Emily Toubali, MPH

Senior Program Manager, Neglected Tropical Diseases

Fatmata Fatima Sesay, BSc, MSc, MSPH

Nutrition Program Manager for HKI-Sierra Leone

Sierra Leone: The Long-Term Impact of the Ebola Crisis on an Already Fragile Health Care System

Sierra Leone: Background

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• 5.7 million people

• Over ½ population under 25 years old

• 40% of population is urban

• 0.02 physicians per 1,000 population

• Sustenance farming, mining

March, 1991 – January, 2002: 11-year Civil War plagues the country

– 50,000+ deaths

– Mass amputations, child soldiers, post traumatic stress disorder

– Interruption of basic health care

– Dilapidated institutions, health systems, infrastructure

– “Blood Diamonds”, “A Long Way Gone”

CIVIL WAR: 1991 - 2002

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• Building capacity of the National Public Health System

• Schools for the Blind

• Nutrition – Vitamin A supplementation – Under 5 deworming – Food fortification

• Neglected Tropical Diseases – Elephantiasis – River blindness – Schistosomiasis (snail fever) – Intestinal worms

Post-Civil War and the work of Helen Keller International

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Lymphatic Filariasis

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Lymphatic Filariasis Elimination Progress

2014 Ebola Crisis:

What Happened and What’s Happening Now

• First Ebola case confirmed in Sierra Leone on May 26, 2014

• State of emergency declared by the President on July 30 and by World Health Organization on August 8

• Ebola infecting >2.5 people for every case confirmed

• Food security and economic issues -Price hikes, panic buying, low agricultural yields, travel and market restrictions

• Limited access to health care for non-Ebola

cases including births and common child illnesses

Photo credit: EPA

New cases in 24hrs:94 Cumulative cases: 4,617 Cumulative deaths:1,149 Survived and discharged: 878

SOURCE: MOHS SIERRA LEONE: 11th Nov 2014

Ebola Cases in Sierra Leone

Current hot spots

Koinadugu (55)

Kono (45)

Kailahun (558)

Kenma (493)

Pujehun (28)

Bo (193)

Bonthe (2)

Moyamba (137)

Tonkolili (281)

Port Loko (644)

Kambia (53) Bombali

(659)

Western Area (1469

First case reported here

Why the current epidemic has overwhelmed Sierra Leone’s health care system

• A public health ‘perfect storm’ in post-war Sierra Leone

• Government and lead agencies not quick

to respond - national apathy and lack of preparedness

• Already weak health care systems • Limited number of trained health

workers • Few hospitals and treatment centers

The Impact On Sierra Leone’s Fragile Health Care

System

• The Ebola outbreak threatens to reverse the health gains made in recent years

• Demoralized local health care workforce • Distrust and fear of health workers • Closure of government hospitals and health facilities

that usually serve hundreds of patients each day • Remaining public health facilities have converted into

Ebola Holding Centers, preventing non-afflicted patients to access other services

• Little or no pre- and neonatal care available

• Vaccinations, vitamin A supplementation

• The supply chain for health services under increasing

• Communities are not attending health facilities for fear of Ebola

• Challenges in re-establishing health services

– Loss of health staff in implementing areas

– Low trust in the health system

– Low uptake of health services

Impact On Health Services and Preventative Care For Women and Children

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Continuing to Monitor Vitamin A Supplementation During the Epidemic

Vitamin A Supplementation Is a Proven, Effective Solution in

Combatting Child Malnutrition

• Reduction in child mortality from 267 of every 1000 children in 2005 to 118 of every 1000 in 2010

• An estimated 24% of this reduction can be attributed to VAS

• Coverage of twice-yearly VAS has significantly improved, reaching more than 90% of children since 2004

Health Minister launching mass VAS distribution: 2012

Remote Monitoring of Vitamin A Supplementation

• Supervision by phone is the only activity maintained by Helen Keller International in Sierra Leone

• Helen Keller International has trained 14 health staff supervisors on to collect VAS data using mobile phones

• We provide feedback and direction remotely for health workers on their progress

• Easy for Ministry of Health Services to tag along VAS monitoring and Ebola work

• Continuing this activity has provided a morale booster for health workers

• Helen Keller International will draw on our experience in rebuilding health systems in post-crisis situations

• Through our work we build the capacity of local governments in

Infectious disease surveillance and control

Famine surveillance and acute malnutrition management

Electronic data capture for more efficient monitoring and evaluation

Supporting Sierra Leone Post-Epidemic

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• Continuing Vitamin A Supplementation

• Re-Establishing Neglected Tropical Disease Control and Monitoring

• Strengthening Food Fortification

Initiatives • Establishing Orange Sweet Potato

Programs

Potential Post-Crisis Programs In Sierra Leone

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• Build a stronger health system

• Address the causes of poor health and nutrition

– Water, Sanitation and Hygiene

– Food security

– Education

– Economic factors

– Women’s rights and empowerment

What’s Needed In Sierra Leone to Prevent A Similar Crisis In The Future

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THANK YOU.

“Although the world is full of suffering, it is also full of overcoming it.” -Helen Keller

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