In 2003, Liberia’s 14 year civil war ended leaving a barely functioning economy, destroyed infrastructure and an impoverished and food-insecure population that had suffered displacement, trauma, and the deaths of over a quarter of a million people. Liberia’s transition to a secure and more prosperous future has suffered a tremendous setback with the Ebola Virus Disease (EVD) outbreak which began in March 2014. The outbreak has taken a significant toll on Liberia’s health systems, economy, and government infrastructure. The combination of a weak existing health system and a highly infectious outbreak has overwhelmed county- and district-level health facilities.
PCI worked with communities in Liberia for over five years, building trust, encouraging better nutrition, building community based resilience to shocks and stresses of all types, and keeping families healthy. When the Ebola epidemic began, PCI leveraged its programming to address the outbreak. Of the 700 communities in which PCI operated in the two hard-hit counties of Bong and Nimba, 95 percent remained Ebola-free. Playing an integral part in the Ebola emergency response, PCI managed three Community Care Centers (CCCs) and an Ebola Treatment Unit (ETU), providing care to communities and strengthening health systems. PCI expanded operations into two new counties aiming to reduce the impact of food insecurity resulting from the Ebola crisis.
STRENGTHENING HEALTH SYSTEMS TO RESPOND TO EBOLA
Since March 2014, PCI has reached over 500,000 people with Ebola-related interventions through the USAID/OFDA-funded Rapid Ebola Awareness, Communication and Training Program (REACT), Ebola Community Care Center Program (EC3), Support for Ebola Treatment Unit Program (STEP) and the USAID-funded Liberian Agriculture Upgrading, Nutrition and Child Health (LAUNCH) program. PCI responded to the crisis by equipping communities and health professionals with the knowledge, infrastructure, and supplies necessary to prevent the spread of Ebola. PCI implemented and expanded the following: community education campaigns; training health care providers; contact tracing / case investigation; constructing infrastructure for the isolation of suspected cases; and providing supplies such as personal protective equipment and sanitation necessities to minimize the spread of the virus. PCI also supported the Government of Liberia by managing the Ganta ETU, the country’s only ETU primarily staffed by the Ministry of Health and Social Welfare (MOHSW).
PREVENTING THE SPREAD OF EBOLA
Community mobilization was a critical component of PCI’s efforts to halt the spread of Ebola. PCI’s comprehensive social and behavior change strategy engaged mothers, community health volunteers, agriculture extension groups, disaster management committees, care groups, WASH committees, traditional chiefs, religious leaders, and trained traditional midwives. Key messages around how transmission occurs, how to prevent transmission, and what to do in case of infection were shared with these groups who use a cascade training method to share the information with their neighbors, peers, colleagues, family members, and anyone else with whom they come into contact. PCI linked all awareness activities directly to the county and district-level health systems to ensure that health systems had the capacity to respond to the increased demand for services. Collaborating with the MOHSW, PCI extended ongoing trainings to health workers on how to manage the outbreak, both the management of patients and management of the treatment environment. Trainings included the following: the use of protective equipment and case management protocols (including triage, treatment of suspected cases, isolation, and management of the deceased); universal precautions; submission of Ebola surveillance reports; hazardous/biological materials management; and sterilization of health facilities. Trainings also included an emphasis on providing equal care for patients regardless of age, ethnicity, religion, gender or disability.
IMPROVING FOOD SECURITY AND REBUILDING LIVELIHOODS
Building on PCI’s leadership in the Ebola outbreak response in Liberia, PCI initiated the USAID/FFP-funded Ebola Emergency Food Security Program, Protect and Empower for Ebola Resilience (PEER), to address the increase in food insecurity and livelihood disruption that were exacerbated by the Ebola outbreak. Through unconditional cash transfers, agricultural inputs vouchers and cash for work activities, the program assisted households affected by the outbreak to reestablish their livelihoods and ensure that their nutritional needs were met. Aligned with Liberia’s seasonal calendar, cash transfer programming allowed PCI to respond to the decline in food access and income caused by the Ebola outbreak by empowering people to meet their basic needs through emergency coping strategies that protected their long-term livelihoods, assets and dignity. PCI targeted households with pregnant and lactating women, children under two years of age, and households affected by Ebola, serving approximately 35 percent of the total population of the Bomi and Grand Cape Mount, approximately 9,240 households.
IMPROVING COMMUNITY HEALTH AND RESILIENCE
In 2010, USAID awarded ACDI/VOCA and PCI a five-year, $40M program designed to increase access to food, reduce chronic malnutrition, and increase access to improved livelihood and educational opportunities in Liberia. As part of the LAUNCH program, PCI implemented large-scale health, education, and risk-reduction interventions in Bong and Nimba counties. PCI addressed chronic malnutrition among pregnant and lactating women and children under two by: improving infant and young child feeding practices at household level, along with child health and hygiene practices; raising awareness about optimal maternal health and nutrition practices; and strengthening the capacity of local health clinics to improve the prevention and treatment of maternal and child illnesses. In 2014 alone, PCI helped improve the health and nutrition of 4,999 pregnant and lactating women and 16,009 children across 700 communities. PCI also strengthened the capacity of communities to support and increase access to education, providing support to over 80 schools. To promote the social and economic empowerment of women, PCI facilitated the formation of 47 Women Empowered (WE) groups comprised of 752 members that have collectively saved over $7,800 to date. Finally, as part of a strategy to help communities become more resilient towards future outbreaks and other emergencies, PCI collaborated with government officials to develop county and community disaster plans and the implementation of an early warning system in target areas.
LEADERSHIP & LOCAL ENGAGEMENT
Through an emphasis on effectively engaging and building the capacity of local stakeholders, including the Liberian MOHSW at the central, county and district levels, PCI galvanized strategic alliances and established a number of networks, tools and evidence-based approaches that were utilized during the Ebola outbreak. PCI served as a key contributor and thought leader during high-level coordination meetings with key international stakeholders such as USAID, Department of State, Department of Defense, CDC, WHO, UN agencies, InterAction, and many others.