EBOLA OUTBREAK – LIBERIA, 2014

Current Status Scale and evolution of outbreak outpacing strategy and plans – 14 of 15 counties now affected – Major urban component – unprecedented – August 29 = 1,631 cases – 145 cases among HCWs = 2% of workforce Projections: – WHO (6 months) = 11,950 – Others = >100,000

Current Status SOURCETOTALMONROVIALOFA EPI 108 All cases1, Confirmed cases Lab tests Samples tested 1,6721, Confirmed cases

Rapid Scale-up Possible Effective control measures exist. Control of outbreak possible Requires – Community engagement – Political will – Collective effort – Resources – Planning

Goal Stop Ebola transmission within 6-9 months and mitigate health and secondary consequences Key milestone: Reverse trend in new cases & areas within 3 months

Objectives 1.Rapidly scale up evidence-based Ebola control interventions in high transmission areas 2.Implement complementary measures as required 3.Ensure availability of essential health services 4.Strengthen capacity of low transmission counties to rapidly limit Ebola transmission

Priority Ebola Control Interventions Ebola Treatment Units Safe burials Infection prevention and control Community engagement – social mobilization Surveillance and contact tracing Aim to get sick people and dead bodies out of homes

COUNTYBEDS NEEDED BEDS AVAILABLE BEDS IN PROCESS GAPCLINICAL PARTNERS Montserrado1, MSF, Uganda team Lofa70 00MSF Bong IMC Margibi Nimba Grand Gedeh TOTAL1, Ebola Treatment Units

Progress – Site identification, Montserrado: 3 of 5 sites identified – Site planning: WFP, contractor – Implementing partner identification: 1 + ?3 – Support for implementing partners – Lab services – Lofa, Bong, Montserrado Next functioning ETUs during week of: – September 8 – Island Clinic – September 22 - Bong

Safe Burials Progress – Revised SOPs – more efficient and safer – Expanded capacity of crematorium Next steps – Training – refresher and new teams – Expand number of teams  Montserrado = 16  Other counties – mapping of needs; training; increase teams – Reserve stock of equipment and supplies – Procure 12 vehicles

Social Mobilization and Community Engagement "Cannot end this outbreak without the community" Issues: lack of confidence; fear; inconsistent messaging; traditional practices Aligning messages – MOHSW develops messages and materials – MoI distributes; Channels of communication – Radio – CHVs – Community leaders – School children

Infection Prevention and Control Identify and train target populations – HCWs – public and private – Ambulance and burial teams – Transport workers – taxi drivers and motorcyclists – Families Provide supplies and equipment – Health facilities – Hygiene kits Supervise and monitor - committees Provide performance-based incentives

Reactivation of Health Facilities Assessments: Unicef, UNMIL, MOHSW Plan – Identify priority facilities: referral for ETUs – Identify priority services: EPI, IMCI, safe deliveries – Identify priority geographic areas: large populations Resolve payment issues Train and equip staff on triage

Implement Complementary and Other Measures Transit centres – Controversial – Community managed Home-based care Temporary measures under IHR – Prohibit travel of Ebola patients and contacts – Conduct exit screening

Strengthen Capacities of Low Transmission Counties Train health staff to identify and respond quickly to suspected Ebola cases – Isolation – Reference laboratory – Reference ETU Implement daily reporting for all counties Raise community awareness Strengthen IPC across

Enabling Environment Strengthen partnerships and coordination structures – Engage all relevant stakeholders – Activate Health Cluster: INGOs, LNGOs, private sector – IMS = Exec Committee of Health Cluster – Establish EOC within MOHSW – Assign senior staff to counties Improve information management – Strengthen data management – Strengthen epidemiological analysis – Standardize indicators for M&E – Improve mapping

Enabling Functions Coordinate with other sectors for delivery of essential services – Logistics, WASH, food security, child welfare – UNMIL – Inter-cluster Working Group

Monitoring and Evaluation Impact measurements: – Reverse the trend in new Ebola cases and infected areas within 3 months Outcome measures – Trends in cases and deaths, by county Coverage and quality indicators by district: – Ebola treatment and referral centres – Airport screening

Way Forward Conduct gap analysis by county to assess availability of priority interventions and resources Convene partners to review gaps and update operational plan collectively Agree on common M&E reporting mechanism Convene Health Cluster and Exec Committee X per week Advocate for more FMT and international partners

Way Forward Advocate for additional resources with donors Finalize MOHSW assessment of health facilities and use to plan reactivation of health facilities Produce weekly sitrep to report against plan and key indicators