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U n i v e r s a l h e a l t h c o v e r a g e a n d c ommu n i c a b l e d i s e a s e s The Sierra Leone Ministry of Health and Sanitation funded the SLNA to provide infection prevention, and control education and training for 568 nurses and other health workers in all 14 districts in Sierra Leone. This took place 14–31 July 2014. The education and training covered: • Information about EVD, especially methods of human-to-human transmission • Signs and symptoms, and identification of suspected cases • Appropriate treatment, management and care • Reinforcement of standard precautions, and infection prevention and control • Practice in the use of personal protective equipment • Safe disposal of waste and safe burial • Supportive care for care-givers Sierra Leone nurses, midwives and other health workers who attended the training identified the challenges they faced as inadequate personal protective equipment; poor working conditions and environment; inadequate knowledge about EVD prevention and care; lack of isolation materials; poor communication; and delays in obtaining laboratory results. They sought adequate personal protective equipment to keep them safe; ongoing education and training; the necessary resources, including human resources, to be able to provide appropriate and sufficient care; and improved working conditions and environment (SLNA, 2014). The Commonwealth Foundation has funded the SLNA to provide additional infection and prevention training, and has indicated a willingness to work with the SLNA and the Ministry of Health and Sanitation in establishing infection prevention committees in all major health facilities, both urban and rural. Sierra Leone faces significant challenges in the future. Following the deaths of doctors, nurses, midwives and other health care workers as a result of EVD, active intervention will be required to rebuild the health workforce. The environment of mistrust between nurses and patients as a consequence of their experience with Ebola has affected the motivation of nurses to continue nursing. Sierra Leone needs nurses more than ever, but the number of nurses will make no difference if the system is not there to motivate and support them. Many people who died are between 30 and 45 years old. There are families and communities who have lost the majority of their adult members, leaving many orphaned children and elderly people. In some communities there is hardly anyone left to cultivate the fields or provide for the family. The Sierra Leone Ministry of Health and Sanitation has prepared a three-stage recovery and resilience plan for post-Ebola. Five pillars have been formed to address the challenges and gaps in the ministry: • Patient and health worker safety • Health workforce • Essential health services • Community ownership • Surveillance and information The plan covers early recovery (six to nine months), recovery (2015–18) and resilience (2018–20). Additionally, a national policy and strategy on infection prevention and control is under development, along with standard operating procedures and training manuals. A national infection prevention and control coordinator has been appointed and 25 focal points have been identified at every tertiary and secondary hospital, with senior nurse supervisors trained alongside international partners and deployed. Plans are underway to incorporate infection prevention and control into all health worker curricula. Meeting infection prevention and control practices through continuing professional development will be a benchmark for the re-licensure of nurses and midwives. Conclusion: A crisis of poor health coverage Wilkinson and Leach state that it was the inherited inequalities from past policies that allowed a virus like Ebola to devastate three countries in the absence of fundamental public health and state capacities. They remind us that dramatic gains in life expectancy and reductions in the burden of disease come from improved living standards, sanitation, nutrition and prevention, rather than from medicine alone, but that this is consistently overlooked by international donors looking for a ‘quick fix’ for particular diseases. The social disruption to families and communities cannot be measured or easily addressed. Overcoming the disruption to education, the economy, food supplies, agricultural production and trade will take time, effort and resources. Other health priorities that have been neglected while responding to the Ebola crisis will need to be factored into plans for recovery. Wilkinson and Leach urge that the Ebola epidemic should be a ‘game changer’ for development, and that the inequalities that created and deepened the crisis are not sustainable. Rebuilding fragile health systems and states must be accompanied by tackling the inequalities, they contend, so that health systems can be sustained with a sufficient home-grown health workforce and locally managed resources, not just with donated goods and services linked to external priorities. The global community failed Guinea, Liberia and Sierra Leone, and it will be a tragedy if too little is done to strengthen the fragile health systems in those countries to ensure that what happened in 2014 will not happen again, or to prevent another crisis developing in another vulnerable country. References CIA (Central Intelligence Agency), 2015. World Fact Book webpage CIA. Available at: www.cia.gov/library/publications/ resources/the-world-factbook/geos/sl.html Accessed 1 April 2015. MSF (Médecins Sans Frontières), 2015. FAQ – Ebola webpage MSF. Available at: www.msf.org/article/faq-ebola-about-disease Accessed 1 April 2015. Sharma, K., 2014. Ebola in West Africa: Commonwealth Secretary- General Statement webpage Commonwealth Secretariat. Available at: www.thecommonwealth.org/media/news/ebolawest africa-commonwealth-secretary-general-statement Accessed 1 April 2015. SLNA (Sierra Leone Nurses Association), 2014. Identified Challenges in the Fight Against Ebola Word document SLNA. Available at: www.sierraleonenursesassociation.org Accessed 1 April 2015. 64 Commonwealth Health Partnerships 2015


Commonwealth Health Partnerships 2015
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