The document describes Partners in Health's Social Protection model for supporting Ebola virus disease survivors in Sierra Leone. It discusses employing survivors as social mobilizers to educate their communities and help break chains of transmission. It outlines providing comprehensive care for over 600 survivors through home visits, clinical follow-up, and socioeconomic support. It also tells the story of a survivor, Jamil, who was initially stigmatized but found purpose through his role with the Social Protection program.

1. Regenerative Health Systems Strengthening Models,
Survivorship Programming
PARTNERS
Social Mobilization
In the PIH SP model, survivors are employed within their
community as educators aimed at breaking chains of transmission
and promoting health seeking behavior. During the peak of the
Ebola outbreak, social mobilizers shared their personal narratives of
surviving Ebola to instill the trust necessary for communities to
change behavior. The greatest challenge of the PIH SP was funding
restrictions for public sector grants which evolved to exclude
support for employing illiterate persons given the reporting
intensive environment. The bulk of our social mobilization activities
during the initial emergency response were supported by
unrestricted funds—a luxury largely available only to well-endowed
foreign organizations—privileging the rapidness of our response.
Comprehensive Care: Access, Follow-up, and Outcomes
As of November 2015, our EVDS clinic had assessed 603 survivors
residing in Port Loko at least once.2 Case Managers—all EVDS—
perform weekly home-visits while accompanying others to clinics,
educational programs and livelihood activities. Clinical sequelae are
common,2 thus the need for early clinical follow-up and
socioeconomic support to overcome barriers to care3 vital to good
health outcomes.1-4 The holistic needs of the patient are met when
regenerative socioeconomic services are linked with health care
delivery, building trust in the health system while ensuring access.
PEOPLE
Following discharge from Hastings Ebola Treatment Center on October 11,
2014, Jamil refused to leave his room due to stigma and discrimination.
After discharge, he was invited to attend a Survivor Conference and was
elected as the chairman of the local chapter of a grass-roots movement of
survivors, SLAES, whose purpose was to provide social support networks for
participating in public policy and service-delivery.
“Rather than to remain idle dwelling on all that I lost, the Survivor Program
employed me with resources to recruit and train fellow survivors to engage
in the response. I organized teams of survivors from SLAES to share our
experience surviving EVD to demonstrate the need to adopt safe behaviors.
As a survivor people listened to me and valued my presence.”
“Because of the job my peers respected me, I was no longer stigmatized and
was able to support my siblings.” After serving as the District Social
Mobilization Lead, Jamil completed his final year of high-school graduating
with honors as the Head Boy. Since graduation, Jamil has returned to PIH
and is now the Port Loko District Coordinator for Social Protection.
ACKNOWLEDGMENTS
We thank Paul Allen Foundation and PIH Unrestricted Donors for making this program possible.
We acknowledge the leadership and guidance of the Sierra Leone Ministries of Education; Ministry
of Health and Sanitation; Ministry of Social Welfare, Gender and Children’s Affairs and SLAES
whose collaboration has informed the regional scaling of the model. Thanks to the Lunsar Baptist
Hospital Eye Unit, Port Loko Government Hospital, the Port Loko District Medical Officer Dr. Tom
Sesay and every health-care worker for their relentless efforts to provide quality care for patients.
Promoting HSS
The success of EVDS’ contribution to the model afforded trust and motivation
towards participating in the program and informed the implementation of health
systems strengthening amidst an emergency response. Coupling socioeconomic
support with employment in service-delivery empowers community-based health
care. A restructuring of international aid limitations must occur for an increase in
comprehensive approaches to care for those who survive disease.
*M. Drasher1, G. Warren1, J. Lascher1, K. Dierberg1,2, K. Hann1, A. Stewart1, C. Cancedda1, J. Chang1, C. Albertson1, E. Headrick1, G. Sherrif1, K. Tekuyama1,3, A. Sesay1, F. Boima1, I.
Bangura1, J. Bangura1, S. Bangura1,4, A. Kanu1, A. Kamara1, S. Conteh1, A. Kargbo1, F. Bangura1, M. Kamara1, S. Kamara1.
Introduction
PIH cherishes the value of survivorship in ensuring a patient-centered experience in the home and health clinic.1 Ebola Virus Disease
Survivors (EVDS) represent a marginalized population in need of health care and socioeconomic support. By pairing health and
socioeconomic services, a comprehensive care framework for vulnerable populations is actualized--promoting opportunities to
overcome the violent structural forces which predispose them to increased morbidity and mortality.
The PIH Social Protection (SP) model demonstrates the feasibility of implementing comprehensive services to improve the health
seeking behavior of vulnerable individuals. EVDS accompanied the PIH SP to empower survivors, led by the national community-
based organization, Sierra Leone Association of Ebola Survivors (SLAES), to address gaps in the Emergency Response, focusing on
breaking the chain of EVD transmission; providing a platform to improve health care delivery; and regenerating the socioeconomic
mobility of EVDS while creating a foundation for conducting strategic health system strengthening through the lens of survivorship.
PRAXIS
Number of survivors
employed in Port Loko
Citations
1 Farmer, P. E., Nizeye, B., Stulac, S., & Keshavjee, S. (2006). Structural violence and clinical medicine. PLoS Medicine, 3(10), e449.
2 Mattia, J. G., Vandy, M. J., Chang, J. C., Platt, D. E., Dierberg, K., Bausch, D. G., … Mishra, S. (2015). Early clinical sequelae of Ebola virus
disease in Sierra Leone: a cross-sectional study. The Lancet Infectious Diseases, 3099(15).
3 Tsai, A. C., Bangsberg, D. R., Frongillo, E. A., Hunt, P. W., Muzoora, C., Martin, J. N., & Weiser, S. D. (2012). Food insecurity, depression
and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Social Science & Medicine, 74(12).
4 Varkey, J. B., Shantha, J. G., Crozier, I., Kraft, C. S., Lyon, G. M., Mehta, A. K., ... & Ströher, U. (2015). Persistence of Ebola virus in ocular
fluid during convalescence. New England Journal of Medicine, 372(25), 2423-2427.
5 Franke, M. F., Kaigamba, F., Socci, A. R., Hakizamungu, M., Patel, A., Bagiruwigize, E., ... & Mukherjee, J. (2012). Improved retention
associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clinical Infectious Diseases, cis1193.
6 Chang, J & Schlough, G. (2015). Comprehensive Care for Ebola Survivors. Presentation at: WHO meeting on survivors of Ebola virus
disease: Clinical care, research and biobanking, Freetown, Sierra Leone.
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#OFEVDSSOCIALMOBILIZATIONSTAFF
NEWEBOLACASES(DAILY)
Port Loko New Ebola Cases vs EVDS Social Mobilization Employment
New Ebola Cases EVDS Social Mobilization Staff
1Partners in Health Sierra Leone, 2Division of Global Health Equity Brigham and Women’s Hospital, 3Institute of Advanced Management and Technology (IAMTECH) Kono, 4University of Makeni Unimak Development Studies.
*Corresponding Author: mdrasher@pih.org
The PIH SP aspired to hire all EVDS in social
mobilization efforts, including the illiterate,
elderly, and the sick.
Integrated community events to register
survivors; the Government of Sierra Leone
utilized the data for status verification.
[PhotobyJonLascher]
Figure 1. Graphical depiction of new Ebola cases in Port Loko versus EVDS social mobilization staff employed in the field. All
Ebola case data obtained from the Government of Sierra Leone’s Ministry of Health and Sanitation.
Figure 2. EVD Survivor Clinic (Port Loko) cross-sectional study, describing the prevalence, nature, and predictors of three
key EVD sequelae (ocular, auditory, and articular) in a cohort of EVD survivors.
Figure 3. Map of EVD Survivor Care, Northern Region, Sierra Leone.
JamilBangura