Presentation by Dr. Rose Macauley at "Post-Ebola Survivors - Research and Recovery Lessons from West Africa," a USAID Brown Bag on May 2, 2019 at USAID/Crystal City. Together with NIH/PREVAIL, today’s session focuses on learnings from these programs in relation to survivor care and post-outbreak recovery of health services and health systems. Facilitator: Jeff Sanderson, Team Leader, West Africa Post-Ebola Programs, JSI R&T/APC The Presenters: Dr. Libby Higgs, Global Health Science Advisor for the Division of Clinical Research at NIAID, NIH (confirmed) Dr. Meba Kagone, former Chief of Party for ETP&SS, Guinea, JSI/APC (confirmed) Dr. Rose Macauley, former Chief of Party for ETP&SS, Liberia, JSI/APC (confirmed) Jeff Sanderson (for Dr. Kwame Oneill, former Director of the Program Implementation Unit, Ministry of Health and Sanitation, Sierra Leone) Background: The Ebola Transmission Prevention & Survivor Services (ETP&SS) program included four components; country programs in Guinea, Liberia and Sierra Leone, and a regional program designed to share best practices and lessons learned. ETP&SS assisted these governments to prevent further Ebola transmission, reduce stigma and other barriers to care for survivors when accessing health services, support the strengthening of needed specialty services, and build more resilient and self-sustaining health systems. The regional program sought to ensure the sharing of lessons learned and best practices across the three countries and the region through meetings, exchanges and conferences with partners such as NIH, WHO, and the West African Consortium. Funded by the Global Health Bureau through the Advancing Partners & Communities Project, John Snow Research & Training Institute implemented the program from July 2016 through July/August 2018.

1. Implementing ETP&SS:
The Liberia Experience
Dr. Rose Macauley
Chief of Party

2. Outline of Presentation
• Background
• Program objectives
• Key interventions
• Selected key outcomes
• Summary

3. Background
• Following the major EVD outbreak in 2014-2015,
there have been a number of small-scale
outbreaks in the 3 countries (Liberia, Guinea,
Sierra Leone) all linked to survivors.
• To help minimize the risk of transmission, USAID
provided funds to JSI through the APC project to
support MOH in its efforts.
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4. Program Objectives
• Improve access to health services
for Ebola survivors and combat
stigma among providers
• Build public health sector
capacity to provide specialized
health services needed for
common complications of Ebola
survivors
• Strengthen coordination and
management of activities for
Ebola survivors
ETP&SS
11
Facilities
in 4
counties
HS & HSS
6
Facilities
in 4
counties

5. Improve access to health services and reduce stigma
among providers
• APC/ETP&SS awarded grants to:
– Two faith-based hospitals to provide comprehensive care
to survivors (at no cost to the survivors)
– Liberia College of Physicians and Surgeons to recruit
specialists to treat survivors (and general population) and
to transfer skills to counterparts
– Phebe School of Nursing to train 60 additional mental
health clinicians
• APC/ETP&SS trained health care workers to reduce
stigmatization

6. • Renovated Eye Unit, and
established dedicated operating
room
• Recruited ophthalmologist to
provide services and transfer skills
to counterparts
• Supported the training of an
ophthalmic nurse to sustain eye
care services
• Coordinated an exceptional team to
screen and perform cataract surgery
for EVD survivors and non-survivors
Improve access to health services: Eye Care Services

7. Building Public Health Capacity
• Procured critically needed
medical and lab equipment for
the target health facilities
• Provided infrastructure support
to enhance specialty care, IPC
and lab services
• Supported training of 60
mental health clinicians to
increase the capacity of
secondary facilities to provide
specialty care

8. Coordination and Management
• National Ebola Secretariat
– Established the national secretariat in
line with the National Survivor Care and
Support policy
– Built capacity of the secretariat through
technical assistance and direct support
• Ebola Survivor Network
– Supported establishment of the Ebola
Survivor Network
– Strengthened network capacity for
mobilizing resources and advocating for
their members

9. Selected Key Outcomes

10. Selected Outcome: Establishment of reliable water
supply at Kolahun Hospital
Water source before Water source after

11. SelectedOutcome:RenovationofInfectiousDisease
OutpatientClinic,JFKMedicalCenter
Right Side View with Water Tower _Before Right Side View with Water Tower _After

12. InsideoftheInfectiousDiseaseOutpatientClinic

13. Selected Outcome:PerimeterWallatDoloTownHealthCenter
• Dolo Town was one of the hardest hit communities during the Ebola
crisis
• The facility was exposed with no wall
• Renovated perimeter wall provides security and enhances IPC / triage

14. Patient
Visits
(5243)
LCPS: 3476
Rheumatology: 818
Ophthalmology: 1587
Psychiatry: 1071
Catholic Hospital: 571
ELWA Hospital: 1196
FBOs: 1767
Selected Outcome: Patient Visits through FBOs
and LCPS Specialists

15. Summary:
Implementing ETP&SS -- The Liberia Experience
• ETP&SS addressed critical needs of Liberia’s Ebola survivors at a
time when it was most important
• ETP&SS interventions in the three countries varied and were
informed by the local context
• Overall, ETP&SS was largely successful in meeting its objectives.
However, implementing the program also had challenges:
– Limited government support created gaps
– Expectations from the survivors were often not aligned with
the mandates of the program
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