Presentation by Jeff Sanderson at "Post-Ebola Survivors - Research and Recovery Lessons from West Africa," a USAID Brown Bag on May 2, 2019 at USAID/Crystal City. Together with NIH/PREVAIL, today’s session focuses on learnings from these programs in relation to survivor care and post-outbreak recovery of health services and health systems. Facilitator: Jeff Sanderson, Team Leader, West Africa Post-Ebola Programs, JSI R&T/APC The Presenters: Dr. Libby Higgs, Global Health Science Advisor for the Division of Clinical Research at NIAID, NIH (confirmed) Dr. Meba Kagone, former Chief of Party for ETP&SS, Guinea, JSI/APC (confirmed) Dr. Rose Macauley, former Chief of Party for ETP&SS, Liberia, JSI/APC (confirmed) Jeff Sanderson (for Dr. Kwame Oneill, former Director of the Program Implementation Unit, Ministry of Health and Sanitation, Sierra Leone) Background: The Ebola Transmission Prevention & Survivor Services (ETP&SS) program included four components; country programs in Guinea, Liberia and Sierra Leone, and a regional program designed to share best practices and lessons learned. ETP&SS assisted these governments to prevent further Ebola transmission, reduce stigma and other barriers to care for survivors when accessing health services, support the strengthening of needed specialty services, and build more resilient and self-sustaining health systems. The regional program sought to ensure the sharing of lessons learned and best practices across the three countries and the region through meetings, exchanges and conferences with partners such as NIH, WHO, and the West African Consortium. Funded by the Global Health Bureau through the Advancing Partners & Communities Project, John Snow Research & Training Institute implemented the program from July 2016 through July/August 2018.

1. Supporting Survivors In
Sierra Leone
ETP&SS Program May 2, 2019

2. WHERE WERE THE EVD SURVIVORS LOCATED (APR. 2016)?
3,466* EVDS
2,877 EVDS
6 USAID PRIORITY DISTRICTS
Districts in pink were the six most affected by the outbreak.

3. PROGRAM CONTEXT IN SIERRA LEONE
• Program designed with USAID Global Health Ebola Team in May 2016.
• JSI/APC arrived after government’s CPES (Comprehensive Program
for Ebola Survivors) had been developed and started implementation
(early 2016). CPES sought to provide access to care for all survivors,
assist in recovering livelihoods, and monitor survivor health status.
• Wide ranging DfID funded support program had also begun in April.
• ETP&SS focused on:
• Stigma reduction, care and support - at PHC level and with CHWs
• Specialty services: mental health, eye care, neurology, including
medicines
• Health Systems Strengthening: Clinical mentorship and referrals
• Capacity building for SL Association of Ebola Survivors (SLAES)

4. CPES ORGANIZATIONAL STRUCTURE

5. MENTAL HEALTH SERVICES
Strengthened mental health services for survivors, families and
communities - defined as a critical area of need - and focus:
• National Mental Health Policy - assisted the MOHS in developing
National Mental Health Policy (2017-2021) and related Strategic Plan
• Series of focused community level Mental Health Interventions:
• Training of mental health nurses
• Community Healing Dialogues
• Psychological First Aid Training for PHC providers
• Supported stronger mental health referral pathways
• Gained recognition for Post-Graduate Diploma in Mental Health
• MH consultations increased from an average of 66 to 176 per month
between 2015‒2018 nationwide (across 14 MH clinics)

6. HEALTH SYSTEMS STRENGTHENING
• Program support for improving access to health services for FHCI
(Identified Vulnerable Population Groups – pregnant and lactating
women, under 5s):
• 14 Clinical Training Officers - line managed by DHMT, provided
mentorship to HCWs in 247 PHUs nationwide. Key indicators were
linked to maternal and child health (plus presence of EVD Survivors)
• 18 Referral Coordinators - line managed by district hospitals,
facilitated referrals and access to specialized care at secondary,
and occasionally, tertiary facilities
• Enhancing Quality of Health Services through Continuum of Care and
development of tools for providers in PHC facilities & District Hospitals
• Clinical mentorship and OTJ Training

7. DEVELOPMENT OF TOOLS FOR PROVIDERS
Mental Health Assessment Tool for PHU
level
CHW MH job
aide
Mentoring tool for
CTOs

8. HSS RESULTS
• RCs facilitated almost 9,000 referrals for all FHCI categories
• Of these referrals: 50% were for maternal cases
30+% were for pediatric cases
17% were for EVD survivors
• Supported 4,300 specialized care visits (18.7% were survivors)
• CTOs mentored more than 1000 HCWs (2,000 clinical mentorship
Sessions) on topics such as RMNCH, patient care, EVD survivor care,
and mental health
• At endline, only 1.3% of EVD survivors with health issues sought
care outside of a facility, compared to 8.7% (baseline) of survivors
• EVD Survivors able to have a healthy and functional life – increased
from 59.3% at baseline to 70.1% at endline

9. PROGRAM IMPLEMENTATION HAS HIGHLIGHTED …
EVD Survivors Health Sequelae
• Mental Health remains a
problem for EVD Survivors (and
for the general population in SL)
• Eye care / ophthalmology is an
area of limited capacity in SL
• Research has yet to find a
conclusive link between EVD
survivors and neurological
complications, yet symptoms
persist in many survivors
Health Systems Strengthening
• The need for additional
investment in MH services remains
high - to ensure needs are addressed
and to reduce stigma and
discrimination
• The transition from the CPES
structure to the MoHS should have
happened earlier to maximize CPES’
impact on HSS

10. A FEW COMMENTS ON LESSONS LEARNED
In post-Ebola recovery settings:
• Critical to start surveillance / health status monitoring quickly;
but potentially only for 12 months
• Also important to start and maintain a BCC campaign regarding
safe sex and other questions
• Government and/or partners need to operate semen testing
Program(s) that male survivors can easily access (public health)
• Survivors will need access to specialty services, especially for eye
care and mental health
• Valuable to assist with the development of a Survivor Association
for advocacy and to support various components of post-Ebola period

11. Thank you! – Q&A