Table of Contents
Introduction
Sierra Leone is one of the world’s poorest countries with a United Nation’s Human Development index rank of 183 out of 187 (Gusky, 2015). The outcome of the war in Sierra Leone from 1991 to 2002 lead to the death of 70,000 people and the displacement of individuals, damage to the health system infrastructure, illiteracy, poverty, and increased rates of infant and maternal mortality (Gusky, 2015). Gusky (2015) stated that other population health issues faced by Sierra Leonean included malnutrition, hepatitis A, cholera, typhoid fever, and lack of access to drinkable water. At the beginning of 2013, Sierra Leone, Liberia, and Guinea were severely impacted by the epidemic of Ebola virus disease (EVD). According to Cancedda et al. (2016), the Ebola epidemic caused over 28,616 infections and 11,310 deaths between 2013 to 2016 in West Africa. Due to the poor, decentralized public health infrastructure, the Sierra Leone government was not prepared to handle the challenge of the Ebola outbreak. The government relied heavily on the assistance of nongovernmental organizations (NGO) in responding to the health needs and preventing the spread of EVD.
Article 1: Strengthening Health Systems While Responding to a Health Crisis: Lessons Learned by a Nongovernmental Organization During the Ebola Virus Disease Epidemic in Sierra Leone
The first article focused on Partners In Health (PIH) involvement in assisting the Sierra Leone’s National Ebola Response Center and the Ministry of Health and Sanitation in coordinating the emergency response to the Ebola outbreak. PIH is a global NGO with over 30 years’ experience, whose mission is to work with the governments to deliver health services to poor and marginalized communities (Cancedda et al., 2016). PIH’s integrated approach to address the Ebola outbreak included prioritizing the prevention of new infections and improving the patient outcomes with a scaled-up delivery of health services for patients with EVD. (Cancedda et al., 2016). PIH’s prevention approach focused on mobilizing communities to recognize symptoms of EVD and referral of potentially infected individuals to health facilities for follow up care. PIH implementation strategies included improving quality clinical care, reducing the risk of transmission among health personnel, strengthen water and sanitation systems, train local health professionals in infection prevention and control, and sustain supply chain of personal protective equipment. At the community level, PIH trained community health workers in conducting health education intervention while providing psychosocial support to individuals.
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PIH committed to a long-term partnership with the government to stay in Sierra Leone beyond the Ebola response to aid government resume to the delivery of regular health services and strengthen the health system. Key lessons learned by PIH include capacity building of health governance and management, encourages early response by the international community to health crisis, provision of quality critical care to patients in halting transmission and saving lives, timely data collection and surveillance, flexibility in how funding is allocation and how to use it , and commitment from the international community to support strengthening of developing countries health systems to quickly identify and contain future public health epidemic.
Article 2: The Effectiveness if International Non-Governmental Organizations’ response Operations during Public Health Emergency: Lessons Learned from the 2014 Ebola outbreak in Sierra Leone
The second article focused on addressing the effectiveness of international nongovernmental organizations (INGO) response to the 2014 Ebola outbreak. Shin, Yeo, and Jung (2018) addressed the role NGOs plays in combating public health crises by establishing medical facilities, support public health systems of host countries, conduct public health education, and provide shelter for victims. Shin et al. (2018) postulate that the contributions and effectiveness of NGOs activities are not well defined on how these organizations should be evaluated on emergency response to public health crises. Shin et al. (2018) conducted research to answer the question ‘to what extent does INGOs’ response activities reduce damages in public health crises such as the Ebola outbreak?’
The key goal of international humanitarian response to the Ebola outbreak was to coordinate services with the Sierra Leone government and strengthen the local response capacity. The priority areas in addressing the outbreak included increasing health care facilities, medical resources, increasing health care personnel, and isolating infected individuals to prevent further transmission (Shin et al., 2018). Shin et al. (2018) state that the major goal of any public health education was to educate community members to stop eating bushmeat including wild bats and monkeys. These animals were suspected of transmitting the disease between animal and human. Shin et al. (2018) explained that different INGOs focus on different priorities, such as providing primary health care delivery, increasing community resilience by creating a sustainable socio-economic environment, community empowerment.
Shin et al. (2018) outlined 5 critical effective public health response strategies for NGOs to utilize during public health crises to decrease damage caused by an epidemic. First, expansion of health care infrastructure such as providing appropriate EVD treatment centers to prevent the spread of the disease in Sierra Leon. Second, increase prompt delivery of medical supplies to isolate and treat Ebola patients. Third, provide public health education that addresses risk, prevention guidelines, and early detection to raise community awareness.
In Sierra Leone, the public health education approach focused on preventing the spread of Ebola and educating community members to not eat bushmeat and addressing cultural practices on burial practices. Fourth, provide response training to first responders on basic first aid and public hygiene for the at-risk population. Shin et al. (2018) indicated that Ebola cases reported by community leaders and public health staff contributed to the reduction in damages to the affected community. Lastly, increase the provision of direct care such as nutrition care services for the vulnerable population. these direct care services aided the government in creating interim care centers to provide psychological supports to avoid trauma side-effects caused by separation for children who were displaced from infected parents.
The research focused on the first 6 months of response operations (May to November 2014) at the chiefdom’s administrative level at which INGOs provided assistance. The dependent variable was the damage caused by Ebola as the severity of the Ebola situation. The research measured the effectiveness of INGOs and its impact in the short-term and long-term basis in Sierra Leone. Shin et al. (2018) summarized that the reduction of affected cases in the short term was due to medical infrastructure and adequate level of medical supplies. The long-term impact on the number of affected cases will be due to community engagement, response training, and direct care services. Shin et al. (2018) research supported the work done by INGOs in responding to public health crises. The research findings served as guidelines for developing implementation policies and evaluation criteria for funding INGO program during public health crises.
Conclusion
Both articles outlined the public health response and implementation strategies that were effective in addressing the Ebola epidemic in Sierra Leone. The public health approach of collaboration, coordination, and empowerment of community in the management of an epidemic is essential in achieving the goal of reducing the damages and improving health outcomes.
