1. Sierra Leone Cross Border Strategy on Prevention and Control of Ebola Operationalization of the Monrovia Communique

2. Situation from Border Districts

3. Background to Monrovia Communique Technical meeting on Cross Border collaboration on the prevention and control of Ebola (09 Dec 2014 in Monrovia) DELEGATES: Governments of Sierra Leone, Liberia, Mali UNMEER, MRU, AU UN Response teams from Guinea, Mali, Sierra Leone, Liberia Context: Cross-border transmission as a prominent feature of the EVD outbreak; More than a thousand informal and poorly regulated border crossing points across MRU; Border communities share livelihoods and population movement patterns do not regard formal borders

4. (Select) Recommendations from the Monrovia Communique to inform Sierra Leone strategy Laboratory samples should be transported to the nearest testing lab, regardless of borders, and results shared in real time. “Open Border Policy” that allows patients to be treated at the nearest Ebola treatment facility without stigmatization because of nationality. Authorities on either side of the border share contact lists and information for monitoring and action on a daily basis; and UNMEER support the establishment of a cross border contacts database to facilitate information flow. Entry and exit points have reinforced capacities for screening, isolation. Rapid response teams with ambulance capacity should be positioned at formal border crossings and be supported with mechanisms to facilitate deployment across borders, if necessary. Ebola supplies be prepositioned near border posts with high cross border traffic allowing for cross border deployment. Full involvement and leadership by elders and traditional leaders, and the building of a network of local, national and international anthropologists amongst them for effective EVD control.

5. Sierra Leone Strategy Border Surveillance and Response Mano River Union: shared information, guidelines and resources across borders, in line with the recommendations of the Monrovia Communique District Specific Operations: strong community watch networks; engagement with community and traditional leaders, community-based surveillance contact tracing and social mobilisation Medical Response: Hubs to be established with necessary surveillance, labs, case management resources (labs, CCCs / EHCs/ ETCs, vehicles, etc.) – to be accessible regardless of nationality Security: support of SLP, RSLAF, ONS, Customs, Immigration, to work with communities and authorities to monitor and enforce border security.

6. Border Crossing Point Sierra Leone Pujehun District Liberia Grand Cape Mount Enablers: MRU: framework for cooperation and shared resources across borders, regardless of nationality Security: facilitate implementation of the framework: providing support to border area, liaising with community watch groups, and coordinating logistics

7. Border Crossing Point ETC & Lab CCC Medical Response Facility (isolation or treatment) &/or Lab Sierra Leone Pujehun District Liberia Grand Cape Mount Implementers: Community Response: strong community watch networks; community-based surveillance and contact tracing Medical Response: hubs to be established with necessary surveillance, labs, case management resources (labs, CCCs / EHCs/ ETCs, vehicles, etc.) – to be accessible regardless of nationality

8. Border Crossing Point ETC & Lab CCC Community surveillance and watch networks Medical Response Facility (isolation or treatment) &/or Lab Sierra Leone Pujehun District Liberia Grand Cape Mount

9. ETC & Lab CCC Community surveillance and watch networks Medical Response Facility (isolation or treatment) &/or Lab Joint Forces Command Centre, Logistics Base (located at a formal check point) Sierra Leone Pujehun District Liberia Grand Cape Mount

10. ETC & Lab CCC Community surveillance and watch networks Medical Response Facility (isolation or treatment) &/or Lab Joint Forces Command Centre, Logistics Base (located at a formal check point) Contact tracing Surveillance Reports Monitoring, Reporting, Logistics requests / coordination Sierra Leone Pujehun District Liberia Grand Cape Mount Contact tracing Surveillance Reports Monitoring, Reporting, Logistics requests / coordination

11. ETC & Lab CCC Community surveillance and watch networks Medical Response Facility (isolation or treatment) &/or Lab Joint Forces Command Centre, Logistics Base (located at a formal check point) Patient transfer Lab transfer Sierra Leone Pujehun District Liberia Grand Cape Mount

12. Border Crossing Point ETC & Lab CCC Community surveillance and watch networks Medical Response Facility (isolation or treatment) &/or Lab Joint Forces Command Centre, Logistics Base (located at a formal check point) Contact tracing Surveillance Reports Monitoring, Reporting, Logistics requests / coordination Patient transfer Lab transfer Sierra Leone Pujehun District Liberia Grand Cape Mount Contact tracing Surveillance Reports Monitoring, Reporting, Logistics requests / coordination Enablers: MRU: framework for cooperation and shared resources across borders, regardless of nationality Security: facilitate implementation of the framework: providing support to border area, liaising with community watch groups, and coordinating logistics Implementers: Community Response: strong community watch networks; community-based surveillance and contact tracing Medical Response: hubs to be established with necessary surveillance, labs, case management resources (labs, CCCs / EHCs/ ETCs, vehicles, etc.) – to be accessible regardless of nationality

13. Moving towards an operational plan Internal discussion and agreement on concept of cross-border collaboration; Political discussions and agreement within the MRU, whilst working on the plans to operationalize the principles and concepts of cross-border collaboration; Begin conversations with Liberian counterparts on the next steps and way forward (whilst MRU is discussing with Guinea); Prepare for launch of plan once MRU formalizes the agreement.

14. Community-based surveillance and watch groups in border communities Medical ‘Hubs’ with border-free access Logistical support and surveillance at border points Strategic Area Key StakeholdersKey questions / areas to consider for planning Surveillance Pillar DERCs Traditional leaders Youth groups & women’s groups (especially traders) SLP UNMEER How to strengthen local, community networks, including across borders? How to best train and resource border communities in this area? How to best engage traditional/community leaders, youth groups and women groups in a sustainable manner? How do these groups interface with security forces on either side of the border? Case Management Pillar Surveillance Pillar Labs RSLAF / Immigration / SLP UNMEER / WHO / CDC / UK JIATF Strategic locations for Hubs in Sierra Leone & key areas for access across borders; Security needs for facilitating access across borders; Communication needs; Current availability and gaps in S.L. hub facilities (labs, CCCs, ETUs, ETCs) Logistics Pillar UNMEER / UK JIATF / US Emb RSLAF / Customs Immigration / SLP Identifying locations for potential joint forces command centres (consider medical hubs) Logistical support and management at border locations Strengthening surveillance and health checks at formal crossing points MRU Collaboration GoSL NERC, MoHS, MoD, SLP, etc. MRU, ECOWAS, AU UNMEER Political engagement for signature of MOU Planning and logistical arrangements: National and Community Ebola Response Security Medical Response Operational Plan Development (Proposed Working Groups)