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1 Response to Ebola Virus Disease 2014 outbreak Final report - Appeal funds for Ebola Project Name: Response to EVD 2014 Project Locations: Côte d’Ivoire, Liberia, Mali, Sierra Leone, Region Project Duration: 12 months Reporting Period: 1 st December 2014 30 th November 2015 Total Grants Amount: 512,175 $USD WARMU Contact & Contact Details: Diawary Bouare Regional Director West Africa mailto:[email protected]

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Page 1: Response to Ebola Virus Disease 2014 outbreak Pool Funds... · 1 Response to Ebola Virus Disease 2014 outbreak Final report - Appeal funds for Ebola Project Name: Response to EVD

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Response to Ebola Virus Disease 2014 outbreak

Final report - Appeal funds for Ebola

Project Name: Response to EVD 2014

Project Locations: Côte d’Ivoire, Liberia, Mali, Sierra Leone, Region Project Duration: 12 months

Reporting Period: 1st December 2014 – 30th November 2015 Total Grants Amount: 512,175 $USD

WARMU Contact & Contact Details:

Diawary Bouare Regional Director – West Africa mailto:[email protected]

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Introduction Background From March 2014 until December 2015, West Africa was seized by the Ebola Virus Disease (EVD) crisis, claiming 11,297 lives,1 as broken down in Figure 1 below.

Location Confirmed, probable, suspected cases of EVD

Confirmed probable, suspected deaths from EVD

Recovered, treated and discharged patients

Sierra Leone 14,122 3,955 1,696

Liberia 10,666 4,806 Unavailable

Guinea 3,804 2,536 Unavailable

TOTAL 28,592 11,297 1,696

Figure 1: Confirmed cases of EVD in Sierra Leone, Liberia and Guinea (WHO Sitrep, December 6th, 2015)

As of 3rd September and 7th November 2015 respectively, Liberia and Sierra Leone had been declared, albeit hesitantly, Ebola-free by the World Health Organization (WHO). The countries of Mali and Côte d’Ivoire were never infected. A new outbreak among a cluster of 3 confirmed cases has since set Liberia back to a new 21-day incubation period, while Guinea has had no new cases in the last 21 days. Sierra Leone has been declared ‘Ebola-free’ and is a third of the way through its 90 day period of enhanced surveillance, set to conclude on 5th February 2016. WHO identifies four factors that contributed to the successful response to EVD; i) decisive leadership and good governance; ii) support from the international community, including financial, logistical and human resources; iii) the co-ordination of the international and national response; iv) effective community engagement. CARE’s contribution to the EVD response came largely in the form of community mobilization activities.

Project Overview In Côte d’Ivoire, CARE targeted women, girls and vulnerable community members with EVD awareness-raising messages that included knowledge on high-risk practices such as unsafe burial and traditional hunting. This was done through a mass-awareness-raising concert, partnering with village savings and loans associations (VSLAs) and engagement of traditional leaders. Though bordering with two Ebola countries, Côte d’Ivoire’s grass-roots efforts to prevent the outbreak of EVD within its borders was successful, early engagement with local leaders being a key factor. Like Côte d’Ivoire, Mali focused its EVD response on prevention through mass media messages for social behavior change, direct training of staff and partners in Ebola prevention and response techniques. CARE also provided the Government of Mali (Segou Region) with equipment needed to increase the country’s level of preparedness for an outbreak. There was no outbreak of EVD in Mali during the time of the intervention. Recognising the impact that grassroots sensitization has on reducing the spread of EVD, Liberia trained and supported 63 general community health volunteers (gCHVs) to engage with communities through focus group discussions and door-to-door campaigning across Bong, Montserrado and Nimba counties.

1 As of 6

th December 2015

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Although there was no direct intervention in Guinea, in Sierra Leone CARE partnered with the Mano River Union Secretariat to facilitate cross border surveillance and screening, social, mobilization and coordination activities along the Sierra Leone/ Guinea borders in the Kambia and Bombali districts. Community engagement in these districts resulted in a large reduction in the number of EVD cases that resulted from border crossings, with residents co-operating with border patrols in becoming more vigilant about movement between the two countries. In addition, Sierra Leone contributed to a national assessment on the relationship between the EVD crisis and increased teenage pregnancy.

Successes, lessons learned, changes CARE’s EVD response activities across the region saw success because of a common two-fold strategy; community entry that prioritized partnership with community leaders and local authorities and community-based messaging that put community members at the heart of implementation. In both Liberia and Sierra Leone, emergency response activities in the targeted locations funded by other donors laid the foundations for smooth implementation of this project’s activities using established structures. CARE collaborated with the respective Ebola Response Centers (ERCs), local government departments and their respective co-ordination cluster groups, community leaders and volunteer workers to ensure the identification, selection and dissemination of EVD prevention messages to vulnerable communities. This level of co-ordination was key to a successful response. The programmatic approach to the EVD response meant that project activities and resources could work in synergy with each other, supplementing where necessary in areas such as logistics and materials, and leveraging where practicable to support activity extensions and new EVD recovery opportunities. For instance, in Liberia CARE worked with the organization Health Education & Awareness in Rural Liberia (HEAR-Liberia) who completed construction of 4 wells in Nimba County, while in western Côte d’Ivoire, CARE worked through the local NGO N'GBOADÔ who organized a mass awareness event with celebrity guests for nation-wide exposure. Across the region, each of the planned activities were undertaken according to schedule and funds were spent. Country offices that saw a change to the original project plan were Liberia, where most funds were used to offset closure support costs, as it had been suggested prior to application for funding and discussed and the second country office was Ghana, where response activities have been changed to prevention and preparedness activities, as discussed regionally. CARE Ghana prevention activities are still on-going.

Project Goals, Results and Activities

Project Goal Across all implementing country offices, the project had one primary goal: to increase public awareness of EVD and disseminate preventive messages through community engagement. In Cote d’Ivoire, Sierra Leone and Liberia, this was undertaken through community leaders, established community groups and volunteers, while Mali partnered with 11 local radio stations to broadcast 3 essential messages together with a series of roundtable discussions in local languages on the subject of EVD.

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Results The project saw the following primary results:

1. EVD awareness raised through community mobilization: Teams of community-based social mobilizers and volunteers led the awareness-raising campaigns and disseminated government-approved EVD-awareness and hygiene messaging, distributed behavior change literature and hygiene kits and facilitated door-to-door hygiene promotion campaigns and focus group discussions to increase household-level understanding of how the virus is spread and what simple measures can be used to prevent the spread.

2. Support for local structures enhanced: CARE worked with and through established local structures, such as VSLAs and Dozo (traditional hunters) in Côte d’Ivoire, general community health volunteers in Liberia and local health teams, local education authorities and Ebola Response Centres in Sierra Leone.

3. Implementation through local partnerships strengthened: CARE partnered with local associations who assisted in the implementation of awareness-raising activities. In Sierra Leone, CARE was part of a consortium of partners who undertook a nation-wide study on the impact of Ebola on teenage pregnancy. In addition the Sierra Leone office engaged theatre and drama groups to address social stigmas associated with EVD, particularly among survivors. CARE in Côte d’Ivoire, on the other hand partner with local NGO N'GBOADÔ to co-ordinate a concert with the participation of local celebrities and attended by 3,000 to give maximum exposure to the EVD messaging activities, while in Liberia partnership with the local association HEAR, facilitated the completion of WASH construction activities in Nima County.

Activities 1. EVD awareness raised through community mobilization 1.1: Training of 60 general community health volunteers (gCHVs) in M&E activities in Nimba County, Liberia A total of 131 gCHVs (28 females / 103 males) that had worked with CARE throughout the EVD response received 2-days of refresher training in community mobilization and behavior change, facilitated by the Ministry of Health, as well as in the collection and recording of data for health promotion activities to support the management of local government information systems. This activity helped gCHVs to reach a total of 84,779 people (32,110 women, 29,797 men and 28,434 children) with EVD messaging in both Counties. Following refresher training, these volunteers were given a small stipend of USD90 for a period of 2 months, beyond their original contracts with CARE. 1.2: Training for community rallies and women’s groups in Segou and Mopti regions of Mali Following orientation sessions, where CARE field staff and NGO partners were trained in EVD response activities, CARE organized Ebola information rallies for 325 women’s association leaders in 34 Districts of Segou and Mopti Regions. Under the supervision of 4 partner NGOs, the rallies facilitated ‘Ebola village awareness’ sessions that reached 7,296 people (6,399 women / 897 men). 1.3: Training of 146 social mobilizers in northern Côte d’Ivoire A total of 186 social mobilizers were identified and trained to promote hygiene and EVD awareness in communities; 40 more than had been originally targeted. The training sessions, which included hygiene awareness, communication, establishing accountability systems, and gender, were provided by trainers in cooperation with the government’s departmental health directorates. In particular, social mobilization activities targeted village chiefs and Dozo. In total 161 village chiefs and traditional hunters

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received training in the dangers of handling corpses, the means of EVD transmission, and the risks of hunting and consumption of bush meat. 1.4: Purchase of 146 demonstration hygiene kits to assist social mobilizers in Côte d’Ivoire in demonstrating hygiene promotion practices Each of the social mobilizers received one hygiene kit consisting of soap, sanitary items, plastic buckets and water dispensers, gloves, maps visibility tools, hand gel, bleach and other cleaning items. In addition, social mobilizers each received visual aids including a free-standing EVD-awareness image pack and 2 posters. Funds remaining were used to purchase additional promotion kits. 1.5: Reproduction and distribution of Information Education Communication (IEC) materials and visibility materials to schools in Ebola affected communities of Kambia, Bombali, Tonkolili and Koinadugu districts, in Sierra Leone With the technical support of the Social Mobilization platform, the project reproduced and distributed 10,000 posters on key Ebola prevention messages, such as proper hand washing with soap and clean water, and recognizing signs & symptoms. These materials were also distributed and displayed in schools, public meeting places, mosques, churches and health facilities. Community sensitization teams also used the materials during door-to-door visits to raise further awareness on Ebola prevention.

1.6: Engagement of theatre groups to perform public dramas aimed at addressing stigma and discrimination against Ebola survivors in Sierra Leone Social mobilization campaigns were organized in the four districts of Kambia, Bombali, Tonkolili and Koinadugu, targeting Community Leaders and Ebola survivors in order to address the issue of stigma and discrimination. In addition, public Ebola sensitization events were held in public meeting places such as lorry parks, health facilities, mosques and churches where large numbers of community members were reached with appropriate messages on Ebola prevention. These activities were accompanied by question and answer sessions involving the audience as a way of assessing their knowledge and correct misconceptions that were prevalent. 1.7: Radio broadcasting of EVD messages in Mali Following training of local radio animators, together with technical support to 11 local radio stations to prepare appropriate messages on Ebola (Vigilance, Symptoms and Transmission), three 3-minute EVD messages in French and local languages, together with 3 EVD round-table discussions between women leaders and professionals, and 3 opinion ‘check spots’ were produced (representing a collective total of 3,072 broadcasts). An end of project survey assessing 480 radio listeners found that 85% of them had increased knowledge of EVD. 1.8: Prepare and Print Communication Visual Materials (Posters, Guides, other) for distribution in Segou Town, Mali Five large posters that promoted Ebola Information and WASH practices were designed, displayed on 16 billboards (4m x 3m) that were installed in major thoroughfares in Segou Town for a period of 3 months.

2. Support for local structures enhanced 2.1: Community vulnerability mapping in Côte d’Ivoire to identify vulnerable households and paths for isolation and transfer of cases to rural health centers The implementation of the project was preceded by the government’s declaration of a national emergency that added significant weight to the implementation of the project: updating and making available the Ivorian Government’s community vulnerability maps. The health districts have relied on

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Community Health Workers (CHWs) to identify vulnerable households and protocols for isolating and transferring cases to health centers. CARE has linked this activity by including CARE-trained Social Mobilizers in gathering vulnerability data. The activities of the social mobilizers have allowed all coverage areas to remain vigilant with regard to suspicious cases or for people travelling from EVD-affected countries. This approach has fostered a good relationship, and support for health centers. 2.2: Provide support to cross border coordination and surveillance among DHMTs in the Bombali, Kambia and Koinadugu districts of Sierra Leone CARE partnered with the Mano River Union (MRU) Secretariat to facilitate cross border surveillance, social, mobilization and coordination activities along the Sierra Leone/ Guinea borders in the Kambia and Bombali districts. The MRU is a regional organization that has the mandate to advocate with and influence regional Governments within the Mano River sub region for effective governance and coordination. CARE also partnered with the District Health Management Teams (DHMTs) and district Ebola Response Centres (DERCs) in Bombali and Kambia districts to orientate community volunteers at community level to undertake social mobilization. Through this effort, there was a drastic reduction in the number of Ebola infected cases that used to cross over from neighbouring Guinea undetected with border residents becoming increasingly vigilant. 2.3: Construction of hand-washing stations at key points in Segou region, Mali CARE procured materials for the set up of 150 hand-washing stations at 19 health centers, 49 schools 20 multi-purpose centres and 16 district offices. The constructions of these stations were scheduled to coincide with other complementary activities in the run up to Global Hand-washing Day on 15th October 2015. In addition, two tents were procured for the Regional Health Department to be used by Security Agents at the Ebola Control Checkpoint in the event of an outbreak. 3. Implementation through local partnerships strengthened 3.1: Conduct Survey to assess the impact of Ebola on teenage pregnancy in Sierra Leone In Sierra Leone, CARE partnered with the Teenage Pregnancy Secretariat of the Ministry of Health and Sanitation, Save the Children, PLAN Sierra Leone and other organizations and is in the process of conducting a national assessment to get a better understanding of the impact of Ebola on Teenage girls in the country. The findings from this assessment will help inform CARE’s future on Adolescent Sexual Reproductive Health, which is currently addressed under CARE Sierra leone’s HAPP (HIV and Aids Prevention Programme). 3.2: Organization of a procession and concert in Côte d’Ivoire In Côte d’Ivoire, CARE worked through local partners N'GBOADÔ to conduct 1-day mass awareness-raising campaign on EVD and hygiene promotion. A procession that promoted EVD messages worked its way through the city of Man, making visible the slogan "no Ebola: you will not overtake me." The procession was followed by a mass concert, with approximately 3,000 people in attendances, with popular Ivorian artistes Kajeem and the Patrons performing. In unison, the audience joined the artistes in singing 'no Ebola you will not overtake me’. This concert was an opportunity for artists to draw the audience’s attention to the threat of Ebola and urge everyone to follow the preventive measures. The concert objectives were strongly enhanced by the presence of the administrative and political authorities in the western region.

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Monitoring Methodology

Each of the four implementing offices had a fairly uniform set of guiding principles for monitoring and evaluating project activities. In addition, each utilized the volunteers and social mobilizers to help gather relevant data for assessment purposes. Assessing knowledge: CARE staffs in all implementing countries were initially oriented in EVD response activities. The tracking of EVD knowledge was led by volunteers and social mobilizers who used a simple questionnaire to assess the level of understanding of EVD – what it is, how it is transmitted and how to prevent transmission – together with the extent to which hygiene messaging is shared and practiced at household level. CARE M&E staff, in consultation with field staff, volunteers and social mobilizers, prepared the questionnaire. The Mali office hired a total of 8 surveyors to collect data (480 questionnaires) in 40 villages over a period of 6 days. Interviewees included local authorities, religious leaders, civil servants, association leaders and household heads. Assessing activities: In Liberia, Sierra Leone and Mali, Team Leader positions were created to ensure that project activities were implemented to maximize on synergies, coordinate on logistics and resources, and align to government priorities and protocols. In Liberia, a project manager who kept track of field activities through regular communication with field-based coordinators led the team. Field visits were also conducted in order to test the reliability of communication, mobilization and data collection so that activities achieved increasingly better results. CARE health volunteers were provided with reporting templates that were used to report to the field-based coordinator on a weekly basis. The coordinator, prior to payment of monthly stipends, randomly verified results. Sierra Leone’s Design Monitoring and Evaluation (DM&E) unit coordinates all accountability related systems. A DM&E Manager, a member of the senior management team, who is the custodian of program quality and impact monitoring, heads the unit. To enhance the organization’s quality system across programs, CARE maintained Monitoring and Evaluation Officers in all operational districts throughout the EVD response period and the above project activities fed into this system. Assessing results: Regular monitoring and evaluation of activities was done by a joint team comprising project team and members of the DERCs, DHMTs, and Social Mobilization platform and community structures in the different areas. Basic monitoring and evaluation tools were developed to capture information on the impact and quality of the response. In hard-to-reach areas, the use of cellular phones was adopted for gathering information. In Sierra Leone, on a periodic basis, national-level monitoring and members of the National Ebola Response Center (NERC) undertook supervision of the response activities. Observations made during those visits were fed back to partners during district and national-level coordination meetings and recommendations were implemented accordingly. This mechanism helped to ensure quality and positive impact of all EVD response activities. After Action Review: In order to contribute to CARE’s understanding of its emergency response performance and to help to promote learning and accountability throughout CARE International, CI

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organized a sub-regional AAR on May 2015. Because of the sub-regional nature and complexity of the Ebola crisis and In order to involve a wide constituency across the organization, CARE’s normal After-Action Review (AAR) process was modified to include a series of pre-AAR cascading steps. This AAR results will serve to prevent similar issues in future emergencies.

Key Achievements

The intervention saw a number of key achievements in all implementing countries: Successful community entry: One of the reasons why Ebola spread quickly in the region was denial of the existence of the virus on the part of communities, together with misinformation about what Ebola was and how it spread. This denial posed a significant challenge to many humanitarian agencies, which upon entering communities found that they were very unwelcome. CARE engaged communities through their local leaders and influential community dwellers, who had earned the trust of the community. When this was done, community leaders accepted help from mobilizers, including gCHVs, selected from among each targeted community and this contributed markedly to successful community entry and a reduction in EVD-risk related behaviours. CARE’s community-based approach saw explicit results and finally a series of ‘Ebola-free’ periods, which continue until now. In addition, this level of close collaboration with communities, through sensitization and community dialogue was key to reducing the stigma of EVD and discrimination against EVD survivors in particular. The combination of mass awareness-raising, hygiene behavior change messaging, and engagement with local leaders and Dozo, involving them directly in sensitization activities contributed to successful sensitization of communities to Ebola and practices that aid transmission of the virus. All hunting activities in targeted communities of Côte d’Ivoire have now been suspended and traditional practices associated with burial have been changed to make them safer. The successful prevention of any EVD outbreak in Côte d’Ivoire can be attributed to early implementation and dynamic community-led awareness raising. Community engagement Social mobilization training and orientation equipped volunteers with tools and knowledge to reach 17,136 VSLA group members (16,231 women and 905 men), almost 77% more than had been initially targeted. Mass awareness activities in Côte D’Ivoire indirectly educated 58,400 people in various communities (36,729 women and 21,571 men). Of the four intervention countries, Cote d’Ivoire mobilized the highest numbers of female volunteers. The refresher training for community health volunteers in Nimba and Bong County, in Liberia, together with health promotion and WASH construction was undertaken in close coordination with the County Health Teams. This collaboration proved key to swift and harmonized implementation. Dissemination of appropriate Ebola prevention messages / information Across the EVD-affected countries, behavior change through dissemination of appropriate government-approved messages and complementary behavior change publications helped to impress EVD-prevention on the hearts and minds of the public. The continuation of hygiene promotion in schools, with the use of published materials, was instrumental in widening the coverage of the messages in the

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communities that the children represented, and helped to reinforce behavior change at the household level, with children becoming agents of change. Decrease in the rate of Cross border infections Because of strong traditional socio-economic ties between Sierra Leone, Liberia and Guinea, frequent incidences of cross border transmission of the virus, particularly along the border districts of Kailahun and Kambia were prevalent, despite the official closure of cross-border trading. Inadequate cross-border surveillance undermined the ongoing emergency response efforts. CARE’s contribution to cross border coordination and surveillance activities, which kept neighbouring communities informed and engaged in surveillance efforts, saw a marked reduction in the number of EVD-infected or high-risk individuals crossing borders.

Challenges and Lessons Learnt

Integration of Ebola prevention activities among VSLA groups The importance of integrating emergency response activities with existing community structures such as VSLAs and other community-based groups cannot be overstated. They are respected spheres of influence at community level through which information can be channeled and spread. Consideration of socio-cultural/linguistic realities for sustainable behavior change Early and consistent engagement with traditional chiefs and Dozo, very quickly helped to correct some endemic practices in the habits of populations. Traditional leaders strongly contributed to the sensitization of communities on the dangers of direct contact with corpses, including dead animals, and ultimately the potential risk that such practices expose the whole community to. The involvement of Dozo and traditional leaders had an immediate impact on changing the behavior of people in the target communities. It is worth noting that the entire region of Segou and neighbouring communities were reached with Ebola messages through radio in their own local languages. EVD assessments quickly found that women were at greater risk of infection due to their traditional and moral responsibility of being caregivers. Against this background, response teams ensured that women were at the heart of activities, including consultation on individual community response strategies. Synergy with state institutions (regional management, departmental health, etc.) The demonstration of political will at national and local government level was noted from the outset of the project, and allowed immediate access to much needed community data held by relevant government departments. Strong relationships built among these state institutions facilitated the commissioning of sector trainers. Working in partnership with communities and their representative associations The fight against Ebola has been successful largely because of the strategy to employ members of the targeted local communities to serve as volunteer mobilizers in disseminating Ebola prevention messages. As a result of the community-based approach, CARE found communities taking ownership of responsibility for avoiding EVD and eradicating it. A long term presence and links with the targeted communities, including links with local authorities, gave CARE an advantage when it was time to enter those communities with EVD response activities; it was easier to build on the level of trust already established in the past.

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In addition, working through local partners in all targeted locations proved to be very useful for coordinating needs assessments quickly, particularly in those parts of the country where there is no official CARE presence. Early assessment of CARE technical capacity While CARE has emergency and humanitarian response capacity across the region, emergency public health skills and resources were limited. The ability to tap into the wider CARE network for technical assistance would have been of great benefit. On the other hand, the project activities gave opportunity for CARE Emergency Coordination Teams to further assess their capacity to manage a long-term emergency response. Regional Management Considering the geographic areas of intervention, it would be more relevant and efficient in the future for CARE Mano River Sub Region to be in charge of the management of such project rather than the Regional Management Unit and its Regional Emergency Coordinator. Indeed, Mano River office is located in Abidjan with the managing director based there, the Ebola Focal Point and the Sub Regional Program Quality and Resource Mobilization Manager based in Liberia. The Mano River Sub Region includes Sierra Leone, Liberia, Guinea and Côte D’Ivoire, most of the countries involved in this intervention. In term of distance, day to day monitoring, regional coordination with key stakeholders, it would be more effective for Mano River Unit to be in charge of the overall management of this project and the Managing Director being the key interlocutor with CMPs.

Advocacy

CARE actively participated in the different cluster groups for the response, namely the Health and Social Mobilization, WASH, Psychosocial and Surveillance groups at both National and District levels. CARE also regularly sat in all the National Ebola Response Center (NERC), District Ebola Response Center (DERC), Incident Management Systems (IMS) coordination meetings, and they were found to be useful forums for contributing to and participating in advocacy activities. In Sierra Leone, where CARE is part of the Ebola Response Consortium, CARE advocated successfully for the adoption and scale up of the Community Events Based Surveillance (CEBS) approach. Since its adoption, the approach has seen important strides in the fight against EVD and has now been incorporated into national guidelines for the Disease Prevention and Control Directorate of the Ministry of Health & Sanitation. Similar advocacy efforts were also jointly undertaken with the Social Mobilization cluster group of the Ministry of Health & Sanitation for harmonization of messages and standardization of guidelines used during the response. In addition, advocacy efforts resulted in the replication of national – level structures for the response at the district level, without which coordination and collaboration would not have been achieved. In Liberia, CARE has been advocating for the Ministry of Health to absorb community health volunteers, engaged by various NGOs as part of the emergency response, to be absorbed into the government payroll in order to sustain community-based health and hygiene promotion activities and to assist with the scale up Integrated Disease Surveillance and Reporting (IDSR) activities on vaccine preventable diseases.

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The Regional Management Unit, with CARE UK, supported as well the Ebola response in term of advocacy and information management. An advocacy strategy and policy paper has been prepared in order to help the team at field level and CI in these areas (see annex 1).

Human Interest Stories

Old Soro raises awareness among fellow Dozo! Soro Paganignan is a traditional hunter commonly known in Côte d'Ivoire as Dozo. He lives in Ferkessédougou in the northern part of the country. Like any true Dozo, Soro was engaged primarily in the cultivation of corn, rice, traditional medicine and hunting. After participating in the sensitization workshops on the prevention of EVD and the risks involved in hunting for bush meat, Soro had a change of heart and decided to abandon his hunting activities. "Hunting takes a lot of time, and doesn’t always result in food for the man" explains Soro. "You can work for one week, spending CFA 10,000 to organize the hunt and return without any game." With his new knowledge and involvement in the fight against Ebola, Soro has realized that hunting is not only an unprofitable activity, but potentially has human cost. Today the old Soro who used to cultivate 1 hectare of rice and 1 hectare of corn, is cultivating 2 hectares of rice and 4 hectares of corn instead. Soro is determined never to go back to traditional hunting. "I continue to educate my fellow countrymen on Ebola prevention measures and the benefits of focusing on cash crops that will never betray us. I eat my fill and I contribute to the welfare of my community".

Photo of Soro and other Dozo “Being Infected with Ebola is not always the end of the world” Twenty-year-old Mabinty Conteh lives with her husband and children in Rosinth village, in the Bombali district of Sierra Leone. Rosinth village was an Ebola hotspot that was quarantined for more than three months, preventing movement in and out of the community and bringing livelihood to a standstill. Mabinty’s husband, Mohamed, caught the virus from his father, who upon returning from a funeral in a neighbouring community fell sick with EVD and was taken care of by Mohamed. This action led to a chain of events that eventually saw five members of the community taken by the virus, including Mabinty’s only daughter.

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Mabinty relates, “most people who survived Ebola celebrated, but for us, it was a completely different story. We continued to mourn the death of our only daughter.” Mabinty and husband were later consoled when she eventually gave birth to a bouncing baby boy. Mabinty explains, “The baby was indeed a blessing to us. Although I considered it a reward from God, deep down I was still worried thinking that he would also fall victim of the Ebola virus. Our village was in bondage for a very long time and it was only with the intervention of CARE that we started seeing light at the end of the tunnel. Now I say to myself “being infected with Ebola is not the end of the world”. Photo of Mabinty (second from the left) and her new baby.

Photos of the intervention

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Financial Report

To reduce start up and operational costs, this pooled fund has been hosted in CARE Mali accounting systems with all accesses limited to the regional team. IPIAs and BAM were signed between the CI member and the Regional Management Team, through the Regional Director for West Africa.

The consolidated recordings of all expenses were done under one FC for the pooled fund. The costs are then distributed to the CMPs based on their percentage budget contribution.

Cumulative financial report in annex 2.

Breakdown of expenditures according to the standard categories:

BUDGET ITEMS COTE D'IVOIRE SIERRA LEONE MALI REGION GHANA LIBERIA TOTAL BURN

RATE BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES BUDGET EXPENSES

HUMAN RESOURCES 13,406 13,405 9,172 9,453 28,799 27,393 65,709 17,850 30,000 - 66,916 66,876 214,003 134,977 63%

EQUIPMENTS 26,564 26,335 21,700 27,164 1,254 2,850 3,030 52,368 56,529 108%

TRAVEL AND TRANSPORTATION 6,210 6,210 7,715 6,239 4,000 4,305 4,000 425 20,769 20,792 42,693 37,972 89%

TRAINNING AND WORSHOP 28,957 28,957 53,413 49,080 12,466 2,504 11,016 10,200 10,454 116,052 90,995 78%

MONITORING & EVALUATION 1,704 1,707 - - 1,789 1,159 10,000 11,925 12,071 25,418 14,937 59%

OPERATIONAL COST 3,610 2,706 - - 51,692 64,136 6,340 6,870 61,642 73,712 120%

TOTAL 80,450 79,321 92,000 91,936 100,000 99,498 90,725 18,275 30,000 - 119,000 120,092 512,175 409,122 80%

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Conclusion

Generally, the impact of grass-roots advocacy and awareness-raising campaigns led by communities cannot be seen and felt within such a short project timeframe. However, hygiene messaging continues to be practiced at community level and, as anecdotal evidence suggests, is having a positive impact on community health in other respects. CARE will continue to provide support for hygiene promotion in 2016 through its various recovery programming, as well as support for community structures. In addition, CARE has left the targetted communities with a group of health volunteers trained in EVD awareness, hygiene and health-promoting practices. It is anticipated that with these basic tools they will continue to assist community health teams and support the behavior change process. It is worth noting that up until the end of this project, no case of EVD has been reported in Mali or Côte d’Ivoire. This indicates that EVD-reduction activities replicated in these countries have made a sizeable contribution to the national effort by targeting activities at the community level. Through the training community leaders and placing them at the heart of the behavior change approach, the project has strengthened community capacity to sustain achievements and manage future emergencies.

Annexes

Annex 1 - CI Advocacy strategy for Ebola response and Recovery Annex 2 – Cumulative financial report