1. Liberia Experience: National Level Coordination and Partnership in Cholera Control. 14-16 May 2008 Dakar, Senegal

2. Background Situation 15 counties and 88 districts Estimated 3 million people - Sparse Pop - density, 84 per sq mile except Monrovia (1 million people) -Infrastructures destroyed by war -Access to safe water - 24% (UNDP 2006), sanitation nationwide - 26% - (UNICEF, 2006) -Low households incomes. ¾ pop on less than US$1 a day (iPRS, 2007) -Infant mortality rate, 102/1000 & crude morality estimate 1.1/10,000/day (CFSN, 2006). -Diarrhea 2 nd cause in morbidity/mortality -Seasons– Wet –April – Oct, Dry Nov-March.

3. Cholera hot spot areas Occurrence (slides line graph) Sierra Leone Guinea Cote DIvoire Atlantic Ocean

4. Trends :2005 -2007

6. LIBERIA MAP SHOWING CHOLERA HOT SPOTS COUNTIES Lofa Nimba Bong Sinoe Gbarpolu Grand Gedeh Grand Bassa River Gee River Cess Grand Kru Bomi Margibi Grand Cape Mount Maryland Montserrado

7. National Strategy Coordination Partnership Surveillance / EWARNS Institutional capacity

8. Coordination Multisectoral approach Decentralized epidemic task force Standardized case management, surveillance & monitoring Partners mapping & up dates. Leadership – MOH/CHT Annual integrated plans. Pooled contingency plans / stocks

9. Partnerships Relevant GOL Ministries / Depts CBOs Hygiene behaviors promotion UN agencies: UNICEF, WHO, UNMIL - Tech. asst; Finance; Resources; logistics. Health/WATSAN NGOs and WATSAN CONSORTIUM Communities

10. Surveillance Standardized data collection tools & analysis at county levels. Pre-positioned investigation & case detection teams.

11. Institutional capacity INGO – (9), LNGO) (26) & CBOs in 4 counties UN agencies –(WHO, UNICEF, UNHCR) Community – ORT corners / Treatment centers, trained Trained staffs & community own resource persons (volunteers).

12. Successes Consistent reduction in attack rates Sustained multisectoral & integrated approach to cholera control Availability of trained local resources at community level. Sustained partners support. Decentralized chlorine stocks Response within 24hrs-48hrs Coherence approaches &Team work. Functional surveillance systems

13. OUR UNIQUE WAYS OF WORKING. Merged GOL coordination & WASH cluster. Innovations - Pooled funding (DFID/ECHO) -WASH consortium – 5 INGOs – services delivery & capacity building through GOL. - Pool funding from partners

14. Limitations/Challenges Deplorable infrastructure states High Poverty level Meager resources skewed towards curative services. Low WASH coverage. Insufficient resources – human & materials Weak national systems / policies enforcement. Inadequate mid-level skilled health personnel to manage cholera control Transition from humanitarian to development. Low access to health services Unreliable data for planning

15. LESSONS LEARNT Pre positioning of stocks - chlorine Routine Well chlorination. HH water chlorination practice Pre-mapping and identification of resources at county levels. Community based hygiene education ORT corners / Treatment centers Sustained partnership & coordination

16. Our Needs Long-term funding from donors, targeting AWD/Cholera / WASH. Support for Skill training on cholera management. Expansion of decentralized cholera confirmation laboratories - Counties Research on cholera to establish evidences for intervention. Support for sustainable WASH activities.