Public Health England's Work in Sierra Leone: Ebola, Reconstruction and Beyond

By: Prof. Paul Johnstone, Regional Director, Public Health England, Resilient Zero/Sierra Leone Director & Dr. Marcus Eder, Consultant Microbiologist, Resilient Zero/Sierra Leone Team Leader | April 2018


Related Video: IANPHI talked with PHE's Chief Executive, Duncan Selbie, to learn more about their efforts in Sierra Leone, post-Ebola and beyond.


Public Health England (PHE) was one of the many major contributors to the international Ebola response after the World Health Organization (WHO) declared the outbreak in West Africa a ‘Public Health Emergency of International Concern’ in October 2014. PHE established three molecular diagnostic laboratories each attached to an Ebola Treatment Centre (ETC), at Kerry Town near the capital, Port Loko, and Makeni and deployed teams of staff to run them. By the summer of 2015, the daily numbers of new cases were down to single figures, which prompted the discussions about sustainability once the emergency was over. Sierra Leone’s President issued the Government’s priorities and listed rehabilitating the health sector (where over 300 healthcare workers had died) and strengthening its public health system as his top priorities. At the request of the Government of Sierra Leone, PHE was commissioned by UK Aid (Department for International Development) to play a major role in this reconstruction and embarked on a two-year £4.5M project called Resilient Zero.    

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Photo of a laboratory technician at Connaught hospital

Sia, a laboratory technician at Connaught hospital working in the newly refurbished facility.

Our objective was to ensure new cases were diagnosed and managed and at the same time, to transfer molecular technology and expertise to the regional hospital system, with a fully trained cohort of local technicians. Additionally, the project would help to establish an emergency training programme as part of the wider cross-government response system.  

Photo of PHE group and Sierra Leone team at Connaught Opening with Deputy Minister

Connaught Laboratory Opening Ceremony on Nov 2, 2017. Attendees (L to R): Paul Johnstone, Duncan Selbie, Madina Rahman (the Deputy Health Minister), Nemata Majeks-Walker (Chair, Administration Board, Connaught Hospital), Guy Warrington (British High Commissioner), Dr Brima Kargbo (CMO), & Onike Rodrigues (Dean, COMAHS).

 
Graduation photo of trainees

Graduation ceremony, Nov 3, 2017. In-country PHE staff Marcus Eder (Microbiologist), Delaram Akhavein (Biomedical Scientist), & Jonathan Ashcroft (Technical Services Manager) with the national staff cohort upon completion of training in molecular diagnostics.

   

By December 2017, our team refurbished three laboratories to be managed by the national leadership at Connaught hospital, the main teaching hospital, and two regional hospitals at Bo and Makeni. Moreover, the most cost-effective test platforms for Ebola and Yellow fever were installed. These installations are significant to Sierra Leone because they allow international assay procurement and supports long-term sustainable procurement for the area. Through this project, a molecular laboratory team of leaders was also developed. Fifteen laboratory staff from the Ministry of Health and Sanitation, Sierra Leone were trained in molecular diagnostics to international and WHO standards while 300 civil servants were trained in emergency planning. In August 2017, those civil servants proved the training a success by effectively responding to the mudslides and major flooding that hit Freetown.

Additionally, we contributed to and supported the deployment of the UK Public Health Rapid Support Team to support Cholera preparedness the after the emergency floods crisis. In doing this, we also supported the government and international partners on bio-security ensuring that all blood samples taken during the Ebola crisis and after are effectively and securely stored while supporting the development of public health infrastructure in meeting International Health Regulations (IHRs) including plans to implement a new Public Health Agency for Sierra Leone

What have we learnt?

This was the first major international commitment since PHE was formed in 2013. We have learned much in the past two years, as it relates to PHE as a national public health agency working to strengthen global health, the need to ensure high technical diagnostic equipment in a sub-Saharan African country and supporting meaningful development. 

As a national public health agency, PHE collaborates with networks such as the International Association of National Public Health Institutes (IANPHI) that is working to improve the world’s health by leveraging the experience and expertise of its member institutes to build robust public health systems.

Photo of the lab before it was refurbished.

Future home of the new laboratory building at Bo Government hospital.

Photo of the lab after it was refurbished

Construction of the new laboratory building at Bo Government hospital.

 During this Sierra Leone project, we learned we needed to be better coordinated across the range of directorates. With each director offering unique expertise through a single governance mechanism we discovered the need for daily interactions with our commissioners from the Department for International Development (DFID) and soon determined this relationship was key to the success of the project. We also realized the significance in building our capacity to offer pastoral care to teams of our staff who were living and working in close quarters and needed to be our ambassadors 24/7. Ultimately, we recognized that better-deployed staff briefings and debriefings as well as occupational health services made available in-country and in the UK is essential to better public health coordination. 

This endeavor taught our team importance of ensuring high technical diagnostic equipment in a sub-Saharan Africa country is critical for sustainability. This included the need that procured test kits were affordable and not requiring chain, equipment was appropriate for West Africa, builders we commissioned to do the extensive upgrades met the right standards, and that we met international procurement laws. Because of this, we are engaged in wider international support on strengthening Sierra Leone’s procurement system.

Lastly, we realized supporting meaningful development means supporting long-term partnerships and not short-term aid project. This is why PHE is now investing time in supporting the new Sierra Leone Public Health Agency as a vehicle to support the country in a partnership of equals, not the traditional donor- receiver relationship, ensuring laboratory and ministry staff are well-trained leaders who are connected to other leaders in the public health community. 

So, What Next?

As a result of our commitment, after Resilient Zero, we are embarking on two further programmes of work; strengthening IHRs and building infrastructure to the UK Public Health Rapid Support Team (jointly implemented by London School of Hygiene and Tropic Medicine and PHE). Our relationship moves from commissioning building work, training and procurement to advice on sustaining the laboratories and emergency planning as part of a wider programme to support Sierra Leone in meeting IHRs. Our major focus for doing this will be through supporting the Sierra Leone Public Health Agency, which now has Presidential and international support.

This work has cemented our long-term partnership with Sierra Leone. The Ministry of Health and Sanitation have said that they see PHE as a friend and long-term partner. This is so important to PHE, Sierra Leone Public Health Agency and the entire global and public health community because good relationships are essential and long-term partnerships that are working to improve health in Sierra Leone and the world. 

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