Liberia

General Context


The MENTOR Initiative is very well established in Liberia, with a long history of successful technical capacity building of health workers at a national level. MENTOR began programmes in Liberia in 2003 and has trained several thousand health workers in the 15 counties. 

Ebola Response
The months of 1st April to 30th June 2015 saw the resurgence of the fatal Ebola virus in Liberia. The Liberians and Liberian government had moved away from acute emergency response towards resilience and recovery activities. However, the further outbreak reveals that continued support in vulnerable health facilities is still a necessity.

MENTOR’s approach is to remain involved in a project until sustainable impact has been made, therefore, building on the limited support and capacity of urban communities is essential. MENTOR has, with continued vigilance, helped to manage infectious diseases, such as the Ebola crisis, through improved surveillance, effective IPC (Infection and prevention control) practices, differential diagnosis and case management capacity.

During the Ebola outbreak, MENTOR integrated a consolidated response approach by building effective differential diagnosis and triage for Ebola, Lassa fever as well as malaria and other priority conditions. It is vital to build a local capacity for IPC across the health system and all communities because the threat of significant outbreaks will continue, long after the bulk of international actors have left.

What MENTOR has been doing


MENTOR has been identified as one of the lead organizations for developing the post Ebola transition and investment plan. In order to prevent devastating outbreaks such as the Ebola crisis, a significant expansion in technical understanding by health workers, trust in the measures, local leadership and support are all essential. This response must include both public and private sector workers, especially in Monrovia, as many of the city’s most vulnerable population sectors are primarily served through private health facilities.

Rebuilding community confidence in seeking care is key and MENTOR has implemented a Safe Serving training package for health care workers when screening and treating patients. There is still a massive task ahead in Monrovia- to train every health worker in the country (public and private sector).With the support of USAID, MENTOR has implemented immersive learning techniques to improve the quality, speed, scalability and cost effectiveness of IPC.

Comic Relief project
Advancing the frontiers of sustainable malaria control in Liberia- A model for Africa
Project dates: April 2011- October 2015
PSACT (Private Sector Act) Project
With funding from Comic Relief, The MENTOR Initiative has implemented a four year project piloting two key innovative malaria strategies in Monrovia, Liberia:
• Working with private medicine stores and pharmacies (MS/Ps) serving the slum communities of West Point and Bushrod Island in Monrovia.
• Using durable wall lining (DL) as a malaria prevention method.

The idea behind the PSACT (Private Sector ACT) project is to develop pharmacists’ and dispensers’ technical capacity to accurately conduct basic differential diagnosis and confirmatory malaria diagnosis which overall substantially improves correct malaria treatment. This allows malaria cases to be managed at medicine store and pharmacy level and 214 MS/Ps have been enrolled as of January 2015.

medicine store

PSACT Project
In June 2014, a high increase in cases managed at the medical store and pharmacy level was observed. The Ebola outbreak in Monrovia had created a feeling of fear and mistrust of health facilities in the population, leading to more use of MS/Ps.

MENTOR adapted the PSACT programme to the emergency situation by providing training in basic Ebola Infection Prevention and Control (IPC) in August 2014, ensuring that access to essential medicines continues as the health system collapsed. 

In September 2014, malaria RDTs were withdrawn from the project after WHO recommendation.

In October 2014, MENTOR further developed the essential training on IPC measures at medical store and pharmacy level, allowing malaria control to continue (OFDA funding). This re-training was rolled out to the hundred outlets in Bushrod Island and West Point and to an additional one hundred new stores in Paynesville.

This OFDA funding expanded community health worker (CHW) activities in November 2014 and increased the 40 CHWs trained to 200 CHWs in 2015.
In January 2015, MENTOR lobbied for a review of the Standard Operating Procedures (SOPs) for private MS/Ps during the Ebola outbreak to further protect dispensers. This then led to the introduction of temperature taking, simple triage of clients and emergency cleaning kits. All associated training of PSACT stores was then supported by MENTOR.

BUDDI (Building Up Defence for Disease Infection)Health care worker using the BUDDI tool as part of IPC training
e-buddi© is a technologically enhanced adaptive learning tool which helps educate local communities about infection control, discouraging dangerous practices, behaviour and rituals. Its objective is to rebuild local health capacity faster, keeping health-workers, patients and communities safer.

The tool has been designed by a partnership  under the Masanga Mentor Ebola Initiative (MMEI) between the Masanga hospital in Sierra Leone, the Mentor Initiative operating in Liberia, and the Plymouth University Peninsula Schools of  Medicine and Dentistry (“PUPSMD”). MMEI has a network of IPC specialists in tackling medical emergencies in remote locations, including Lassa fever, SARs and Ebola; e-learning and IT programme development experts. For more info visit  http://mmei.uk/

New Prevention Method
Durable Wall Lining StudyDurable Wall lining (7)
Durable lining (DL) was originally a deltamethrin-impregnated polyethylene material, which is designed to cover domestic walls that would normally be sprayed with residual insecticide (IRS). However, due to the rapid development of insecticide resistance in West Africa, deltamethrin and all other insecticides of the same chemical class, became relatively ineffective by 2012. As a consequence, after an intense period of research and development by the creators of DL, new active ingredients from classes of chemistry not previously used in mosquito control, were discovered and developed into a new generation of DL. With this new DL, MENTOR is now delivering a full scale real life (Phase III). This aims to develop an evidence base for DL’s feasibility, effectiveness, acceptability and durability of DL, this will inform national policy and development.

Who benefits?
Direct beneficiaries in the DL study are community members in 42 clusters (villages or groups of villages) in Bomi County. Half of the population receive DL, in addition to long lasting insecticidal nets (LLIN) that they previously received through a national distribution campaign. The other half acts as a control, and have similar LLIN coverage, yet still benefit from the testing and treatment. Mothers caring for their children benefit indirectly from the testing as they benefit from overall reduction of malaria.

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