Liberia’s success story in dealing with Ebola
Liberia which is one of the hardest hit countries in Ebola infection has succeeded in minimising the outbreak. The succes, according to experts at WHO, is due to good organisation and empowered local teams.
Essentially the government decided to decentralize the Ebola management system and break it down into four smaller systems. This allowed for better quality control on surveillance, case finding, contact tracing, and overall management of key response activities necessary in tackling the Ebola outbreak.
A WHO analysis later found a direct link between implementing a full package of control interventions, including community engagement, acceptance, and ownership of the response, and the decline and then end of new cases in Liberia.
Sector approach
In late November 2014, following the height of the Ebola outbreak in Montserrado, the largest county in Liberia, the country’s National Incident Management System began working to decentralize the Ebola response. Teams were organized and partners were integrated into a new “sector approach,” that divided the county into four sectors.
This new method worked by grouping smaller, localized teams for a more nimble and rapid response and empowering local staff for enhanced community engagement. It also introduced a new performance-based management system, which made every staff member involved accountable for their own work.
The zone-level approach reflected historical community identities and ties. Instead of dividing epidemiological zones by purely administrative district organization, it localized the areas, so communities could track their own Ebola cases and contacts. Health officials, local citizens and partners worked together in each sector and made operations more effective, taking advantage of the strong sense of community and identity.
The objective of the Montserrado sector approach was to “hunt the Ebola virus disease” in controlled zones of the sector, using timely local responses. In 2 months, the sector approach brought the Ebola outbreak under control in Montserrado. Sector teams coordinated with localized response teams, increasing outreach and handling issues locally using a ‘good neighbor’ approach and “door-to-door” engagement.
The sector approach worked because it was managed by the people of Liberia in their own communities. Also those who came from outside to help, respected local voices, laws and leadership.
Customized solutions to fight Ebola
Agile, customized sector solutions were encouraged, leaving sector leaders free to design localized responses around a strongly structured, technical “pillar” based organization. The Health Ministry, Incident Managers and partners agreed that these would cover case detection (investigation, tracing and active case finding), epidemiological surveillance, case management, psycho-social activities and community engagement. A similar framework was adopted at all levels of the “sectoral system” from the national level, to county, sector and zone levels.
Active daily coordination of sectors and cross cutting responsibilities reduced overlapping activities, fostered improvements and supported areas where performance was lagging. A WHO expert team from India, which had vast experience in combating polio in that country and knew the importance of good localized epidemiology and response, provided robust technical support, helping build strong cohesive sector teams.
