Building Resilient Health Systems Focus on Stronger Health Systems Improves Services for the Most Vulnerable: Pregnant Women, Children Under-5, Lactating Mothers, and Ebola Survivors in Sierra Leone

Ebola survivors–as with the health system in Sierra Leone—are slowly recovering from the Ebola virus disease outbreak that devastated the country between 2014 and 2016. In collaboration with the Ministry of Health and Sanitation (MOHS), the USAID-funded Advancing Partners & Communities’ (Advancing Partners) Strengthening Health Services Post-Ebola (SHSPE) program is helping survivors access health services and regain livelihoods after the overwhelming losses they suffered during and after the outbreak.

Through its collaborative approach, the SHSPE program has implemented a range of interventions that have strengthened the health system by enabling health workers to provide better services and connecting Ebola survivors and other vulnerable populations with the specialty care they need. Skills built in specialty areas like mental health, ophthalmology, neurology, and ENT will support both vulnerable groups and the general population. The program has also engaged communities to reduce stigma and reintegrate Ebola survivors.

Referral Coordinator Nandy Fofana participates in a consultation with an Ebola survivor and his doctor.

Better Referral Pathways and Clinical Training Systems Lead to Improved Care for Ebola Survivors

Ebola survivors are often in need of specialty health services that cannot be provided at the local level. Nandy Fofana is a Referral Coordinator (RC) in Port Loko district. Nandy works with local health facilities to ensure that patients who need a higher level of care can be referred quickly. As part of the Sierra Leonean Government’s Comprehensive Program for Ebola Survivors (CPES), Advancing Partners has trained and mentored 18 RCs across the country to facilitate incoming and outgoing referrals at secondary and tertiary level of care facilities. They provide a critical link between primary care facilities and the more specialized levels of care within the health system.

“The Clinical Training Officers and Referral Coordinators have helped make the health system more resilient, self-reliant.” – Dr. Sarian Kamara, Deputy Chief Medical Officer

To improve the level of care for Ebola survivors and other vulnerable populations covered under the MOHS’ Free Health Care Initiative (FHCI), Advancing Partners has provided mentorship for primary health care workers through Clinical Training Officers (CTOs). Michael Kposowa is one of 14 CTOs supported by the project nationwide. He works in Western Area Urban district. Michael says his role as a CTO is to provide clinical mentorship and coaching to health facility staff on a wide range of clinical areas, including reproductive health, family planning, eye care, and mental health.

Clinical Training Officer Michael Kposowa providing mentorship training to a group of health workers.

Survivor Association Empowers Members through Support Groups and Adult Literacy Classes

Glenna Beckley, Finance Officer of the Sierra Leone Association of Ebola Survivors (SLAES), joined SLAES to advocate for the needs of Ebola survivors like herself as many survivors lost their employment because of health issues and stigmatization.

“…for a vulnerable group like Ebola survivors, there needs to be an association that represents what they want…” – Glenna Beckley Finance Officer at SLAES

The adult literacy program has helped 189 learners in Sierra Leone’s Western Area Urban and Western Area Rural districts. Survivors are learning basic literacy skills including reading, writing, and numeracy.

With help from Advancing Partners and Partners in Health, SLAES offers survivor-to-survivor support groups and adult literacy classes that can help survivors regain their livelihoods in the aftermath of Ebola.

An Ebola survivor participates in an adult literacy class offered by SLAES.

Upgraded Health Facilities Create Healthier Communities

M’balu Kamara is the Officer-in-Charge at Magbafth Maternal Child Health Post (MCHP) in Tonkolili district. She survived Ebola and came back to her health clinic, motivated to care for patients. With support from Advancing Partners, M’balu’s health facility is now able to serve its community better. The facility now meets infection prevention and control standards, which was made possible through facility renovation, installation of solar power, borehole drilling with a water tower to ensure 24/7 access to water, and through training and mentorship for health workers through the CTO.

With upgraded clinics and enhanced capabilities of health workers, patients are increasingly seeking care at their local health facilities. With better health facilities, communities are becoming more resilient.

Based on the Sierra Leone MOHS Health Management Information System, the total number of outpatient visits for Magbafth MCHP was 4,121 in 2013, which decreased to 2,974 in 2015 during the EVD outbreak, and then increased to 6,217 in 2017. The number of deliveries with skilled birth attendants increased from 87 in 2015 during the EVD outbreak to 154 in 2017. See charts below.

M’balu checks the blood pressure of one of her patients.
“…with this support, if something like Ebola comes back, … we have the knowledge now, for saving lives.” - M’Balu Kamara, Officer in charge at Magbafth MCHP, Tonkolili district
Patients leave the Magbafth MCHP after being seen by M’balu and her staff.

About the Program

The Strengthening Health Services Post-Ebola program in Sierra Leone is part of the regional Ebola Transmission Prevention & Survivor Services (ETP&SS) program, funded by USAID and implemented by JSI’s Advancing Partners & Communities Project. The program supports the recovery of survivors and health systems from the Ebola outbreak in Sierra Leone, Guinea, and Liberia. The ETP&SS program mitigates the risk of Ebola resurgence and improves access to health care services for Ebola survivors and other vulnerable population groups. Targeted interventions include improving access to health services for Ebola survivors by training health workers, renovating selected health facilities, reducing stigma among health care providers, and building health system capacity for specialized services.

In Sierra Leone, the program works with the MOHS and other stakeholders to support the implementation of CPES at the national, district, and community levels. With a comprehensive set of initiatives designed to strengthen the health system and build self-reliance for the long term, Advancing Partners has enabled the country to be better prepared for future outbreaks. In close partnership with the MOHS and within the framework of CPES, the initiatives carried out by Advancing Partners will continue under the ownership of the MOHS and have lasting impact for a stronger, more resilient health system in Sierra Leone.

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