Presentation about JSI's Advancing Partners and Communities project's approach to post-Ebola health reconstruction in Sierra Leone made at the 2017 American Evaluation Association conference.

1. Post Ebola Health Reconstruction in Sierra Leone:
Using a Needs Assessment to Design a Project
American Evaluation Association Annual Conference
Washington DC
November 10th, 2017
Marc Cunningham, USAID
Soumya Alva, JSI
Nikki Davis, JSI

2. Background
SIERRA LEONE HAS EXPERIENCED THE WORST EVD EPIDEMIC
IN HISTORY
Diminished confidence in
the post-Ebola health
sector resulted in:
• one-quarter reduction
in institutional
deliveries
• 39% fewer children
treated for malaria
• one-fifth reduction in
basic immunization
1,369
882 856 814 789
14
Sierra
Leone
Central
African
Republic
Chad Nigeria South
Sudan
United
States
Maternal Mortality Rates per 100,000 live births
(WHO, 2015)

3. Health System Challenges
2014 Survey of health facilities by UNICEF
categorized gaps in four major areas:
• Inadequate training of health facility
personnel
• Lack of necessary medical equipment
• Weakened diagnostic capability at the facility
level
• Stockouts of essential medicines at peripheral
health units (PHUs)

4. Advancing Partners and Communities:
Rebuilding Health Services Project
• Improve regulatory and
policy environment
• Increase the capacity and
effectiveness of the health
workforce and community
platforms
• Improve physical and
operational conditions of
CHPs and MCHPs

5. Approach to Conducting the Baseline
• Retrofit a framework?
• Stakeholder engagement – DHMT and IPs (including
infrastructure experts), community entry
• Tools adapted from WHO-SARA, USAID/MCSP
• 3 Program tiers
• Results to be used for program development

6. “Building the Plane While You’re Flying”

7. Baseline Facility Assessment
• Jan-Feb 2016 using Android tablets
– to better understand the capacity and infrastructure
of the PHUs in the five priority districts
– to establish a benchmark against which
improvements during the project can be measured
• Criteria: PHUs managed by MOHS, not renovated in
the last 5 years, 268 PHUs
Baseline and
Endline
conducted in
5
project districts
Assessmen
t covered
73%
Peripheral Health Units
in those districts

8. Methodology: 4 Data Collection Tools
General Facility
Overview
(staffing, service provided,
quality of service)
Infrastructure
Assessment
(infrastructure, water
access, waste disposal, etc.)
Minor Medical
Equipment
(clinical equipment for
maternal, neonatal, and
child care, delivery kits,
etc.
Health Staff Survey
(training received and
knowledge on key areas on
MCH)
• Health staff survey in 50% of PHUs meeting criteria
• Drawings of health facility structure
• Pictures of health facility
• Team: APC, Implementing partner, DHMT/MOHS

9. Poor Infrastructure
85% of facilities
had no functional
power
53% had building
conditions needing
rehabilitation

10. Poor Water and Sanitation Facilities
55% of
facilities did
not have a
functioning
improved
water source
14% had no
functional
toilet, others
needed
renovation

11. Infection Prevention & Control: Limited
Waste Disposal Facility
On average,
facilities did not
have the
necessary waste
management
facilities

12. Available & Functioning RMNCH/IPC
Equipment Safety and sharps
boxes are the
most common
RMNCH key item
on hand at
facilities. However,
many gaps in
availability of
other equipment.

13. Available & Functioning Delivery Kit
EquipmentFunctioning Delivery Kit
Equipment is reasonably
available. But no facility had a
complete delivery kit

14. Limited Staff Training & Knowledge
Levels
% scoring 80% or higher
IPC 49%
Newborn health 89%
Child health 29%
Maternal health 48%

15. Community Engagement
82% of facilities
had a functional
Facility
Management
Committee but
fewer met
frequently

16. Direct Use of Baseline Findings
• Selection of sites for infrastructure improvement
– Based on condition of facilities & # deliveries
• Water: Completely misunderstood gap in access to
water
– 55% facilities - no functional improved water source in
the compound
– 40% facilities - no source of water at all
– Repair/rehabilitation of water source in disrepair ->
water to 1/3 facilities
• Training – selection of training topics
• Overlooked the importance of community engagement

17. Programmatic Changes
• Water
– more boreholes, dug more wells, IPs prioritize repair
of wells in the facilities they were doing infra work
• Community engagement
– designing the strategy, policy work, and work with the
health facilities to strengthen FMCs

18. CLICK TO ADD TITLE OF FULL PAGE
GRAPHIC
Click and add insert graphic here
(5” high x 8.5” wide maximum).
“If there is a good facility here which
takes care of us, we will be happy.”
—Ramatu Turay, client