2. Sierra Leone - Background Population : ~ 6 million Civil War: 1991 – 2002: atrocities, child soldiers, mental health challenges – few/no services etc Health Average life expectancy: 57yrs Maternal Mortality Rate: 5 th highest in world 88% of women: female genital mutilation Infant Mortality Rate: 11 th highest in world Drinking water supply 20% of urban population, 1% of the rural population - piped home drinking water – (inclds the) 84% of urban population, 32% of rural population with access to improved water source eg protected wells. Remaining 68% of the rural population rely on surface water (50%), unprotected wells (9%) and unprotected springs (9%).

5. Tonkolili District - Background District ~ 7,003 sq km. Rural ----with mines Estimated population 385,322. ? Civil War history Shares boundaries with 7 other Sierra Leone districts ( majority of which - on-going transmission of Ebola Jan ). 11 Chiefdoms Many areas hard to reach by road. Many areas without mobile phone coverage. Even more areas without internet/wifi connections Magburaka - district headquarters - close to the border with Bombali district. Ebola The first known case in Tonkolili district - 31 year old male student who presented with fever of two days onset on the 24 th July, 2014 at Magburaka Government Hospital. – He was a Community Health Assistant student who – Escaped from a Private Hospital where he was under quarantine in Freetown – as a health care contact of person with Ebola. He moved in with his parents in Magburaka. He survived. (Family quarantined – none infected)

7. A Graph Showing Monthly Trend of Ebola Cases April to November 30 th 2014

8. Report on Ebola outbreak in Tonkolili District From 3 rd April – 30 th November 2014 NoData ElementNo. Of Cases 1Suspected Cases705 2Lab Confirmed Cases371 3Negative256 4Missing63 5Others14 6Pending7 7Confirmed Death120 8Cured/Discharges146

9. Nov 30 th List of Heath workers affected with Ebola in Tonkolili District NoCadreProbableConfirmed positive Out come SurvivedDied 1Doctor0101 2Mid Wives/Nurses0000 3Laboratory Technician0312 4Community Health Assistant & Worker 0422 5SECHN0110 6M C H Aides0303 7TBA0110 8Vaccinator0202 9Admin00 10Ambulance Driver0211 11Cleaner0101 12Pharmacist Technician0110 TOTAL019712

10. Total Contacts Line Listed by Chiefdom as at 30 th November 2014 vs Later Slide NoChiefdomTotal contacts Line listed Contacts Completed 21 days Contacts being Monitored 1Kholifa Rowalla625335290 2Kholifa Mabang11 0 3Mara Malal75 0 4Tane502390112 5Gbonkonlenken543298245 6Kunike55753918 7Kunike Barina128 0 8Sambaya Bendugu000 9Kalansogoai000 10Kafe Simira1026240 11Yoni610382228 Total31532220933

11. Yoni Kholifa Mabang Malal Mara Kholifa Rowalla Gbonkolenken Konike Barina Konike Tane Kate Simira Sambaia Bendugu Kalansogia Tonkolili District Surveillance Map showing Hot spot Chiefdoms since outbreak

13. Treatment Facilities Primary health Centres CCCs Holding Centres Hospital (Magburaka) Maternity Laboratory - Ebola Ebola Treatment Centres November-----------------December Adjacent Districts

14. District Ebola Response (DERC) CO-ORDINATION OF REPONSE ACTIVITIES NERC: National ----- *DERC worked via specified pillars. Co-ordination committee Technical committee for each pillar, each chaired by DHMT & co-chaired by partners:  Surveillance & Epidemiology  Case Management  Burials  Contact Tracing  Social Mobilisation  Psycho-social  Logistics  Security *In addition to the District Health Medical Team (DHMT), district response - supported by many agencies – International and local including WHO, UNFPA, World Vision, CDC, Concern Worldwide, AU, MSF, Real Women, Farmers Group etc. *Daily meeting - update & co-ordination (7/7: 5.30pm)

15. PARTNERS IN THE EBOLA OUTBREAK –TON - incomplete incomplete - draft NoName of PartnerArea of Involvement 1Concern World Wide  Provide vehicle for transportation of survivors  Provide funds for training  Make joint sensitization with DHMT  Provision of non food items  Fuel support to command center  Fund IPC training for PHU staff  Food distribution to quarantine homes  Give support to CCC  Social mobilization 2IRC  Train CHWs  Maintenance on DHMT vehicle  Support staff 3World Vision  Support to burial Teams in four chiefdoms  Training of burial teams in four chiefdoms 4WHO Provide vehicles for surveillance activities Fuel support for surveillance activities Provide Technical support to DHMT on surveillance activities

16. INVOLVEMENT OF PARTNERS CT………incomplete NoName of PartnerArea of Involvement 5CDC  Through Ehealth provided a 30 KVA generator to DHMT for surveillance activities  Give technical support to DHMT on surveillance activities 6SNAP  Food support to quarantine homes  Social Mobilization  Train contact tracers and supervisors 7Red Cross  Burial of corpses in 7 chiefdoms  Social Mobilization  Support to burial teams 8ADAXX  Chlorine and veronica buckets 9 New Harvest Ministry Action Aid Care International Africel Islamic Group King Hong  They all gave their own Bits by providing food and none food items 10 AU, MSF, Lionheart etc

18. WHO (World Health Organisation)- Tonkolili My Contract Purpose : To contribute to the control of the Ebola outbreak and prevent further spread by breaking the cycle of transmission. Specific objectives: Strengthen WHO’s support for the Tonkolili DERC with particular emphasis on surveillance and epidemiological support. Support a functional responsive Ebola surveillance system which informs intervention planning by quality data analysis, interpretation and review. Support on-going process evaluation and quality assessment of interventions especially:  Cases: o By ensuring thorough investigation of all cases, o By identifying and recommending both prevention and control interventions o By identifying and seeking remedies to barriers in the implementation of recommended interventions  Strengthening Contact Tracing activities  Strengthening Decontamination Activities  By identifying and contributing to training and refresher needs of HCWs Support data reporting to national level and feedback to the community To support the Tonkolili DERC effort through fostering positive relationships with DHMT, DC and other agencies involved in the district response.

19. Surveillance Systems/Actions  8am daily Alert/Case Investigation meeting (WHO)  9am daily surveillance meeting to Review Lab results, incld sample tracking & other aspects of outbreak – Active surveillance based on actions relating to daily surveillance meeting - incld Cases: source, control Burials Contact Tracing Quarantined homes/Villages: decontamination Quarantined homes/Villages: supplies – food/non food ( veronica buckets, Chlorine, clothes, IPC training of families etc) Information/Data flows: local, between districts, national (Training) (Co-ordination: local, between districts, national)

20. Lab Samples & Tracking Examples

21. Cases: Alert (Case) Investigation 8am daily Structure (Geography) (Resources) Links

26. Strengthening Contact Tracing activities Contact Tracers Structure (Geography) (Resources) Contacts

28. Strengthen Decontamination Activities Support data reporting to national level and feedback to the community

29. Identify and contribute to training and refresher needs of HCWs

30. Support data reporting Quality Quantity Data Harmonisation Sharing/Flow

32. Ebola Trend in Tonkolili Since late November (epi week 45) the rate of disease has declined.

33. Outcome

35. Information - Communications Within District – Expectation – Feasibility – Requirement Adjoining Districts: patient flows, contact flows Nationally – Expectation – Feasibility – Requirement

37. Week 3 2015

42. Co-ordination, Gaps, Overlaps, Challenges Ebola deaths/illness/effects – other than Ebola disease Ebola effects on health, health services, basic economy etc – short term & long term Move to “normal” health services: volunteers, allowances, training etc – dismantling, re-structuring Logistic constraints & supports Which Organisations will remain? Funding, Sustainability, ?undermine or support Local solutions

43. Challenges - Cameos Burials Resources at local level Hard to reach Areas – alerts Delays Village 1 Village 2 Village 3

45. Practicalities Pre-departure Arrival/1 st few days In the Field (Irish Connections) End of Deployment/Return

46. THANKS FOR LISTENING