Ebola Response in Liberia; Field Experiences, Challenges and Lessons Learnt during the Response, 2014-2015

Abstract

The 2014-2015 Ebola Virus Disease (EVD) outbreaks which began in Guinea and later spread to Liberia, Sierra Leona and other countries have been responsible for a number of infections and deaths among the communities including health workers. The natural host of the EVD virus has not been identified even when scientific evidence points to bats as the natural reservoirs to similar strains of EVD virus. EVD male survivors have also been identified as a potential source of infection among the populations. Some of the reasons attributed to this rapid spread of EVD to other countries have been weak early warning systems to identify and notify health authorities of such diseases of high epidemic potential. Liberia has been one of the countries to be declared EVD free on two different occasions in 2015 each with a different epicenter. Despite a number of international organizations coming together to support control efforts in Liberia, the coordination of response activities by the Ministry of Health and Social Welfare and replicated at all levels of the surveillance systems was the key in suppressing the outbreak. Adoption of the Integrated Disease Surveillance and Response (IDSR) guidelines as recommended by World Health Organization (WHO/AFRO) was a positive step towards the structuring of response activities. Capacity building of health workers in infection control and prevention and surveillance was important to improve skills of health workers to triage EVD cases as recommended by WHO. Training community health volunteers in contact tracing and active case search was important in strengthening theEarly Warning Disease surveillance system. Decentralization of response activities in addition to establishing Ebola Treatment units and Community Care Centers in all counties was vital in containing the spread of infection. Even when EVD was associated to high levels of stigma, community and in-M. Lubogo et al. 89 dividual counseling sessions led by community leaders enabled building community trust to refer cases for treatment. The EVD survivors distributed in different parts of the country are potential sources of new EVD infections. This will require strengthening early warning systems and response capacity at all levels.