An ICAP team conducted a three-week, rapid assessment of Ebola community care centers (CCCs), a new model of care that aims to break the cycle of household transmission of the Ebola virus.
With funding from the UK Department for International Development (DFID), ICAP team members visited 11 sites across six districts—Bo, Bombali, Kambia, Koinadugu, Port Loko, and Western Area—to assess the safety, effectiveness, acceptability, and operational feasibility of these centers, where patients with symptoms suggestive of Ebola receive care and support as they await diagnosis and transfer to Ebola treatment units or referral for other medical services.
In Sierra Leone, where the number of Ebola cases recently surpassed 10,000 and there are fewer than 900 Ebola treatment beds, community care centers have emerged as a promising intervention where few alternatives exist. ICAP’s assessment is a critical step for the previously untested model of care, and an opportunity to garner lessons learned that can lead to the safe and effective delivery of quality services and facilitate the rapid detection and isolation of newly detected Ebola cases.
“While the impact of Ebola has been tragic in every way, novel approaches to confronting this emergency can also inform future responses to other health threats in the country,” said Dr. Susan Michaels-Strasser, associate director for nursing and project director for the Global Nurse Capacity Building Program at ICAP.
ICAP brought its expertise in monitoring, evaluation, and research to the development of the protocol and data collection methods. Using a 168-item site assessment survey, information was gathered on patient flow, laboratory services, on-site standard operating protocols, and other key operational areas of the community care centers. ICAP’s team also conducted nearly 60 in-depth interviews with national and district-level stakeholders, site staff, and community members to assess knowledge and attitudes about community care centers.
“The CCC is better because it’s in the community,” said an Ebola survivor and survey participant. “Many people died from Ebola before the CCC was established because there is no hospital in the community. Now people are using this place as a hospital.”
In Sierra Leone, the limited number of healthcare workers (just over 130 doctors and 1,000 nurses for a population of six million), combined with the tragic loss of close to 200 healthcare workers to Ebola disease, and the prioritization of higher cadre of workers to staff Ebola treatment units, leaves minimal human resources available to staff the community care centers. Despite these challenges, nurses and other healthcare workers can be found at these centers working diligently to control the outbreak.
“Nurses are vital,” said Hossinatu Mary Kanu, chief nursing officer in Sierra Leone. “They play a central role in all aspects of the Ebola response.”
Kanu articulated the many challenges nurses face as they work with patients, often having borne the brunt of this disease among family members or colleagues.
“It will take a long time for us to stand again and become a resilient health system,” she said. “We are hopeful that with support we can build our systems.”