EVD/MVD Preparedness Project

The Ebola Virus Disease (EVD) outbreak of 2014-2016 in West Africa was the largest ever recorded outbreak of Ebola. In February 2021, Guinean public health authorities confirmed a new outbreak of EVD across the border with Liberia. As of April 10, 2021, a total of 23 suspected cases have been reported, including 16 confirmed cases and seven probable cases, of which nine have recovered, and 12 have died (case fatality ratio 52.2%). The number of health workers infected was five. Most of the confirmed and probable cases reported are female (13/23; 60.9%), and the most affected age group are those over 40 years.

This outbreak experience in Guinea is a major challenge. Contact follow-up remains of particular concern, with many contacts lost to follow-up. Isolating suspected patients is also a problem, and the source of infection in Gouécké, which is remarkably close to the Liberian border, has not yet been identified. Those lost to follow-up can easily cross the border for various reasons.

Therefore, the cross-border transmission of infectious disease outbreaks remains a threat due to the frequent movement of people across porous borders for socio-economic, cultural, and medical care reasons, requiring cross-border collaboration to enhance health security. The management of health emergencies at the border level remains a major challenge for countries due to the complexity of borders, including the multiplicity of entry points. It is of note that communities across borders are most often intertwined by family bonds and frequently engage in uncontrolled travel from one side of the border to the other. These facts constitute a challenge to consider in outbreaks and/or pandemics for surveillance officers and cross-border collaboration.
Along the Guinea border with Liberia, there are three counties: Lofa, Bong, and Nimba. These counties have 20 official points of entry (4 designated) and 90 unofficial connections and 80 communities bordering Guinea. Guineans come for healthcare because these communities have functional health facilities, and intermarriages allow for several days crossing individuals between the two countries.
Therefore, the project amid to strengthen Community Event-Based Surveillance (CEBS), providing for early detection of cases through un-official connections, strengthen the existing formal borders where the training of Port Health Officers, and where there is none,
The US-CDC is funding this project through AFENET Liberia. AFENET is partnering with the National Public Health Institute of Liberia (NPHIL) to enhance EVD/MVD preparedness within bordering communities to Guinea with the below objectives.

Objectives

To enhance EVD preparedness and response at the three Guinea-border counties.
  1. To support the “training of trainers” workshop and the county level training in data management and safety monitoring.
  2. To support for three months EVD, AEFI surveillance, and data management
  3. To strengthen Community Health Volunteers’ (CHVs’) and Community Health Assistant (CHA’s) knowledge, skills, and capabilities in CEBS in border communities and provide support for the community structure.
  4. To buildknowledge of PoE officers on EVD, routine disease surveillance, WASH, and infection prevention and control at ground crossings.
  5. To support official borders with IPC materials and WASH materials

Achievement

National Level support for coordination
The project provided administrative support to NPHIL for three months :
  • Fuel support – USD 3,000 worth of fuel coupon
  • Communications support – USD 6,000 worth of communications card
County-level support for coordination – Bong, Nimba, and Lofa
  • Each county has received monthly Operational support for three months ( USD$ 500 per month).
  • Communication cards worth USD 625 were provided to each county for three months.
  • Coupons worth USD 500 were also provided to each county for three months.
Supervision support to surveillance officers  (DSOs and CSOs)- Bong, Nimba, and Lofa
  • The project provided fifty USD worth of Communications cards each to 20 DSOs and four CSOs from the three counties. support –USD$ 50 each
  • Each of the four CSOs received USD 25 worth of fuel coupons as support for Motorbikes, while each of the twenty DSOs received USD 10 worth of fuel coupons as well.
  • The project procured twenty (20) laptops worth USD$ 30,000 for seventeen (17) County Surveillance Officers and three (3) National staff.
At Community level
  • To enhance surveillance within bordering communities, the project procured ten tablets worth USD 5,000 to be used by CHAs/CHVs in the field for data collection during active case search activities.
Activities conducted at county level
  • We supported the training of sixty county-level supervisors in EVD/MVD preparedness for two days (twenty persons per county).
  • Each supervisor received USD$ 150 for the two days.
  • During the two days of training, all county EVD/MVD readiness checklists were reviewed and validated by NPHIL WHO and the AFENET team.
Currently, the country is about to commence the implementation of the EVD vaccine in three counties. We supported the EVD vaccine rollout.

The below-listed materials were provided to the Ebola vaccine rollout team for three months.

Supervision materials
  • One Benq MS550 Office Projector
  • Three pcs of Mercury surge protector
  • 12 pcs of the manuscript book
  • One internet router including subscription fees for three months
  • Monthly communications support of 55 USD worth of scratch cards had been provided for three months.
  • The project trained 120 Community Health Volunteers (CHVs) from 75 bordering communities within the three counties. The CHVs were trained in Community Event-Based Surveillance (CEBS) using developed job aids. The CHVs training highlighted case detection and reporting of suspected EVD/MVD cases and other IDSR notifiable diseases.
  • Thirty CHVs (ten from each county) were selected to conduct thirty days of active case search within bordering towns or villages from November 18 to December 17, 2021.
  • DSA, transportation Reimbursement and feeding was provided for all participants.
  • Two hundred eighty (280) pieces of Jobs Aides were provided to the three counties and distributed to bordering health facilities and CHVs.
  • We have provided monthly communication cards for 120 CHVs for three months (USD 10 scratch cards each for three months).
  • We provided monthly Incentives for 120 CHVs for three months (USD 25 each per month for three months).
  • We trained seventy-three (73) POE officers from twelve official borders on EVD/MVD case definition.We also build the capacity of the POE staff on effective screening, IPC, and isolation management guidelines.
  • We printed and laminated 400 EVD/MVD case definition posters for all POE in the three counties. Those posters were distributed to all participants to be posted at viewable locations.
  • DSA, transportation Reimbursement, and feeding was provided to all participants.
The project procured and provided the below listed IPC materials to the National Public Health Institute of Liberia (NPHIL). Those various IPC materials were supplied to County Health Teams (Bong, Nimba, and Lofa) for distribution to proximal health facilities along the borders.

IPC supplies include:

  • 300 cartoons of Examination Gloves
  • 70 cartoons of surgical gloves
  • 50 Buckets of Chlorine (HTH 45 Kg)
  • 50 cartoons of Liquid hand Soap
  • 50 pairs of rainboots

Collaborating Partners

AFENET Liberia
Center for Disease Control
Ministry of Health of Liberia
National Public Health Institute of Liberia
Vital Strategies
Community Based Initiative in Liberia
Bill and Melinda Gates Foundation
Resolve to save Lives