specific objectives:
– Re-energise Sierra Leoneans in the fight against Ebola and encourage
personal commitments to ending the outbreak;
– Inform communities about the behaviours that continue to drive the EVD
transmission in their own communities;
– Encourage behaviours which can prevent transmission, such as regular
hand washing with soap and water; and
– Find, isolate and treat Ebola cases through targeted door-to-door
surveillance and contact tracing.
Campaign Strap Line: “Leh we tap Ebola”
Leh we tap Ebola
We are asking the public to take a personal and community
commitment to end Ebola.
For example
Leh we Tap Ebola:
I commit… to protecting my community
I care … about mama Salone
I promise… to help end Ebola
Zero Ebola Campaign – Nationwide
Campaign strategies:
• Trained teams with local community members will move from
house to house to engage community members in
conversations about Ebola contraction and transmission
• Households visited will be given a bar of soap and will be
marked with a sticker with EVD messages
• Independent monitors will visit hard to reach communities to
ensure that all households have been visited
• Subsequent 3 Saturdays will be hotspot Ward/Village focused
Zero Ebola Campaign – Teams and Training
• 3 person teams comprising DHMT, Ward Community
Taskforce, trained Social Mobiliser from DERC
• Team training to be developed and delivered by MOHS,
WHO and UNICEF
• National level Training of Trainers to begin Thursday 19th
March
• Integrated teams to be fully trained by Wednesday 25th
March
Target Populations
The Zero Ebola campaign needs to reach everyone in a
relevant and new way, especially:
– People who live in hotspots: Western Area, Port Loko and
Kambia
– Paramount Chiefs, Traditional Leaders and Healers
– Women
– Young people
– Resistant communities
– Okada riders & taxi drivers
Which channels will zero ebola use?
Campaign channels:
– Community Engagement through Social Mobilisers working to
empower community leaders
– Multimedia Reinforcement: Posters, Videos, Radio (interviews
and PSAs), TV
– Branded materials: t-shirts, posters, videos
– Social Media: #LeWeTapEbola
National Campaigns
National Day of Remebrance
Timing
1 month after Sierra Leone declared Ebola-free
Features
•
•
•
•
•
•
Day set aside for commemoration of those who died during the Ebola crisis and were
therefore not given proper traditional burials
To include Ebola and non-Ebola deaths
Would give family members and communities closure to the painful experience of losing
their “un-honoured” dead
Commemorated from community level up to national level
Possibly construct memorial sites at District level with names of all the dead with
mechanism for adding names of those who die between 25th May and Ebola-free
declaration for Sierra Leone
Make use of existing community structures at district and community levels to make the
National Day of Remembrance successful at local level
The Strategy Recap
Critical
Interventions
EVD
Event
Management
Success = Closing the
Implementation Gaps
• DERC planned, NERC
supported
• “Zero Ebola” Campaign, National
coverage, Hotspot Districts focused
• Rapid Response Teams
• National Day of Remembrance
National
Campaigns