Testing a Monitoring and Evaluation System to Capture and Communicate the Ebola Response Effort in Selected Areas in Liberia

Ithar Hassaballa1 Charles Sepers1, Stephen Fawcett1, Davison Munodawafa2, Peter Phori2, Ephraim Chiriseri2, Florence DiGennaro Reed1, and Jerry Schultz1

1. Department of Applied Behavior Science 2. World Health Organization African Regional Office

• No conflict of interest.

Presenter Disclosure

• WHO Collaborating Centre at KU (KU CC)• Capturing and Communicating the Ebola Response Effort

• Background• Methods

• Context & Partners• Ebola Response Effort• Monitoring & Evaluation Approach

• Results• Sensemaking

• Discussion• Lessons Learned• Recommendations for Practice

• Conclusion

Presentation Map

• Designated as a WHO Collaborating Centre in 2004

• Provides:• Support for building capacity through the Community Tool

Box• Training & technical assistance on M&E• Guidance to WHO Regional Offices

KU Work Group for Community Health & Development

• WHO Tasked with: • Monitoring & Evaluating the Ebola Response Effort

• KU CC • Monitoring & Evaluation Capabilities

Responding to the Needs of WHO Regional Office for Africa

• Ebola Outbreak• Longest and largest in history of disease • Enormous health, social, and economic

consequences• Intense Transmission• Delayed identification of the disease• Denial, Fear, & Panic

• False rumors• Limited understanding of the disease

• Little to no capacity for diagnosis and treatment • Community Health Volunteers provided home-

based care

Background– Ebola Outbreak in West Africa

• Participating Communities

• Collaborating Partners: KU CC, WHO AFRO

• Intersectoral Action to address the Ebola outbreak • Local, national, regional, and international organizations

Methods– Context & Partners

Focused on Changing the Conditions:1) Reduce exposures

• Chlorinated water buckets for sanitation• Safe burials

2) Address vulnerabilities/capabilities • Education about Ebola• Training on protective behaviors• Community engagement efforts

3) Reduce differential consequences Provide access to Ebola diagnosis and treatment Engage Ebola survivors

Methods– Ebola Response Effort

1) Situation Assessment2) Community Organization & Mobilization3) Preparing the Workforce– Training & Capacity

Building4) Health Information Communication 5) Delivery of Essential Services & Supports6) Environmental Changes7) Policy Changes 8) Health System & Community Transformation

Methods– Ebola Response EffortIntervention Components

• KU CC Designed M&E System • Liberia-based evaluation consultant • Trained using an Evaluation Codebook• KU CC team member provided feedback on monthly

reports (secondary observer)• Accurate characterization of activities or interobserver

agreement was at 92%

• WHO Analysis • Computing incidence of Ebola

• Combining instances of confirmed, suspected, and probable cases

Methods– Measurement– Capture

Methods– Monitoring & Evaluation Approach

Dissemination Efforts

Monitoring & Evaluation System

Results– Communicate

• Decline in incidence of Ebola • Reported zero cases continuously for a period 42 days.

• World Health Organization • Declared Liberia Ebola Free on 09 May, 2015 • Declared Liberia Ebola Free (for the second time) on 03

September, 2015

Results Continued

Community engagement critical in bringing about community/system changes

Intervention required sustained and coordinated intersectoral action

WHO’s convening power Using an an M&E system was important in

capturing key activities

Discussion– Lessons Learned

Strengthen the local health system Build capacity and sustain leadership through

training & technical support Establish an Africa-based forum—not one outside

the continent Address social determinants that are the root

causes of outbreaks Reduce differential exposures (e.g., poor housing,

sanitation) Address vulnerabilities/capabilities (e.g., through primary

education for girls) Reduce differential consequences (e.g., provide universal

access to diagnosis and treatment)

Discussion–Recommendations for Practice

Current Work

“You get what you inspect,

not what you expect.”Bill Foege, House on Fire: The Fight to Eradicate Smallpox (2011)

Health Behaviors

Health Care

Broader Determina

nts

• Behavioral science• Urban planning,

Design• Anthropology

• Medicine, Nursing• Public

Administration

• Public health• Education• Policy and Law

Community Health and Well Being

“If you want to go quickly, go alone.

If you want to go far, go together.”

~African proverb

1. United Nations Development Programme. Recovering from the Ebola crisis: A summary report of the United Nations, The World Bank, European Union and African Development Bank as a contribution to the formulation of National Ebola Recovery Strategies in Guinea, Liberia and Sierra Leone, 2015. [Internet]. 2015 Mar 12. Available from: http://www.undp.org/content/dam/undp/library/crisis%20prevention/Recovering%20from%20the%20Ebola%20Crisis-Full-Report-Final_Eng-web-version.pdf.

2. Mullan Z. The cost of Ebola. Lancet Glob Health [Internet]. 2015 July 9; available from http://dx.doi.org/10.1016/S2214-109X(15)00092-3.

3. United Nations. Making a difference: The Global Ebola Response: Outlook 2015. 2015 Jan [Internet]. Available from: https://ebolaresponse.un.org/sites/default/files/ebolaoutlook.pdf.

4. WHO. Ebola response roadmap. 2014 Aug 28 [Internet]. Available from: http://apps.who.int/iris/bitstream/10665/131596/1/EbolaResponseRoadmap.pdf?ua=1.

5. Feldmann, H., and Geisbert, T.W. Ebola haemorrhagic fever. The Lancet 377.9768 (2011): 849-862.6. Fawcett S, Collie-Akers V, Schultz J, Cupertino P. Community-based participatory research within the Latino

Health for All Coalition. J Prev Interv Community. 2013; 41.3:142-154.7. Fawcett SB, Sepers CE, Jones J, Jones L, McKain W. Participatory evaluation of a community mobilization effort

to enroll residents of Wyandotte County, Kansas residents through the Affordable Care Act. Am J Public Health. 2015; 105 (S3):S433-437.

8. Fawcett SB, Schultz J. Community-based participatory research for health: From process to outcomes. NewYork: Jossey-Bass. 2008. Appendix 1, Using the Community Tool Box's Online Documentation System to support participatory evaluation of community health initiatives; p. 419-430.

9. WHO. Ebola situation report. 2015 Jan 28. [Internet] Available from: http://apps.who.int/ebola/en/ebola-situation-report/situation-reports/ebola-situation-report-28-january-2015.

10. Dhillon R, Yates R. Building back better: priorities for Ebola-affected countries. Lancet Glob Health [Internet]. 2015 July 9; Available from: http://dx.doi.org/10.1016/S2214-109X(15)00032-7

11. Liberia Map. https://www.google.com/search?q=lofa+and+margibi+maps&biw=1920&bih=1065&source=lnms&tbm=isch&sa=X&ved=0CAgQ_AUoA2oVChMI0oGbirf-xwIViwuSCh3K5A2D#tbm=isch&q=liberia+map+with+counties&imgrc=-E4PuKMPTWcYnM%3A

References

Thank you!

Ithar Hassaballaithar@ku.edu