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Table 5 Data extracted and results from all nine reports

From: The link between the West African Ebola outbreak and health systems in Guinea, Liberia and Sierra Leone: a systematic review

Report number

Author

Title

Objective

Building block

Relevant data extracted and results

1

WHO

How Liberia reached zero cases of EVD

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Leadership and governance

Leadership and coordination of the country president, health officials and the government was adequate. Presidential advisory committee on EVD was established and introduction of an incident management system helped ensure that resources and capacities were placed when needed. Health officials realised the importance of community engagement and responded accordingly.

Health financing

This added more supplies, human resources, more treatment beds, increased laboratory capacity, more contact tracing and ensured safe burial teams were deployed. Funding helped installation of transparent walls around treatment centres allowing families and friends to watch what was happening, thus increasing trust. Funding helped increase transportation to treatment facilities. Most of this was international funding.

2

WHO

Ebola virus disease (EVD) in West

Africa: an extraordinary epidemic

Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak

Information and research

Limited EVD detection and diagnostics facilities was a reason for the silent progress of Ebola in West Africa.

Medical products and technologies

Health centres lack resources to implement basic infection prevention measures.

Health workforce

Limited health workforce was noticed and this added a burden on health centres leading them to more infection transmission and slow response.

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Health workforce

The epidemic was characterised by the high numbers of health care personnel infected by the disease. In the 3 countries, more than 800 contracted the disease and more than 500 died.

3

WHO

Report of the Ebola interim assessment panel

Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak

Information and research

The panel found that there was no data collection, aggregation, analysis or shared in a timely manner and sometimes not at all. There was also lack of proper surveillance.

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Health workforce

There was a noticed short deployment of personnel. This added to the outbreak chaos where there as a constant, rapid turnover of staff and some didn’t have the required capacities. There was a shortage in the coherent human resources management process as some were confused of their exact job description and to whom to report.

4

CDC

A plan for the community event-based surveillance to reduce Ebola transmission – Sierra Leone, 2014–2015

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Information and research

Community Event – Based Surveillance (CEBS) system was developed to help strengthen the country’s Ebola surveillance and response capabilities. It is developed to supplement case finding and contact tracing, the core of Ebola surveillance in the West African response. CEBS started in a few low and medium transmission districts and will be deployed to other parts of Sierra Leone.

5

CDC

Use of a nationwide call centre for Ebola response and monitoring during a 3 day house to house campaign – Sierra Leone, September 2014

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Information and research

A national Ebola toll free call centre was established in Sierra Leone by the Emergency Operations Centre. This helped to report cases and deaths to public health officials and offers health education messages to the public. This also helps supporting surveillance and alerting any emergencies. Public health officials, then respond promptly delegating tasks to the concerned personnel and start contact tracing and follow up (such as safe transportation of Ebola patients to treatment units or safe burials)

6

CDC

Rapid assessment of Ebola infection prevention and control needs--six districts, Sierra Leone, October 2014

Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak

Medical products and technology.

* There was insufficient PPE supplies, running water, incinerators, chlorine and blood collection supplies all over the three countries.

* Due to delays in patient transport and bed availability, home care took place and carers were not trained on ow to deal with cases properly.

* There were delays in transporting patients and specimens due to limited availability of ambulances and fuel. The vehicles were not even properly decontaminated. This risks the lives of the teams and the suspected patients. The time between confirming results was long and this jeopardised the process of separation of patients suspected from confirmed in holding centres.

Health workforce

* Health systems in the three countries lack adequate number of trained and competent staff in IPC. There was also lack of payments in addition to this shortage that lead more staff to leave and this was compounded by the staff fatigue from the burden of having more patients. IPC training wasn’t properly given to staff, ambulance teams and cleaners where as some burial teams and laboratory technicians had some trainings. This made them unable to safely screen or isolate suspected Ebola cases before transport health centres for treatment.

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Information and research

IPC training protocols and programs were developed by the MoH in Sierra Leone. There was also monitoring and evaluation programs for the IPC implementation and quality assurance using IPC metrics. The National Ebola IPC ensures that gaps are identified and responses offered promptly.

7

CDC

Assessment of Ebola virus disease, health care infrastructure, and preparedness – four counties, South-eastern Liberia, August 2014

Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak

Medical products and technologies.

* There was shortage in gloves, hand washing stations, water jugs (in case there was no water stations), PPE (and staff were not trained in using it), soap, bleach, alcohol hand gel and there was no adequate water nor electricity. Bamboo washing stations were created to compensate for this shortage. There was no waste disposal nor isolation facilities.

* There was no proper connections in place as internet, phone signals or even radio.

* Transportation was also a major challenged for patients and specimens transport.

Information and research

No surveillance nor training on case investigation, case management, contact tracing, or safe burial practices had been was offered in counties and hospitals.

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Health workforce

Nurses abandoned facilities, staff left Liberia and in some cases, staff were not paid for three months.

8

CDC

Developing an incident management system to support Ebola response - Liberia, July-August 2014

Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone

Leadership and governance

Incident Management System was introduced by the MoH and Social Welfare in the early months of the outbreak.

9

CDC

Challenges in responding to the Ebola epidemic - four rural counties, Liberia, August-November 2014

Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak

Medical products and technologies

* There was a lack in proper communication due to shortage in proper telephone coverage and leaders were not able to notify specified health staff on suspected cases, arrange clinical checks or notify each other on any specimen results on time.

* Transportation was also a problem as specimens were not transferred on time to laboratories.

Health workforce

* Health staff in the four counties reported lacking necessary training in case investigation, contact tracing, infection control (including safe burial practices), and health education

* Only Grant Bassa had an ambulance team trained in loading and transport of patients and trained staff in case investigation and contact tracing.

* There was only one laboratory technician trained in collecting and handling specimens safely in Grand Cape Mount and Grand Bassa.

* Sinoe had not technicians at all.

* All counties were short on drugs at clinics and PPE and staff were not trained in using it properly.