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Sierra Leone

Could the Ebola outbreak become an opportunity for reflection and action on strengthening the health System in Sierra Leone?


The limited technical capacities that, among others, have slowed down the emergency response have also challenged the capacities of the health system to provide the population with the basic health services leading to their disruption.


This has also been the consequence of the number of health staff infected and dead as result of the epidemic. “Many of the health workers infected since the beginning of the outbreak were working outside of Ebola facilities […] fewer precautions, lack of training and protective equipment have contributed to health staff engaging in unsafe behavior and either being infected or considered as such with the consequent closure of the health structure” (U.Sebinwa, Health and Nutrition Head of Department, ACF).


Infection, Prevention and Control: a way to improve safety and limit disruption of services


Improving the safety of health workers and beneficiaries is paramount to ensure health services are provided and health facilities attended. ACF in Moyamba district is implementing a programme aiming at contributing to this goal by training the health staff on the respect of the “infection, prevention and control” measures. 


IPC consists on training health staff on how to conduct the triage, on providing protective equipment and consumables and train the staff on how to use them; […] ACF is also supporting the staff in adapting the structure of the health centre to include an isolation room for those patients that at triage level are identified as suspected” (T.Murungi, former ACF Field Coordinator in Moyamba District). 


By training and monitoring the health staff’ capacities, and by providing them with supplies we are seeing them regaining confidence in what they are doing [….] also, the communities are slowly going back to the centres despite sometimes challenging the presence of the isolation room […] sometimes communities don’t understand why people going for help should be isolated.” (U.Sebinwa). 


Strengthening Maternal and Child Health Care (MCHC)


In the past couple of years the attention on MCHC has increased, particularly with the introduction of the free health care. However this is one of the health sectors the most impacted from the secondary effects of the Ebola epidemic. 


Considering the already high rate of maternal and child mortality in Sierra Leone, and the expected deterioration of the situation, ACF in Moyamba is working with 10 Community Health Care (CHCs) supporting them on the implementation of the “Basic Package of Essential Health Services” (BPHS) with focus on maternal and neonatal care and on WaSH. 


The particularity of the situation imposes ACF to focus particular attention, during the IPC training in the PHUs and the support provided at CHCs level, on pregnant women and undernourished children. Indeed, their status could influence, positively or negatively, the appearance of signs and symptoms resulting in a wrong diagnosis by the health staff.


Since ACF is implementing the programme on IPC and BPHS, mothers are slowly starting to come back to the health facilities […] however we are still encountering challenges thus we have established an incentive system providing baby kits to mothers who attend all the consultations [pre-natal, delivery and post-natal]” (U.Sebinwa, Health and Nutrition Head of Department, ACF). 


Way forward


The implementation of the IPC at PHUs level is improving the working conditions of the health staff that can provide health services in a safe manner to the communities. On their hand the communities are slowly re-gaining trust in the health system as they can see that safety measures are in place and respected by the staff. 


Considering the improvements obtained at community level, and the needs appearing in the district hospitals to implement the same measures, ACF is evaluating the opportunity of supporting the one in Moyamba and the one in Kambia. 


Indeed, with the decrease in the number of confirmed cases every day, and the scaling-down plan of the Ebola response currently under discussion, there is an increasing need to strengthen the health staff’ capacities to prevent potential infections while continuing to provide communities with health services, primary and non. 


Yet, in the framework of the activities aiming at strengthening the health system to ensure that this, in the future, is capable to avoid services’ disruption, ACF is considering extending the support to the CHCs for a longer period covering the full BPHS.



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