Supportive Supervisory Visit to Sierra Leone Helps Ensure Excellence through Team Work

August 31st, 2017

Each year, END in Africa Project Director Bolivar Pou conducts supportive supervisory visits to the six countries covered by the neglected tropical diseases (NTD) project, to discuss project management, progress, and challenges with local stakeholders. Stakeholders include the leadership of the ministries of health (MOH), NTD program staff, project subgrantees, and other in-country partners working to prevent and control or eliminate the 5 NTDs targeted through preventive chemotherapy (PC NTDs). The first part of these visits involves a thorough review of the activities implemented during the fiscal year, plans for the rest of the year, challenges encountered, and progress to date. The project director also works with the subgrantees and national NTD programs during these visits to find efficient ways to address any ongoing challenges. In the second part of the visits, the project director takes field trips to observe NTD activities as they are implemented. In 2017, Sierra Leone was one of the countries he visited.

During his visit, Mr. Pou engaged in discussions with the Sierra Leone country director of Helen Keller International (HKI, END in Africa’s subgrantee in Sierra Leone) and her team), met with the national NTDP manager and his team, and participated in the annual meeting of the NTD Task Force. He also observed the implementation of an integrated LF/onchocerciasis survey in Port Loko during a field visit. After a few days of brainstorming with NTD stakeholders in the country to find more efficient ways of addressing program challenges, Mr. Pou met with the Minister of Health and Sanitation in a briefing on the progress made toward NTD control in Sierra Leone with USAID support. That meeting also involved a discussion of some of the challenges encountered and how the END in Africa project is working with other stakeholders to address the challenges. Such visits enable the project director to ensure excellent implementation of the END in Africa project in the country through team work.

Impact of NTDs on the People of Sierra Leone

Since 2007, Sierra Leone’s national NTD program (NTDP) has covered the following NTDs: onchocerciasis (river blindness or robles’ disease), lymphatic filariasis (LF, or elephantiasis), schistosomiasis (bilharzia), soil-transmitted helminthiasis (STH, or worms including round worm, hook worm, and whip worm), Guinea worm disease, and Buruli Ulcer. The U.S. Agency for International Development’s NTD Program, which funds the FHI 360-managed END in Africa project as part of its efforts to control PC NTDs including LF, onchocerciasis, schistosomiasis, and STH, has been supporting Sierra Leone since since 2007 (since 2010 through the END in Africa project).  Currently, the national NTD program receives an estimated 80% of the funds required to control the four aforementioned PC NTDs from the U.S. Government.

Transmitted by mosquitos, LF causes chronic disabilities including hydrocele, lymphedema, and elephantiasis, by damaging its victims’ lymphatic vessels. LF affects an estimated 120 million people around the world. Globally, the World Health Organization (WHO) ranks LF as the second most common cause of long-term disability, and an estimated 40 million people suffer from clinically significant LF manifestations.

Onchocerciasis is a parasitic disease transmitted by the black fly (Simulium spp.), which can permanently damage the skin and eyes and cause blindness. Both onchocerciasis and LF are responsible not only for personal suffering, disfigurement. and disabilities, but also indirect losses, as their victims become incapacited and thus, less productive at work, in school, and at home. Their diminished productivity is also a significant impediment to socioeconomic advancement. All of Sierra Leone’s 14 health districts are endemic for LF, and 12 of the 14 are endemic for onchocerciasis. Consequently, Sierra Leone’s entire population of approximately 7 million people is at risk for these diseases.

Progress Comes Despite Historical and Recent Challenges to Sierra Leone’s Health System

Located in West Africa, Sierra Leone endured a civil conflict between 1991 and 2002 that devastated the country and almost brought the entire health care delivery system to a standstill. The socio-economic situation started improving after the civil conflict ended in 2002, causing many experts to begin to view the country’s economic prospects more optimistically. Unfortunately, the country suffered a temporary setback with the outbreak of Ebola Virus Disease (EVD) in West Africa, which surfaced in neighbouring Guinea in December 2013, spreading to Liberia in March 2014 and Sierra Leone in May 2014. The EVD outbreak lasted about 18 months and its socio-economic impact is believed to have been almost as devastating as the civil war of 1991–2002.

Despite these challenges, Sierra Leone’s NTDP has made remarkable progress towards LF elimination since starting integrated mass drug distribution campaigns using ivermectin and albendazole in 2007, for river blindness and LF. By 2013, Sierra Leone’s NTD program had not only completed the required number of years of treatment for LF in 12 of the country’s 14 health districts, but it had also conducted impact assessment surveys for LF, called pre-transmission assessment surveys (pre-TAS), in those 12 districts. The 2013 pre-TAS results showed that 8 of the 12 districts had passed the LF pre-TAS. Mass drug treatment will be stopped in these 8 districts if the results of the final LF evaluation (called a transmission assessment survey or TAS), which END in Africa Project Director Pou observed on his recent visit, show that LF transmission is below the threshold set by the WHO. Sierra Leone’s NTDP also used the LF TAS platform to assess the impact of mass drug treatment on onchocerciasis in the 8 districts, all of which are co-endemic for both diseases. Both surveys (for LF and onchocerciasis) were conducted in schools among children ages 6-7 years for LF and age 5-9 years for river blindness. Results of these surveys are still being tabulated and will be published on this website when they become available.