1. Reproductive Health in the time of Ebola: the story of Kenema district Laura Miller International Rescue Committee (IRC) – Sierra Leone IAWG Meeting – Amman Jordan February 26, 2016

2. -32,380 child deaths annually estimated in Sierra Leone -1,781 maternal deaths annually estimated in Sierra Leone In September 2014, CDC estimated that between 550,000 to 1.4 million people would get Ebola Virus Disease (EVD) in Liberia and Sierra Leone without additional interventions. FOCUS WAS TO STOP THE CHAIN OF TRANSMISSION.

3. Three main modes of transmission of EVD: 1.Unsafe burial practices 2.Community/ household level care 3.Transmission in the health facility

4. Kenema

5. Kenema – August 2014 51 health care workers had died from Kenema Government Hospital (KeGH) 404 of the 698 (58%) EVD patients were treated at KeGH by September 1, 2014

6. Health system was not prepared for EVD patients along the entire patient pathway

7. Training package developed by IRC, WHO and MoHS. Training curriculum based on six IPC principles: -Social distancing -Hand washing -Screening -Isolation -Waste management -Clinic management -SIDA funding to support trainings in 120 PHUs in Kenema in two weeks - IRC and MoHS joint facilitation of trainings at the health facility -IPC materials supplied to all facilities Infection Prevention and Control (IPC) and Screening for suspected EVD at the primary health care level

9. Maternal Health in Kenema (July to September) -Facility Based Delivery – vaginal (-14.5% decline) -Facility Based Delivery - cesarean (-81.0% decline) Nationally, 23% decline in institutional deliveries Antenatal Care in Kenema (July to September): Attended 4 th ANC (-14.8% decline) Nationally, 27% decline Postnatal Care in Kenema (July to September): --16.6% decline for Kenema

10. Family Planning in Kenema Contraceptive pills (-20.6%) Injections (-30.2%) Implants (-22.6%)

11. Challenges with reproductive health during Ebola: Lack of access to RH services under quarantine Insufficient quantities of FP commodities EVD + pregnant women

12. Sierra Leonean health care system DID NOT collapse In October 2014, only 4.1% of primary health care facilities were closed Health care workers continued working Women continued seeking health services

13. IPC partnership to support Sierra Leonean health workers Partnership between seven INGOs of the Ebola Response Consortium (ERC), the Ministry of Health and Sanitation (MoHS), UNICEF and Centers for Disease Control (CDC) accomplished the following: Nationally approved IPC training package for primary health care Trained over 4,500 health care workers from 1,180 primary health care facilities in 6 weeks Provided IPC supplies to all facilities Ongoing supportive supervision from INGOs and MoHS

14. Health care workers continued to care for women and children on the front lines 444 health care workers have been infected (over 50% have died) Most health care worker infections happened outside Ebola care facilities