1. AFRICAN PARTNER OUTBREAK RESPONSE ALLIANCE
APRIL 20, 2015

2. OVERVIEW OF EBOLA OUTBREAK IMPACT AND RESPONSE
BY: DR. JOSIAH T. GEORGE CPT. KOWO, JOSEPH

3. OUTLINE Introduction Background to Situation Analysis
Situation Report (March March 12, 2015
Impact of the Ebola virus Disease in Liberia
Health System
Socioeconomic
The Responses
Multi stakeholders partnership and collaboration
The Liberia Investment Plan

4. Introduction Background to Ebola Situation Analysis 2014-April 2015
The Ebola virus disease (EVD) outbreak, which began in December 2013 in the forest region of Guinea, in a town That borders Liberia and Sierra Leone, has led to widespread infection and death rates.
As of April 2015 the World Health Organization (WHO) reported a total of 22,460 suspected, probable, and confirmed cases (of which 10,228 in Liberia) with 8,829 deaths (of which 4,499 are in Liberia).
Health workers have been 30 times more at risk than the adult population with total of 822 confirmed and probable cases of health workers infections (374 in Liberia) and 488 deaths (188 in Liberia).

5. Ebola Case and Death Summary by County
DAILY REPORT
Laboratory2 Confirmed Cases (Alive and Dead)
Confirmed Cases on Contact List 
Cumulative3 cases 23 May-April 11th 2015
Cumulative deaths2
New1 suspected and probable cases (Alive and Dead)
Total
Suspect
Probable
Confirmed
Bomi
332
114 79
139
175
Bong
741
468 33
150
184
Gbarpolu 35 16 3 14
Grand Bassa
181 56 71 54 81
Grand Cape Mount
433
288 52 94
303
Grand Gedeh 11 9
Grand Kru 69 47 18 4 28
Lofa 5
763
185
146
488
Margibi 1
1373
527
453
392
590
Maryland 2 55 49 39
Montserrado 23
5733
3059
869
1797
2427
Nimba
362
115
131
116
River Gee 38 25 8 20
River Cess 44 10 24 27
Sinoe 67 42 7 30
NATIONAL 31
10,228
5176
1879
3150
4499
1 From daily county reports of aggregated data for that day
2Laboratory confirmed cases of suspects and probable cases identified during the preceding days
3From individual-level data from the Case Investigation form; cases may be reclassified according to surveillance case definitions
↑Increase in daily reported cases by county
County did not report

6. 1
New1 suspected and probable cases by County over the past 7 days. The total of 207 as of the date reported.
0 cases
1-9 cases
10-49 cases
50 and more cases
Legend-New Cases April 5th- April 11th2015 15 14 74 2 1 3 2
142 8 3 15 6
1 Data from daily county reports of aggregated data
© Liberian Ministry of Health

7. Healthcare Worker (HCW) Cases and Deaths
County
New1 suspected and probable cases (Alive and Dead)
Total
Susp
Prob
Bomi
Bong
Gbarpolu
Grand Bassa
Grand Cape Mount
Grand Gedeh
Grand Kru
Lofa
Margibi
Maryland
Montserrado
Nimba
River Gee
River Cess
Sinoe
NATIONAL
Laboratory2 Confirmed cases
Total
Alive
Dead
Cumulative3 Confirmed HCW Cases
Cases
Deaths 18 14 41 16 8 4 10 22 71 38
188 94 12 2 3 1
374
1 Data from daily county reports
2 Based on laboratory tests of suspects and probable cases identified during the preceding days
3 Aggregated data of confirmed HCW cases

8. Health System Factors Facilitating the EVD Outbreak
Inherent weakness in the Health system
Not robust data and surveillance system for early detection for
early disruption of the outbreak
The measures for preparedness and response not up to the tasks
with inadequate coordination with national authorities for emergency
preparedness and response
Command and control mechanisms were not functioning satisfactorily
The laboratory system at onset could not diagnose EVD, which was a weak
link
Contact tracing was often delayed/not done, resulting in multiple infections.
As the EVD outbreak had never occurred in the country, there was no high
index of suspicion and also no experience in handling the disease.
The situation was made more precarious by the severe shortages of qualified
health workers, combined with poor working conditions and lack of in-
service training.
Ebola is a health emergency, however, the incapability of the health system made the outbreak a national and international health emergency.

9. Impacts of the Ebola Virus Disease in Liberia
Health System
Pre-existing structural vulnerabilities of the health systems and limited health workforce capabilities hindered an effective response to the epidemic and may have contributed to its scale.
The EVD outbreak led to significant drops in utilization of the health services during August-December 2014 compared to the same period in
Outpatient visits dropped by 61% for Liberia, and 51% if Montserrado is excluded. The drops in OPD attendance were observed in all counties and were largest in Montserrado, Margibi, Bomi, and Grand Cape Mount counties.
The Ebola crisis particularly devastated the already fragile healthcare systems in Liberia. Health services were rendered dysfunctional with health facility closures, community distrust and fears, and the fear and refusal of unprotected health workers to provide routine health services.
Occupational and health safety IPC measures

10. Contd: Health Workforce
As of 11 April 2015, 188 health workers had died from Ebola, out of 374 cases. These numbers include all types of workers in health facilities. The total number of health workers, all types, in the iHRIS database is about 11,000. Therefore, 3.4% of health workers developed EVD and 1.6% died from Ebola.
Health Information
During the second half of 2014, the DHIS reported rates for routine information fell but remained above 80% in most counties, except Montserrado and Margibi counties.
Health Products and Technologies
The country experienced failure in the supply chain management system, resulting in health facilities experiencing shortages of essential medicines, thus allowing the proliferation of sub-standard, counterfeited medicines.
Preliminary analysis indicates that health workers have been at a 30 times greater risk of EVD infection than the general population.

11. Socioeconomic
The EVD outbreak has strained government finances, increased national deficits and resulted in drastic shortfalls in domestic revenue. These substantial impacts have rippled beyond the borders of the most affected countries and have carried an estimated regional economic cost of 0.5 – 6.2 billion USD and indicate the inextricable linkages between health systems resilience, socioeconomic development and growth, and global security.
Communities sought care from the traditional, private and informal health providers, driving up out-of-pocket expenditure on health. The number of outpatient visits plummeted by 61% with drops of 43% in antenatal care, 38% in institutional deliveries, 45% in measles and 53% in DTP3 vaccination between August – December 2014 (compared with the same period in 2013)
Socioeconomic impact includes: health and nutrition deficits, reduction in daily human economic activities, transportation hindrances, job insecurities.
Government reconstruction plan and projects placed on hold, with all energy focused on the fight against EVD.

12. Response Strategy
Against the backdrop of an inherently weak health system which facilitated the Ebola outbreak in Liberia, response strategy is geared towards strengthening the entire health system and services in Liberia. Areas of opportunities are that:
The government in collaboration with different partners established Ebola treatment centers and units and strengthened referral systems between the regular health facilities and these treatment centers/units.
The infection prevention and control (IPC) approaches were introduced both at the health facilities and within the population that impacted positively on behavior, sustained information, education and communication.
Epidemic preparedness and response measures including strengthening of surveillance, contact tracing and laboratory capacity are hallmarks.
With the surge in partnership, various types of support provided, including funding, technical assistance, donations, etc which are springboard for the initial recovery process as the outbreak subsides and comes to an end.
The ministry and partners have initiated rapid and comprehensive assessment of health system to set the agenda for rebuilding the health sector for better performance in terms of health, prevention and control of diseases and ensuring quality curative care to meet needs in an equitable and effective manner.

13. Response Contd.:
The Government of Liberia through the Ministry of Health has crafted a response plan named “Liberia Investment Plan” in which the focus is the building of resilient health system with emphasis in the following areas:
Health workforce
Medical supplies and diagnostics
Infrastructure and technology
Information and communication
Epidemic Preparedness and Response, including Surveillance
and early warning systems
Community engagement
Quality service delivery
Leadership and governance
Sustainable health financing
The emphasis in these areas and the scope of intervention will be on those interventions that strengthen the performance of the health system to meet health needs and facilitate the health system’ resilience, while at the same time greatly contributing to rapid return and sustainability of the original trajectory towards attainment of the health policy and plan goals and targets.

14. Activities During the Ebola Outbreak
Ebola Sensitization and awareness,
The hall mark of our response
Awareness session at the Armed
Forces Training Command
Soldiers attentively following messages presented on Ebola

15. Engagements with soldiers’ spouses and dependents
Participants following hand wash procedure
DHAPP sponsored support to quarantine soldiers

16. Pre-deployment training for AFL soldiers in the Ebola response
AFL/US Army 101st Airborne joint ETU training for health workers

17. THANKS FOR YOUR ATTENTION
Q & A