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 Sierra Leone OFDA Grant Number: AID-OFDA-G-16-00067 Country/Region: Bombali, Kambia, Koinadugu and Port Loko 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 Lunsar 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 Gbendembu 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.