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Sierra Leone
Population 2015: 7.0 million
Life expectancy 2015: 50.1 years (Males = 49.3; Females = 50.8) compared to average of 60.0 for the African region and 71.4 globally
Healthy life expectancy at birth 2015: 44.4 years
MMR (per 100,000 live births) 2015: 1,360 compared to average of 542 for the African region average and 216 globally
U5M rate (per 1,000 live births) 2015: 120.4 compared to the average of 81.3 for the African region and 42.5 globally
The Ebola Outbreak 2014-16
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2014 2015 2016
EVD Epi Curve 2014 - 2016
Sierra Leone
The building blocks of the Ebola response
BurialsTreatmentCase Investigation
Community EngagementLab Survivors
Engaging with communities consistently and at scale remains a challenge for health programmes and planners
1986 2016The Panel is surprised and dismayed by serious gaps in the early months of the outbreak in terms of engaging with communities, some of these gaps still exist in the late phase of the outbreak……
Report of the Ebola Interim Assessment Panel page 20
“Engagement with affected communities and families… is not simply about getting the right message across; we must learn to listen if we want to be heard.”
World Health Organization, 2015, quoted in Smith and Upshur, p. 312
“Where we have had success, it has developed from honest dialogue.”
Beyond Ebola: From dignified response to dignified recovery; Report by the International Federation of Red Cross and Red Crescent Societies, p. 5.
“The response works when communities—through their leaders—are in a position to “own” both the outbreak and the response, to plan for themselves and to implement their plans.”
Making a Difference, Global Ebola Response Information Centre, 2015, p. 11.
“At-risk communities and local actors must be the key drivers of change and at the core of a decision-making process that draws on local knowledge and capacities.”
Alasan Senghoreerson, IFRC Africa Regional Director (Beyond Ebola: From dignified response to dignified recovery; Report by the International Federation of Red Cross and Red Crescent
Societies, p. 5).
Engaging with communities consistently and at scale remains a challenge for health programmes and planners
• the current design of CE interventions do not take into account that engagement and resiliency are dynamic processes - not states of existence;
• CE research generally ignores the community of health professionals;
• CE research generally focuses on education and information, not on emotions and feelings;
• insufficient attention has been given to the development of engagement processes that support effective sustainability of practices;
• the dynamics between geopolitical communities and communities of practice of health professionals need to be explored to achieve effective engagement; and
• the CE literature has not sufficiently investigated the impact of trauma histories on the quality of engagement.
What is the core essence of the community engagement for quality, people-centred and resilient health services?
People-centred & community-competent
health services and programmes
stra
tegi
c lev
els o
f the
hea
lth sy
stem
• Know and manage self• Know and manage context• Co-production of health
and well-being
1. Reflective, reflexive practitioners
2. Skills in engagement You I
Me WE
A resilient health system
“A health system’s resilience can be defined as the capacity of health actors, institutions and populations to prepare for and effectively respond to crisis; maintain core functions when the crisis hits; and, informed by lessons learnt during the crisis, reorganise if required.”
Lancet May 2015
10
Information Products(Weekly Epidemiological Bulletin)
Weekly National Bulletinby MoHS Weekly Bulletins by DHMTs
with support from WHO field teams
Summary report of Priority Diseases, Conditions and Events through IDSR Weeks 1 to 36, 2017
DiseaseCurrent Week : 36 Cumulative : Weeks 1 —
36Cases Deaths CFR(%) Cases Deaths CFR (%)
Acute Flaccid Paralysis 0 0 0.0 42 1 2.38
Acute Viral Haemorrhagic Fever 0 0 0.0 70 22 31.43
Acute Jaundice Syndrome 0 0 0.0 21 1 4.76
Animal bite case (dog/cat) 18 0 0.0 1,089 4 0.37
Suspected Cholera 0 0 0.0 31 0 0.00
Diarrhoea with severe dehydration case under 5 years 95 0 0.0 7,683 78 1.02
Dysentery (Bloody diarrhoea) 58 0 0.0 2,585 7 0.27
Clinical Malaria 51,306 2 0.0 2,045,259 186 0.01
Malaria tested 50,989 2 0.0 2,033,550 138 0.01
Malaria tested positive 29,258 54 0.2 1,162,883 1,531 0.13
Severe Malnutrition in <5s 377 1 0.3 18,087 127 0.70
Maternal death 4 4 362
Suspected Measles 3 0 0.0 2,700 1 0.04
Suspected Meningococcal meningitis 0 0 0.0 57 7 12.28
Suspected Monkey Pox 0 0 0.0 4 0 0.00
Neonatal Tetanus 0 0 0.0 26 6 23.08
Severe Pneumonia 398 9 2.3 18,159 331 1.82
Suspected Typhoid Fever 1,788 0 0.0 57,394 39 0.07
Suspected Yellow Fever 0 0 0.0 37 0 0.00*No reported cases of Anthrax, Buruli ulcer, Chikungunya, Dengue Fever, Dracunculiasis, Plague, Influenza due to new subtype and Small pox
Key Highlights
3 suspected measles cases reported from Bombali (1), Western Area Rural (1) and Western Area Urban (1).
• Bombali: DRRT currently investigating• Western Rural: 1yr old boy, fever with rash,
conjunctivitis, coughing. No sample collected• Western Urban: <5yrs case reported from
ODCH, sample collected and sent to CPHRL for testing
58 cases of dysentery reported this week, a decrease from an average of 62 cases in the past 3 weeks
95 cases of Diarrhea w/ severe dehydration in children <5yrs were reported, a decrease from an average of 108 in the last 3 weeks
1,788 cases of suspected typhoid fever reported, an increase from the average of 1,747 reported in the past 3 weeks, majority from Western Area Urban (554), Kono (411) and Bombali (264) districts
Decline in severe malnutrition cases, from an average of 642 in the previous 3 weeks to 377 cases this week
12
IDSR training roll-out coverageApril 2015
December 2015
• A total 144 TOTs and 2,300 health facility personnel were trained in 2015-2016
• 96 hospital focal in 2017• 832 clinicians being trained on their role in
IDSR-2017
October 2015
National IDSR Reporting (2015-2016)
838179
7167
63
7070
6264
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7067
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68
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7781
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8480
828387
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919192
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8992
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9492
94959493949395949394
969796979693
9698
9698
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WK 35WK 36WK 37WK 38WK 39WK 40WK 41WK 42WK 43WK 44WK 45WK 46WK 47WK 48WK 49WK 50WK 51WK 52WK 53WK 1WK 2WK 3WK 4WK 5WK 6WK 7WK 8WK 9WK 10WK 11WK 12WK 13WK 14WK 15WK 16WK 17WK 18WK 19WK 20WK 21WK 22WK 23WK 24WK 25WK 26WK 27WK 28WK 29WK 30WK 31WK 32WK 33WK 34WK 35WK 36WK 37WK 38WK 39WK 40
2015 2016Epidemiological Week
HF R
epor
ting
Rate
(%)
National Surveillance Quarterly Review Meeting
End of Year Festive Season
Easter Festivity
Measles Campaign week
Week 35, 2015 to Week 40, 2016
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• 8,367 CHWs trained in 9 out of 14 districts• ToT Conducted in remaining 5 districts
No
of c
ases
Involving communities in surveillance and response
Number of CHWs per DistrictCommunity Based Surveillance (CBS) roll out
Completeness rate = 81%
8
1 571
4 043
961
570 0 34
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1 000
1 200
1 400
1 600
Diseases/Events
CBS Alerts in 2017 (Week 1-32