1. Improving the Impact of Malaria SBCC through Effective Coordination Presented by WANI KUMBA LAHAI SIERRA LEONE 9 th FEBRUARY 2016 ADDIS ABABA, EHTIOPIA

2. Background- Mass Drug Administration (MDA) for Malaria during Ebola Outbreak in Sierra Leone Sierra Leone experienced an outbreak of the Ebola Virus Disease (EVD) in May, 2014. It created numerous challenges for the continuation of routine health delivery services. Malaria, Pneumonia & Diarrhoea remained the primary killers of children under-five in Sierra Leone. It had short and long term adverse effects on both maternal and child health interventions. At that time, linkages between the communities and health facilities were weakened Detection & management of Ebola & Malaria had been challenging as initial clinical presentations are similar.

3. Background During the EVD outbreak, several health facilities were transformed into Ebola Holding or Treatment Centers ( preventing patients to access other services)and regular health facilities became associated with Ebola. Most Private health facilities were short down The number of antenatal care visits declined by 27% nationally and under-five clinics by 39% during the period from May to September 2014. There was a drastic increase in malaria morbidity and mortality

4. BACKGROUND- Map of Sierra Leone Mass Drug Administration (MDA) in eight most affected EVD “Hot Spots” districts covering a population of 2,386,968. Kambia, Port Loko, Bombali, Koinadugu, Tonkolili, Moyamba, Western Area Rural and Western Area Urban

5. BACKGROUND Goal: To contribute to the containment of the Ebola outbreak and thereby reduce malaria morbidity & mortality. Objectives: To rapidly reduce malaria-related incidence and mortality rates by providing intervalled MDA using Artesunate +Amodiaquine tablets-targeting the seven (7) high burden districts and all populations (all ages above 6months and pregnant women) To rapidly reduce the number of febrile Ebola suspected episodes that would otherwise have required screening & isolation in the Ebola holding centers to exclude Ebola as the cause of the illness, and reduce the risk of Ebola transmission among malaria patients.

6. PROGRAMME DESCRIPTION-Method Malaria and Ebola response programs implemented a door-to-door Mass Drug Administration (MDA) as a directly observed treatment with a three-day course of Artesunate/Amodiaquine (AS/AQ) tablets.. To coordinate these efforts, a high-level planning meeting was held with the National Ebola Response Center (NERC) and District Ebola Response Centres (DERC).

7. PROGRAMME DESCRIPTION-Method The team developed a communication plan, with support from partnerships with Roll Back Malaria. The first MDA cycle was conducted in December (5 th -8 th ) 2014 and the second cycle was conducted in January (16 th -19 th ) 2015. The non touch policy was used in the administration of the medicines.

8. RESULTS IEC materials produced and distributed National, District and Chiefdom advocacy /sensitization meetings with key stakeholders and decision /policy makers. The team created campaign jingles (translated in the local dialects-6) that were aired in fourteen community radio stations Conducted radio panel discussions and phone in programmes. TV panel discussion programs, Advocacy in newspapers, and health-related text messages using the Tera messaging system.

9. RESULTS Relevant stakeholders and existing local leaders (e.g., traditional leaders, religious leaders, community health workers, etc.) were key to improving the acceptance of these MDA activities, which led to a high uptake of the medicine. The proportion of malaria outpatient cases (all ages) decreased by 47% in MDA communities and 22% in the non-MDA communities. Malaria inpatient cases also decreased by 29% in the MDA Peripheral Health Units

10. DISCUSSIONS These social mobilization efforts were key to engaging communities around malaria and Ebola prevention and treatment activities. Challenges included the fact that messages were challenging during times of apprehension and mistrust of the health system, as well as reaching hard-to-reach populations

11. DISCUSSIONS- Fortunately, this complementary approach to Ebola prevention allowed health facilities to meet their malaria-related targets, while also building a system that is useful for any future outbreaks where a quick reduction of malaria burden is needed.

12. Lessons Learnt: Joint planning among all levels and stakeholders; Existence of chiefdoms bylaws helped for high acceptance and compliance; Social mobilization and community engagement, use of media and other approaches gave high awareness about the MDA and distinction with Ebola and malaria;

13. Lessons Learnt Use of Paramount chiefs and existing Community Health Workers who are part of the communities gave confidence to beneficiaries for acceptance and high uptake of the medicines; Increased acceptance for drug administration in the Ebola quarantine households; High demand for the drugs; Better coordination with partners; Rumours and misconceptions addressed earlier.

14. Conclusion Working in collaboration with communities/partners and timely advocacy with key stakeholders greatly contributed to a successful planning, implementation and outcome of the MDA Programme. This experience can be useful for other future outbreaks where quick reduction of malaria burden is needed and was a complimentary approach to contain the Ebola epidemic in Sierra Leone.