Ebola recovery process inSierra Leone and the

traceability of EU funding

Alex Chimbaru22 February 2017

Three Phases of Ebola Action in Sierra Leone

Sierra Leone

Population 2015: 7.0 million

Life expectancy 2015: 50.1 years (Males =49.3; Females = 50.8) compared toaverage of 60.0 for the African region and71.4 globally

Healthy life expectancy at birth 2015: 44.4years

MMR (per 100,000 live births) 2015: 1,360compared to average of 542 for the Africanregion average and 216 globally

U5M rate (per 1,000 live births) 2015:120.4 compared to the average of 81.3 forthe African region and 42.5 globally

Sierra Leone’s protracted civil conflict, which ended in 2002, eroded vitalinfrastructure and human capacity. And the country was hit by the world’slargest Ebola Virus Disease (EVD) outbreak in 2014-15.

1985

1991-2002 2014-2015

2016

The Ebola Outbreak 2014-16

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2014 2015 2016

EVD Epi Curve 2014 - 2016

Sierra Leone

Impact of the Ebola outbreak

• Reduction in community confidence in the health sector which resulted in:– Decreased use of health facilities: 48/1185 (4.1%) health centers closed;– 23% decrease in institutional deliveries; still birth rate and maternal

mortality increased;– 39% decrease in children treated for malaria;– 21% decrease in childhood immunization (penta3);– Lower proportion of women reporting pregnancy-related care;– Up to 90% drop in family planning visits (Government of Sierra Leone

2014)• Rise in teenage pregnancy (65%);• Orphaned children (over 16,000 children lost one or both parents to Ebola in

the 3 affected countries);• Psychological impact and stigmatization of survivors;• Close of schools and markets for about a year – students lost 784 school

hours;• Considerable loss ( 6-8%) of GDP;• Rise in poverty incidence ~14% during 2014-2015.

7 November 2015 – the end of the outbreak

A resilient health system

“A health system’s resilience can be defined as the capacityof health actors, institutions and populations to prepare forand effectively respond to crisis; maintain core functionswhen the crisis hits; and, informed by lessons learnt duringthe crisis, reorganise if required.”

Lancet May 2015

From Ebola emergency to a well functioning health system

Outcomes

Key Result Areas under 10-24 months PresidentialRecovery Priorities

12Prevent, detect,

respond toepidemics and

ensure zerocases of EVD

Save the livesof 600

women and5000 children

Sierra Leone has among the world’shighest rates of maternal and childmortality, costing the country ~30,000lives annually

Sierra Leone has had great success withEbola, but ongoing work is required toensure no further outbreaks

What has to be doneIncrease and upskillstaff to ensureimproved service andengage communities

Ensure availability oflife saving medicinesand equipment at thefacility level

Focus on the key causesof child and maternalmortality

There are over 4,000 EVD survivors whohave specific health care needs

3Comprehensivecare for EVD

survivors

Using and applying the building blocks of the Ebolaresponse to develop a resilient health system

BurialsTreatmentCase Investigation

Community EngagementLab Survivors

Disbursements by donors for Ebola response, recoveryand research

Total approximately US$5.9 billionSource: Resources for Results V 2016

67%

12%

19%

2%All bilateral agencies

European Union

International andregional financialinstitutions(excluding EU)

Private foundations

DonorDisbursements

(in millions US$)

All bilateral agencies 3,960

European Union 715.9

International financeinstitutions 1,094.21

Private foundations 145.73

African Union 0.9

West African Economicand Monetary Union 4.5

Breakdown of key Ebola response, recovery and research areas(all donors)

Source: : Resources for Results V 2016

Official Development Assistance from EU toSierra Leone in 2015

Total approximately US$74 millionSource: OECD-DAC database 2017

Government of Sierra Leone - WHO 2016-17Partnership: From Ebola to Health

HealthRecoveryPriorities

IDSR Rollout

IPCStrengthening

ReducingChild andMaternalMortality

EnhancingHuman

Resources forHealth

CommunityEngagement

Improvingmanagementfor Health and

a ResilientHealth System

Ministry of Health and WHO have identified sixpriorities in line with the Government’s 10-24Month Health Recovery Plan.

Through these, WHO is committed tosupporting the Government to achieve thegoals set out in the Presidents Recovery Plan.

A resilient ZERO and a Sustainable HealthSystem

A Reduction in Maternal and Child Mortalityand Morbidity

→ EU providing catalytic funding to theGovernment of Sierra Leone tostrengthen the health system

Linking Surveillance with Response

Indicator Measure

1 Proportion of events detected by HWs 90%

2 Proportion of events detected by CHWs 6%

3* Proportion of events notified on time (within 24hrs) 92%

4* Proportion of cases with rapid response within 48hrs 90%

5 Proportion of investigated cases with lab results within 3 – 7days (n=58)

17%

Outbreak detection & response indicators, week 1 – 52, 2016 (n=88)

*IDSR target is ≥80%

Thank you!