Sierra Leone Ebola ResponseGetting To A Resilient Zero

National Ebola Response Centre

March 2015

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

Focus required on high transmission districts but not to the detriment of low transmission districts

Number of days with no confirmed cases as at 17th March 2015

Pujehun

Bonthe

Kenema

Tonkolili

Koinadugu

Moyamba

Western Rural

0 20 40 60 80 100 120

110

94

88

63

25

22

22

3

3

1

1

1

1

0

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

Critical Interventions

EVD Event

Management

National Campaigns

Success = Closing the Implementation Gaps

• DERC planned, NERC supported

• Rapid Response Teams

• “Zero Ebola” Campaign, National coverage, Hotspot Districts focused

• National Day of Remembrance

The Strategy

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

Critical Interventions• National level summary of Critical Interventions has been collated with

input from Pillars and partners• Specific interventions, proposed actions, delivery leads, timelines,

quality indicators and monitoring mechanisms have been documented • All components of the critical interventions to be monitored and

evaluated by dedicated team• Districts required to report on implementation of critical interventions

within District Plans by 18th March• Emphasis on identifying challenges and closing implementation gaps

Critical Interventions

Excerpt for Monitoring and Evaluation Framework

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

Locations Situation

Information gaps

Comment

Assessment

DERC Activities

Key Statistics or Points to Note

NERC Action

AS ATEVD EVENT WESTERN AREA CLUSTER UPDATE POC

• WAERC staff and epi teams are monitoring closely and checks are being made to quickly identify suspected cases at the earliest sign of symptoms.

• The unexpected movement of some of the suspect cases to a temporary facility without a planned processes has hindered follow up.

Nil. For information only.

These clusters are not unexpected due to date of exposure and are all linked to quarantine homes so the source of infection is known and contained.

Nil

Close monitoring of the quarantine homes, supported by social mobilisation engagement with the surrounding communities continues.

In addition to routine case monitoring WAERC is currently tracking clusters of positive cases related to the following Wards:• 349 - Consider Lane – linked to a herbalist death 24 Feb• 392 - Crabtown – linked to a herbalist death 25 Feb

Epi advice remains that the cases are safely contained in quarantine and no other actions are required.

EVD Event Management

• Increasing role of multi-disciplinary Rapid Response Teams including– epidemiologists led by MOHS, WHO and CDC who rapidly investigate hot

spots and transmission chains related to the event, ensure complete contact tracing and other controls are in place, and provide technical support

– Social mobilisers who engage with affected families and communities with messaging targeted to respond to specifics of the EVD event

– NERC Field Monitors supporting DERC as required including active case finding, community engagement and cash management of Rapid Response Funding

EVD Event Management

Develop and implement actions for

critical interventions

Respond toEVD event

management

Lessons learnt from the event and fed back

into the critical interventions

• 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

National Features and Messaging

• Stay at home for 3 days • 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

Hotspot Features

• Door-to-door active case finding & engagement led by community taskforces• Community taskforces supported by skilled social mobilisers and community monitors

working with DERCs

“Zero Ebola” Campaign – National Coverage, Hotspot Districts Focused

During Campaign, Hotspot DistrictsTo 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

National Campaigns

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

National Campaigns

National Day of RemebranceTiming 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

Critical Interventions

EVD Event

Management

National Campaigns

Success = Closing the Implementation Gaps

• DERC planned, NERC supported

• Rapid Response Teams

• “Zero Ebola” Campaign, National coverage, Hotspot Districts focused

• National Day of Remembrance

The Strategy Recap