The weekend the World Health Organization declared that the 18-month Ebola outbreak in Sierra Leone was officially over, was poignant. On the Sunday morning, when the champagne glasses hadn't yet been cleaned, the crowds were still dispersing from the overnight beach

parties, and the church congregations were dancing and clapping in jubilation, we were back on the road for a traditional reconciliation ceremony in one of the capital's former Ebola hotspots.

Recovering from Ebola is a remarkable achievement, but surviving doesn't mean everything returns to how it was before. On an individual level, health issues can persist in addition to lost livelihoods, stigma and trauma. At a community level, Ebola has also caused considerable damage – something that UNICEF with support from DFID is working to counteract. The day after the Ebola outbreak ended, we're back at work.

At the dusty Lion's football field in the Ferry Junction area of the capital, men, women and children shelter under a make-shift tarpaulin roof that billows up and down in the heavy winds. The rainy season is sending out a parting shot before it leaves for next year. After the introductions, it's the turn of 12-year-old Aminata* to take the microphone. She tells of the care she received from the community when she was in Ebola quarantine – the encouraging hand-written notes passed to her by friends along with gifts of fruit and other small presents. However she also shares the downside – being kept apart from her brother after he was discharged from the treatment centre: those around thought they were

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UPDATE SIERRA LEONEUnite for children

October - December 2015

The day after the end of the Ebola outbreak

Education cannot wait, even during emergencies

Free health supplies give lifeline to mothers and babies in Sierra Leone

Working with communities to curb teenage pregnancies

In Sierra Leone, preventing Ebola with a laugh

Providing care and protection in Ebola times and beyond

Contents1

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October - December 2015

9

The day after the end of the outbreak

By John James

Chief Communications Specialist

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October - December 20152

protecting her from further harm.

She also speaks about the moment she was told her mother had died of Ebola – news she only received after the burial had taken place. As she described losing her “best friend”, her “everything” and “the only person she had ever felt close to”, people throughout the small gathering sobbed heavily. Her father had first gotten ill, and been cared for at home by Aminata's mother and brother. All three later died while under care at an Ebola Treatment Unit.

Aminata was followed on the podium by a young boy, Ibrahim*. He had lived with an uncle who fell sick with Ebola. A neighbour called the 117 hotline and the uncle was taken away by health care workers, though he died the same day. In the coming weeks several other people in the household were also infected, and the house was under quarantine for around 60 days. Ibrahim described how his friends stayed away, and how his home was nicknamed the 'Ebola house'. When the quarantine ended, no-one wanted to play with him and friends ran away. At football time, no-one picked him for the team. In school, no-one wanted to sit next to him.

In communities, Ebola has caused divisions, hurt and trauma that puts social cohesion at risk. In response, UNICEF is working with partners to use traditional healing ceremonies to promote dialogue and restoration. This sort of ceremony was last used at the end of the civil war in Sierra Leone to help facilitate community healing.

Many families were unable to say goodbye to the deceased in the traditional way, either because of the speed of burial or because they themselves were in quarantine or isolation. The normal rites such as vigils, religious ceremonies, and the traditional sharing of 'fourah' (rice paste) with kola nuts and the meat of a sacrificed animal were limited by quarantine, restrictions on gatherings, and economic hardship. “A lot of people felt they hadn't been able to

move on because these acts of remembering and sharing are very central for communities, including in the appeasing of the dead,” said Batu Shamel, a Child Protection officer with UNICEF. “In some communities they believe that without these ceremonies, the deceased won't transfer successfully to the next life.”

The Ebola outbreak has also created divisions between neighbours, and between community leaders and communities. Unresolved tensions and accusations of blame remain in instances where neighbours might have called the 117 hotline to report a sick person next-door, who later died after they were taken away. Contact tracers who placed people in quarantine attract residual ill-feeling even if they were doing a vital job. And some survivors and other affected people continue to feel the effects of stigma and discrimination.

These community healing ceremonies represent the first chance for such grievances to be aired. In an emotional scene, one community member openly accused a local councillor of being responsible for the death of his relative because of the councillor's reporting of the sick man to the 117 hotline. The meetings give opportunities to community leaders and others to explain why certain things were done, and to ask for forgiveness for the hurt caused. At the end of the meeting, dialogue was restored between the two parties, and a greater understanding of what went on.

On Sunday 8 November 2015, the day after the ending of the outbreak, a memorial church service was held in Ferry Junction and the names of the deceased were read out and commemorated. In the afternoon, as the wind and rains died down, prayers were said, and after testimony from children and adults, community leaders asked for pardon, and promised to support the affected. As the sun came out, a lamb was killed and shared out, with rice paste and kola nuts. The world may not yet have a cure for Ebola, but the hard work of healing its after-effects is now underway.

Social worker Hawa Mansaray from NGO partner DCI introduces the ceremony at Ferry Junction. ©UNICEF Sierra Leone/2015/James

* Name of child changed to protect identity

Quick thinking by head teacher Abdul Kamara saved Kroo Bay Community Primary School's ch i ldren f rom d isaster. Moments before the deluge, 150 students and the school's eight teachers were inside, busy with the day's lessons.

“I was inside and I could see the rain coming down heavy,” said Abdul. “I went out to see how the water was rising. When I saw how close the water was to the school, I instructed the teachers to remove the kids. A few minutes later, I saw the water enter the school.”

Within a few hours the flood waters rose to within five inches of the school roof.

Kroo Bay Community Primary School is located in one of the coastal slum areas of Sierra Leone's capital Freetown, vulnerable to regular floods in the rainy season. But the torrential downpours in Freetown on 16 September 2015 were unprecedented.

“This kind of flooding has never happened before,” said Abdul. “Normally flooding comes in, but it doesn't come in to destroy like that. The floods even broke down the

railing of the bridge that we use to get here.”

The Government of Sierra Leone responded to the floods emergency by opening up the National Siaka Stevens and Atouga stadiums as temporary shelter for those who had lost their homes in Freetown. UNICEF joined the humanitarian response and has been providing emergency water, sanitation and hygiene (WASH), shelter, health, nutrition and protection interventions. UNICEF is also supporting the government respond to the education needs of children affected by the floods across the country, including children from the Kroo Bay community.

“We went to Kroo Bay which is probably the most severely affected community in Freetown, and we saw the community school almost totally damaged,” said Lang Ma, UNICEF Education Specialist. “We saw mud and debris everywhere – on the floor, on campus, in the classroom. It is frustrating for us adults, and it's even more frustrating for children who are not able to go back to the school after this.”

UNICEF education teams are working to help the community transition back to a normal life.

“We are going to provide educational opportunities and psycho-social support to take care of their learning

3

Education cannot wait, even during

emergencies

October - December 2015

October - December 20152

protecting her from further harm.

She also speaks about the moment she was told her mother had died of Ebola – news she only received after the burial had taken place. As she described losing her “best friend”, her “everything” and “the only person she had ever felt close to”, people throughout the small gathering sobbed heavily. Her father had first gotten ill, and been cared for at home by Aminata's mother and brother. All three later died while under care at an Ebola Treatment Unit.

Aminata was followed on the podium by a young boy, Ibrahim*. He had lived with an uncle who fell sick with Ebola. A neighbour called the 117 hotline and the uncle was taken away by health care workers, though he died the same day. In the coming weeks several other people in the household were also infected, and the house was under quarantine for around 60 days. Ibrahim described how his friends stayed away, and how his home was nicknamed the 'Ebola house'. When the quarantine ended, no-one wanted to play with him and friends ran away. At football time, no-one picked him for the team. In school, no-one wanted to sit next to him.

In communities, Ebola has caused divisions, hurt and trauma that puts social cohesion at risk. In response, UNICEF is working with partners to use traditional healing ceremonies to promote dialogue and restoration. This sort of ceremony was last used at the end of the civil war in Sierra Leone to help facilitate community healing.

Many families were unable to say goodbye to the deceased in the traditional way, either because of the speed of burial or because they themselves were in quarantine or isolation. The normal rites such as vigils, religious ceremonies, and the traditional sharing of 'fourah' (rice paste) with kola nuts and the meat of a sacrificed animal were limited by quarantine, restrictions on gatherings, and economic hardship. “A lot of people felt they hadn't been able to

move on because these acts of remembering and sharing are very central for communities, including in the appeasing of the dead,” said Batu Shamel, a Child Protection officer with UNICEF. “In some communities they believe that without these ceremonies, the deceased won't transfer successfully to the next life.”

The Ebola outbreak has also created divisions between neighbours, and between community leaders and communities. Unresolved tensions and accusations of blame remain in instances where neighbours might have called the 117 hotline to report a sick person next-door, who later died after they were taken away. Contact tracers who placed people in quarantine attract residual ill-feeling even if they were doing a vital job. And some survivors and other affected people continue to feel the effects of stigma and discrimination.

These community healing ceremonies represent the first chance for such grievances to be aired. In an emotional scene, one community member openly accused a local councillor of being responsible for the death of his relative because of the councillor's reporting of the sick man to the 117 hotline. The meetings give opportunities to community leaders and others to explain why certain things were done, and to ask for forgiveness for the hurt caused. At the end of the meeting, dialogue was restored between the two parties, and a greater understanding of what went on.

On Sunday 8 November 2015, the day after the ending of the outbreak, a memorial church service was held in Ferry Junction and the names of the deceased were read out and commemorated. In the afternoon, as the wind and rains died down, prayers were said, and after testimony from children and adults, community leaders asked for pardon, and promised to support the affected. As the sun came out, a lamb was killed and shared out, with rice paste and kola nuts. The world may not yet have a cure for Ebola, but the hard work of healing its after-effects is now underway.

Social worker Hawa Mansaray from NGO partner DCI introduces the ceremony at Ferry Junction. ©UNICEF Sierra Leone/2015/James

* Name of child changed to protect identity

Quick thinking by head teacher Abdul Kamara saved Kroo Bay Community Primary School's ch i ldren f rom d isaster. Moments before the deluge, 150 students and the school's eight teachers were inside, busy with the day's lessons.

“I was inside and I could see the rain coming down heavy,” said Abdul. “I went out to see how the water was rising. When I saw how close the water was to the school, I instructed the teachers to remove the kids. A few minutes later, I saw the water enter the school.”

Within a few hours the flood waters rose to within five inches of the school roof.

Kroo Bay Community Primary School is located in one of the coastal slum areas of Sierra Leone's capital Freetown, vulnerable to regular floods in the rainy season. But the torrential downpours in Freetown on 16 September 2015 were unprecedented.

“This kind of flooding has never happened before,” said Abdul. “Normally flooding comes in, but it doesn't come in to destroy like that. The floods even broke down the

railing of the bridge that we use to get here.”

The Government of Sierra Leone responded to the floods emergency by opening up the National Siaka Stevens and Atouga stadiums as temporary shelter for those who had lost their homes in Freetown. UNICEF joined the humanitarian response and has been providing emergency water, sanitation and hygiene (WASH), shelter, health, nutrition and protection interventions. UNICEF is also supporting the government respond to the education needs of children affected by the floods across the country, including children from the Kroo Bay community.

“We went to Kroo Bay which is probably the most severely affected community in Freetown, and we saw the community school almost totally damaged,” said Lang Ma, UNICEF Education Specialist. “We saw mud and debris everywhere – on the floor, on campus, in the classroom. It is frustrating for us adults, and it's even more frustrating for children who are not able to go back to the school after this.”

UNICEF education teams are working to help the community transition back to a normal life.

“We are going to provide educational opportunities and psycho-social support to take care of their learning

3

Education cannot wait, even during

emergencies

October - December 2015

needs and also their social-emotional needs, so that when the schools are rebuilt or refurbished, they are ready to go back to school, ready to continue their learning,” said Lang Ma.

The Freetown floods occurred at a particularly critical time for sixth grade students who were preparing to sit for their National Primary School Examination (NPSE). As a temporary measure, Abdul Kamara arranged for sixth graders who remained in the community with their families, to study for their exams at the Kroo Bay Community Centre, which was not as badly affected by the floods. For children who had moved to the stadiums from Kroo Bay, arrangements were made for sixth graders to receive tutoring in the Child Friendly Spaces that were set up by NGOs with the support of UNICEF.

On the day of the national exam, UNICEF, in partnership with the Ministry of Education, Science and Technology and NGO partners made arrangements to ensure the 106 sixth graders at both stadiums were able to access to examination centres and sit for their exams.

The educational needs of children in lower grades are also being looked after as part of the emergency response to the floods. More than 500 children have been registered at the Child Friendly Space that is operated by Save the Children with support from UNICEF at the national stadium. There they are receiving lessons, psycho-social counselling and meals. UNICEF has also provided the space with three early childhood education (ECD) kits for pre-school age children.

Eight-year-old first grader Saidu Mansaray is busy drawing using the coloured pencils from the ECD kits. “I

was in school when the water came and my mother came and took me from there to our house, but the water spoiled our house,” said Saidu. “I am here at the stadium with my mother, father, brother and sister. I am drawing a house because I need a place to sleep. When I am a big man I want to be a carpenter because I want to build my house. I am enjoying this place.”

“Children must be allowed to be children, even in emergency situations,” said Lang Ma, UNICEF Education Specialist in Early Childhood Development. “The ECD kit is basically a big metal box containing teaching-learning materials and toys that can cater for fifty children ages zero to six. In emergency situations, children's regular education opportunities are lost – they cannot go to school and they cannot go to kindergarten and they are in a shelter – and sometimes even homeless. It is therefore crucial to bring education to children in an emergency situation. The box is like a mobile kindergarten or pre-school that we can take to an emergency situation. When children are playing with the kit, they are engaging in fun, educational activities, and they feel normal. They feel safe. They feel like they can go on with their lives.”

While these temporary measures are catering to the educational needs of affected children, assessments are on-going to provide long-term solutions.

“The only thing I need to do now is to advocate for the school to be demolished and build a new one,” said Abdul. “Our school is no longer safe, not only for the kids, but for the teachers as well. Meanwhile, I will ask the community to give me the community centre from which to run the school.”

4

Dr. Lang Ma, UNICEF Education Specialist, at the Child Friendly Space ©UNICEF Sierra Leone/2015/Kassaye

October - December 2015 5

Marie Tarawally, 20, with her one-month-old baby Yusufu, disembarked s l o w l y f r o m t h e motorbike taxi after arriving at the gate of Pate Bana Marank Community Health Centre (CHC) in Bombali district, northern Sierra Leone.

With her small baby, Marie had travelled seven miles on dusty and pot-holed roads from their village, Robuya, to attend neo-natal clinical services at the health centre.

“I travelled all the way from my village to seek better health care for my baby since it's free of charge,” said Marie as she entered the health centre. Inside, dozens of lactating mothers and their under five children are awaiting treatment for common ailments like malaria, acute respiratory infections, diarrhoea, malnutrition and other childhood diseases.

Although the Ebola outbreak in Sierra Leone was declared over by WHO on 7 November 2015, the disease is still very much in people's minds. Marie's village was the last in the country to record a case, and the village she has travelled to, Pate Bana Marank, was

one of the worst affected village communities in the country with 119 Ebola deaths recorded. Health workers in the centre continue to follow infection prevention and control measures strengthened during the Ebola outbreak.

But even last year Ebola was not the biggest childhood killer in these parts. Sierra Leone has one of the highest rates of child and maternal deaths in the world with a maternal mortality ratio of 1,165 per 100,000 live births and under 5 mortality at 156 per 1,000 live births (figures recorded before Ebola struck).

In an effort to end these needless child and mother deaths, UNICEF has been working with partners like the European Union, DfID and USAID to support the Government's Free Health Care initiative, launched by H.E. President Dr Ernest Bai Koroma in 2010. This includes supplies of lifesaving drugs for the treatment of common childhood illnesses like malaria, diarrhea and respiratory infections, and drugs to help pregnant mothers deliver safely. Good quality anti-biotics, deworming tablets, and oral rehydration salts are also part of package that is available free of charge at all peripheral health facilities as well as in hospitals, for pregnant and lactating mothers and children up to five years of age.

Free health supplies give lifeline to mothers and babies in Sierra Leone

By Issa Davies

Communication Officer

October - December 2015

needs and also their social-emotional needs, so that when the schools are rebuilt or refurbished, they are ready to go back to school, ready to continue their learning,” said Lang Ma.

The Freetown floods occurred at a particularly critical time for sixth grade students who were preparing to sit for their National Primary School Examination (NPSE). As a temporary measure, Abdul Kamara arranged for sixth graders who remained in the community with their families, to study for their exams at the Kroo Bay Community Centre, which was not as badly affected by the floods. For children who had moved to the stadiums from Kroo Bay, arrangements were made for sixth graders to receive tutoring in the Child Friendly Spaces that were set up by NGOs with the support of UNICEF.

On the day of the national exam, UNICEF, in partnership with the Ministry of Education, Science and Technology and NGO partners made arrangements to ensure the 106 sixth graders at both stadiums were able to access to examination centres and sit for their exams.

The educational needs of children in lower grades are also being looked after as part of the emergency response to the floods. More than 500 children have been registered at the Child Friendly Space that is operated by Save the Children with support from UNICEF at the national stadium. There they are receiving lessons, psycho-social counselling and meals. UNICEF has also provided the space with three early childhood education (ECD) kits for pre-school age children.

Eight-year-old first grader Saidu Mansaray is busy drawing using the coloured pencils from the ECD kits. “I

was in school when the water came and my mother came and took me from there to our house, but the water spoiled our house,” said Saidu. “I am here at the stadium with my mother, father, brother and sister. I am drawing a house because I need a place to sleep. When I am a big man I want to be a carpenter because I want to build my house. I am enjoying this place.”

“Children must be allowed to be children, even in emergency situations,” said Lang Ma, UNICEF Education Specialist in Early Childhood Development. “The ECD kit is basically a big metal box containing teaching-learning materials and toys that can cater for fifty children ages zero to six. In emergency situations, children's regular education opportunities are lost – they cannot go to school and they cannot go to kindergarten and they are in a shelter – and sometimes even homeless. It is therefore crucial to bring education to children in an emergency situation. The box is like a mobile kindergarten or pre-school that we can take to an emergency situation. When children are playing with the kit, they are engaging in fun, educational activities, and they feel normal. They feel safe. They feel like they can go on with their lives.”

While these temporary measures are catering to the educational needs of affected children, assessments are on-going to provide long-term solutions.

“The only thing I need to do now is to advocate for the school to be demolished and build a new one,” said Abdul. “Our school is no longer safe, not only for the kids, but for the teachers as well. Meanwhile, I will ask the community to give me the community centre from which to run the school.”

4

Dr. Lang Ma, UNICEF Education Specialist, at the Child Friendly Space ©UNICEF Sierra Leone/2015/Kassaye

October - December 2015 5

Marie Tarawally, 20, with her one-month-old baby Yusufu, disembarked s l o w l y f r o m t h e motorbike taxi after arriving at the gate of Pate Bana Marank Community Health Centre (CHC) in Bombali district, northern Sierra Leone.

With her small baby, Marie had travelled seven miles on dusty and pot-holed roads from their village, Robuya, to attend neo-natal clinical services at the health centre.

“I travelled all the way from my village to seek better health care for my baby since it's free of charge,” said Marie as she entered the health centre. Inside, dozens of lactating mothers and their under five children are awaiting treatment for common ailments like malaria, acute respiratory infections, diarrhoea, malnutrition and other childhood diseases.

Although the Ebola outbreak in Sierra Leone was declared over by WHO on 7 November 2015, the disease is still very much in people's minds. Marie's village was the last in the country to record a case, and the village she has travelled to, Pate Bana Marank, was

one of the worst affected village communities in the country with 119 Ebola deaths recorded. Health workers in the centre continue to follow infection prevention and control measures strengthened during the Ebola outbreak.

But even last year Ebola was not the biggest childhood killer in these parts. Sierra Leone has one of the highest rates of child and maternal deaths in the world with a maternal mortality ratio of 1,165 per 100,000 live births and under 5 mortality at 156 per 1,000 live births (figures recorded before Ebola struck).

In an effort to end these needless child and mother deaths, UNICEF has been working with partners like the European Union, DfID and USAID to support the Government's Free Health Care initiative, launched by H.E. President Dr Ernest Bai Koroma in 2010. This includes supplies of lifesaving drugs for the treatment of common childhood illnesses like malaria, diarrhea and respiratory infections, and drugs to help pregnant mothers deliver safely. Good quality anti-biotics, deworming tablets, and oral rehydration salts are also part of package that is available free of charge at all peripheral health facilities as well as in hospitals, for pregnant and lactating mothers and children up to five years of age.

Free health supplies give lifeline to mothers and babies in Sierra Leone

By Issa Davies

Communication Officer

October - December 2015

To date, the European Union alone has spent €7.6 million in support of the Free Health Care initiative in Sierra Leone.

Despite a difficult journey to the clinic, young mothers like Marie know the value of seeking out this treatment. At her young age, she is a mother of four with the eldest six years' old.

“As a teenager,” said Marie, “I dropped out of school and got married off at an early age when I lost my mother who was paying my school charges at that time. I suffered a lot when I became pregnant and had my first baby. My husband had to sell some of his farm production to pay my hospital charges and buy drugs to save my and our baby's life.”

She is happy that she no longer has to pay hospital charges and buy drugs. With a broad smile she added “And in fact, I didn't pay even a single cent at the clinic for any of the three babies I had after.”

She acknowledged that free services had given her the confidence to use the health centre rather than herbalist for the treatment of her children.

The European Union through UNICEF has supported the Government of Sierra Leone to take actions to strengthen the fragile health system in Sierra Leone, especially upgrading facilities through infrastructure support and improving the availability of skilled health care providers. At the end of 2015, construction work on 16 new or rehabilitated health facilities was launched in districts across the country.

During the Ebola outbreak, the EU worked with UNICEF to sponsor trainings on infection prevention and control, and improved knowledge and information on managing preventable diseases.

Vaccination campaigns – temporarily suspended during the Ebola outbreak – were also relaunched in April 2015. Marie – herself a polio victim – makes sure to get her baby vaccinated at the clinic: “I do not want the same unfortunate fate to happen to my baby,” she says.

“Most of the mothers and babies you are seeing today are here to get marklate [vaccination]. Many thanks to the donors for providing the money that procured all these drugs that are used to treat us free of charge.”

6

Marie stands at the entrance of Pate Bana Marank CHC with her baby ©UNICEF Sierra Leone/2015/Davies

October - December 2015 7

Working with communities to

curb teenage pregnancies

By Harriet Mason

Communication Officer

All too often, adolescent girls disappear from the development agenda, even as progress is made on education, health, HIV/AIDS and protection against violence. The importance of redoubling efforts and focusing on adolescent girls is the emphasis of the 2015 International Day of the Girl Child. This year's theme is 'The power of the adolescent girl: Vision for 2030'.

UNICEF and its partners are supporting local and national programmes to help prevent pregnancy among teenage girls and keep them in school.

Every afternoon, 17-year-old Isatu Jah and a group of other young girls gather in a community hall in the village of Kpangbama, in southern Sierra Leone, to plan for the future. This is the Empowerment and Livelihoods for Adolescents (ELA) club, which works to reduce teenage pregnancy by providing a safe space for girls through training in life skills,

with a strong focus on sexual and reproductive health.

Isatu says some of her teenage friends have become mothers, and their experience motivated her to join the

programme.

“I joined the ELA club to empower myself and prevent myself from getting pregnant. I'm happy to say that the ELA programme has been key in helping me stay in school,” she says.

When the girls are on holidays, their mentor, Mbalu Kaikai checks on them. “I visit each and every one of them at their homes to make sure they are ok. We discuss any issues they have and try to address them together,” Ms. Kaikai says.

In addition to discussing teenage pregnancy, the girls can also get training in tie-dye, soap making, tailoring or hairdressing, and are coached in financial literacy skills to help them learn the concept of saving and become self-reliant. After the training, they receive start-up materials and a loan, to help them set up small businesses so they can support themselves and their families.

Impact on health and progress

Teenage pregnancy is a pervasive problem in Sierra Leone that affects girls' and young women's health and their social, economic and political progress and empowerment. The Ebola crisis has exacerbated the

October - December 2015

To date, the European Union alone has spent €7.6 million in support of the Free Health Care initiative in Sierra Leone.

Despite a difficult journey to the clinic, young mothers like Marie know the value of seeking out this treatment. At her young age, she is a mother of four with the eldest six years' old.

“As a teenager,” said Marie, “I dropped out of school and got married off at an early age when I lost my mother who was paying my school charges at that time. I suffered a lot when I became pregnant and had my first baby. My husband had to sell some of his farm production to pay my hospital charges and buy drugs to save my and our baby's life.”

She is happy that she no longer has to pay hospital charges and buy drugs. With a broad smile she added “And in fact, I didn't pay even a single cent at the clinic for any of the three babies I had after.”

She acknowledged that free services had given her the confidence to use the health centre rather than herbalist for the treatment of her children.

The European Union through UNICEF has supported the Government of Sierra Leone to take actions to strengthen the fragile health system in Sierra Leone, especially upgrading facilities through infrastructure support and improving the availability of skilled health care providers. At the end of 2015, construction work on 16 new or rehabilitated health facilities was launched in districts across the country.

During the Ebola outbreak, the EU worked with UNICEF to sponsor trainings on infection prevention and control, and improved knowledge and information on managing preventable diseases.

Vaccination campaigns – temporarily suspended during the Ebola outbreak – were also relaunched in April 2015. Marie – herself a polio victim – makes sure to get her baby vaccinated at the clinic: “I do not want the same unfortunate fate to happen to my baby,” she says.

“Most of the mothers and babies you are seeing today are here to get marklate [vaccination]. Many thanks to the donors for providing the money that procured all these drugs that are used to treat us free of charge.”

6

Marie stands at the entrance of Pate Bana Marank CHC with her baby ©UNICEF Sierra Leone/2015/Davies

October - December 2015 7

Working with communities to

curb teenage pregnancies

By Harriet Mason

Communication Officer

All too often, adolescent girls disappear from the development agenda, even as progress is made on education, health, HIV/AIDS and protection against violence. The importance of redoubling efforts and focusing on adolescent girls is the emphasis of the 2015 International Day of the Girl Child. This year's theme is 'The power of the adolescent girl: Vision for 2030'.

UNICEF and its partners are supporting local and national programmes to help prevent pregnancy among teenage girls and keep them in school.

Every afternoon, 17-year-old Isatu Jah and a group of other young girls gather in a community hall in the village of Kpangbama, in southern Sierra Leone, to plan for the future. This is the Empowerment and Livelihoods for Adolescents (ELA) club, which works to reduce teenage pregnancy by providing a safe space for girls through training in life skills,

with a strong focus on sexual and reproductive health.

Isatu says some of her teenage friends have become mothers, and their experience motivated her to join the

programme.

“I joined the ELA club to empower myself and prevent myself from getting pregnant. I'm happy to say that the ELA programme has been key in helping me stay in school,” she says.

When the girls are on holidays, their mentor, Mbalu Kaikai checks on them. “I visit each and every one of them at their homes to make sure they are ok. We discuss any issues they have and try to address them together,” Ms. Kaikai says.

In addition to discussing teenage pregnancy, the girls can also get training in tie-dye, soap making, tailoring or hairdressing, and are coached in financial literacy skills to help them learn the concept of saving and become self-reliant. After the training, they receive start-up materials and a loan, to help them set up small businesses so they can support themselves and their families.

Impact on health and progress

Teenage pregnancy is a pervasive problem in Sierra Leone that affects girls' and young women's health and their social, economic and political progress and empowerment. The Ebola crisis has exacerbated the

October - December 2015

8

situation. The closure of schools, combined with the economic impact on the economy, has increasingly led poor and vulnerable families to adopt desperate survival strategies.

The survey 'Children's Ebola Recovery Assessment in Sierra Leone' by Plan International, Save the Children, World Vision International and UNICEF found reports of increased child labour, exploitation, violence and exposure to teenage pregnancy. Most girls who became pregnant have not been able to return to school.

Meanwhile, a rapid assessment conducted by the United Nations Population Fund (UNFPA) on adolescent pregnancy still awaits official confirmation, but preliminary results indicate that more than 14,300 girls in Sierra Leone became pregnant during the Ebola health emergency.

The Government has launched a new scheme to set up special systems to help pregnant girls continue their education, so that they can more easily resume formal education after pregnancy. With support from DFID, Irish Aid, UNICEF and UNFPA, the project includes providing psychosocial counseling, health information and access to maternal and neonatal health services.

Community members including parents, men, boys and traditional leaders have also been involved in discussions on issues such as teenage pregnancy, early marriage and domestic violence.

“When I see girls who are pregnant, I feel bad because I know they will not be able to care for themselves and their children well,” says Madam Jamie, a resident of Kpangbama.

“I always encourage girls to stay in school, because that will help them live better lives in future,” she adds.

Benefits of education

While teenage pregnancy remains a major issue affecting girls and young women in Sierra Leone, it has been on the decline in Kpangbama. “Girls are not getting pregnant as they used to before,” says mentor Ms. Kaikai. “They are more aware of reproductive health and family planning facilities. None of our schoolgirls got pregnant when schools closed down, and I'm sure they will all return to school when they reopen.”

Isatu agrees that she and other girls in her village are now aware of the benefits of education and are inspired to focus more on their schooling.

“I'm working harder in school because I know it is important for me to be educated to improve life for my family. There is a proper time for everything, including sex,” she says. “I will like to be a nurse after I finish school, because I want to help my people get good medical care.”

The ELA programme, run by BRAC Sierra Leone, also receives support in preventing teenage pregnancies. “Adolescent girls should be in school preparing for their future lives, not pregnant and raising children,” says Geoff Wiffin, UNICEF Representative in Sierra Leone. “This is why we are working closely with partners to ensure girls get every opportunity to stay in school and be educated.”

October - December 2015 9

A theatre group in Sierra Leone uses comedy to share the message that the Ebola outbreak is over, but awareness is still a matter of life and death.

Pa Jonsin is having a crisis. His son Junior has come home shaking with fever, and when the boy vomits, panic ensues. Fortunately this is not real life, but a theatrical drama unfolding in front of an audience in Kaf fu Bul lom Chiefdom.

More than a hundred villagers, including many children, have gathered to watch the antics of the Pan Family Theatre Group as they perform an Ebola-themed play in the village centre. At times the audience looks

concerned, and at other times they burst into laughter and applause.

“Mr. Jonsin's son came home with the Ebola virus,” says Fatmata Mansery, spokesperson for the Pan Family Theatre Group, who also plays a member of the Ebola response team. “So as soon as he sees the signs and symptoms of Ebola, he decides to call the 117 hotline. We come and rescue his son – that's the purpose of 117. If you feel sick, if you have dead bodies, you must call 117 – don't touch the person. Call 117 and they will come and pick the person or the dead body and bury him.”

Vigilance

At the height of the Ebola epidemic, large public gatherings were banned, as a measure to protect public health. Now that the ban has been lifted, the

In Sierra Leone, preventing

Ebola with a laugh

By Indrias Kassaye

Communication Specialist

October - December 2015

8

situation. The closure of schools, combined with the economic impact on the economy, has increasingly led poor and vulnerable families to adopt desperate survival strategies.

The survey 'Children's Ebola Recovery Assessment in Sierra Leone' by Plan International, Save the Children, World Vision International and UNICEF found reports of increased child labour, exploitation, violence and exposure to teenage pregnancy. Most girls who became pregnant have not been able to return to school.

Meanwhile, a rapid assessment conducted by the United Nations Population Fund (UNFPA) on adolescent pregnancy still awaits official confirmation, but preliminary results indicate that more than 14,300 girls in Sierra Leone became pregnant during the Ebola health emergency.

The Government has launched a new scheme to set up special systems to help pregnant girls continue their education, so that they can more easily resume formal education after pregnancy. With support from DFID, Irish Aid, UNICEF and UNFPA, the project includes providing psychosocial counseling, health information and access to maternal and neonatal health services.

Community members including parents, men, boys and traditional leaders have also been involved in discussions on issues such as teenage pregnancy, early marriage and domestic violence.

“When I see girls who are pregnant, I feel bad because I know they will not be able to care for themselves and their children well,” says Madam Jamie, a resident of Kpangbama.

“I always encourage girls to stay in school, because that will help them live better lives in future,” she adds.

Benefits of education

While teenage pregnancy remains a major issue affecting girls and young women in Sierra Leone, it has been on the decline in Kpangbama. “Girls are not getting pregnant as they used to before,” says mentor Ms. Kaikai. “They are more aware of reproductive health and family planning facilities. None of our schoolgirls got pregnant when schools closed down, and I'm sure they will all return to school when they reopen.”

Isatu agrees that she and other girls in her village are now aware of the benefits of education and are inspired to focus more on their schooling.

“I'm working harder in school because I know it is important for me to be educated to improve life for my family. There is a proper time for everything, including sex,” she says. “I will like to be a nurse after I finish school, because I want to help my people get good medical care.”

The ELA programme, run by BRAC Sierra Leone, also receives support in preventing teenage pregnancies. “Adolescent girls should be in school preparing for their future lives, not pregnant and raising children,” says Geoff Wiffin, UNICEF Representative in Sierra Leone. “This is why we are working closely with partners to ensure girls get every opportunity to stay in school and be educated.”

October - December 2015 9

A theatre group in Sierra Leone uses comedy to share the message that the Ebola outbreak is over, but awareness is still a matter of life and death.

Pa Jonsin is having a crisis. His son Junior has come home shaking with fever, and when the boy vomits, panic ensues. Fortunately this is not real life, but a theatrical drama unfolding in front of an audience in Kaf fu Bul lom Chiefdom.

More than a hundred villagers, including many children, have gathered to watch the antics of the Pan Family Theatre Group as they perform an Ebola-themed play in the village centre. At times the audience looks

concerned, and at other times they burst into laughter and applause.

“Mr. Jonsin's son came home with the Ebola virus,” says Fatmata Mansery, spokesperson for the Pan Family Theatre Group, who also plays a member of the Ebola response team. “So as soon as he sees the signs and symptoms of Ebola, he decides to call the 117 hotline. We come and rescue his son – that's the purpose of 117. If you feel sick, if you have dead bodies, you must call 117 – don't touch the person. Call 117 and they will come and pick the person or the dead body and bury him.”

Vigilance

At the height of the Ebola epidemic, large public gatherings were banned, as a measure to protect public health. Now that the ban has been lifted, the

In Sierra Leone, preventing

Ebola with a laugh

By Indrias Kassaye

Communication Specialist

October - December 2015

Government of Sierra Leone, in partnership with NGOs, the World Health Organization and UNICEF, has stepped up social mobilization efforts to ensure that people don't let their guard down, which has made theatre interventions like this one possible.

“Through these drama groups, we are reviving a long tradition of using comedy to address social issues in Sierra Leone,” says Fredrick James, the UNICEF Communication for Development Officer responsible for the initiative. “Comedians helped bring peace and reconciliation following the civil war. Now we are using them to fight Ebola.”

Creative approach

In the play, Pa Jonsin does the right thing when his son

comes home sick. He calls 117, and the ambulance team arrives promptly and takes charge of the situation.“We have this creative way of making the messages, because people were tired of us telling them the same messages [over and over] again,” says Joy Caminade, of UNICEF Sierra Leone. “This is a way for them to enjoy the messaging, to be more attentive to the messengers, and be able to take home the messages to their families, to their communities, to their friends and to their classmates.”

“This play is very good for us,” says 12-year-old Zeinab Khoury. “It is a reminder to all of us children to wash our hands before we enter the classroom.”

The Ebola outbreak in Sierra Leone infected at least 8,704 people and killed at least 3,589.

11

By bringing isolation facilities to the village level and making it easier for people to seek treatment, Community Care Centres in Sierra Leone have made a critical contribution towards getting to zero Ebola transmissions. They have also helped build public trust in the medical system, critical for a healthier future.

After two days suffering severe headaches, Mamadu Sesay thought he might have contracted the Ebola virus. Fearing the worst, Mamudu made his way to the Kania Community Care Centre (CCC) in Sierra Leone's Kambia District, operated by the District Health Management

Team, with support from UNICEF and the UK Department for International Development (DFID).

“I walked here by myself, because I felt really bad,” says Mamadu. “I was afraid I might have Ebola.”

Seeking professional medical help is not a reflex for everyone who gets sick in Sierra Leone, and trust in the public health system was undermined by the Ebola epidemic, which severely stretched resources.

Ebola also had a heavy impact on health workers themselves: Between January 2014 and March 2015, more than 325 were infected by the virus, and more than 150 died, in a country that before the epidemic had fewer than 140 doctors for its 6 million population, according to the World Health Organization.

Providing care and

protection, in

Ebola times

and beyond

October - December 2015

Historically, villagers have been more inclined to seek the help of traditional healers when they fall ill. But herbs and home remedies don't work against Ebola, and they even contributed to its spread by keeping people out of quarantine and not following standard infection prevention and control guidelines.

Breaking down barriers

Within this context, the CCCs were set up by UNICEF, with support from DFID, in Bombali, Tonkolili, Kambia and Kono districts. Two more CCCs were later added in Western Area. The CCCs didn't just bring isolation facilities to the village level – essential in containing local outbreaks; they also broke down barriers to people seeking care.

At the height of the Ebola crisis, 46 UNICEF-supported centres were providing services throughout the country. Staff received training on infection prevention and control (IPC), and protocols were put in place before they opened. In addition to practicing correct use and disposal of Personal Protective Equipment (PPE) and reviewing IPC principles, there were role plays involving different patient scenarios.

“CCCs bridged the gap between the community and the health system,” says Liya Aklilu, UNICEF Health Specialist and UNICEF CCC Coordinator for the Ebola Response. “The UNICEF CCCs alone screened 33,391 people – and we're still counting. They cast a very wide net, which is what you need to do in order to proactively identify suspected cases. Their location in the community and accessibility were also crucial, as our data show that people came to the CCCs early, when symptoms presented, making early isolation a possibility and helping to reduce possible transmission in the community.”

The idea was go beyond the notion of 'Build it and they'll come' and instead invest actively in making sure communities used the facilities and put aside misplaced fears about Ebola. One of the ways this was carried out was by engaging people as liaisons between villagers and the CCC.

Dauda Kamara is the community focal point working with the Kania CCC. “When the CCC started, people in the community were afraid, saying that the CCC staff are going to give something that is going to kill all of the community,” he says. “That is why UNICEF got together with the paramount chief, the section chief and the head of town and engaged some of us to take responsibility – to work with the CCC and the community members.

“I would go to the community and discuss with them, telling them the importance of the CCC and inform them of the advantage of the CCC. Now a lot of them are

coming to the CCC before going to the Peripheral Health Unit [PHU].”

Procedures in place

When Mamadu arrived at the CCC feeling sick, he was met by Amara Kamara, a security guard who Mamadu knows from his village. Amara assisted him with the precautionary procedures taken when entering the health facility.

“I am the security guard protecting life and property,” Amara says. “When a patient comes, my responsibility is to tell the patient to do the handwashing and take his or her temperature. After that, I will show him or her where to go for triage.”

The CCCs employ staff from the community like Amara in order to foster good relations, community ownership and utilization. Day-to-day operations such as screening and providing care are led by nurses from the District Health Management Teams. Hygienists, cleaners and secur i ty s ta f f respons ib le fo r sa fe ty and decontamination staff are also recruited from the community.

After checking Mamadu's temperature and interviewing him, including asking whether he has other symptoms of Ebola, the attending nurse determined that Mamadu did not meet the case definition for admission to the CCC and referred him to the nearby PHU for further tests. The CCCs supported the existing health system not just by isolating suspected cases, but also ensuring referrals were exchanged between the two.

Leaving the CCC, Mamadu appeared visibly relieved at the good news that the symptoms and pain he had been experiencing over the past two days did not correspond to Ebola. At the PHU, located a short walk from the CCC, a rapid diagnostic test kit was used to diagnose that Mamadu had instead contracted malaria, another potentially deadly disease that shares some symptoms of Ebola but is far more easily treated. Mamadu was provided free medication and sent home.

A lasting lesson

If there's a lesson from the outbreak, it is the importance of community engagement. Long after the Ebola outbreak has passed, winning the trust of communities to use health systems will have a lasting benefit. In the fight against the numerous and largely preventable causes of childhood and maternal deaths, which in Sierra Leone occur at some of the highest rates in the world, this trust will be a fundamental advantage.

10 October - December 2015

Government of Sierra Leone, in partnership with NGOs, the World Health Organization and UNICEF, has stepped up social mobilization efforts to ensure that people don't let their guard down, which has made theatre interventions like this one possible.

“Through these drama groups, we are reviving a long tradition of using comedy to address social issues in Sierra Leone,” says Fredrick James, the UNICEF Communication for Development Officer responsible for the initiative. “Comedians helped bring peace and reconciliation following the civil war. Now we are using them to fight Ebola.”

Creative approach

In the play, Pa Jonsin does the right thing when his son

comes home sick. He calls 117, and the ambulance team arrives promptly and takes charge of the situation.“We have this creative way of making the messages, because people were tired of us telling them the same messages [over and over] again,” says Joy Caminade, of UNICEF Sierra Leone. “This is a way for them to enjoy the messaging, to be more attentive to the messengers, and be able to take home the messages to their families, to their communities, to their friends and to their classmates.”

“This play is very good for us,” says 12-year-old Zeinab Khoury. “It is a reminder to all of us children to wash our hands before we enter the classroom.”

The Ebola outbreak in Sierra Leone infected at least 8,704 people and killed at least 3,589.

11

By bringing isolation facilities to the village level and making it easier for people to seek treatment, Community Care Centres in Sierra Leone have made a critical contribution towards getting to zero Ebola transmissions. They have also helped build public trust in the medical system, critical for a healthier future.

After two days suffering severe headaches, Mamadu Sesay thought he might have contracted the Ebola virus. Fearing the worst, Mamudu made his way to the Kania Community Care Centre (CCC) in Sierra Leone's Kambia District, operated by the District Health Management

Team, with support from UNICEF and the UK Department for International Development (DFID).

“I walked here by myself, because I felt really bad,” says Mamadu. “I was afraid I might have Ebola.”

Seeking professional medical help is not a reflex for everyone who gets sick in Sierra Leone, and trust in the public health system was undermined by the Ebola epidemic, which severely stretched resources.

Ebola also had a heavy impact on health workers themselves: Between January 2014 and March 2015, more than 325 were infected by the virus, and more than 150 died, in a country that before the epidemic had fewer than 140 doctors for its 6 million population, according to the World Health Organization.

Providing care and

protection, in

Ebola times

and beyond

October - December 2015

Historically, villagers have been more inclined to seek the help of traditional healers when they fall ill. But herbs and home remedies don't work against Ebola, and they even contributed to its spread by keeping people out of quarantine and not following standard infection prevention and control guidelines.

Breaking down barriers

Within this context, the CCCs were set up by UNICEF, with support from DFID, in Bombali, Tonkolili, Kambia and Kono districts. Two more CCCs were later added in Western Area. The CCCs didn't just bring isolation facilities to the village level – essential in containing local outbreaks; they also broke down barriers to people seeking care.

At the height of the Ebola crisis, 46 UNICEF-supported centres were providing services throughout the country. Staff received training on infection prevention and control (IPC), and protocols were put in place before they opened. In addition to practicing correct use and disposal of Personal Protective Equipment (PPE) and reviewing IPC principles, there were role plays involving different patient scenarios.

“CCCs bridged the gap between the community and the health system,” says Liya Aklilu, UNICEF Health Specialist and UNICEF CCC Coordinator for the Ebola Response. “The UNICEF CCCs alone screened 33,391 people – and we're still counting. They cast a very wide net, which is what you need to do in order to proactively identify suspected cases. Their location in the community and accessibility were also crucial, as our data show that people came to the CCCs early, when symptoms presented, making early isolation a possibility and helping to reduce possible transmission in the community.”

The idea was go beyond the notion of 'Build it and they'll come' and instead invest actively in making sure communities used the facilities and put aside misplaced fears about Ebola. One of the ways this was carried out was by engaging people as liaisons between villagers and the CCC.

Dauda Kamara is the community focal point working with the Kania CCC. “When the CCC started, people in the community were afraid, saying that the CCC staff are going to give something that is going to kill all of the community,” he says. “That is why UNICEF got together with the paramount chief, the section chief and the head of town and engaged some of us to take responsibility – to work with the CCC and the community members.

“I would go to the community and discuss with them, telling them the importance of the CCC and inform them of the advantage of the CCC. Now a lot of them are

coming to the CCC before going to the Peripheral Health Unit [PHU].”

Procedures in place

When Mamadu arrived at the CCC feeling sick, he was met by Amara Kamara, a security guard who Mamadu knows from his village. Amara assisted him with the precautionary procedures taken when entering the health facility.

“I am the security guard protecting life and property,” Amara says. “When a patient comes, my responsibility is to tell the patient to do the handwashing and take his or her temperature. After that, I will show him or her where to go for triage.”

The CCCs employ staff from the community like Amara in order to foster good relations, community ownership and utilization. Day-to-day operations such as screening and providing care are led by nurses from the District Health Management Teams. Hygienists, cleaners and secur i ty s ta f f respons ib le fo r sa fe ty and decontamination staff are also recruited from the community.

After checking Mamadu's temperature and interviewing him, including asking whether he has other symptoms of Ebola, the attending nurse determined that Mamadu did not meet the case definition for admission to the CCC and referred him to the nearby PHU for further tests. The CCCs supported the existing health system not just by isolating suspected cases, but also ensuring referrals were exchanged between the two.

Leaving the CCC, Mamadu appeared visibly relieved at the good news that the symptoms and pain he had been experiencing over the past two days did not correspond to Ebola. At the PHU, located a short walk from the CCC, a rapid diagnostic test kit was used to diagnose that Mamadu had instead contracted malaria, another potentially deadly disease that shares some symptoms of Ebola but is far more easily treated. Mamadu was provided free medication and sent home.

A lasting lesson

If there's a lesson from the outbreak, it is the importance of community engagement. Long after the Ebola outbreak has passed, winning the trust of communities to use health systems will have a lasting benefit. In the fight against the numerous and largely preventable causes of childhood and maternal deaths, which in Sierra Leone occur at some of the highest rates in the world, this trust will be a fundamental advantage.

10 October - December 2015

In 2015 UNICEF Sierra

Leone received

contributions from:

Ÿ The Governments of Canada, Germany, Ireland, Italy, Japan, The Netherlands, Norway, Sweden, Switzerland, United Arab Emirates, United Kingdom, USA

Ÿ The European Union, United Nations, African Development Bank, GAVI Alliance, Global Fund against AIDS/TB/Malaria, Bill & Melinda Gates Foundation Micronutrient Initiative, United Nations Foundation, IKEA Foundation, CERF, OFDA, The World Bank

We also received

contributions from UNICEF

National Committees in:

Ÿ Australia, Austria, Belgium, Denmark, Germany, Iceland, Italy, Japan, Luxembourg, The Netherlands, Norway, Poland, Sweden, Switzerland, United Kingdom, Global - Thematic Humanitarian Resp and USA

For more information,

please contact:

John James

Head of External Relations

and Advocacy

UNICEF Sierra Leone

Mobile: +232 76 102 401

Facsimile: +232 22 235 059

E-mail: jjames@unicef.org

URL: http://www.unicef.orgwww.youtube.com/user/UNICEFSL

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Flickr: www.flickr.com/photos/unicefsierraleone

www.facebook.com/unicefsierraleone twitter:@UNICEFSL

Design & Layout by Tolu J. Bade/2015/UNICEF Sierra Leone

©UNICEF Sierra Leone/2015/Bade