The battle against Ebola
Project partner
“Now I want to be a doctor� - Celina Kamanda, a young Ebola survivor
The battle against Ebola
Written by: Nell Walker Produced by: Richard Durrant 3
The UK’s Department for International Development led the response to the Ebola crisis in Sierra Leone, committing £427 million to the epidemic and getting the country back on its feet
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he Ebola crisis of 2014 brought West Africa to its knees and the rest of the world to arms. The UK’s Department for International Development (DFID) played a major part in containing and fighting the disease, having been tasked by the Prime Minister, David Cameron and Justine Greening, Secretary of State for International Development, to step in and help Sierra Leone’s government. DFID has the ability to respond to up to three international crises at one time, thanks to their partnership with the international development company, Crown Agents and its Conflict, Humanitarian and Security Operations Team – otherwise known as CHASE OT. CHASE OT allows DFID to respond to emergencies exceptionally quickly. For example, when a natural disaster occurs – such as the April 2015 Nepal earthquake – a CHASE OT team will be assembled
in a tactics room, a plan laid out, and within a 24-hour period there are boots on the ground. The goods follow later; that’s where the supply chain comes into the equation. DFID steps in John McGhie, Supply Chain Demand Manager for DFID, is a busy man. When the World Health Organisation declared the Ebola crisis an international emergency, it was soon realised that the international supply chain was unable to cope with the depth of goods and flexibility required, and so the British government put into place its own end-to-end supply chain to handle operations on location in Sierra Leone. “Although you can acquire some information from initial reports, it’s only when you actually have people on the ground that you can truly assess what is needed,” McGhie says. “We unfortunately don’t have the time to sit and discuss things; we need to actually get people there. It’s peoples’ lives at risk.” Before the supply chain
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‘It’s only when you actually have people on the ground that you can truly assess what is needed’
Yusuf Kabba - an Ebola survivor and campaigner
“No one company could physically tackle what we were facing” – John McGhie, Supply Chain Demand Manager for DFID
‘Working with world experts, we worked out what an Ebola treatment centre looked like and what supplies were needed’
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could begin moving, DFID had to work out not only what was needed, but how it would slot together. “Essentially back in Whitehall we looked at it and said ‘what is a treatment centre?’ Working with world experts who had dealt with Ebola on a smaller scale, we worked out what an Ebola treatment centre looked like and what supplies were needed.” Acquiring supplies At this point, the basic items could be gathered: “At the beginning we had to think about patient numbers and consumption rates. We needed treatment centres, with 100 beds, able to operate for at least a six month period. Medical staff would be changing their Personal Protective Equipment (PPE) every shift, taking blood samples from patients, conducting physical checks and prescribing essential medicines. How many nurses are required, how many doctors, how many cleaners would be going in and out of the red zone?” The centres needed an isolation area, triage, labs, separate wards for suspected and confirmed cases, facilities for decontamination and a mortuary. Air conditioners were required, as temperatures within the tents could reach 44 Celsius, plus all manner of PPE – something that would need to be removed and replaced every time a medical worker entered or left a red zone – and, of course, medical supplies. “All these things were ongoing during the August/
September period and being mobilized from October through to the opening of the first fully-formed treatment centre in November. It all had to work in sequence so that we could get on top of it, and this constantly evolved with the pattern of the outbreak.” At its height, the outbreak was bringing 500 people a week into the doors of 15 emergency treatment centres across the country, 6 of which were UK built, and CHASE OT could no longer tie up so much of its services in one place. “It became clear that the Ebola response was absorbing the majority of CHASE OT’s operations, so it meant that if there was another global disaster – and in the time CHASE OT
Yusuf Kabba - The President of the Sierra Leone Association of Ebola Survivors, Reaching out to Ebola survivors in Magazine Wharf, Freetown
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Equipping the Ebola fight in Sierra Leone November 7, 2015 was a remarkable day for Crown Agents and International Procurement Agency (IPA) – but also a day like any other. It was remarkable because it was the day that Sierra Leone was officially declared free of Ebola. It was the Holy Grail that we had been working towards for more than a year. But then it was just like any other day because we still had plenty of work to do – on the Ebola response and on much more. At both companies we did take a moment, however, to reflect on the magnitude of the achievement, which had seemed so distant and so desperate when work first began. A year previously, the work being done was on a scale and with an urgency that few, if any, had seen before. The outbreak was rising to its peak. Rates of infection in Sierra Leone topped 500 in one week in November 2014. The international
response was surging into action and Crown Agents and IPA were at the heart of things. Our core procurement and supply chain contingent was swelled with anyone who could be of assistance – director-level staff were rolling up their sleeves, getting on the phone and calling suppliers. Procurement, supply chain, logistics, health, IT, finance and HR staff – people from all over the companies – all had vital and urgent roles to do. At that point Crown Agents had sourced, procured and shipped everything needed to equip the first of the Ebola treatment centres funded by the UK government’s Department for International Development (DFID) in Sierra Leone. We had also been given our orders to do it all again for six more centres.
The award-winning CAIPA partnership, between Crown Agents and IPA, was also being formed, to establish the supply chains for the resupply and continued operation of the ETCs. The pressure of the situation was unlike anything we’d seen before because of the simple fact that it was literally a matter of life and death for the people in Sierra Leone. Between September 2014 and September 2015, CAIPA procured more than 10 million individual items from over 240 suppliers. 2,118,548 kilogrammes of products were shipped by air and sea freight from all over the world to Sierra Leone. When an all-consuming incident like the Ebola outbreak happens, it’s easy to forget that the rest of the world keeps spinning. During 2015 Vanuatu was stricken by Cyclone Pam, the earthquake in Nepal required a huge humanitarian
response and the refugee crisis in the Mediterranean called upon international humanitarian assistance. Throughout the Ebola work Crown Agents and IPA’s expertise has also been needed elsewhere so, on November 7, no-one took their foot off the pedal, work continued, supply chains for medical supplies and solar panels and infrastructure and technical assistance and more, kept moving. Work also continued on the Ebola response, moving into decommissioning, donation and making sure that all the positive medical advances made in Sierra Leone during the outbreak are leveraged for future health systems strengthening.
What is CAIPA? CAIPA was formed in November 2014 as a partnership between Crown Agents and International Procurement Agency (IPA) to help fight Ebola in Sierra Leone. IPA holds the DFID procurement contract for Sierra Leone and Crown Agents was able to offer additional supply chain capacity and experience in the region, so the decision to join forces was an easy one to make.
The Ebola response captured the best of what a partnership like CAIPA could offer: • More than 215 combined years of history in international procurement and supply • Strong and productive relationships with governments, donors and suppliers • Multi-disciplinary expertise spanning supply chain, logistics, consultancy & financial services • Agile international staff accustomed to getting things done in the most extreme environments CAIPA’s job is not over yet. The reporting of one new case of Ebola in Sierra Leone on January 15, reflects the ongoing risk of new flare-ups of the virus in the Ebolaaffected countries. CAIPA must still maintain the supply chains
and facilities to isolate and treat any such flare-ups and to scale up and down as necessary. Looking to the future, those supply chains and systems will also be used for wider health systems strengthening work, including for distribution under the Free Health Care programme run by DFID, the Government of Sierra Leone and UNICEF. We’re also supporting Public Health England in running four labs in Sierra Leone that were initially set up within the ETCs, but have now been relocated within Sierra Leone to take on a bigger role in general medical testing. Further afield, CAIPA has also begun working in South Sudan to provide emergency medical health supplies – including pharmaceuticals and medical consumables – country wide in support of the work being carried out by the national Ministry of Health and DFID.
For more information please visit: Crown Agents www.crownagents.co.uk International Procurement Agents BV www.ipa-bv.nl
Crown Agents was involved in the UK government’s Ebola response from the outset: its embedded Operations Team (OT) within DFID’s Conflict, Humanitarian and Security Department worked on the initial setting up of the seven British ETCs in Sierra Leone. Crown Agents is an international development company that takes on clients’ fundamental challenges and makes lasting change to the systems and organisations that are vital for people’s well-being and prosperity. Headquartered in London, it has more than 180 years of experience in international procurement and has international offices, project operations and agents across the world. IPA is one of the leading organisations in providing superior supply, procurement, consultancy services and emergency response to principals in all parts of the developing world on a strictly independent basis. It was founded in 1981 and is based in Bussum in The Netherlands. The partnership’s work with DFID on the Ebola was recognised with two awards at the European Supply Chain Excellence Awards, taking the honours for International Operations and for the Public and Third Sectors. It has also been shortlisted for the Outstanding International Collaboration Award at the British Expertise International Awards 2016.
“There will be life after Ebola” - John Sesay
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have had to deal with the Nepal earthquake, the outbreak of hostilities in Yemen, the migrant crisis in Europe and through Syria, the issues around the border of Turkey – as bad as the Ebola crisis was, they couldn’t have one operation tie up what we have been tasked by the government to tackle,” McGhie says. CAIPA offers aid A normal response for CHASE OT would last between one and three months, but Ebola had the potential from the beginning to stay longer and spread wider: “No one company could keep up with the demand for PPE, so DFID’s procurement unit ordered from several companies. No one company could physically tackle what we were facing.” The procurement unit decided that supply chain needed help to cope with this enormous drain, leading to a partnership between Crown Agents and IPA, known as CAIPA. Crown Agents is a large, long-standing organisation and IPA is smaller and proactive; “This provided us with the kind of platform we required, because what is needed today is not what’s going to be needed next week, and this was a constant evolving pattern where we were assessing what was necessary.” This extra support from external contractors contributed towards the development of over 70 community care centres which were located around the country to help quickly isolate and treat
1000 The number of Department for International Development employees
Celina Kamanda - an Ebola survivor
British Army Sergeant Sulaiman Kamara meets Ebola survivors in Magazine Wharf, Freetown
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cases. What remains now is DFID’s legacy. “The reason I was brought out here was to maintain the supply chain for DFID, but also manage the transition of what happens once this is over. Moving from active treatment to surveillance, through to recovery, through to development… All to help and support the Government of Sierra Leone to get back to normal.” Pre-Ebola crisis, Sierra Leone had one of the fastest growing economies in the world. This dropped to growth of only 1% in 2015. “It was a country that was ready to step ahead and make significant increases which then
got cut off at the knees. We want to leave a legacy of capability within the government.” Sierra Leone today Sierra Leone reached zero cases of Ebola in November 2015, but as the new flare up in January of this year demonstrates, the virus will emerge in clusters every so often. Ebola has also delayed immunization programmes and led to many people feeling afraid of hospitals – increasing Sierra Leone’s exposure to other diseases such as malaria and cholera. However, DFID is developing a programme of support for a free healthcare service for pregnant woman, lactating mothers and children under five (as Sierra Leone has one of the highest child mortality rates in the world, with 8.7 percent of babies dying under the age of one), and the elderly. This is all in the name of allowing the people of Sierra Leone to continue to live healthily and without fear. DFID has gone above and beyond during the operation in Sierra Leone, working with the national government and its partners including the World Health Organisation, Centres for Disease Control and Prevention, the Ministry of Defence, Public Health England, the National Health Service and the Australian Government-funded Aspen Medical. In the fight against Ebola, the international aid has proven invaluable, and will continue to allow a damaged nation to get back onto its feet as it recovers from one its weakest points in history.
‘It was a country that was ready to step ahead and make significant increases, which then got cut off at the knees. We want to leave a legacy of capability within the government’
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Department Of International Development Whitehall • London • SW1A 2HB Tel: 0000000 www.gov.uk/dfid