Regenerative Health Systems Strengthening Models,

Survivorship Programming

PARTNERS

Social Mobilization

In the PIH SP model, survivors are employed within their community as educators aimed at breaking chains of transmission and promoting health seeking behavior. During the peak of the Ebola outbreak, social mobilizers shared their personal narratives of surviving Ebola to instill the trust necessary for communities to change behavior. The greatest challenge of the PIH SP was funding restrictions for public sector grants which evolved to exclude support for employing illiterate persons given the reporting intensive environment. The bulk of our social mobilization activities during the initial emergency response were supported by unrestricted funds—a luxury largely available only to well-endowed foreign organizations—privileging the rapidness of our response.

Comprehensive Care: Access, Follow-up, and Outcomes

As of November 2015, our EVDS clinic had assessed 603 survivors residing in Port Loko at least once.2 Case Managers—all EVDS—perform weekly home-visits while accompanying others to clinics, educational programs and livelihood activities. Clinical sequelae are common,2 thus the need for early clinical follow-up and socioeconomic support to overcome barriers to care3 vital to good health outcomes.1-4 The holistic needs of the patient are met when regenerative socioeconomic services are linked with health care delivery, building trust in the health system while ensuring access.

PEOPLE

Following discharge from Hastings Ebola Treatment Center on October 11, 2014, Jamil refused to leave his room due to stigma and discrimination. After discharge, he was invited to attend a Survivor Conference and was elected as the chairman of the local chapter of a grass-roots movement of survivors, SLAES, whose purpose was to provide social support networks for participating in public policy and service-delivery.

“Rather than to remain idle dwelling on all that I lost, the Survivor Program employed me with resources to recruit and train fellow survivors to engage in the response. I organized teams of survivors from SLAES to share our experience surviving EVD to demonstrate the need to adopt safe behaviors. As a survivor people listened to me and valued my presence.”

“Because of the job my peers respected me, I was no longer stigmatized and was able to support my siblings.” After serving as the District Social Mobilization Lead, Jamil completed his final year of high-school graduating with honors as the Head Boy. Since graduation, Jamil has returned to PIH and is now the Port Loko District Coordinator for Social Protection.

ACKNOWLEDGMENTSWe thank Paul Allen Foundation and PIH Unrestricted Donors for making this program possible.

We acknowledge the leadership and guidance of the Sierra Leone Ministries of Education; Ministry

of Health and Sanitation; Ministry of Social Welfare, Gender and Children’s Affairs and SLAES

whose collaboration has informed the regional scaling of the model. Thanks to the Lunsar Baptist

Hospital Eye Unit, Port Loko Government Hospital, the Port Loko District Medical Officer Dr. Tom

Sesay and every health-care worker for their relentless efforts to provide quality care for patients.

Promoting HSSThe success of EVDS’ contribution to the model afforded trust and motivationtowards participating in the program and informed the implementation of healthsystems strengthening amidst an emergency response. Coupling socioeconomicsupport with employment in service-delivery empowers community-based healthcare. A restructuring of international aid limitations must occur for an increase incomprehensive approaches to care for those who survive disease.

*M. Drasher1, G. Warren1, J. Lascher1, K. Dierberg1,2, K. Hann1, A. Stewart1, C. Cancedda1, J. Chang1, C. Albertson1, E. Headrick1, G. Sherrif1, K. Tekuyama1,3, A. Sesay1, F. Boima1, I. Bangura1, J. Bangura1, S. Bangura1,4, A. Kanu1, A. Kamara1, S. Conteh1, A. Kargbo1, F. Bangura1, M. Kamara1, S. Kamara1.

IntroductionPIH cherishes the value of survivorship in ensuring a patient-centered experience in the home and health clinic.1 Ebola Virus Disease Survivors (EVDS) represent a marginalized population in need of health care and socioeconomic support. By pairing health and socioeconomic services, a comprehensive care framework for vulnerable populations is actualized--promoting opportunities to overcome the violent structural forces which predispose them to increased morbidity and mortality.

The PIH Social Protection (SP) model demonstrates the feasibility of implementing comprehensive services to improve the health seeking behavior of vulnerable individuals. EVDS accompanied the PIH SP to empower survivors, led by the national community-based organization, Sierra Leone Association of Ebola Survivors (SLAES), to address gaps in the Emergency Response, focusing on breaking the chain of EVD transmission; providing a platform to improve health care delivery; and regenerating the socioeconomicmobility of EVDS while creating a foundation for conducting strategic health system strengthening through the lens of survivorship.

PRAXIS

Number of survivors

employed in Port Loko

Citations1 Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449. 2 Mattia, J. G., Vandy, M. J., Chang, J. C., Platt, D. E., Dierberg, K., Bausch, D. G., … Mishra, S. (2015). Early clinical sequelae of Ebola virus disease in Sierra Leone: a cross-sectional study. The Lancet Infectious Diseases, 3099(15). 3 Tsai, A. C., Bangsberg, D. R., Frongillo, E. A., Hunt, P. W., Muzoora, C., Martin, J. N., & Weiser, S. D. (2012). Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Social Science & Medicine, 74(12).4 Varkey, J. B., Shantha, J. G., Crozier, I., Kraft, C. S., Lyon, G. M., Mehta, A. K., ... & Ströher, U. (2015). Persistence of Ebola virus in ocular fluid during convalescence. New England Journal of Medicine, 372(25), 2423-2427.5 Franke, M. F., Kaigamba, F., Socci, A. R., Hakizamungu, M., Patel, A., Bagiruwigize, E., ... & Mukherjee, J. (2012). Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clinical Infectious Diseases, cis1193.6 Chang, J & Schlough, G. (2015). Comprehensive Care for Ebola Survivors. Presentation at: WHO meeting on survivors of Ebola virus disease: Clinical care, research and biobanking, Freetown, Sierra Leone.

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Port Loko New Ebola Cases vs EVDS Social Mobilization Employment

New Ebola Cases EVDS Social Mobilization Staff

1Partners in Health Sierra Leone, 2Division of Global Health Equity Brigham and Women’s Hospital, 3Institute of Advanced Management and Technology (IAMTECH) Kono, 4University of Makeni Unimak Development Studies.

*Corresponding Author: mdrasher@pih.org

The PIH SP aspired to hire all EVDS in social mobilization efforts, including the illiterate, elderly, and the sick.

Integrated community events to register survivors; the Government of Sierra Leone utilized the data for status verification.

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Figure 1. Graphical depiction of new Ebola cases in Port Loko versus EVDS social mobilization staff employed in the field. All Ebola case data obtained from the Government of Sierra Leone’s Ministry of Health and Sanitation.

Figure 2. EVD Survivor Clinic (Port Loko) cross-sectional study, describing the prevalence, nature, and predictors of three key EVD sequelae (ocular, auditory, and articular) in a cohort of EVD survivors.

Figure 3. Map of EVD Survivor Care, Northern Region, Sierra Leone.

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