Communicate with Vulnerable Groups

1. Highlight key risks:

1. Communicate with vulnerable groups:

1. Encourage safer behaviours:

1. Address unsafe rumours & beliefs:

1. Communicate our plans:

1. Communicate through trusted & accessible inter-personal, traditional & mass communication channels:

1. Create effective two way communication between partners and communities:

1. Monitoring & Evaluating our response by:

UNICEF Sierra Leone Cholera Preparedness and Response Communication Plan

Emergency Cholera Communication Planning Sierra Leone

Summary

Key Recommendations

1. Don’t panic. Face the challenge and take decisive concerted action to put in place the following preparedness measures.
2. Reactivate the national and district cholera task forces; share and discuss cholera communication plan at national task force meeting before end September 2011.
3. Rapid verification and response team[1]. Identify named staff within organisations who could support immediate mobile emergency verification and response at district and Freetown levels in case of a suspected outbreak between now and October 2011 (end of rainy season). This inter-agency team should have leadership, Cholera, WASH and medical experience and would be a standby emergency back-up measure with clear Terms of Reference drawn up. Attention should be given to verification of cholera; identifying and putting barriers around the transmission reservoirs; community focussed cholera communication; stabilisation, referral and case management.
4. Alert District Health Officers and Primary Health Units to exercise increased vigilance for cholera cases and to report these to MoHs immediately.
5. Finalise and implement the draft MoH cholera preparedness and response plan before end September 2011. This should include prepositioning of cholera kits/supplies and identification of Cholera Treatment Sites and preparation of CTC job descriptions at district level.
6. Finalise key cholera messages and communication materials as the reference point for all agencies before end September 2011.
7. Integrate cholera awareness into existing WASH messages and health promotion immediately; especially through CLTS and School Sanitation Hygiene Education interventions.
8. Conduct cholera preparedness and response training at district level by end 2011 – prevention, control and case management.
9. Conduct cholera communication training and response planning at district level in October 2011.
10. Revitalise and train the Blue Flag Volunteers (Community Health Volunteers) as well as mother support group leaders and Red Cross volunteers for surveillance (active case finding), community communication, early administration of ORS and early referral.
11. In the event of an outbreak before end of this rainy season if there are too few personnel with appropriate training, health care workers who have previous experience of cholera outbreaks or who have received adequate training should be mobilized to provide on-site training and supervision of the less experienced personnel. A consideration for further validation by the Cholera Task Force would be to support the building of a contact database of Blue Flag Volunteers, Health, WASH and Community Development Workers who have past Cholera experience.
12. Use the excellent WHO guideline – “Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness” (2004) as a practical and useful reference
13. The above actions should connect with additional preparedness measures for 2012.

Key Findings

1. There is an alarmingly low level of cholera preparedness in Sierra Leone. There was not a single cholera kit in the entire country at the time of the visit. UNICEF has since ordered three and the organisation has played a timely role in bringing cholera risk and preparedness back onto the national agenda.
2. Given the lack of/weak coordination consistently raised by key informants,an outbreak in the short term would likely be met by a chaotic and disjointed response before it could be brought under control. The Disaster Management Office has the official mandate to coordinate response and there has been little or no interface between ONS and MoHS. UNICEF can play an important role in facilitating this linkage/conversation.
3. The vibrio cholerae bacteria is presumed endemic in Sierra Leone and there is a history of serious outbreaks with case fatality rates usually well above the WHO minimum acceptable rate of 1%. The conditions to create an outbreak are widespread - poor sanitation, poor quality of and low access to safe water, unsafe hygiene practices (high open defecation and low proper hand washing rates) and low public awareness about cholera.
4. A new reality since the end of the war is the rapid expansion and creation of slums in the bay areas of Freetown built on compacted garbage or land unsuitable for human habitation with extremely low sanitation and safe water access. These slums are on the receiving end of sewage, flood debris and waste from the hills surrounding Freetown during the April to October rainy season.
5. The quality of epidemiological reporting is unreliable and there is no rapid cholera testing facility or kit in the country. After Malaria, “diahorrea with vomiting” is a highly reported incidence of morbidity. It is simply not known whether there have been any cholera related deaths in 2011. Since the last publicly declared epidemic in 2009 key informants felt that this was a question of luck rather than effective prevention measures. The last WHO cholera country profile was updated September 2009.
6. Twenty seven key informant interviews and a cholera emergency communication planning workshop (with key actors who would be involved in a response) found highly variable levels of knowledge, experience and understanding of the causes, symptoms, prevention and treatment of cholera. There is a lack of consistency on basic cholera facts and messages.
7. There are individuals within the government, UN system and NGOs who had substantial cholera response experience during the serious outbreaks in 1996 and 2006. New health staffs have limited field cholera response experience and variable knowledge of the disease.

Paul O’Hagan UNICEF WCARO C4D Consultant 13 September 2011

[1] Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness (2004 WHO)

The team might consist of:a physician who will both verify patients’ clinical symptoms and train health care workers in good case management;a microbiologist who will take stool samples (and environmental samples) for laboratory confirmation of cholera and train health care workers in correct sampling procedure;expertise in community based communication and information who will assess how the community reacts to cholera and define and disseminate key health messages;an epidemiologist who will assess data collection and surveillance procedures;a water and sanitation expert to investigate the possible sources of contamination and start the appropriate treatment of these sources.