Liberia Experience:National Level Coordination and Partnership in Cholera

Control.

14-16 May 2008Dakar, Senegal

Background Situation• 15 counties and 88 districts• Estimated 3 million people- Sparse Pop - density, 84 per sq mile except

Monrovia (1 million people) - Infrastructures destroyed by war- Access to safe water - 24% (UNDP 2006),

sanitation nationwide - 26% - (UNICEF, 2006)- Low households incomes. ¾ pop on less than

US$1 a day (iPRS, 2007)- Infant mortality rate, 102/1000 & crude

morality estimate 1.1/10,000/day (CFSN, 2006).- Diarrhea 2nd cause in morbidity/mortality- Seasons– Wet –April – Oct, Dry Nov-March.

Cholera hot spot areas

• Occurrence (slides line graph)

Sierra

Leone Guinea

Cote D’Ivoire

Atlantic Ocean

Trends :2005 -2007

0

200

400

600

800

1000

1200

1400

jan feb mar april may jun jul aug sept oct nov dec

2005

2006

2007

Liberia cholera trend in 2008

231

80

107

2 0 00

50

100

150

200

250

J anuary February March

Months

Cas

es a

nd D

eath

s

Cases

Deaths

LIBERIA MAP SHOWING CHOLERA HOT SPOTS COUNTIES

Lofa

Nimba

Bong

Sinoe

Gbarpolu

Grand Gedeh

Grand Bassa

River Gee

River Cess

Grand Kru

Bomi

Margibi

Grand Cape Mount

Maryland

Montserrado

National Strategy

• Coordination• Partnership• Surveillance / EWARNS• Institutional capacity

Coordination

• Multisectoral approach • Decentralized epidemic task force • Standardized case management,

surveillance & monitoring• Partners mapping & up dates.• Leadership – MOH/CHT• Annual integrated plans.• Pooled contingency plans / stocks

Partnerships• Relevant GOL Ministries / Depts • CBOs Hygiene behaviors promotion• UN agencies: UNICEF, WHO, UNMIL- Tech. asst; Finance; Resources;

logistics.• Health/WATSAN NGOs and WATSAN

CONSORTIUM• Communities

Surveillance• Standardized data collection tools

& analysis at county levels.• Pre-positioned investigation & case

detection teams.

Institutional capacity

• INGO – (9), LNGO) (26) & CBOs in 4 counties

• UN agencies –(WHO, UNICEF, UNHCR)• Community – ORT corners / Treatment

centers, trained • Trained staffs & community own

resource persons (volunteers).

Successes• Consistent reduction in attack rates• Sustained multisectoral & integrated

approach to cholera control• Availability of trained local resources at

community level.• Sustained partners support.• Decentralized chlorine stocks• Response within 24hrs-48hrs• Coherence approaches &Team work.• Functional surveillance systems

OUR UNIQUE WAYS OF WORKING.

• Merged GOL coordination & WASH cluster.

• Innovations - Pooled funding (DFID/ECHO) -WASH consortium – 5 INGOs – services delivery & capacity building through GOL.

- Pool funding from partners

Limitations/Challenges• Deplorable infrastructure states• High Poverty level• Meager resources skewed towards curative services.• Low WASH coverage.• Insufficient resources – human & materials• Weak national systems / policies enforcement.• Inadequate mid-level skilled health personnel to manage

cholera control• Transition from humanitarian to development.• Low access to health services • Unreliable data for planning

LESSONS LEARNT• Pre positioning of stocks - chlorine• Routine Well chlorination. • HH water chlorination practice• Pre-mapping and identification of

resources at county levels. • Community based hygiene education • ORT corners / Treatment centers• Sustained partnership & coordination

Our Needs• Long-term funding from donors,

targeting AWD/Cholera / WASH.• Support for Skill training on cholera

management. • Expansion of decentralized cholera

confirmation laboratories - Counties • Research on cholera to establish

evidences for intervention.• Support for sustainable WASH activities.