International Medical Corps

Final Narrative Report

Organization: International Medical Corps Headquarters Mailing Address: 12400 Wilshire Blvd., Suite 1500 Los Angeles, CA 90025

Reporting Period: Final (May 01, 2016 to June 30, 2017) Headquarters Contact Person: John Acree VP of International Programs Tel: +1 (202) 828-5155 Fax: +1 (202) 828-5156 [email protected]

Field Contact Person: Vandy Kamara Country Team Leader +232 78297107 [email protected]

Program Title: Support to District-Led Ebola Virus Disease (EVD) Recovery and Community-Based Preparedness in

OFDA Grant Number: AID-OFDA-G-16-00067

Country/Region: Bombali, Kambia, Koinadugu and Districts, Sierra Leone

A. PROGRAM OVERVIEW AND PERFORMANCE

Sierra Leone was at the Center of the Ebola Virus Disease (EVD) outbreak in West Africa with 8,706 confirmed cases (CDC.gov). In March 2016, WHO declared Sierra Leone free of EVD after 42 days without a reported case. However, there had been two previous declarations and then cases had resurfaced prior to March 2016. The Ebola Treatment Centers (ETC) run by International Organizations closed their doors at the end of December 2015. The final International Medical Corps (IMC) ETC shut its doors at the end of February 2016.

Sierra Leone has not had a reported case of EVD since January 2016. Due to this, many resources were pulled out of the EVD response system in Sierra Leone leading to cuts in the support for the rapid response teams (RRT) in the local District Health Management Teams (DHMT). Large gaps were identified in the capacity of local stakeholders to respond to a suspect case of EVD.

For this reason, IMC embarked on a project funded by this award entitled ‘Support to district Led Ebola Virus Disease Recovery and Community Based Preparedness in Sierra Leone.’ This project aimed to enhance community resilience to EVD or similar disease outbreaks. There were three main components to the program:

1. Training and mentorship of the staff in the peripheral health units (PHUs). This included WASH training in IPC and waste management and medical training in screening and referral and case management. Community based activities comprised of health promotion activities targeting local stakeholders, village development committees and Facility management committees also took place. The psychosocial support (PSS) team offered intervention in the area of protection and psychosocial first aid. 2. Preparation of the District Health Management Teams (DHMT)/District Emergency Operations Committee (DEOC) for emergency response. IMC undertook simulation trainings for emergency response in each district of operation. This included simulation training and theory for all members of the RRT in the district. It began with community surveillance and identification of a case to case management, WASH and PSS. 3. Formation of RRT. RRTs were formed by IMC in order to respond to a suspect case in any of the operational districts. IMC identified locations for rapid response setup in each district and assembled a team qualified to respond to a suspect case if needed. This team consists of WASH, medical, health promotion, PSS and operational staff. If called in to respond, the site can be setup in 72 hours and be fully functional for the intake of patients.

This project was carried out in four districts (Kambia, Bombali, Koinadugu and Port Loko) which were identified due to location in proximity to the border and greatest need for possible intervention. IMC was operational in the past in all districts and had an established relationship with the local stakeholders and communities.

However, not all activities were fully implemented during the third quarter in 2016 because of challenges beyond IMC’s control. By the end of the second quarter (October 2016), IMC had pre-positioned RRTs and supplies in targeted districts, and conducted rapid response training and simulations for those teams at its Training Center in Port Loko in all four pillars: Clinical, WASH, Health Promotion (HP) and Psychosocial Support (PSS). Community-based psychosocial and health promotion activities was implemented as planned in 39 villages across the 4 districts. Coordination with the Government of Sierra

Leone, DHMTs and other partners, especially those in the Inter-Agency Rapid Response Team (IA-RRT) was essential to the program’s success. However, anticipated support to health facilities and capacity development for DHMTs was precluded by the new MoHS requirement for health partners to enter into a Service Level Agreement (SLA), which includes direct financial support.

Based on gains made between May and October 2016 and in light of the thus far unsuccessful advocacy by NGOs and donors for the MoHS to remove the SLA financial support requirement, IMC proposed a six- month cost extension in 2017 (from January to June) focused on continuing and expanding on community- based disease prevention and preparedness. IMC continued working with community structures that were already part of established local leadership and social systems (i.e. village development committees, traditional healers) and support the development of other community groups (i.e. community health clubs, psychosocial support groups) that enhanced "community engagement and mobilization". Through this support to communities, local capacity and commitment to engaging with formal health and social welfare systems, including importantly disease monitoring, was increased. IMC's programming at the local level during this cost extension was led by experienced training officers and managers who were retained from the IMC supported RRTs that were phase out by December 31, 2016. A manager and 3 training officers from different sectors (WASH, health and PSS) were assigned to each district to implement the community based interventions.

B. PROGRAM PERFORMANCE AGAINST WORK PLAN & INDICATORS

Program Goal: To enhance community resilience to EVD or similar disease outbreaks.

Key achievements for the reporting period included:

During the reporting period, there were two sets of indicators: those between May 01, 2016-December 31, 2016 – prior to Modification 01, and from January 01, 2017-June 30, 2017 – after Modification 01.

The list of district-approved beneficiary communities (39) is included here:

2017 approved 2016 PHUs approved communities for all District Chiefdom communities (39) interventions (39)

Maforay MCHP (PSS Maforay* Maforki activities only) Magbengbera MCHP Magbengbera Marampa Rolembray MCHP Rolembray Tainkatopa Makama Rogbaneh Rogbaneh MCHP Port Loko (10 communities in Safroko 2016) Dibia Rokutolon MCHP Rokutolon Kalangba MCHP Kalangba Mapella Lokomasama Mapella MCHP Bundulai (PSS Bundulai* activities only) Bureh Kasseh Maconteh Kalangba Bureh MCHP Kalangba Bureh

Kagbanthama CHP Kagbanthama Kissy Koya MCHP Kissy Koya Koya Mabora MCHP Mabora Tonko Limba Kasoria MCHP Mile 14* Samu Rosinor CHP Mange Bissan* Mambolo Macoth MCHP Macoth Barakuya MCHP Barakuya Bramaia Kambia (9 communities) Gbolon MCHP Gbolon MCHP Masungbala Gballan Thallan MCHP Gballan Thallan Fodia MCHP Fodia Gbiledixin Worreh MCHP Worreh Magbema Wulathenkle MCHP Wulathenkle Mongo Seria MCHP Community dropped Kasonko Kasanikoro MCHP Kasanikoro Kamba Mamodia CHP Kamba Mamodia Folosaba Dembelia Dogoloya CHP Dogoloya Kamaron MCHP Kamaron Koinadugu (9 communities) Diang Badala MCHP Badala Kalkoya MCHP Kalkoya Wara Wara Bafodia Kadanso MCHP Kadanso Sengbeh Bambukoro CHP Bambukoro Wara Wara Yagala Heremakono MCHP Heremakono Masongbo CHP Masongbo Loko Ngowanhun Maharie MCHP Maharie Paki Masabong Makolor CHP Makolor Safroko Limba Kabombeh CHP Kabombeh Makarie MCHP Makarie Bombali (9 communities) Makarie Gbanti Kerefay Loko MCHP Kerefay Loko Mabiana MCHP Mabiana Magbaimba Ndowahun Hunduwa MCHP Hunduwa Kaponkie MCHP Kaponkie Sella Limba Kamabaio MCHP Community dropped

Note: communities with red asterisks (*) are the 4 new communities added based on interventions while those with red print under 2016 approved communities were dropped.

May 01, 2016 – December 31, 2016:

Rapid Response Capacity: Following the recruitment and training of staff members in the districts with their respective coordinators, the project team conducted nine trainings, surpassing the original target of eight trainings and achieving 112.5%. A total of six RR Simulation trainings for IMC staffs were conducted at the Lunsar Training Center (LTC). Two trainings were district team trainings for Kambia (3-5 October 2016) and Bombali (10-12 October 2016) while the other four were inter-district trainings from 31 October – 10 November 2016.

Feedback from simulation exercises provided essential input for the training curriculum for future coordination with potential WHO/MoHS emergency response training.

The uniqueness of the inter-district trainings, other than being two-day compact refreshers, was the team compositions in which the various pillars from different districts were combined to work together: Port Loko Med/ Kambia WASH/ Koinadugu PSS/ Bombali; Port Loko HP/ Kambia PSS/ Koinadugu Med/ Bombali WASH; Port Loko WASH/ Kambia Med/ Koinadugu HP/ Bombali and Port Loko PSS/ Kambia HP/ Koinadugu WASH/ Bombali Med. The idea behind the inter-district trainings was to test the level to which the staff had conceptualized the requirements of a response, regardless of the team they worked with; unlike in the previous five trainings in which the staff were familiar with each other since they were from the same district office. Another major component of the inter-district trainings was the PPE donning and doffing didactic and practical session for all staff including the health promotion and psychosocial teams who had previously not donned PPE.

Additional trainings for the medical team were carried out at various district offices in topics such as round two training in use of clinic in a can (CiAC) in Kasumpe CCC, Group Dynamics and Personalities, clinical management of patients with EVD and IPC protocols.

The Community Care Center (CCC) kits together with other supplies needed for a response were stored in the IMC Lunsar warehouse. In alignment with the OFDA extension, the CCC kits were distributed to DHMT, using the agreed distribution plan, to reinforce MoHS capacity to rapidly respond. Each team (WASH, Medical, HP and PSS) developed a checklist for items specifically needed during a response to ensure that all needed items would be transported to the relevant CCC site in the event of a response. Basic need and hygiene items were distributed to the Ministry of Social Welfare, Gender, and Children’s Affairs (MSWCGA) to support CCC admission and provide social service care and improve individual well-being.

Rapid Response related indicators were reported as zero due to the lack EVD or related outbreaks necessitating a response need. WASH and Medical assessments were completed in the chiefdoms, in preparation for potential rapid response, and the start of health facility based activities in the event that the SLA was approved. To enhance community resiliency to potential emergency outbreaks, HP and PSS teams continued the facilitation of community level activities, including health education, preparedness trainings, group psychosocial support sessions, and the development of community resiliency plans. Coordination meetings with MSWGCA staff, paramount chiefs, and community stakeholders further strengthened existing linkages and prompted the utilization of appropriate referral mechanisms.

Lessons learned during RR Simulation Trainings • Proper and early mapping of resources is prudent to ensure required items are available. It was noted during the dry run training in the last reporting period that the assumed complete CCC kit had only one tent instead of the required four and had no drugs or PPE, as they were not prepositioned by UNICEF. IMC obtained necessary resources for proper implementation of simulations.

• Team work will be needed to speed up processes i.e. set up of CCC. The total time for set up was reduced drastically (by up to 2 hours) when the teams worked together rather than have only the engineers do the set up.

• There is a need to conduct continuous trainings and refreshers on the theory surrounding rapid response and EVD response to keep responders up to speed at all times. This was evidenced by poor

scores in pre-tests during the inter-district trainings which were refreshers only one month after the first set of trainings. In addition, mistakes made by the medical team in diagnosis, decision to admit or not or management and treatment of patients in the CCC proved the need to continuously train teams.

Health Facility Preparedness: Engagement with DHMTs and PHUs, though successful during the first months of the project, was hindered by the fact that IMC did not have an approved SLA which was a requirement instituted by the MoHS in previous reporting periods. In the last quarter, Ministry of Health and Sanitation (MOHS) instated a new requirement of a compulsory surcharge for institutional support as part of the SLA, which prevented IMC from having the SLA agreement signed. Throughout the first 3 quarters, it remained unclear how negotiations regarding the SLA requirement of direct financial support to the MoHS would unfold. For that reason IMC adjusted the existing project in order to still fully achieve the objectives of the intervention utilizing a community based approach.

Due to the above, the only engagement with the DHMTs was weekly DHMT review and feedback meetings and donation of equipment, pharmaceutical and non-pharmaceutical items to the DHMTs who would later distribute to PHUs.

Between 1 November - 9 December 2016 the medical team was able to complete distribution of equipment, pharmaceutical and non-pharmaceutical items including returning of the CCC Kit (to Port Loko DHMT) to all 4 supported DHMTs. This distribution was as per the agreed distribution plan.

Protection and Psychosocial Support: According to project design, “A community psychosocial support group (PSSG) is a support group consisting of community members with a desire to promote wellbeing and resiliency in their community. Peers will participate in group sessions (group psychosocial counseling and trainings) to process the impact of recent emergencies on wellbeing, evaluate skills sets for coping with stressors, and develop considerations to support community members in an emergency.” In 16 selected communities across the four districts, IMC established PSSGs, and their members participated in weekly group counseling and capacity development sessions. Each PSSG has about 15 members, male and female, who were identified in cooperation with community leaders. The PSSGs demonstrated a high level of engagement and ownership over their activities.

Psychosocial Support Groups (PSSGs) set up at Community Level District Chiefdom Community No. of No. of Group Members PSSGs Port Loko Maforki Maforay 1 PSSG 15 members Maranpa Rolembray 1 PSSG 15 members Dibia Rokutolon 1 PSSG 15 members Lokomasama Bundulai 1 PSSG 15 members Kambia Magbema Wulathenkle 1 PSSG 15 members Gblehdixing Fodia 1 PSSG 15 members Worreh 1 PSSG 15 members Mambolo Macoth 1 PSSG 15 members Bombali Gbendembu Gowanhun Masongbo 1 PSSG 15 members

Paki Masabong Makolor 1 PSSG 16 members Safroko Limba Kabombeh 1 PSSG 15 members Makarie Gbante Makarie 1 PSSG 16 members Koinadugu Folasaba Dembelia Dogolaya 1 PSSG 15 members Diang Badalda 1 PSSG 15 members WaraWara Bafodia Kakoya 1 PSSG 15 members Sengben Bambukoroh 1 PSSG 16 members

The 12-session group counseling program was designed to address the themes of Trust Building, Basic Emotional Regulation Skills, Communication Strengthening, Stress Management, Grief and Loss, Basic Problem Solving Skills, and Resilience Strengthening. In addition, a 9-session program of training and mentorship in psychosocial support during an emergency response included the topics of Basic Understanding of Human Psychology, Basic Communication Skills, Psychological First Aid (PFA) and PSS Considerations for Vulnerable Populations/Protection. To further strengthen psychosocial support capacity during an emergency response, monthly one-day coordination trainings for district MSWGCA and MoHS staff, as well as PSSG members, were held during the reporting period. It should be noted that MoHS staff recognized the value of and attended these district-level trainings despite no SLA.

In November-December 2016 the handover of the community psychosocial support groups (PSSGs) to the MSWGCA was done in all community PSSGs in the 4 OFDA operational districts. IMC PSS Coordinator, the Focal Person of the MSWGCA for the districts and the PSS Officers held a meeting with the members of each community PSSG, their respective community leaders and other community members, in order to link the community PSSGs to the MSWGCA to ensure the sustainability of the community PSSGs (8 communities/4 communities per district each one of both districts). The MSWGCA will provide support and guidance to all community PSSGs in order to facilitate the sustainability of the community PSSGs and the psychosocial support to be provided by those groups to their communities.

A total of 16 Closure Sessions of the PSS Program Activities were held at community level, thus each of the community PSSGs had a closure session in their community, in which the 16 community PSSGs took ownership and having also the participation of the community leaders, other community members and 35 staffs of the MSWGCA (9 staffs in Bombali, 8 staffs in Koinadugu, 9 staffs in Kambia, 9 staffs in Port Loko). Moreover, meetings were held among the members of the community PSSGs and the staff of the MSWGCA. Thus, the members of each community PSSG had a meeting with the staff of the MSWGCA at district level to agree on how the community PSSG and the staff of the MSWGCA should move forward to work together in coordination and ensure the sustainability of the community PSSGs.

Community Preparedness: Seventy-eight (78) of the following community structures were rehabilitated/formed: Facility Management Committees (FMCs), Community Health Workers (CHWs), Village Development Committees (VDCs) and Community Health Clubs (CHCs). IMC trained staff and mobilized the community structures to establish community early warning systems on Ebola Virus Disease (EVD),. In the absence of an SLA and the approved community health worker (CHW) policy, working with the other two community structures mentioned above (FMCs and CHWs) was not possible. IMC therefore re-focused its health promotion activities on village development committees (VDCs) and community health clubs (CHCs). One VDC and one CHC in each of the 39 targeted communities. However, due to terrain and weather conditions, one of the identified communities by DHMT in Kambia District was inaccessible. The project could not continue

working in that community which brought the total communities with VDCs and CHCs formed/restructured to 38 in the 4 project operational sites.

Formation/Restructuring of Community Structures – Engaging community structures and actors outside the formal health system in community-based disease prevention and control is critical in building community resilience during post health emergency periods. A total of 100 community structures were to be established by the project from May - December 2016. By the end of the 2nd quarter of implementation (July- September 2016), a total of 62 community structures comprising of 28 Community Health Clubs, 16 Psycho Social Support Groups and 24 Village Development Committees were formed/ restructured. During the 3rd quarter (October- December 2016) an additional 26 community structures were restructured / formed (15 Village Development Committees and 11 Community Health Clubs) across the four project operational districts. This brought the total of community structures formed or restructured to a total of 88 out of a target of 100.

This success could be attributed to the strong community mobilization and engagement strategies employed by program staff.

Training of traditional healers on basic Infection Prevention and Control Measures – Traditional healers in Sierra Leone are often the first health consultation point especially in very remote areas. In addition, they are viewed by community members as key informants and trusted by the community. However, they are not easily identified, as they are most times reluctant to disclose their profession especially with the ban imposed on their activities during the Ebola Virus Disease outbreak.

During the period under review, community meetings were held by project staff with the objective to facilitate the identification of 100 traditional healers (project target) across the four project districts. This identification process was followed by registration of participants who met the criteria selection. Five day trainings on basic infection prevention and control measures were facilitated by project staff in all the districts for a total of 98 (98%) out of the 100 traditional healers selected to be trained. Two of the traditional healers were unable to attend due to other competing priorities which emerged at the last minute.

The content of the training included the following topics:

• Roles and responsibilities • Myths and misconceptions about communicable disease including Ebola Virus Disease causation, • Introduction to basic Infection Prevention and Control measures • Standard precautions • Hand Hygiene • Ebola Virus Disease case definition • Isolation of clients • Client referral • Early Warning Systems • Risk identification ( EVD and other communicable • Community Event Based Surveillance • Community Based Simulation

It is interesting to note that the training resulted into cohesion among traditional healers that were trained in one of the project operational districts. A group of 25 traditional healers decided to form an association and further selected their executive members to register the association with the relevant government institutions. Before the training, members of the association operated as individuals because they always viewed each other as competition and this training served as a revelation to the fact that they could achieve more together.

The table below shows the breakdown of the attendance of IPC trainings for traditional healers.

Number of traditional healers trained and mobilized by district Sex District Male Female Total Port Loko 18 (75%) 6 (25%) 24/25 Kambia 13 (52%) 12 (48%) 25/25 Bombali 14 (58%) 10 (42%) 24/25 Koinadugu 21 (84%) 4(16%) 25/25 Total 66 (67%) 32 (33%) 98/100 (98%)

Training of Village Development Committee (VDC) Executives Capacity building of community based structures is one of the key strategies implemented by the project. This strategy is geared towards enhancing community resilience to potential EVD outbreak and also form the basis of the project’s sustainability plan.

During the 2nd quarter of implementation, 24 VCDs with a total participation of 120 executive members were trained on a three-day curriculum covering VDC Roles and Responsibilities, Introduction to EVD Early Warning System, EVD Risk Reduction and Communication, EVD Signs and Symptoms, EVD Prevention and Control, Use of Sanitary Facilities and Germ Theory.

During the 3rd quarter of implementation, 14 VCD executives with a total of 70 participants were provided with trainings across Bombali and Koinadugu Districts. Topics covered during these trainings included were the same as those during the 2nd quarter.

With the additional trainings conducted during the first quarter, the cumulative number of village development committees trained across the project operational sites of Koinadugu, Bombali, Kambia and Port Loko districts was 38 with 190 executive members (83 females and 107 males) who participated in all the trainings conducted.

EVD risk mitigation/reduction communication plans One key activity to be implemented by village development committees after going through the training provided for them by the project, is to facilitate the development of EVD risk mitigation/reduction communication plans in their respective communities. In the 3rd quarter of implementation, VDCs and CHCs mobilized their communities to facilitate a total of 37 EVD risk mitigation/reduction communication plans in 39 communities across the 4 project operational districts. These plans were displaced at strategic locations such as community meeting places in the communities. However, during the cost modification implementation (4th quarter), continued implementation of activities in 6 of the communities that had developed EVD risk mitigation/reduction communication plans during the 3rd quarter where critically

reviewed by the project. 4 of the 6 communities were replaced with new communities and 2 were discontinued with. The reason for the decision was due to the inaccessibility of these communities as experienced during the 1st to the 3rd quarter of implementation. Thus at the beginning of the 4th quarter, only 35 communities had EVD risk reduction/mitigation communication plans in 39 communities.

Village Development Committees Monthly Meetings VDCs were able to demonstrate one of their key roles and responsibilities (Monthly meetings) after participating in the trainings provided for them by the project. During these meetings, VDCs would set their monthly health promotion actions plans such as mobilizing communities during Maternal and Child Health Week campaigns organized by the Ministry of Health and Sanitation, environmental sanitation, community outreach health education sessions and selection of community event-based surveillance focal point persons were developed and implemented, and work towards accomplishing them during the month. The activities that were not accomplished as planned would be carried over to the following month. It is also important to note that, a total of 61 monthly meetings were conducted by VDCs during the first reporting phase. During these monthly meetings, VDC monthly.

VDCs Implementing At Least Four Health Promotion Activities per Month As part of the activities conducted by the village development committees and community health clubs in the 38 project sites, an average of 37% (5% in October, 34% in November and 71% in December 2016) of both community structures implemented at least 4 health promotion activities per month.

Community Health Club (CHC) Weekly Sessions The participatory health session delivery guide and methodology that is used by IMC in conducting weekly health sessions with CHCs has the potential to enhance the skills and confidence of the participants to work collaboratively with government and NGO partners in managing community health risks and responding to public health threats. With respect to CHCs, 10 community health clubs were established during the reporting period. The additional community health clubs established brought the total number of community health clubs established in the 4 project operational districts (Koinadugu, Bombali, Port Loko and Kambia) to 38. In addition, 8 weekly sessions were conducted with the 10 community health clubs established during the reporting period. A total of 192 community health club members (103 males and 97 females) attended the weekly sessions.

The topics facilitated included: • Rapport Building • Introduction to Ebola Virus Disease Early Warning Systems • Ebola Virus Disease Risk Identification • Ebola Virus and other communicable diseases risk mitigation and communication • Community Event- Based Surveillance

Community Event-Based Surveillance System (CEBS) Advocacy Meetings/Activities This activity was only conducted during the 3rd quarter and the activity linked indicator was discontinued during the 4 quarter. The project conducted 4 community event-based surveillance system (CEBS) advocacy campaign meetings with both chiefdom and community stakeholders across the project operational district (Kambia, Koinadugu, Bombali and Port Loko). The meetings were conducted on the 5th, 6th and 9th of December 2016 at district levels with 190 VDC executives from 38 communities, community chiefs, Paramount chiefs, PHU staff, Honourable Members of Parliament and religious leaders. During these meetings, project exit plans were also discussed with participants. The advocacy meetings were conducted with the objective of enlisting community and chiefdom stakeholders’ continued support

for CEBS activity implementation when the project would have phased out. Sustainability for other project activities such as VDC and CHC activities were also discussed during the meetings. Statements were made by the different participants (paramount chiefs and representatives of NGOs and DHMTs). At the end of the meetings, community and chiefdom representatives who attended these meetings pledged their continued support for all HP community interventions as evidenced by the speech of the Paramount chief of Marampa chiefdom “I will give my total support to all the VDCs and CHCs in my chiefdom through my chiefdom authorities. I encourage the VDCs to discuss their respective needs with me so that we can collectively find ways of addressing such needs”.

January 01, 2017 – June 30, 2017:

The project implemented the following activities as per agreed work plan:

• 13 Community based simulation trainings with community members • Refresher trainings for 175 Village Development committee executives on their roles and responsibilities in building community resilience to EVD or similar outbreaks • Response coordination trainings for 115 health care workers • Facilitated 83 village development committee monthly meetings and 312 health promotion implementation activities • Community health club weekly facilitation sessions • Weekly psychosocial support group trainings and counseling sessions • Project lessons learnt and exit workshop with 46 project staff and 2 partners • Certification of 117 trained community structures and 98 traditional healers • Psychosocial follow-up assessments • Participated in 9 coordination meetings

Protection and Psychosocial Support:

Psychosocial Support Group Training Sessions – Community psychosocial assessments were completed in 23 additional communities for psychosocial interventions. This assessment resulted in the formation of the 23 psychosocial support groups mentioned below. Following the community psychosocial assessment exercise, individual psychosocial assessments were also conducted with 358 PSSG members by program staff in the 23 additional communities.

PSSG weekly training session in Kambia district Furthermore, psychosocial trainings were conducted by program staff for the 23 additional psychosocial support groups across the 4 program districts. These trainings were facilitated on weekly basis at community level. A total of 3 training topics were facilitated during the reporting period, which each topic covered in 3 modules accumulating to 9. The topics facilitated included: • Basic communication Skills and Psychological First Aid (PFA) • Basic understanding of Human Psychology • PSS consideration for Vulnerable Population

Psychosocial Support Group Individual Counseling Sessions – A total of 5 individual counselling session topics were facilitated during the reporting period. The topics facilitated included; • Stress Management • Communication Strengthening • Grief and Loss • Basic Problem Solving skills • Basic Emotional Regulation skills

Community Preparedness:

Community-based Simulation Trainings – IMC phased out its Rapid Response Teams (RRT) in all the districts by 31st December 2016 according to the contractual agreement with OFDA. However, in order to enhance community preparedness and resilience to potential EVD and other epidemic outbreaks in implementing the cost modification, the community-based rapid response Standard Operating Procedure (SOP) was developed by the project to train community members across the four project operational sites of Bombali, Koinadugu, and Port Loko and Kambia districts. Subsequently, project staff were trained on the use of the developed SOP to implement the activity in communities.

The project continued to conduct community-based simulation trainings as part of its community resilience building strategies. During the project implementation period (January – June 2017), 39 (100%) community-based simulations (one training session per community) were conducted by project staff. The key components of the training included; community entry strategy, patient assessment, donning and doffing of PPE, addressing issues relating to Ebola Virus Disease and other communicable disease myths/ misconceptions during question and answer sessions.

Critical changes observed in the communities because of the community - based simulation trainings conducted by the project included; • Increased confidence among community members to don and doff in PPEs and wash hands with water mixed with chlorine (0.05%) which indicates they no longer have fear for PPE and chlorine. To note is that the community members were under strict supervision and instructions during the demonstrations. The idea of community members donning and doffing was to allay the fears that PPE was used by aliens. It was made clear that PPE is to be used by trained healthcare workers only, hence none was left with the communities. • Enhanced the capacity of community participants to recognize signs and symptoms of Ebola Virus disease and other communicable diseases like measles, cholera, etc. • Improved referral mechanisms between traditional healers and peripheral health units. • Improved referral mechanisms between community members and MSWGCA • Community members are now confidently able to perform their roles and responsibilities in the event of disease outbreaks.

Formation/Restructuring of Community Structures – During the first quarter of the cost modification implementation period (January - March 2017), an additional 31 out of a revised target of 16 community structures (4 Community Health Clubs (CHCs), 4 Village Development Committees (VDCs) and 23 Psychosocial Support Groups (PSSGs) were formed

bringing the total number of community structures formed between October 2016 to March 2017 to 57. The cumulative number of community structures formed/ restructured at the end of quarter 4 was 119. It is interesting to note that the overall target of 100 was exceeded by 19.

Number of community structures ( VDCs, CHCs and PSSG) formed/ restructured October – December 2016 January – April 2017 Overall Target = 38 Revised Target = 16 Target= 100 ( May 2016 to December 2016) VDC CHC PSSG Total VDC CHC PSSG Total Overall total for October 2016 to March 2017 15 11 0 26 4 4 23 31 57

Training of Village Development Committee (VDC) Executives Similar trainings as those done during the first reporting period were conducted for an additional 4 VDC executives with a total of 20 participants (Males 10 and Females 10) during the 4th quarter. The objective of the training was to improve the knowledge and skills of VDCs in terms of disease prevention and control. Also, the training emphasized on their roles and responsibilities, formation and membership criteria of the committees, the basics of leadership, ability to identify problems in the village, support to community based disease surveillance, how to hold meetings and keep records, appropriate health care seeking, risk identification and mitigation. The trainings were facilitated by project staff over a two-day period. As part of the critical outcomes of the trainings, EVD and other communicable disease mitigation plan development were facilitated by the trained VDCs in all 4 communities.

EVD risk mitigation/reduction communication plans During the cost modification implementation (4th quarter), IMC continued implementation of activities in 6 of the communities that had developed EVD risk mitigation/reduction communication plans during the 3rd quarter where critically reviewed by the project. 4 of the 6 communities were replaced with new communities and 2 were discontinued with. The reason for the decision was due to the inaccessibility of these communities as experienced during the 1st to the 3rd quarter of implementation. Thus at the beginning of the 4th quarter, only 35 communities had EVD risk reduction/mitigation communication plans in 39 communities. In March of the 4th quarter, VDCs and CHCs in the 4 new communities facilitated the development of EVD risk mitigation/ reduction communication plans bringing the total of communities with EVD risk mitigation communication plans to 39.

Refresher training for Village Development Committee (VDC) Executives –

To retain the existing talents and continue to empower community structures to improve implementation of project related activities, the 168 VDC executive members (males 115 and females 53) that were trained during the 3rd quarter of implementation were provided with a one-day refresher training in April 2017 across the 4 project operational districts. Topics covered during initial training were:

• Introduction to EVD Early Warning System • EVD Risk Reduction and Communication • EVD Signs and Symptoms • EVD Prevention and Control • Use of Sanitary Facilities • Germ Theory

Topics covered during the refresher trainings were:

• VCD Roles and Responsibilities of • Leadership and Problem Solving Skills • Advocacy and Networking • How to identify and develop risk mitigation plans

The trainings were facilitated by project staff over a two-day period. It is interesting to note that, after the trainings, VDC members advocated for construction of wells with a hand pump, mobilized communities to construct sanitation facilities and monitored proper utilization of these facilities, facilitated environmental sanitation activities and development of EVD and other communicable diseases mitigation plans were facilitated by the trained VDCs in all 4 communities. Below is a table indicating sanitation facilities constructed by community members.

Sanitation Facility Constructed Utilized Correctly % utilized correctly Plate track 1051 956 91% Cloth line 1108 1042 94% Tipping tap 97 71 73% Compost fence 169 163 96%

The table above shows the total number of the various types of sanitation facilities (Plate track, cloth line, tipping tap and compost fence) that were constructed in 39 project operational communities. According to the table, community members constructed more plate tracks (1,051), cloth lines (1,108) and compost fence when compared to tipping taps. Also, a high utilization of cloth line (94%), plate track (91%) and compost fence (96%) were observed among community members when compared to tipping taps. The low construction of tipping taps was attributed to the fact that community members were challenged with accessing containers used in the construction of tipping taps. The high utilization of plate tracks, cloth lines and compost fences could be attributed to the trainings conducted with community participants, regular supervision of project activities and effective community mobilization and engagement strategies applied by the project. Also, it indicates that, as a result of the trainings conducted, community members were able to link disease prevention to such high level of positive social behaviour change practices.

Village Development Committee Monthly Meetings – Village Development Committee monthly meetings were a critical element of the roles and responsibilities of all the VDCs trained by the project. During the period under review, 75 monthly meetings were conducted by VDCs across the 4 project operational districts. These meetings served as platforms for the development of community action plans and mapping out strategies to implement actions developed. Action plans that were not accomplished during one month were rolled over to the following month and given priority for Village Development Committee members completion. The monthly meetings coupled with the trainings facilitating monthly meeting at Fodia- Kambia District

contributed to construction of community meeting huts (known locally as palava huts), regular community environmental sanitation activities, rehabilitation of roads leading to their communities and construction of sanitation facilities. The monthly action planning meetings also enhanced the capacity of VDC executives to take on leadership roles which increases the committee’s potential to sustain project activities.

A cumulative target of 125 out of 234 VDC monthly meetings were achieved at the end of the implementation period (January to June 2017). It is therefore observed that a total of 109 monthly meetings were not conducted and reported on by VDCs. This was as a result of the following;

• Trainings for 4 new VDCs established were conducted in March 2017 and so VDCs in those 4 communities only started conducting and reporting on monthly meetings at the end of March 2017. • Although the project was designed to implement activities with a total of 35 VDCs that were trained by IMC during the EVD response period. The project decided to assess the functionality of these VDCs and restructure those that were not functional during the month of January up to mid-February 2017.

VDCs Health Promotion Activities – During the reporting period all 39 VDCs implemented at least 4 health promotion activities across the 4 project operational districts. In one of the operational communities, Kaponkie, in , the VDC supported the construction of a traditional healers’ client consultation hut. As a result, traditional healers in that community no longer use their dwelling houses for consultation. The hut serves as a barrier to transmission of

diseases to the families of the traditional healers and the Traditional Healers’ consultation hut contructed community as a whole. In 4 communities ( Rolembray, with the support of Village Development Committee at Maharie, Kamaron and Kasanikoro), VDCs facilitated Kaponkie- Bombali District fencing of community wells with hand pumps, developed and implemented by-laws for the use of the wells and established committees to ensure that they facilitate minor repairs on the pumps. These communities now have access to safe drinking water as reported by a community member. Health promotion activities linked to community-based event surveillance activities were conducted by VDCs during the period under review. Furthermore, during regular transect walk activities by VDCs, a total of 7 suspected sick community members were referred to different PHUs to seek further medical examination and treatment.

Response Coordination Trainings for Health Care Workers Four response coordination trainings were conducted from the 16th – 19th May 2017 with a total of 107 participants (males 78 and females 29). The participants included traditional healers, representatives from the Ministry of Health (Nurses), Ministry of Social Welfare, Gender and Children’s Affairs, Community – Based Organizations and Non-Governmental Organizations. The objective of the training was to strengthen participants’ capacity in Emergency Preparedness planning, Disaster Management and improve on their risk communication skills during emergency. The following topics were facilitated during the training sessions:

• Public Health Preparedness • Communication and Information • Risk Communication • Guiding Principles for Risk Communication • Public Communication • Media Monitoring • Health Education • Health Promotion • Social Mobilization/Community Engagement

Community Health Club (CHC) Weekly Sessions As part of the project’s effort to train and mobilise community structures, the project continued to conduct weekly health sessions with CHCs to enhance their skills and confidence to work collaboratively with government and NGO partners in managing community health risks and responding to public health threats. Between April and May 2017, 4 additional health related topics were facilitated by project staff to community health clubs making a total of 9 topics facilitated during the entire implementation period (January – June 2017). The topics facilitated included:

• Ebola Virus Disease signs and symptoms • Ebola Virus Disease prevention and control • Use of sanitation facilities • Germ Theory

Certification of Trained Members Of Community Structures One of the ways to motivate community partners in implementing community-based projects is by providing them with non-financial incentives. This also had the potential to positively impact sustainability of project activities. During the period under review, 1,497 members of the community structures trained by the project (Village Development Committees, Traditional healers, Psychosocial Support Groups and Community Health Clubs) on enhancing community resilience to EVD or similar disease outbreaks were provided with Community Health Club, Psychosocial Support Group, certificates in 39 project implementation Village Development Committee and Traditional Healers after certification ceremony at Magbengbera communities in 4 districts. The certificates were handed over to the members of the trained community structures by the community authorities (chiefs, mammy queens, Ward Committee members, etc.). During one of the certification ceremonies, a member of the VDC whilst giving a vote of thanks said “I personally thank International Medical Corps and OFDA for providing us with trainings that will help us respond to any disease outbreak at the community level even when the project would have been completed. The certificates will serve as a motivation for us to continue to implement what we have been taught by project staff.”

During the exit and lessons learned all-staff workshop, certificates were presented to 13 Health Promotion Officers, 11 Psychosocial Officers and 13 Clinical Officers for facilitating trainings on enhancing community resilience to EVD or similar disease outbreaks with community structures. Certificates were also presented to the 4 District Managers and 1 Monitoring and Evaluation Manager for successfully implementing project operations in the districts.

Project Exit and Lessons Learnt Workshop with Staff and Partners Capturing lessons learned from projects is key for any organisation. For this purpose, a one-day (30th May 2017) project exit and lessons learnt workshop was conducted with project staff and representatives of MOSWGCA. The purpose of the workshop was to gather any insights gained during the project that can be usefully applied on future programs. The workshop was attended by a total of 48 participants (46 project staff and 2 MOSWGCA representatives). The workshop sessions included the following:

• Workshop overview and objectives • Project Monitoring and Evaluation presentation and discussions

• Overall project management discussions Program staff displaying their certificates of • Workshop evaluation service to IMC after the project exit workshop at Lunsar- During the workshop, small group works and presentations were the key facilitation methods used. Key lessons learnt highlighted by participants during the workshop included;

• Monthly project implementation review meetings conducted by the project contributed to the successes gained during the implementation period of the project. During these meetings, project indicators were presented and strategies review discussed to improve on indicators that were observed to be below the project target. • Regular supportive supervision visits and feedback mechanisms have the potential to positively impact on project implementation. The introduction of regular supportive supervision visits from the inception up to the end of the project contributed to enhancing staff capacity to implement activities as per agreed project work plan. The supportive supervision visits also gave staffs assurance that the management teams were concerned about their welfare in the field. • Building the capacity of community-based structures and effective engagement with community partners to implement project activities is critical to achieving project goals and objectives. The project continued to work with community structures that were already part of the established local leadership and social systems (i.e. village development committees, traditional healers) and supported the development of other community groups (i.e. community health clubs, psychosocial support groups) that will enhance community engagement and mobilization. • Staff trainings on project implementation strategies at the start of the project and on quarterly basis provided a clear insight to the staff on the planned implementation strategy. During such

trainings, project indicators and the work plan were reviewed and critical implementation challenges addressed. C. INDICATORS

To see an additional break down of program indicators please see Annex 1

C. ANTICIPATED ACTIVITIES FOR NEXT PERIOD

Program activities ended June 30, 2017.

D. PROGRAM CHALLENGES OR CONCERNS

Notwithstanding the successes reported by the project, the project also encountered the following challenges related to implementation.

• The lack of SLA precluded implementation of the facility-based health activities in all districts, including training of health providers and CHWs during the first reporting period. However, an alternative strategy was developed and agreed upon to strengthen rapid response and resiliency in communities, with the support of MSWGCA. • Full participation of community members in community based simulations was challenging in the initial stages. Some community members had fear for chlorine and PPE which made them either not attend the trainings or attend but would leave the training as soon as sprayers and PPEs were introduced. To overcome this challenge, project staff allowed community members to fill in the sprayers with water and encouraged them to don in PPEs. This restored their confidence and participation • Farming season and periodic market days contributed to a drop in the attendance in CHC trainings, PSSG training/counselling sessions and VDC monthly meetings especially in the month of May 2017. Group members prioritized going to do their farm work rather than attending training sessions, which was completely understandable considering that this is the beginning of the rainy season. However, project staff were able to work with the communities to reschedule and create a balance between their activities and those that were project supported. • Given the conclusion of program and IMC country mission, a few members of program staff resigned prior to the end of the implementation period. The remaining program staff were able to adjust community activities to ensure coverage of the gap developed in 6 communities.

E. SUCCESS STORY

BUILDING A RESILIENT COMMUNITY THROUGH TRAINING

In terms of health care seeking at community level, traditional healers in Sierra Leone have a large following and they are often considered as the first port of call for those who are ill, especially in very remote areas and also serve as key informants in their communities. In light of government restrictions placed on treating patients outside of health care facilities during the Ebola outbreak, traditional healers were not easily identified as they were often reluctant to disclose their profession for fear of arrest and fines. However, as a result of the high level of trust and confidence built by project staff through effective community engagement method, the project was able to overcome the challenge of identifying traditional healers and facilitated trainings with them with the objective of improving on their basic Infection Prevention and Control (IPC) practices such as hand hygiene before, during and after care for their clients, proper waste management, referrals of clients, chain of disease transmission, importance of isolating clients, EVD and other communicable disease prevention.

Alusine Samura, a traditional healer who lived at Kaponkie, one of the project operational communities in Bombali District and approximately 106 kilometres from the district headquarter town of . According to Alusine Samura, he has practiced traditional healing for over 20 years and in the course of taking care of his clients, he did client consultations in his dwelling house, never practiced regular hand washing, sometimes ate together with his clients and indiscriminately disposed waste as a result of treatment around his compound. Because he was ignorant of the negative implications

In February 2016, Alusine Samura was one of the 24 traditional healers that were identified by the project staff implementing activities in Bombali District during a community meeting at Kaponkie to attend a five day basic IPC measure training facilitated by the project. Alusine so excited about the training that he was the first participant to arrive at the training venue. During the training, Alusine actively participated in all the sessions by making very brilliant contributions. During the training evaluation session, Alusine commented that “From the training I have attended, I now know that traditional healers have been involved in high risk practices whilst taking care of their clients which could have cost them their lives. Thanks to OFDA and Exited Alusine Samura participating in a five International Medical Corps for empowering”. day IPC training at Makeni- Bombali District

Immediately after the training, Alusine engaged his colleagues from the same community and chiefdom who attended the training to start thinking of constructing an isolation hut at Kaponkie. According to him, the construction and effective utilization of the isolation hut will help prevent disease transmission. His suggestion was greeted with very high interest. Upon his return to Kaponkie, he again called a community meeting which was attended by all the traditional healers in the community and chiefdom that participated in the training including members of the Village Development Committee, Community Health Club and Psychosocial Support Group in the Kaponkie community. During the meeting, Alusine explained the importance of the workshop and encouraged the VDCs and community stakeholders to support the construction of an isolation hut at Kaponkie. He explained the health benefits the hut will bring not only to the traditional healers but to the community and Alusine Kamara with his clients infornt of the newly constructed isolation hut chiefdom at large. After a lot of discussions during the

community meeting, the construction of traditional healers’ isolation hut was endorsed by the VDC, community authorities and the rest of the community. Within a month, the consultation hut was constructed at Kaponkie which is now been used by all traditional healers in and around Kaponkie community. Traditional healers in and around Kaponkie community no longer consult or isolate their clients in their dwelling houses which has the potential to prevent them from contracting diseases from their clients and infecting their families and the community at large.

Also, the training contributed to building Alusine Samura’s confidence, addressing the issue of myths about EVD and fear for chlorine. Alusine Samura demonstrated this by volunteering to don and duff in a PPE during a community – based simulation training conducted by project staff at Kaponkie. As a result of this, other community members became confident to touch him dressed in PPE which had never happened at Kaponkie. Before, the intervention of the project in Kaponkie, community members including Alusine Samura believed that people dressed in PPE during the Ebola Virus Disease response were alien and were responsible for the spread of the disease. During the community – based simulation training, one of the traditional healers mentioned that “they are now better prepared to respond to any future disease outbreak as they are no longer afraid of PPE, chlorine and have concluded that all they heard about the past EVD outbreak Alusine Samura donning in PPE during a were mere myths”. community – based simulation training

F. ANNEXES

Annex 1: Copy of International Medical Corps Sierra Leone AID OFDA G 16-00067 Indicators COMMUNICABLE DISEASES

Number of Rapid Response Teams prepared for standby Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 4 NA 4 0 4 0 Discontinued 4

Number of Suspect EVD patients evaluated by Rapid Response Teams, if deployed ‐ DISAGGREGATED BY SEX AND AGE Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Age Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Not disaggregated by age 0 NA NA NA 0 0 0 Discontinued 0 0 ‐ 11 months 0 NA NA NA 0 0 0 Discontinued 0 1 ‐ 4 years 0 NA NA NA 0 0 0 Discontinued 0 5 ‐ 14 years 0 NA NA NA 0 0 0 Discontinued 0 Male 15 ‐ 49 years 0 NA NA NA 0 0 0 Discontinued 0 50 ‐ 60 years 0 NA NA NA 0 0 0 Discontinued 0 60 + years 0 NA NA NA 0 0 0 Discontinued 0 TOTAL (M) 0 NA NA NA 0 0 0 Discontinued 0 Not disaggregated by age 0 NA NA NA 0 0 0 Discontinued 0 0 ‐ 11 months 0 NA NA NA 0 0 0 Discontinued 0 1 ‐ 4 years 0 NA NA NA 0 0 0 Discontinued 0 5 ‐ 14 years 0 NA NA NA 0 0 0 Discontinued 0 Female 15 ‐ 49 years 0 NA NA NA 0 0 0 Discontinued 0 50 ‐ 60 years 0 NA NA NA 0 0 0 Discontinued 0 60 + years 0 NA NA NA 0 0 0 Discontinued 0 TOTAL (F) 0 NA NA NA 0 0 0 Discontinued 0

Number of district‐level rapid response simulations completed Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 8 0 8 0 3 6 0 9 Number of community‐based rapid response simulations completed Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 NA 39 39 NA NA NA 26 13 39

Number of EVD confirmed cases evaluated by Rapid Response Teams Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 NA NA NA 0 0 0 Discontinued 0

Time elapsed between district trigger point and establishment of the CCC Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative TBD < 72 hours NA <72 hours NA NA NA Discontinued 0

Percentage of referrals transferred from community to CCC in IMC ambulance in districts without ambulance transfer capacity Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Cumulative TargJune 2016 2016) 2016) 2017) 2017) Cumulative NA 100% NA 100% NA NA NA Discontinued #DIV/0!

COMMUNITY HEALTH EDUCATION/ BEHAVIOR CHANGE

Number of CHWs trained and supported ‐ DISAGGREGATED BY SEX Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Male NA NA 0 0 0 Discontinued 0 Female NA NA 0 0 0 Discontinued 0 TOTAL 0 2000 NA NA 0 0 0 Discontinued 0

Number of healthcare workers trained and supported ‐ DISAGGREGATED BY SEX AND PROVIDER TYPE Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Provider Type Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Doctor 0 0 0 0 0 0 Nurse 0 2 1 0 1 4 CHW 0 12 6 1 3 22 Midwife 0 0 0 0 0 0 Male Traditional Healers 0 7 3 136 33 179 TBA 0 3 0 1 0 4 Other 0 0 1 3 43 47 TOTAL (M) 0 24 11 141 80 256 Doctor 0 0 0 0 0 0 Nurse 0 12 2 1 4 19 CHW 0 0 0 1 2 3 Midwife 0 0 0 0 0 0 Female Traditional Healers 0 2 0 62 17 81 TBA 0 2 0 2 1 5 Other 0 0 0 0 12 12 TOTAL (F) 0 16 2 66 36 120 TOTAL 0 150 360 360 0 40 13 207 116 376

Percentage of CHWs provided with supportive supervision by PHU staff Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative TBD 100% NA NA NA NA NA Discontinued #DIV/0!

Number of meetings conducted with PHU staff and VDCs/FMCs (VDC monthly meetings, FMC quarterly meetings) Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Each VDC = 1 per Each VDC = 1 Each VDC = 1 month; per month; per month; Each FMC = Each FMC = 1 Each FMC = 1 0 1 per month per month per month 0 0 0 50 75 125

Number and percentage of CHWs specifically engaged in public health surveillance Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Number Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 70% NA NA 0 0 0 Discontinued 0 Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Percentage Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0% 70% NA NA 0% 0% 0 Discontinued 0%

Percentage of VDCs/FMCs implementing at least four health promotion activities per month Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative NA 70% 70% 70% NA NA 46.15% 44.87% 66% 46%

MEDICAL COMMODITIES

Number of supplies distributed by type Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Supply Type Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Medical Kits 0 0 0 0 0 Equipment 0 192 0 0 192 0 192 Consumables 0 18382 0 0 18382 0 18382 Other 0 0 0 0 0 BUILDING COMMUNITY AWARENESS/ MOBILIZATION

Number of community structures (VDCs and FMCs) formed or restructured Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apri‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 78 0 78 0 52 26 26 0 104 Number of community structures (VDCs, FMCs, CHCs, PSSGs) formed or restructured Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apri‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 94 8 102 16 52 26 31 0 125

Number of community structures trained and mobilized to establish community early warning systems on EVD Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apri‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 78 0 78 0 52 14 78 0 144

CAPACITY BUILDING TRAINING AND PARTNERSHIP

Number of trainings conducted in implementing EVD early warning activities Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 4 NA 4 0 3 Discontinued Discontinued 3

Number of community event‐based surveillance system (CEBS) advocacy meetings/activities conducted with stakeholders Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 20 NA NA 0 0 4 Discontinued Discontinued 4 Number of interface meetings conducted between communities and DEOC/DHMT and other partners Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 20 NA NA 0 4 61 Discontinued Discontinued 65

Number of communities with EVD risk reduction and communication plan Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016) 2016) 2016) 2017) 2017) Cumulative 0 39 0 39 0 0 36 39 39

Number of community members (VDC members, CHC members, PSSG members, students, traditional healers) trained and mobilized, by sex Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Age Baseline 2016 Target 2017 Target Target June 2016) 2016) 2016) 2017) 2017) Cumulative Not disaggregated by age NA NA NA 441 585 1026 0 ‐ 11 months NA NA NA 0 1 ‐ 4 years NA NA NA 0 5 ‐ 14 years NA NA NA 0 Male 15 ‐ 49 years NA NA NA 0 50 ‐ 60 years NA NA NA 0 60 + years NA NA NA 0 TOTAL (M) NA NA NA 441 585 1026 Not disaggregated by age NA NA NA 378 507 885 0 ‐ 11 months NA NA NA 0 1 ‐ 4 years NA NA NA 0 5 ‐ 14 years NA NA NA 0 Female 15 ‐ 49 years NA NA NA 0 50 ‐ 60 years NA NA NA 0 60 + years NA NA NA 0 TOTAL (F) NA NA NA 378 507 885 TOTAL 0 NA 898 898 819 1092 1911 PSYCHOSOCIAL SUPPORT

Number of individuals supprorted by psychosocial support sessions provided (by psychosocial officers) to patients, families, and health workers ‐ DISAGGREGATED BY SEX Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Age Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Not disaggregated by age 0 2746 1797 1698 1329 7570 0 ‐ 11 months 0 0 0 1 ‐ 4 years 0 0 0 5 ‐ 14 years 0 0 0 Male 15 ‐ 49 years 0 0 0 50 ‐ 60 years 0 0 0 60 + years 0 0 0 TOTAL (M) 0 2746 1797 1698 1329 7570 Not disaggregated by age 0 2036 1350 1452 1220 6058 0 ‐ 11 months 0 0 0 1 ‐ 4 years 0 0 0 5 ‐ 14 years 0 0 0 Female 15 ‐ 49 years 0 0 0 50 ‐ 60 years 0 0 0 60 + years 0 0 0 TOTAL (F) 0 2036 1350 1452 1220 6058 TOTAL 0 3000 5000 8000 0 4782 3147 3150 2549 13628

Number of health care providers trained in psychosocial support and mental health awareness ‐ DISAGGREGATED BY SEX AND PROVIDER TYPE (e.g., doctor, nurse, community health worker, midwife, and traditional birth attendant Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Provider Type Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Doctor 0 0 0 0 0 0 Nurse 0 2 1 1 2 6 CHW 0 12 6 27 28 73 Midwife 0 0 0 0 0 0 Male TBA 0 3 0 0 3 6 Traditional Healer 0 7 3 30 64 104 Other 0 0 1 13 24 38 TOTAL (M) 0 24 11 71 121 227 Doctor 0 0 0 0 0 0 Nurse 0 12 2 6 9 29 CHW 0 0 0 6 6 12 Midwife 0 0 0 3 0 3 Female TBA 0 2 0 11 8 21 Traditional Healer 0 2 0 23 24 49 Other 0 0 0 6 10 16 TOTAL (F) 0 16 2 55 57 130 TOTAL 0 150 360 360 0 40 13 126 178 357

Number and percent of beneficiaries reporting improvement in their feeling of well‐being or ability to cope. Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Number Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative TBD TBD TBD TBD NA NA NA NA 0 Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Percentage Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative TBD TBD TBD TBD NA NA NA NA 0

PROTECTION COORDINATION, ADVOCACY AND INFORMATION

Number of MSWGCA, CBOs, and community leaders trained and supported on PSS and protection (total and per 10,000 population within project area) ‐ DISAGGREGATED BY SEX Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Sex Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative Male 0 65 65 0 130 Female 0 29 29 0 58 TOTAL 0 100 100 100 0 94 94 0 188

Number of coordination meetings (monthly) conducted with PHU, MSWGCA, CBOs, and community leaders (i.e. paramount chiefs, imams) Cumulative Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 8 24 32 0 4 8 17 5 34

Number of collaboration exercises facilitated for simulation of CCC Q1 (May‐ Q2 (July‐Sep Q3 (Oct‐Dec Q4 (Jan‐Mar Q5 (Apr‐Jun Baseline 2016 Target 2017 Target 2017 Target June 2016 2016) 2016) 2017) 2017) Cumulative 0 8 NA 8 0 3 6 Discontinued 9