Region/Country: Africa and Middle East/Sierra Leone
20 June 2015

IOM Sierra Leone Summary Sheet

The International Organization for Migration signed a cooperation agreement with the Government of Sierra Leone in April 2001 and has been operating in the country ever since. In the aftermath of the 10 year civil war, IOM Sierra Leone in close partnership with relevant line ministries has been engaged in programming centered on the reintegration of refugees, government capacity building, community stability and social cohesion, counter trafficking, diaspora engagement, reparations to war victims and livelihoods training activities.

Fast forward to October and November of 2014. The Ebola epidemic is in full swing with over 500 cases per week. IOM dispatched two assessment missions to Sierra Leone at the request of the Director General and made the decision to respond to its first Level 3 ‘health emergency’ with Ebola emergency response activities in Sierra Leone, Liberia and Guinea.

As of 20 June 2015 Sierra Leone is slowly emerging from the grip of an unprecedented Ebola Virus Disease (EVD) outbreak that has devastated the population and further weakened a fragile health services system through the unfortunate deaths of several prominent medical practitioners and depletion of Infection Prevention and Control (IPC) resources and infrastructure at hospitals. Sierra Leone has recorded the highest rate of EVD transmission worldwide with over 12,706 confirmed EVD cases and 3,908 deaths

[1]

as of 24 May 2015 according to the World Health Organization (WHO).

The Ebola outbreak in Sierra Leone has had direct and indirect impacts on the capacity of the health care system in all three most affected countries, but significantly in Sierra Leone where health care workers infected with Ebola (304) and deaths (221) to 17 June reflects a significant loss of valued human resources and consequently an inability to provide basic and primary health care. The deaths of experienced health care workers and those who supported the health system administration, is a compounding deficit that takes a “generation of education, training, and experience” to replace.  While the international community has responded to the EVD for containment and control, and in doing so has supported the provision of EVD specialty care, primary care services, public health expertise, the health system remains fragile.

From December 2014 when IOM assumed management of the National Ebola Training Academy from the United Kingdom’s Ministry of Defense to late June 2015, IOM has rapidly scaled up its project activities in response to the epidemic. Consequently staff presence on the ground has grown from 10 at the beginning of the IOM response to approximately 160 and growing as a result of expanded Health and Humanitarian Border Management operations at the time of writing. IOM Sierra Leone is headquartered in Freetown with 3 sub-offices in Lungi, Port Loko district, Kambia district and Bombali district.

Core IOM thematic areas: Migration and development; Facilitating migration; Regulating migration; Forced migration.

Current IOM projects in Sierra Leone:

Project:                 Training Academy for Frontline Ebola Response Practitioners in Sierra Leone

Duration:             9 months (01 November 2014 – 31 August 2015)

                UK Department of International Development

 

Project:              Mobile Clinical Infection Prevention and Control Training for Ebola Treatment Facility Frontline Practitioners and Academy Training for Clinicians Providing Non-Ebola Health Care Services

Duration:           6 months (15 January – 15 July 2015)

                                United States Agency for International Development/OFDA

 

Project:                Health and Humanitarian Border Management (HHBM) Phase II

Duration:             4 months (30 May 2014 – 30 September 2015)

                                United States Agency for International Development/OFDA

 

Project:               Health and Humanitarian Border Management Support to the Republic of Sierra Leone Armed Forces (RSLAF) in Port Loko and Kambia

Duration:             3 months (30 May- 31 August 2015)

                                UK Department of International Development

 

Project:                Distribution of Emergency Interim Care Kits

Duration:             9 months (01 December 2014 – 31 August 2015)

                                United States Agency for International Development/OFDA

 

Project:              Strengthening Community Social Mobilization for the Prevention and Control of Ebola Virus Disease

Duration:           6 months (15 January – 15 July 2015)

                              United States Agency for International Development/OFDA

 

Total Staff Count: 115 (14 internationals; 101 nationals, HHBM currently scaling up to 187 staff; total count will rapidly surpass 200)

 

Project highlights as of 20 June 2015:

National Ebola Training Academy: On 01 December 2014, the International Organization for Migration (IOM) in collaboration with WHO, the Ministry of Health and Sanitation (MOHS), and the College of Medicine and Allied Health Services (COMAHS), assumed management of the Training Academy from the United Kingdom’s Ministry of Defense.

Cumulative Training Academy/Mobile Training operational data for 01 December 2014– 20 June 2015

(weekly numbers in brackets)

Course Name

Number of

courses run

Total number of

National students

Total number of

International Students

Cumulative

Total

3 day Ebola clinician IPC

2 day Simulated Patient care

23 (1)

 

589 (15)

 

355

 

944

1 day Ebola clinical IPC

2 day Simulated patient care

4

26

59

85

1 day clinical

augmentation

2

25

41

66

3 day basic IPC/PPE/3 day WHO Ebola basic IPC

65 (3)

5,821 (123)

51 (1)

5,872

Mobile Training 3 day IPC/PPE/Clinical

Decontamination/2 day modified IPC

30 (1)

1074 (49)

0

1073

1 day clinical pilot

1

33

24

57

Total

125 (5)

7,568 (188)

530 (1)

8,097

 

As of 20 June 2015, IOM and partners have completed the training curriculum with new clinical modules designed and rolled out by WHO and IOM to reflect epidemiological realities, and to date have trained 8,097 health care professionals and frontline Ebola responders including doctors, nurses, hygienists, social mobilizers, and contact tracers on Ebola-centric Infection Prevention and Control measures, correct hand washing techniques, chlorine mixing, site decontamination, spill cleanup, donning and doffing of Personal Protective Equipment and lectures on Ebola.

Over 7500 students are native Sierra Leoneans and approximately 530 are international. Initially in December 800 students were being trained per week under the UK MOD model but this number was quickly reduced to 300. Currently an average of 100 students per week are being trained in Freetown. This reflects both the general decline in transmission rates as well as a decreased demand for centralized training. Contrastingly the demand for training in the districts is on the rise and since mid-January, Training Academy staff have been broken into 3-6 person rapidly deployable mobile training teams which respond to training requests from MOHS, WHO, UNMEER, peripheral health units and private medical facilities.

The Academy is located at two converted training sites (Siaka Stevens National Stadium and the Nursing Faculty, COMAHS) with a staffing structure of 5 international (4 Ugandans from Makerere University’s School of Public Health in Kampala) and 10 national trainers; physicians and Masters of Public Health. Previously the staff count was over 30 IOM trainers and WHO provided three clinical trainers, MOHS 6, and COMAHS 4. The Training Academy also employs 10 Ebola survivors as expert patient simulators. They share their experiences 4 times per week via survivor’s panels (2 per week at each Academy site), provide in-depth exposure to signs and symptoms during small group teaching sessions, as well as adding a serious realism to clinical training scenarios in the Stadium site’s mock Ebola Treatment Unit.

All students are placed and evaluated using pre and post-tests. Placements, especially for the 3-day basic IPC course reflect both language and literacy skills. Courses are offered in Krio and English and where students have a low level of reading and writing evaluation methods can be adapted and conducted verbally. A final practical assessment is given on skills learned and a final written evaluation is filled out by students for course feedback. A database of graduates is maintained including contact information and place of work.

As of 1 May 2015 in partnership with the College of Medicine and Allied Health Services and the Ministry of Health and Sanitation, IOM has begun to refurbish the Faculty of Nursing. The faculty is the largest in the country with roughly 1000 students and has not been renovated since opening in the 1960’s. The facility lacks running water, basic power generation, and security features. After the refurbishment is completed IOM’s IPC training will be consolidated at the faculty site as of June 2015.

The Academy continues to evolve and to apply its resources to needs arising.  Currently the training teams are delivering a new 3-day augmented general IPC module designed for 1600 students. These students include nursing, medical, pharmacy and lab technician--all faculties within the College of Medicine and Allied Health Sciences. This 3-day training will provide knowledge and skills to work safely within the hospital wards where they will carry out aspects of their practical studies.

With its well-earned position as the largest training academy in the region, the National Ebola Training Academy is now poised to make another significant and lasting contribution in Sierra Leone. In collaboration with the Ebola Response Consortium the training resources will be targeted at establishing standardised Infection Prevention and Control in 5 government hospitals through the training of all respective staff. As well, the MoHS has requested IOM to establish general health screening in all government hospitals, reflective of its proven success within the Health and Humanitarian Border Management programme.    

Mobile Training: As of early January 2015 IOM, under an award from OFDA, began responding to training requests from the Ministry of Health, WHO, UNMEER and private medical facilities to train frontline responders and medical practitioners at the district level. Initially due to a national travel ban and cost, district level professionals were unable to access training at the Academy in Freetown and Mobile Training was begun with these limitations in mind. As of 12 June the Mobile Training project which uses Training Academy staff broken down into teams of 3-6 rapidly deployable teams, have trained over 1000 frontline Ebola responders on IPC in Port Loko, Kono, Kailahun, Bombali, Kambia, Kenema, Pujehun, Bo, Western Area Urban/Rural and Tonkolili districts.

As transmission rates decline, IPC training will transition away from Ebola-centric training and move towards general IPC measures with an Ebola component and facilitate training for staff at government hospitals, university students at the College of Medicine and Njala University, the Defense School of Nursing, and private medical facilities in 8 districts.

Emergency Care Kits: IOM has distributed and pre-positioned in Peripheral Health Units (PHUs) over 3000 emergency interim care kits to probable/suspect/confirmed/quarantined cases in communities that are awaiting access to treatment facilities. IOM has 5 project partners in total including Medair in Freetown, World Hope International in Bombali and Wellbody’s Alliance in Kono (both are also partners on Social Mobilization), ACF in Western Area, Moyamba and Kambia and Partners in Health in Port Loko. As well an award modification was granted that allowed IOM’s own team of 32 social mobilizers to work in low income coastal communities in the Freetown area.

Kit composition is in line with the national SOP and includes ORS, gloves, chlorine, aquatabs, EVD messaging, 2 aprons, buckets, soap. The original intent of the kits was to provide interim household care to suspected EVD patients awaiting onward transport to Ebola treatment facilities however due to epidemiological trends, IOM has received authorization from donor the US Office for Foreign Disaster Assistance (OFDA) to distribute the kits in a more flexible manner to quarantined homes; pre-position them in communities through the Community Events Based Surveillance (CEBS) mechanism through partner ACF; and as hygiene kits after removing the apron and gloves. IOM and ACF will pre-position 3 or more kits per Kambia community (around 880 communities) to be managed by respective Community Health Monitors in the event of EVD and/or another infectious disease (cholera for example) requiring interim care. IOM has 5 field monitors supporting partners in kit distribution/pre-positioning.

Social Mobilization: IOM and two implementing partners- World Hope International in Bombali district and Wellbody’s Alliance in Kono district- intended to address some of the identified gaps in social mobilization (SM), including the continuation of harmful traditional practices including the washing of deceased family members. The community-centered SM intervention included the training of 100 community and religious leaders/representatives and survivors from different sectors of society that were deployed to engage with their community to respond to Ebola. In addition, selected communities in 18 chiefdoms learnt basic Infection Prevention and Control (IPC) measures to prevent EVD transmission and develop a community-led action plan to reduce the risk of transmission. To date both partners have reached out to over 20,000 individuals through community engagement and the use of hundreds of social mobilizers and community health workers.

As a result of declining transmission rates in both Kono and Bombali, WBA in Kono has become involved in disease identification and referral of late stage malaria and measles after outbreaks in the district. WBA is using its teams of Community Health Workers to engagement with communities on health promotion and being vigilant against possible Ebola outbreaks. In Bombali WHI has become involved in the reopening of schools since 14 April and is now contributing to dissemination of Ebola awareness messaging as well as leading on community engagement around culturally sensitive safe burial practices. WHI has also trained over 100 Cultural Liaison Officers to support safe and dignified burials while remaining sensitive to traditional cultural practices.

HHBM: Phase I of the Health and Humanitarian Border management (HHBM) project focused on supporting the establishment of a robust health screening process at Lungi International Airport and ended on 17 May. The monitoring of over 50,000 passengers (100% of all flights) was completed, over 300 airport officials trained and 100 flip books describing the EEHS process have been printed. IOM in combination with partners also held 3 Emergency Simulation Exercises to test and reinforce airport staff preparedness using multiple real time emergency scenarios acted out by Ebola survivors who work as expert patients with IOM’s Training Academy in Freetown.

IOM, supported by new project donor United States Agency for International Development (USAID) Office for Foreign Disaster Assistance (OFDA), is scaling up operations to include land borders with Guinea in Kambia and Bombali districts and seaports in Freetown while continuing airport activities.

Since mid-May 2015, IOM Sierra Leone has activated Phase II of its Health and Humanitarian Border Management (HHBM) project in Kambia District by providing 100% monitoring of the entry/exit health screening process at the Category A (permanently manned, infrastructure in place) international border crossing with Guinea at Gbalamuya with the deployment of 25 IOM monitors that are in operation in 8 hour shifts 24 hours per day, 7 days per week.

Visiting technical experts from IOM Mali and IOM HQ have conducted extensive training of local staff to establish the Flow Monitoring Point (FMP) system in order to capture vital traveler data on such categories as point of origin/destination, gender, age and contact information.

IOM will deploy six roving 7-monitor teams to provide comprehensive monitoring coverage of health-screening points.

To meet the demands of covering such a vast geographical area, HHBM Phase II is presently recruiting a total of 187 staff to be deployed over 5 locations – Kambia, Bombali, Port Loko, Lungi International Airport and Freetown seaports to cover air, land and sea borders, as well as major internal transit routes. A new sub-office has been opened in Kambia to support IOM efforts on the ground.

 

Current Vacancies in IOM Sierra Leone

Position Title Name of host institution
Midwife in Kurubola Community Health Centre Kurubola Community Health Centre (CHC). (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected other peripheral health units in Koinadugu district)
Midwife in Mongo Gbendugu Community Health Centre

Mongo Community Health Centre (CHC). (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected other peripheral health units in Koinadugu district)

Nurse in Kabala Government Hospital

Kabala Government Hospital and some Community Health Centre in Koinadugu district. (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected 6 Community Health Centre or Peripheral Health Units in Koinadugu district)

Obstetrician or Gynaecologist in Kabala Government Hospital

Kabala Government Hospital. (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected 6 peripheral health units in Koinadugu district)

Midwife in Kabala Government Hospital

Kabala Government Hospital and some Community Health Centre in Koinadugu district. (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected 6 peripheral health units in Koinadugu district)

Surgical Doctor in Kabala Government Hospital

Kabala Government Hospital. (It is requested to conduct frequent outreach, preventive, promotional and curative activities in the selected 6 peripheral health units in Koinadugu district)

 


[1]WHO Ebola Situation Report 27 May 2015.

CapitalFreetown
Population (2015):6.5 million
Area:71,740 km sq
Languages :English
Currency:Leone (SLL)
GDP per Capita PPP (2014):USD 2,053
HDI Rank (2014):181 of 188
Remittances (2014 estimate):USD 104 million
Immigrants (2015):1.4%
Women as a Percentage of Immigrants (2015):45.2%
Population under 15 (2015):42.4%
Adult HIV Prevalence (2014):1.40%

For more information on IOM’s Sierra Leone activities please contact:

IOM Sierra Leone Response | jbaker@iom.int | Public Information/Project Development | nbishop@iom.int

Please find IOM Sierra Leone on Facebook at www.facebook.com/iomsierraleone

Source: un.org