IDSR SUPPORTIVE SUPERVISION IN CENTRAL MONROVIA & CAREYSBURG DISTRICTS, MONTSERRADO COUNTY By: Interns from Tubman University and SDA University, April 25-May 1,2018

The IDSR supportive supervision was done by: Emmanuel Dwalu(NPHIL), Yolaine K. Waka (NPHIL), Kadiatou Balde(NPHIL), Sackor B. Toe(Tubman University), Comfort Smith(Tubman University), Lawrence T. Tanwone (Tubman University) , Henrietta Morgan(SDA University) Rhoda Moore(NPHIL) ,Zinnah Luther Koenig(Intern), Alexlyn S. Monlue(NPHIL), Rosemary H. Lott (Intern), Patrick Woi (Intern),Wonbin Surzue(NPHIL), Beatrice E. Gibson(Intern

Table of Contents Background Objective Methods Key Findings: (Achievements, & Constraints) District Health Facility Community Next step

Background & Methods

Background Public health surveillance and public health action functions are fundamental for national and global health security but this requires sustained hands on technical and managerial capacity for all at service delivery and leadership levels. In so doing, NPHIL continues to work towards strengthening the national disease surveillance system guided by the Integrated Disease Surveillance and Response(IDSR) With this, Interns from the Adventist and Tubman Universities, participated in a supportive supervision inorder to gain practical field experience as it relates to public health activities.

Supervision Objectives To motivate and expose interns to practical field activities in Public health To ensure data quality, identify implementation gaps and health system barriers that constraint IDSR delivery at sub-national levels. Validate and harmonize Health Facilities data with national Identify health system/operational challenges that constraint IDSR program Improve health staff skills and knowledge through onsite mentorship

Why a Supportive Supervision? Validate and Harmonize reported data Improve staff skills to reflect acceptable standards inform programs on key findings of on- going plans to address operational needs Ensured accountability and quality assurance

Distribution of Health Facility(s) Methodology1/2 Distribution of Health Facility(s) Purposive sampling Sample size of 2 health districts (rural and urban) Respondents: DSOs, HF, surveillance Focal Persons and CHVs District Total Facility(s) Hosp H/C Clinics Comm. Careysburg 8 1 7  2 Central Monrovia 15 2 3 10  0 Total 23(100) 3(13%) 17(74%) Purposive because of accessibility and performance (Selective/subjective based on program objectives). Clinics randomly based on HMIS data

Methodology 2/2 The tools used for data collection were: IDSR Checklist as primary data collection tool: Administration (Competency) Data Collection, reporting Analysis Investigation and Confirmation of Cases Epidemic Preparedness and Response Supervision and Feedback; Safe and Dignified Burial Community Event-Based Surveillance (Perceptions, knowledge and attitudes) Secondary data: Past 3 months IDSR data report ( Jan.- March 2018)

Key Findings

District Level Facility level Community level Key Achievements/Strength Both District surveillance officers are trained in frontline Field Epidemiology and IDSR modular training Both districts have office space for surveillance activities (Central Monrovia) One out of two Districts have functional computers used for surveillance activities (Central Monrovia) 96% (n=22) of the health facilities visited have SFP 90% (n=21) of the health facilities have community simplified case definition pined on the wall. 73% (n=17) of the health facilities have means of communicating to the district 65% (n=15) of the health facilities visited have IDSR weekly ledger Effective team work between HFs and Community Volunteers Improved information sharing among health facilities, districts and communities Good community engagement by CHAs/CHVs improved community involvement with surveillance activities

District Level Facility level Community level Areas Need Improvement/Constraint Intensify supervisory visit to all facilities (Central Monrovia) Posting of updated line graphs, IDSR indicators and catchment map on the walls of the office Proper filling in of the weekly IDSR ledger (central Monrovia) Need to do more follow ups for feedback on lab results Availability of transport for DSO DSO was not interviewed due to inaccessibility to his office (Careysburg) All health facilities visited do not have specimen collection kits 84% (n=19) of the HF do not have functional triage and isolation 83% (n=19) of the health facilities reported of not receiving feed back 57% (n=13) of the health facilities visited do not have IDSR standard case definition and alert epidemic threshold charts updated within the past one month 52% (n=12) of the health facilities do not have IPC supplies Referral system Feedback mechanism from health facility to community CHAs/CHVs regular meetings with community

Actions taken District Level Facility level Community level Case investigation forms of AFP were given to Hydro Merci Clinic Mentorship on IDSR reportable diseases to SFPs Health facilities were mentored in proper filling of IDSR weekly ledgers

NPHIL to provide districts with IDSR materials (ledger, etc) District Level Facility level Community level Recommendation Encourage central Monrovia district DSO to visit health facilities for supervision NPHIL to provide districts with IDSR materials (ledger, etc) NPHIL to print and supply Districts with laminated case definitions to be pined on the walls of each health facility Districts should have updated catchment map for health facilities and population Provision of transport for central Monrovia DSO MOH/NPHIL supply specimen collection kits to HFs CHT and partners to ensure improvement in triage and isolation Improve feedback at all levels Train SFPs in IDSR (Hydro Merci, Soniwein, Kingsville, Slemp, Crozieville clinics) Encourage DSOs to do more visits to investigate zero reports In health facility. Improve accessibility of data Develop mechanism to ensure IDSR feedback from health facility to community CHAs/CHVs schedule regular meetings with community Improve referral system

Data verified by National Supervisors in two Districts In Central Monrovia there were cases seen but not reported: 4 suspected cases of ABD at Ahmadiyya Clinic 2 suspected cases of measles at SDA Cooper Hospital, In Careysburg, there were cases seen but not reported: 3 suspected cases of ABD, 3 suspected cases of Human Rabbies 10 suspected cases of Measles(Bensonville Hospital) 2 suspected cases of Measles (Kingsville Clinic) 1 suspected case of Human Rabbies ( White Plains Clinic)

Photos from supervision

Acknowledgement National Public Health Institute of Liberia National supervisors Montserrado County Health Team SFPs DSOs ZSOs CHAs

Thanks