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Implementing ETP and SS: The Liberia Experience

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Presentation by Dr. Rose Macauley at "Post-Ebola Survivors - Research and Recovery Lessons from West Africa," a USAID Brown Bag on May 2, 2019 at USAID/Crystal City.

Together with NIH/PREVAIL, today’s session focuses on learnings from these programs in relation to survivor care and post-outbreak recovery of health services and health systems.

Facilitator: Jeff Sanderson, Team Leader, West Africa Post-Ebola Programs, JSI R&T/APC

The Presenters:
Dr. Libby Higgs, Global Health Science Advisor for the Division of Clinical Research at NIAID, NIH (confirmed)
Dr. Meba Kagone, former Chief of Party for ETP&SS, Guinea, JSI/APC (confirmed)
Dr. Rose Macauley, former Chief of Party for ETP&SS, Liberia, JSI/APC (confirmed)
Jeff Sanderson (for Dr. Kwame Oneill, former Director of the Program Implementation Unit, Ministry of Health and Sanitation, Sierra Leone)

Background:
The Ebola Transmission Prevention & Survivor Services (ETP&SS) program included four components; country programs in Guinea, Liberia and Sierra Leone, and a regional program designed to share best practices and lessons learned.
ETP&SS assisted these governments to prevent further Ebola transmission, reduce stigma and other barriers to care for survivors when accessing health services, support the strengthening of needed specialty services, and build more resilient and self-sustaining health systems.
The regional program sought to ensure the sharing of lessons learned and best practices across the three countries and the region through meetings, exchanges and conferences with partners such as NIH, WHO, and the West African Consortium.
Funded by the Global Health Bureau through the Advancing Partners & Communities Project, John Snow Research & Training Institute implemented the program from July 2016 through July/August 2018.

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Implementing ETP and SS: The Liberia Experience

  1. 1. Implementing ETP&SS: The Liberia Experience Dr. Rose Macauley Chief of Party
  2. 2. Outline of Presentation • Background • Program objectives • Key interventions • Selected key outcomes • Summary
  3. 3. Background • Following the major EVD outbreak in 2014-2015, there have been a number of small-scale outbreaks in the 3 countries (Liberia, Guinea, Sierra Leone) all linked to survivors. • To help minimize the risk of transmission, USAID provided funds to JSI through the APC project to support MOH in its efforts. 3
  4. 4. Program Objectives • Improve access to health services for Ebola survivors and combat stigma among providers • Build public health sector capacity to provide specialized health services needed for common complications of Ebola survivors • Strengthen coordination and management of activities for Ebola survivors ETP&SS 11 Facilities in 4 counties HS & HSS 6 Facilities in 4 counties
  5. 5. Improve access to health services and reduce stigma among providers • APC/ETP&SS awarded grants to: – Two faith-based hospitals to provide comprehensive care to survivors (at no cost to the survivors) – Liberia College of Physicians and Surgeons to recruit specialists to treat survivors (and general population) and to transfer skills to counterparts – Phebe School of Nursing to train 60 additional mental health clinicians • APC/ETP&SS trained health care workers to reduce stigmatization
  6. 6. • Renovated Eye Unit, and established dedicated operating room • Recruited ophthalmologist to provide services and transfer skills to counterparts • Supported the training of an ophthalmic nurse to sustain eye care services • Coordinated an exceptional team to screen and perform cataract surgery for EVD survivors and non-survivors Improve access to health services: Eye Care Services
  7. 7. Building Public Health Capacity • Procured critically needed medical and lab equipment for the target health facilities • Provided infrastructure support to enhance specialty care, IPC and lab services • Supported training of 60 mental health clinicians to increase the capacity of secondary facilities to provide specialty care
  8. 8. Coordination and Management • National Ebola Secretariat – Established the national secretariat in line with the National Survivor Care and Support policy – Built capacity of the secretariat through technical assistance and direct support • Ebola Survivor Network – Supported establishment of the Ebola Survivor Network – Strengthened network capacity for mobilizing resources and advocating for their members
  9. 9. Selected Key Outcomes
  10. 10. Selected Outcome: Establishment of reliable water supply at Kolahun Hospital Water source before Water source after
  11. 11. SelectedOutcome:RenovationofInfectiousDisease OutpatientClinic,JFKMedicalCenter Right Side View with Water Tower _Before Right Side View with Water Tower _After
  12. 12. InsideoftheInfectiousDiseaseOutpatientClinic
  13. 13. Selected Outcome:PerimeterWallatDoloTownHealthCenter • Dolo Town was one of the hardest hit communities during the Ebola crisis • The facility was exposed with no wall • Renovated perimeter wall provides security and enhances IPC / triage
  14. 14. Patient Visits (5243) LCPS: 3476 Rheumatology: 818 Ophthalmology: 1587 Psychiatry: 1071 Catholic Hospital: 571 ELWA Hospital: 1196 FBOs: 1767 Selected Outcome: Patient Visits through FBOs and LCPS Specialists
  15. 15. Summary: Implementing ETP&SS -- The Liberia Experience • ETP&SS addressed critical needs of Liberia’s Ebola survivors at a time when it was most important • ETP&SS interventions in the three countries varied and were informed by the local context • Overall, ETP&SS was largely successful in meeting its objectives. However, implementing the program also had challenges: – Limited government support created gaps – Expectations from the survivors were often not aligned with the mandates of the program 15

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