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“Ebola Na Fini (Ebola Hasn’t Finished)”

September 11, 2015

In Liberia, Sierra Leone, and Guinea, almost 28,000 cases of Ebola have been reported and nearly 12,000 people have died from the disease since the start of the outbreak in 2014. Although thousands have defied the odds and survived Ebola across the West African region, strengthening the health care system is the most sustainable way to put a stop to the spreading of the virus. That’s why UUSC has been working with two partners on the ground to build effective community health systems in Liberia and Sierra Leone.

Not out of the woods yet

The country with the highest number of Ebola cases, Sierra Leone, has recently experienced its first week without new cases. Guinea is hopefully on the same path to no cases. However, at the end of June 2015, just when Liberia began to consider Ebola a thing of the past, new cases appeared. After the country had been disease-free for nearly two months, the report of an individual dying in Montserrado County brought fear as the government and communities realized that Ebola was not eradicated. Since the resurgence, there have been six confirmed cases in Liberia. On September 3, 2015, the World Health Organization declared Liberia free of Ebola for a second time. The country has subsequently entered an intense 90-day surveillance period for new cases.

Expanding community health services in Liberia

In Liberia, UUSC partners with Last Mile Health (LMH) to train health care workers in remote Liberian villages in order to address the Ebola epidemic in River Cess communities. LMH has created a network of frontline community health workers (CHWs) who are essentially a system of trained “neighbors” whom community members know and trust. Instead of relying solely on doctors and hospitals that might be non-existent or might be located too far away, LMH is training village residents to advance the right to health on a daily basis. The overall goal: to eradicate Ebola and lay the foundation for a strengthened health care system.

The scale-up of the CHW model with LMH’s standard primary health curricula is currently being rolled out across Rivercess County in two phases. Here’s what that has looked like so far for LMH:

  • Trained over 1,300 CHWs
  • Trained nearly 750 members of community health committees, which support CHWs and create accountability mechanisms
  • Named the lead community health partner by Liberia’s Ministry of Health in plan to establish a health system utilizing professional community health workers
  • Recruited nearly 100 CHWs in June to serve in three health districts: Yarnee, Central C, and Jowien

It’s not ending there, though. Approximately 50 additional CHWs will be recruited in November and December to serve in the remaining three health districts: Timbo, Jo River, and Doedain. And, as mandated by the Ministry of Health, LMH will establish access to primary health care services in all communities further than five kilometers from the nearest health facility. It is estimated that in covering the entirety of Rivercess County and the remote area of Gboe-Ploe, as well as maintaining coverage of the Konobo District, direct health services will be extended to more than 50,000 Liberians who are living in over 300 remote villages.

Stopping transmission in Sierra Leone

Meanwhile, Wellbody Alliance, UUSC’s partner in Sierra Leone, is implementing a rapid, effective, and robust community-based response to Ebola in Kono District in order to stop transmission chains. Drawing on their years of experience developing and managing CHW programs in partnership with the Ministry of Health, Wellbody has doubled their corps of highly trained CHWs and established an Ebola Treatment Unit. Wellbody is also implementing the first ambulance system in the district to provide safe, expedited transport of Ebola patients from even the most decentralized locations. 

On July 23, 2015, Kono celebrated its 150th consecutive day without a confirmed case of Ebola. With UUSC’s support, Wellbody Alliance has played an integral role in containing the epidemic and continues its integrated response to meet the evolving health-care needs of its communities. Ebola-related food shortages have led to a spike in malnutrition rates, and a secondary outbreak of measles continues to spread throughout the district. Therefore, Wellbody’s community health workers perform community visits to each house that include measles and malnutrition screenings. Since the implementation of the UUSC-supported project in January 2015, Wellbody Ebola CHWs have screened and engaged 613,826 individuals.

An effective and transformative model

UUSC’s partners work at both the grassroots and “grasstops” levels. Their transformative model of working with community health workers is a profound resource for the national ministries of health. When UUSC invests in CHWs, the results are evident. This investment has an estimated return of up to $10 for every $1 spent through productivity gains from a healthier population. This model not only protects against catastrophes like Ebola but it also serves as the foundation of a resilient health system in Liberia.

In a July 2015, a U.N. report titled Strengthening Primary Health Care through Community Health Workers: Investment Case and Financing Recommendations made a global case for CHW investment through a rich body of evidence and experience. Notable among the findings of the report is the following: “supporting Community Health Workers is a game-changing investment: CHWs are critical for increasing access to health care and, if scaled up, could save up to 3 million more lives each year.”

Getting healthy communities back on their feet

While the region works toward being free of new Ebola cases, life still goes on. The trial of two vaccines in the three most affected countries is encouraging. But the quality of life depends a lot on economic success. The Ebola virus has had a crippling effect on the economy — incomes are dropping, access to financial services is scarce, and food production is decreasing. Building a resilient health-care system and a resilient economy will take time and significant resources. This is a prime opportunity to support grassroots efforts to transform the health infrastructures of entire countries and get healthy communities back on their feet and back to work.

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