Ebola Health Action Team (E.H.A.T) Strengthening Health Care Capacities

Duke Ebola Innovation Challenge Team:

Sulzhan Bali | Ph.D. - MSc-GH, DGHI- India Lyttleton Braima | B.Sc. Econ. - MIDP, Sanford School of Policy- Sierra LeoneBolun Li | BS Mathematics - MSc-GH, DGHI- ChinaLily Martyn | BA Epidemiology - MSc-GH, DGHI- USANaman Pandey | B.Tech - IT, MS - Engg Mgmt, Pratt School of Engg- IndiaStarling Shan | BA Intl Relations & Communications - MSc-GH, DGHI- China

November 2, 2014

E.H.A.T - Strengthening Healthcare Workers Capacity Current Situation & Challenge Our Solution

Healthcare Worker Shortage HCWs Protection

HR Gap Lack of Incentive

Community Stigma

Key Facts

• People Deliver Health• World Bank Estimation: another 5000 health care workers are

needed in West Africa

Controlling Ebola Outbreak

Building Capacity for Future Outbreaks

Increase Public Health

Awareness

Key ForceHCWs

E.H.A.TEbola Healthcare-worker Action Training

EHAT TrainingEHAT Certification EHAT training

EHAT KITProvides essential tools for field work

E.H.A.T. Training E.H.A.T. Kit

How Will E.H.A.T. Work

Increase the number of HCWs and build health system capacity in long-term

1) Recruit previously trained HCWs and community volunteers

2) Ensure 1 team (10-20 HCWs) per catchment (rural) or per

zone (urban)

2) Provide 3 levels of certificate (monetary incentives for level 1

and career opportunities for level 3)

3) Train the team in standardized protocol and buddy system

4) Repeat the training every 6 month at designated community

centers

1) Oral Rehydration Sachets (EHAT-ORS)

2) Pocket book in local language with standard protocols

3) Temperature Monitor (continuous temperature sensing

with button for emergency and connected to analog

phone)

4) Analog Phone

5) Hand Sanitizer

Provide HCWs with inexpensive but essential tools for personal protection during delivery work

Why will EHAT succeed? Sustainable, Scalable, Cost-effective & Holistic Solution

Fill the gap of HCW shortage and address issues of recruitment, retention, and inequitable distribution of HCWS in Ebola stricken areas

Ensure access to medicine and tools; increase HCWs motivation with supplies

Tools are inexpensive but essential

Hand Sanitizer (< $1)

Oral Rehydration Sachets (< $1)

Analog Phone (<$15)

Temperature Monitor ($6-$10)

Training in standard protocol for EHAT Kit usage and disease management can be duplicate at other community centers

Easy copy of 3 level of certificates with WHO support to gain international qualification

Reduce community stigma of Ebola and gain pride to be HCWs through spreading awareness by EHAT member from catchment

Training will provide HCWs with skills required to work as HCWs for other diseases like childhood infectious diseases, HIV, TB

Challenges

Community applicability

How can EHAT be customized to each country’s needs?

Understanding the root & stigma of Ebola fear

Are diagnostic capabilities available at PHU?

Understanding the HCW shortage and HCW distribution in each country

Partnerships, recruitment & retain of HCWs

How can we strengthen public-private partnership?

Our idea focuses on recruiting and retaining HCWs to build health systems capacity in the Ebola stricken areas

Understanding these components in greater detail will help better adapt our design, integrate into the current healthcare structure, and effectively leverage healthcare workers.

Additional information- PPE & the EHAT Monitor

• Measures temperature• Hypoallergenic clip• 3d battery life• Analog phone compatible, 15 USD• Inexpensive: < 6-10 USDSource: Avantari, manufacturer

Source: Personal communication with Avantari founder

ReflectionHard WorkDifferent backgrounds, ONE attribute - on Halloween night, we gathered in the living room, costumed as community health workers, and came up with the ultimate solution for Ebola CHW.

CollaborationIt is never easy for a six-headed dragon to attack the same target, but once it does, the target will hardly escape – and our target is EBOLA! We conclude with a graph that suggests to you how to tame a six-headed dragon: basically you need three things – knowledge, hard work and collaboration.

Knowledge We discussed like we were in a model stakeholders meeting, with perspectives from many sides; there are views from a politician, epidemiologist, technician, economist, business-minded woman, and journalist digging into/questioning all the ideas. Our explosion of ideas were well seasoned through rethinking, refining, and reflecting, eventually becoming the ultimate E.H.A.P strategy.

Thank you’s & Outtakes

1. Monitoring healthcare worker’s vitals by regular weekly checkups

2. Ebola Socks - Water resistant, Modeled on Leech Socks 3. Providing clean water in form of Water Packets to affected

areas by government4. Temperature monitoring watches5. Shoes with anti-perspirant; Laundry bleach + foot powder6. Troops and military for HCWs safety7. Sending pictures to doctors for better treatment results

Appendix: Understanding the System

PHU (primary health unit/peripheral health unit): lowest tier of health service delivery in rural areas:

1. Maternal and Child Health Post (MCHP): ideally should service 500 – 5,000 people in villages within a 3-mile radius

2. Community health post (CHP) should service about 5,000 – 10,000 people in villages within 5-mile radius

3. Community Health Center (CHC) should service about 10,000 – 30,000 people in villages within 5 – 10-mile radius

CHC at chiefdom headquarters

District hospitals are the main referral centers for the village and chiefdom level facilities.

District Hospitals are Located in District Headquarter towns. ● In big towns and cities, target local council wards or divide the city/town into zones to ease operation (management and

coordination).● Private and faith based health clinics/health centers in big towns/cities.

MCHP and CHP are at village level