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Adaptive Programming: Responding to Coronavirus in Sierra Leone

8th June 2020

Health programmes around the world have found themselves on the front line of the global response to the current pandemic. Across Crown Agents’ wide portfolio of work to strengthen health systems in a number of countries, we’re seeing our teams called on to provide critical support to many different aspects of the local COVID-19 response. In some cases, these demands are additional to continuing with the project’s original focus; in other cases, pivoting efforts and re-purposing resources to respond to COVID-19 has become a more pressing priority than the original scope of work. In Sierra Leone, where we work at the district level in Makeni (Bombali district)—a 3-hour drive away from the capital city, Freetown—Crown Agents team leader Dr. Ikechukwu (Ike) Ogbuanu is temporarily adapting programme operations and implementing innovative strategies in response to demands resulting from the Coronavirus outbreak.

Dr. Ogbuanu leads the Child Health and Mortality Prevention Surveillance, or CHAMPS site in Sierra Leone. CHAMPS is a global initiative that collects, analyses and shares evidence to prevent children mortality in areas where it is highest. Crown Agents is delivering CHAMPS in Sierra Leone, where we’re contracted by Emory University to act as managing agent for the initiative; along with in-country technical partnerships with Focus1000, World Hope International and ICAP.

With Sierra Leone still rebuilding after the catastrophic 2014-15 Ebola epidemic, this pandemic outbreak just 3 years on poses a major challenge to the country’s still fragile healthcare system. Having already been embedded in local structures in Bombali district, Dr. Ogbuanu’s CHAMPS team was in a strong position to assist with local response efforts by expanding the scope of their work. As part of the local COVID-19 response, CHAMPS is now providing technical assistance in surveillance and data management, as well as logistical support for the Makeni Regional Hospital, the Covid19 isolation and treatment centers and the District Health Management Team.

Infection Prevention and Control

Currently, Sierra Leone has under 1,000 cases of the virus, but with overcrowding and high malnutrition rates, COVID-19 has the potential to rapidly penetrate the whole country. To slow the spread of the virus in Makeni, CHAMPS community engagement teams have been deployed in awareness raising activities. Leveraging relationships built through years of interacting with communities around sensitive issues relating to child mortality, the teams are using known community structures and local mass media to communicate COVID-19 risks and encourage preventive measures. This includes adapting the usual bi-weekly slot on the local radio slot from typical CHAMPS messaging to instead educate audiences about COVID-19 and respond to general health questions in the local language.

Deploying Expertise

Laboratory based testing is an important component of CHAMPS’ research. As testing for COVID-19 becomes a more urgent task, CHAMPS’ lab equipment and specialist personnel are being redeployed in support of government efforts. The lack of advanced laboratory diagnostic testing capability was seen as a key contributor to the spread of Ebola six years ago and as a result, government health officials are keen to draw on the scientific expertise of the CHAMPS team. CHAMPS lab technicians are supporting molecular testing for COVID-19 in Freetown, whilst the project’s informatics teams are designing cloud-based systems to facilitate COVID-19 case data collection and analysis.

Tracking and Surveillance

The CHAMPS programme is also strengthening the district’s disease surveillance and monitoring efforts through personnel, vehicle and logistics support. There are currently 26 CHAMPS staff embedded in the COVID-19 response team in the district. With clinical backgrounds and training in disease surveillance, these teams have been easily re-deployed to support the efforts of the under-resourced district surveillance team in conducting active case searches for the virus in health facilities and communities.

The CHAMPS team’s rapid COVID-19 pivot is not only helping to meet the immediate needs of communities in Bombali District, but it is also having positive secondary impacts in achieving the programme’s original goals. As Dr Ogbuanu notes, “Through the opportunities provided by our funders to pivot to the COVID-19 response in our district, we have been able to better determine what investments are needed in the health system to reduce child mortality and improve healthcare. This pivot is providing us the opportunity to not just examine the causes of death in young children, but to be proactive in preventing all deaths within the Makeni community.”