OFDA Closeout Report: Respond and Rebuild: Fighting Ebola and Strengthening Health Systems in Sierra Leone

The organization was invited by the Government of Sierra Leone to join the response, and PIH accepted the invitation due to the intense need in West Africa and the organizational expertise, skills, and resources it had to offer. PIH's intervention was guided by several principles, including partnership with the public health sector, maintaining quality, scale, and safety, and comprehensive intervention across all levels of the health system. The health sector in Sierra Leone was weak even before the Ebola outbreak, with only two physicians per 100,000 people, compared to 20 per 100,000 as the average for low-income countries. The area targeted by PIH's program had an insufficient number of active government health workers, and those who were present had not been sufficiently trained. Prior to the outbreak, Sierra Leone had poor health-related indicators, including a high under-five mortality rate and one of the highest maternal mortality rates in the world. The existing health system was further weakened by Ebola, with more than 200 health workers dying from the disease, and countless hospitals and health centers shutting down. Health care providers abandoned their positions and went on strike due to a lack of medical supplies, personal protective equipment (PPE), and support needed to ensure their safety while serving the public. Weaknesses in the existing primary health care system hindered the country's response to Ebola, including education and outreach efforts, case finding, and contact tracing. PIH's intervention in Sierra Leone included supporting the adoption of safe isolation practices for suspected Ebola patients within a network of health facilities, and undertaking expansive survivor reintegration and support activities. The organization's approach was guided by the principles of partnership with the public health sector, maintaining quality, scale, and safety, and comprehensive intervention across all levels of the health system. PIH's core activities and major accomplishments in improving treatment and isolation practices included establishing Community Care Centers (CCCs) and Holding Units, providing triage and isolation support at public facilities, and supporting district response management and capacity-building. The organization also provided survivor psychosocial and reintegration support, and implemented project management and coordination approaches to ensure effective implementation of its activities. The health sector assessment conducted by PIH identified several key indicators, including a 27% increase in household income among program participants compared to the control group, and improvements in food security indicators across all target communities. The assessment also highlighted the importance of comprehensive intervention across all levels of the health system, including Ebola Treatment Units (ETUs), Community Care Centers (CCCs), and community-level engagement. PIH's intervention in Sierra Leone was guided by a commitment to continuity between emergency response and long-term health system strengthening. The organization's approach was designed to build a more resilient health system, and to address the underlying weaknesses in the existing health system that contributed to the Ebola outbreak.