IFRC’s management response to the Real-time Evaluation (RTE) of
the West Africa Ebola Virus Disease (EVD) operations
1.
Summary of the rationale for this RTE, and the management response ...................... 2
1.1.
Background to the West Africa Ebola situation .......................................................... 2
1.2.
Control of Ebola ........................................................................................................... 3
1.3.
Concluding remarks on the RTE report ....................................................................... 4
2.
Summary of recommendations related to the main evaluation questions. .................. 5
3.
Response to cross-site recommendations (pages 8-9 in the evaluation report) ............. 7
4.
Response to detailed recommendations per country ................................................. 11
4.1.
Guinea - response to detailed recommendations (pages 39-41) .............................. 11
4.2.
Sierra Leone - response detailed recommendations (pages 60-61) ......................... 17
4.3.
Liberia – response to full list of recommendations (pages 80-81) ............................ 22
IFRC Real Time Evaluation Management Response
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1. Summary of the rationale for this RTE, and the
management response
In line with the current IFRC approach1, this RTE was commissioned in October 2014 and conducted from late
November to December 2014. Based on the RTE Terms of Reference, the purpose is “to assess the policy
adherence, relevance and appropriateness, efficiency, effectiveness, and connectedness of the Red Cross Red
Crescent response to the Ebola outbreak in West Africa. Specifically it will assess: the extent to which the
response has followed the Principles and Rules for Red Cross and Red Crescent Humanitarian Assistance; the
relevance of the five-pillar response strategy; if IFRC systems and structures are have been effective and
efficient in achieving objectives; to what extent operations address long term interconnected problems in the
three host countries”.
The ‘zero’ draft was received on 30 December 2014. The RTE team approached the evaluation with a focus on
assessing how the IFRC was contributing to saving lives from Ebola. Given the directions of the epidemic and
where it was currently going, what more, the team sought to find out, could be done within the Red Cross Red
Crescent mandate to shorten this outbreak? The team of four evaluators visited the three countries, working in
teams, and using a rigorous participatory and analytical approach that involved collection and review of
existing secondary data (quantitative and qualitative), direct observation, semi‐structured key informant
interviews, focus groups, workshops and a survey. In summary, the RTE team found very dedicated delegates
and National Society staff and volunteers working with great dedication in difficult circumstances. The people
and the work that they are doing is a great credit to the Red Cross Red Crescent Movement as well as the
organization and leadership of the response to this epidemic.
The unpredictable pattern of this epidemic coupled with the weak systems in the three post-conflict countries,
has made this a difficult challenge. The epidemic is still not coming under control in Guinea and Sierra Leone,
even though there has been a marked downward trend in Liberia. Although Liberia has achieved considerable
success it has not reached elimination and there is a potential for new chains of transmission flaring up.
1.1. Background to the West Africa Ebola situation
Although there have been 35 documented outbreaks of Ebola previously (23 in humans) since 1976, the
cultural and geopolitical context of West Africa, coupled with fragile systems in the three post-conflict regions
created the environment for this disastrous outbreak. This is certainly a leading public health crisis of the
decade and certainly the outbreak of the decade, having infected more than 22,500 persons and killed 9,000 by
February 2015.
The outbreak began in Meliandou, Guinea, with the death of a child probably infected from a bat in December
2013. The outbreak was recognized in January 2014, in the border area between Guinea, Sierra Leone and
Liberia, but poor communications and political and cultural resistance hampered the full recognition of the
extent of the outbreak. By early May, most responders had concluded the epidemic was burning itself out.
However, a failure to trace contacts and to conduct active case finding allowed the epidemic to quietly build
up. The massive flare up of cases occurring from May/June onward caught many local as well as international
organizations by surprise, and in many cases unprepared.
There were 124 new confirmed cases reported in the week of 1 February: 39 in Guinea, 5 in Liberia, and 80 in
Sierra Leone. Weekly case incidence increased in all three countries for the first time this year.
In Guinea the disease has largely remained a rural disease and continues to spread in rural hard-to-reach areas.
The western district of Forecariah, which borders the Sierra Leonean district of Kambia, remains the worstaffected district in Guinea, with 13 new confirmed cases in the first week of February. The geographic spread is
of concern as it indicates worsening control prospects. As of 1 February there had been 89 cases reported in
the previous 21 days and a cumulative number of cases of 2,975. Guinea reported two new health worker
infections in the week of 1 February. Contact tracing is being carried out generally and in the week up to 25
January, 54 per cent of new confirmed and probable cases arose among registered contacts. This was an
increase of 30 per cent from the previous week. During the week of 1 February 2015, 91 per cent of all
registered contacts were seen on a daily basis.
1
Project/programme monitoring and evaluation (M&E) guide and the IFRC Framework for Evaluation
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In Sierra Leone the first impacts were seen in Kailahun and Kenema. An urgent response by the Red Cross
established a treatment centre in Kenema and with other activities and good local organization, the infection
has continued here at low levels. A total of 80 new cases were reported in Sierra Leone in the week of 1
February, compared with 65 the previous week. The western districts of Port Loko and the capital Freetown are
the worst-affected areas. Nine of 14 districts in the country reported at least 1 confirmed case, up from 7
districts in the previous week. As of 1 February 2015, there were 262 cases in the previous 21 days with a
cumulative total of 10,740, still making it the hardest hit of the three countries.
In Liberia the surge in cases started in July, and much of that was in Montserrado County, which includes
Monrovia. A large effort to build treatment beds in Monrovia and a comprehensive Safe and Dignified Burial
program by the Red Cross helped halt transmission and bring the numbers of new cases each day to single
digits. Even with the small number of new cases, the potential for flare up still remains. Leadership from the
Ministry of Health through the Incident Management System (IMS) has been particularly strong. During the 21
days leading up to 1 February there were 17 new cases bringing the total up to 8,745 cases to date. However,
the distant locations of some new cases are a warning that there is still considerable work to be done before
zero new cases are reached. There were no health workers diagnosed with EVD during the most recent period
of time.
1.2. Control of Ebola
Among the 23 outbreaks of Ebola in Africa, all have been rural in origin, with some previously spreading into
hospitals located in small towns. This West African epidemic has demonstrated the consequences of failing to
keep the epidemic contained in the rural areas, as the nature and difficulties of control in urban areas are
exacerbated. As a public health disaster, the course of the Ebola epidemic and the nature of response is
considerably different from other disasters which move predictably from more acute to less acute needs.
The control of the Ebola epidemic can be summarized as three interrelated public health principles:
 Recognition of the Ebola infection
 Infection prevention and control measures
 Treatment of those suspected and confirmed as having Ebola
These three principles are captured in the Red Cross 5-pillars activity approach which includes, 1) social
mobilization and beneficiary communications, 2) safe and dignified burial, 3) psychosocial support, 4) tracing
and monitoring of contacts and 5) clinical case management.
The Red Cross has played a major role in all three elements during this epidemic. Different elements are
important at different phases in the epidemic. No single organization has the capacities for all of these
activities, but the Red Cross and Red Cross volunteers are well placed in communities to play a major role in all
control activities, working closely with the district or county health teams. As the epidemic phase shifts, the
nature of these roles needs to shift as well. The epidemic is currently at one of these inflection points.
With these efforts by the Red Cross and others around the five pillar approach, why has Ebola still not been
eliminated and what will be necessary to finally eliminate Ebola? The major reasons fall into several areas.
1.
Cases are being missed or not quickly identified:
 This represents a failure of active surveillance—going to look for disease. It is estimated that the
source of transmission is unknown in approximately 40% of the new cases. Contact tracing is a
community based activity that is done working with district and county health teams. People in the
community maintain regular surveillance for the sick and those coming or leaving the community. This
is done in collaboration with the existing local health system. National authorities take these data to
understand national and local patterns. The Red Cross volunteers do contact tracing in many places,
which is following contacts of known or suspected cases. This is a difficult task, often connected with
strong resistance from the contacts; however, ramping up this effort toward more active case finding
is possible with additional training in contact tracing skills and social mobilisation techniques.
 Communities still fail to recognize Ebola virus disease through misconceptions or active resistance:
increasingly, Ebola is infecting remote areas where communication is poor. It is estimated that for
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every known Ebola case there are 1.5 unreported cases. Especially in Guinea the situation is volatile.
Recent incidences have raised the security level in the capital to level orange.
2. Infection prevention and control measures are inadequate:
At the household level when people become sick, those who care for them need protection. There have not
been adequate provisions of protective equipment and instructions to assist in caring for the sick at home with
a minimal risk before the sick person can be transported to a treatment centre.



3.
With early recognition, others must be protected against infection until the person with Ebola can
reach treatment. Community Care Kits or Home Protection Kits can reduce risks of infection, along
with safe transportation.
Hospitals and clinics have initially played a role in spread of Ebola. Major deficits in infection
prevention and control measures were found in health facilities in six districts of Sierra Leone, and
similar findings for Liberia were reported at the IMS meeting in December. Continued training and
vigilance are needed for hospital workers to avoid infection.
Safe burial practices can prevent transmission of disease. This has been a major contribution by the
Red Cross to Ebola elimination. Maintaining personal protection and protocols for the teams and
drivers requires continued vigilance.
Treatment of those suspected or confirmed with Ebola
 Isolation and treatment must start as soon as there is suspicion or diagnosis of Ebola.
 As the infection is spreading into remote areas, this becomes an increasing challenge.
 Structuring ‘hubs” for rapid response, as the Red Cross has begun in Liberia or rapid construction of
small scale treatment units – isolation units- , as the Red Cross has now done in Kono will facilitate
more rapid treatment and minimise further transmission.
 Transportation of suspected or confirmed patients remains a huge challenge.
 Treatment includes rehabilitation and recovery including social rehabilitation and reintegration into
communities. Helping people to get their lives back is both a treatment and a humanitarian task.
These three fundamental principles are useful to measure and assess the success and the deficits in the
application of control measures. Understanding these will help Ebola control programs such as the Red Cross,
to identify weaknesses that the virus can exploit in the communities that their volunteers serve. This will help
elimination programs to get ahead of the epidemic curve, instead of just being reactive to new directions of the
outbreak spread.
The critical information needed during an Ebola outbreak comes from the field sites. It is the lack of accurate
field data that resulted in the resurgence of Ebola after April/May 2014. Although many organizations work
with these data, it is still collected by local staff in the areas involved. The quality of the data used for
epidemiological trends and estimated outbreak development is only as good as the data collected. The Red
Cross volunteers have been very active in the contact tracing/monitoring in the three countries, working in
collaboration with local district and county health teams, often taking on surveillance work beyond just
contacts. The area of surveillance is one of the key areas that need to expand to eliminate the disease.
1.3. Concluding remarks on the RTE report
The final RTE report was received on 4 February 2015. As the observations, preliminary findings and
recommendations had been discussed with the operations managers and National Societies in the affected
countries already at the time of the field visits in December 2014, it will come as no surprise that most of the
recommendations are accepted by IFRC management and the implementation is well in process or already
completed. IFRC management would like to take the opportunity to thank the evaluators for a timely and
relevant real time evaluation.
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2. Summary of recommendations related to the main evaluation questions.
Considering the criteria of upholding policy, efficiency, effectiveness, relevance and appropriateness and connectedness, the RTE ToR explored the
following questions. The overall summary recommendations made here are given in more detail in the country-based recommendations table below.
ToR questions
Upholding policy
a) To what extent are the Principles and Rules for Red Cross
and Red Crescent Humanitarian Assistance being followed
in the operation?
2)
Relevance and appropriateness
a) How were the needs assessed (including analysis and
predictions made), and how was criteria established for
launching emergency appeals?
b) Is the IFRC response strategy (with its five pillar approach)
delivering appropriately in proportion to the needs?
c) Is the regional appeal relevant/appropriate?
d) Is the response strategy balanced with realistic donor
support estimates?
3)
Efficiency and effectiveness
a) How well is the operation delivering on existing needs
identified?
i) Systems: Are the existing IFRC systems and structure
(including response tools2) appropriate to deliver
efficient and effective response to the outbreak?
ii) Use of resources: How effective and efficient is the
system to mobilize and utilize resources (financial, HR
1)
2
Related key RTE recommendations
See detailed table below.
A. The IFRC should consider the unpredictable direction of the epidemic. The IFRC needs one or more mid-to-high level
specialists for strategic epidemiological support both at HQ and in the field to help “get ahead of the curve.” instead of
just being reactive. The Red Cross is seen by some as good implementers but without much technical depth.
B.
The large Red Cross volunteer base is an underutilized resource for stopping this epidemic. It has worked famously as
burial teams, but now needs to diversify, given the changing nature of the epidemic. Volunteers working with district
and county health teams in disease surveillance and active case finding could shorten this epidemic.
C.
Communications and psychological support are important Red Cross activities, but should be ramped up considerably in
some places using additional technical expertise. Stigmatization of survivors is an emerging need. Providing material
assistance to Ebola widows, orphans and vulnerable persons would meet an important need.
D. More needs to be done, and urgently to ensure the safety and wellbeing of volunteers. Volunteer psychosocial needs
Including DREF, Emergency Appeal & EPOA; GLS, HR, RDRT, ERU, SOPs, IFRC Delegations, DMU, etc.
IFRC Real Time Evaluation Management Response
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or others)?
iii) Timeliness: are services being delivered within
adequate time?
iv) Coordination:
(1) Is internal coordination within the secretariat
efficient and effective?
(2) Is the coordination mechanism effective and
working for all Movement members?
(3) Is the coordination with other humanitarian actors
effective?
v) Human resource support
(1) Are the safety and support measures (including
psycho-social) in place for staff and volunteers
effective and relevant?
(2) Are staff and volunteers sufficiently equipped and
trained to perform the tasks required of them?
4)
Connectedness
a) How well is the operation likely to deliver on predicted
future needs?
i.
Is the structure and strategy currently in place
sufficient to ensure an efficient and effective response
for the probable future operation?
ii.
How can the operation scale up in an appropriate
manner, considering recovery needs of the population
and capacities of operating National Societies?
IFRC Real Time Evaluation Management Response
have received limited attention; few if any volunteers from burial teams have access to direct counselling. When the
first volunteer died in Guinea on 5 December 2014, neither the GRC nor IFRC had a ready plan to support his family or
colleagues. The safety particularly of burial teams and other volunteers needs urgent attention
E.
The Guinea program organizational management issues are in need urgent attention. A strong operations manager for
the permanent position should be recruited.
F.
Guinea Red Cross volunteers face security threats in some parts of the country as a result of poor communityhumanitarian relationships, and this is jeopardizing operations. The GRC and IFRC should work with the Guinea
government and ICRC to improve security.
G. There is growing fatigue among IFRC staff at all levels. Teams have been doing excellent work against great odds, but
many feel underappreciated, and low morale is a problem in some places. This is a time for strong leadership to
demonstrate a movement-wide appreciation. The risk of burn-out and loss of effectiveness of key people in this
response is real, considering this epidemic will persist for some time.
H. The number of delegates with specialized skills in communications, psychosocial support and surveillance should be
increased, but working according to specific ToRs planned in an integrated way.
See detailed table below.
Page 6
3. Response to cross-site recommendations (pages 8-9 in the evaluation report)
1. Greater epidemiological and public health resources
Management Response
Key follow-up action/deliverable (specify responsibility for
implementation of action)
Accepted
IFRC will strengthen the technical epidemiological capacity in the field
and at the secretariat in order to ensure in-house capacity to guide
data collection, for data analysis, trend analysis and scenario planning.
Plan research on SDB to feed future IFRC interventions
Timeframe
Responsibility
JanuaryFebruary
Completed
Regional Ebola Management Unit
March-April
Technical Ebola Advisor
Timeframe
Responsibility
DecemberFebruary
Completed in
countries of
operation
Country Operations
Final
recruitment for
ECSU in
February
completed
ECSU
Ebola Coordination and Support Unit Geneva
(ECSU)
Comments:
2. Better use of information
Management Response Key follow-up action/deliverable (specify responsibility for
implementation of action)
Accepted
The report is pointing to a well-known institutional weakness.
Country Operations, Regional Hub and ECSU will be strengthened
with Information managers to ensure data collection, management
and data reporting e.g. dash-board type of products
Regional Ebola Management Unit
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
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3. Support and “duty of care” for volunteers. This takes several forms
a. Safety from contracting Ebola infections
b. Physical Safety of volunteers
c. Psychosocial support for volunteers
d. Support of Morale and non-monetary incentives, recognition and more specific appreciation
e. Prompt payment of incentives
Management response
Key follow-up action/deliverable (specify responsibility for Timeframe
implementation of action)
a. Accepted
Produce standard protocols for SDB and conduct refresher trainings
Dec-Feb
Refresher
trainings ongoing
SDB Manual
almost
completed
b. Accepted
Strengthen collaboration on the ground between RC Movement On-going
partners, including ICRC and local authorities
c. Accepted
Establish protocol for systematic debriefings and support for
ASAP
Volunteers.
Responsibility
Technical Ebola Advisor with SDB managers and
focal points
Country Operations, supported by Regional Ebola
Management Unit
Regional PSS coordinator and PSS country delegates
ECSU
Produce Anti-stigma campaign
d. Accepted
e. Accepted
Prepare certificates and medals for volunteers
February,
almost
completed
JanuaryFebruary
Ensure recognition by senior level in the Red Cross national societies On-going
in the countries
Strengthen support for financial management and speeding up December
financial procedures
completed
Regional Ebola Management Unit
Country Representatives and Operations Managers
Country Operations
Embed financial delegates in NS
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 8
b. This recommendation is particularly relevant for Guinea where physical safety of Red Cross teams continue to be a real issue. Consolidated efforts between Red Cross
Movement partners in collaboration with Guinea authorities in combination with social mobilisation training of teams struggle to provide the best possible protection of
Red Cross teams, but there is no easy solution to this issue.
4. Contact Tracing: Moving from contact tracing to active case finding
Management response
Key follow-up action/deliverable (specify responsibility for Timeframe
implementation of action)
Accepted
Retrain and repurpose volunteers to build capacity for social Januarymobilisation and contact tracing
February
In process
Comments:
Responsibility
Country Operations
5. Increased Communications. Moving from Social mobilisation and beneficiary communication to Behaviour Change Communications and mass-media awareness
Responsibility
Management response
Key follow-up action/deliverable (specify responsibility for Timeframe
implementation of action)
Partially Accepted
Refocus social mobilisation planning and communication for JanuaryRegional Ben Comms Coordinator and country Ben
behaviour change.
February
Comms delegates
Speed up expenditure of communication budgets
On-Going
Operations Managers and Ben Comms coordinator
and delegates
Strengthen regional technical capacity for Ben Comms by recruiting Recruitment
Regional Ebola Management Unit
regional Beneficiary Communications coordinator
completed in
December
Comments: This recommendation is closely linked to the Recommendation 1 above about repurposing. Mass-media awareness is only partially relevant for the social
mobilisation efforts in the forest area, where there is no access to mass-media: neither GSM, radio, TV or other and the majority of the population is illiterate.
IFRC Real Time Evaluation of Ebola Operations - Management Response
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6. Recovery Phase. Recovery efforts should start now
Management response
Key follow-up action/deliverable (specify responsibility
implementation of action)
Accepted
Recovery Assessment mission to develop plans for recovery
for Timeframe
January-March
Recovery
Mission in
motion
Responsibility
Regional Ebola Management Unit, supported by
ECSU and DCM
Comments:
7. Regional Ebola Management Unit: Need to strengthen the technical depth within communications, public health and information management
Responsibility
Management response
Key follow-up action/deliverable (specify responsibility for Timeframe
implementation of action)
Accepted
Recruit technical coordinators for communications, public health and ASAP
Regional Ebola Management Unit
information management
completed
Comments:
8. Emergency Operations Plans: Stronger emphasis on process and outcome indicators
Management response
Key follow-up action/deliverable (specify responsibility for Timeframe
implementation of action)
Accepted
Revise indicators in the upcoming operations updates, and revisions Varies from one
of appeals and EPOAs
operation to the
other
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
Responsibility
Operations managers
Page 10
4. Response to detailed recommendations per country
4.1. Guinea - response to detailed recommendations (pages 39-41)
1. IFRC organizational management
Organizational management issues in Guinea need urgent attention, including:
a) A strong IFRC operations manager with proven leadership and management capacity for the permanent position should be recruited to take over from the current
acting Operations Manager in Guinea;
Management response
Accepted
Key follow-up action / deliverable (specify responsibility for implementation of action)
The recruitment is in process. It has been difficult to recruit for this position; it has been readvertised twice as no suitable candidate was identified. The Head of Regional Ebola
Operations and the Regional Team has spent a disproportionate amount of time over the
past months to support the Guinea operation, including the HR and Logistics coordinators.
(Guinea country representative and incoming operations manager)
Timeframe
Recruitment
finalised
operations
manager
started
February
Responsibility
Country Representative
b) Attention should be given not only to IFRC office processes (timely meetings, reporting, decision-making) but also to team-building and staff morale; management
should take the initiative to congratulate and encourage staff at all levels.
Management response
Accepted
Key follow-up action / deliverable (specify responsibility for implementation of action)
The organogram and job descriptions to be improved. Staffing to be increased with the
objective of strengthening the operational set up. Team building and office routine processes
will important elements to strengthen for the incoming operations manager. (Guinea
country representative, incoming operations manager and HR Delegate)
Regular planning meetings with GRC to take place, including the establishment of the
National Coordination Commission for improved operational collaboration. First joint
planning session to take place in December between the field officer, GRC HQ and IFRC, with
the objective to contribute to a more robust operation with a higher degree of work
satisfaction. (Guinea country representative and incoming operations manager)
Timeframe
Responsibility
DecemberFebruary
Operations Manager
On-going
Country Representative
and Operations
manager
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
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2.
GRC Organizational capacity
a)
Action is needed to increase the responsiveness of GRC leadership, which is currently slow and ineffectual, due to staffing shortages and exhaustion, and also to
culture, attitudes and personalities.
b) The new National Ebola Commission within the GRC should be monitored and supported to deliver on its promise of improved decision-making.
c) Where possible, IFRC should offer more technical support and oversight to GRC on programmatic activities.
d) The IFRC should consider pushing for staff to be based in the GRC office, at least part-time (particularly a finance manager).
Management response
a)
Partially accepted
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Recruitment of country representative (Head of Regional Ebola Operations and Regional
Representative West Africa Regional Office)
December,
completed
Country
Representative,
supported by
Regional Ebola
Management Unit
b) Accepted
IFRC country operational team to participate actively in the National Ebola commission
meetings and joint field missions
DecemberJanuary,
completed
Operations Manager
c)
Create decentralised and mobile structure with more hubs for technical support and
supervision.
January
Country
Representative and
Operations Manager
Accepted
Completed
Technical Health
Delegate in place
since December
d) Accepted
Some key functions to be based at GRC NHQ, such as finance, ben comms and PMER
DecemberJanuary, on-going
Country
Representative
Finance Delegate ,
based at GRC
since December
Comments:
a) GRC leadership has been responsive under very difficult operational conditions with a complex political context in the country. The leadership is open to improvements in
the operation such as establishment of the National Ebola Commission; however dialogue is on-going for a more de-centralised operational structure to be implemented. A
new country representative has been added to provide continuous support for GRC senior management and governance.
IFRC Real Time Evaluation of Ebola Operations - Management Response
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b) There is a structure to monitor the National Ebola Commission (IFRC, ICRC, GRC), it is formalised in the TOR of the Commission.
3.
Volunteer safety and wellbeing:
a) More needs to be done to ensure the safety and wellbeing of volunteers, and to give the volunteers a sense of appreciation and respect.
b) Additional non-financial incentives should be considered immediately, including certificates that volunteers can use to gain employment after the outbreak,
celebratory events, NFIs.
c) Financial process needs attention to ensure that volunteer per diems are not delayed.
d) Competency-based on-the-job certification for volunteers is highly recommended
e) Red Cross volunteers face security threats in some parts of the country as a result of poor community-humanitarian relationships, and this is jeopardizing
operations. The GRC and IFRC should work with the Guinea government and ICRC to ensure that all RC teams are supported by local government and law
enforcement when needed.
f) Psychosocial activities need to be implemented; including one-on-one counselling for SDB volunteers.
g) The GRC and IFRC should develop a formal plan or protocol for responding to volunteer deaths due to Ebola and supporting the victim’s family and teammates.
h) The IFRC, GRC and ICRC should develop risk matrix whereby activities are suspended rather than putting volunteers at risk.
i) No further duties should be added to the list of tasks that SDB volunteers are currently asked to undertake.
Management Response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Improve volunteer training, including refreshers. PSS delegate (French speaking) to be placed
in Guinea in the field. Open hotline to PSS delegate for volunteers (Country Representative
and Operations manager)
DecemberJanuary
Country
Representative
b) Accepted
Provide gifts, medals and certificates for appreciation of all volunteers (and staff) involved in
Ebola response and organise recognition events at national level. Plan in Recovery
Assessment for financial and non-financial incentives for reintegration of volunteers into
society
February-March
Country
Representative and
Operations manager.
GRC Senior
Management
c)
Increase IFRC support for NS financial management at HQ and in the field. Embed financial
delegate in GRC. (Country Rep and Ops manager)
NovemberDecember,
completed
Country
Representative
d) Accepted
Develop standard format and system for certifying volunteers
February
Operations Manager
e)
Close collaboration on security management with local government to protect GRC teams.
On-going
Country
a)
Accepted
Accepted
IFRC Real Time Evaluation of Ebola Operations - Management Response
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Strengthen contact with local authorities, national Ebola coordination mechanisms in
Conakry and ICRC prior to sending teams to locations with tension. (Security Coordinator)
Representative and
GRC Senior
management,
supported by IFRC
Security Coordinator
f)
Accepted
Relocate PSS delegate for Guinea to be based in the field (See comment). (Head of Regional
Ebola Operations)
PSS delegate
relocated to
Guinea in
December
Regional Ebola
Management Unit
g)
Partially Accepted
Develop protocol for handling volunteer deaths. Compensation guidelines exist since
October (Operations manager, HR delegate, security Coordinator with GRC)
February
Operations manager
N.a. (See comment)
On-going
Operations Manager
On-going
Operations Manager
h) Partially accepted
* Field supervisors be reminded not to add new tasks to SDB volunteers (Operations
Manager, technical health delegate and field coordinator together with GRC counterparts)
i) Accepted
Comments:
a)
e.
This recommendation should be more specific in particular to expand on what “more” entails
One-on-one counselling may not be appropriate in this context. This needs to be explored further and evidence provided.
h. This already exists and throughout the operation there have been localities that could not be visited due to the perceived risk, and other places that would
temporarily not be visited until the risk was deemed to be at an acceptable level
4.
Program strategy and implementation
a)
The focus on SDB is appropriate; implementation is good but could be improved, particularly in terms of quality assurance: the IFRC currently has no way of
knowing if activities on the ground are, in reality, being implemented according to protocols (for example, SDB teams are meant to have 7 people, but we were
frequently told that SDB teams acted with only 5, 4 or 3 people).
b) The IFRC should conduct an immediate rapid assessment to determine the current gaps/needs of volunteers in terms of facilities, supplies, and numbers of
volunteers.
c) Supervision and quality assurance needs attention: a plan is in place for recruitment and deployment of mid-level managers/supervisors throughout the country,
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 14
and this needs to be executed as a matter or priority.
The network of non-SDB volunteers (currently inactive) needs to be re-activated for social mobilization through intensive training and a dedicated campaign.
The IFRC should recruit delegates with health promotion and BCC/C4D skills who can liaise with UNICEF and other partners.
Implementation of two or three phase simultaneous operational approach – emergency rapid response and preparedness/recovery
IFRC leadership should meet with other sector-lead organizations to determine how Red Cross volunteers could be used to fill gaps in other pillar activities in which
they are not currently active (e.g. village-level communication, contact tracing, psychosocial support to community members).
h) IFRC should discuss with GRC slow financial acquittal, resulting in late payment of volunteers
i) Monitoring and evaluation to support GRC decision making and resource mobilisation
j) Engage more in contact tracing, possibly join efforts with other organisations with volunteers perhaps being supervised directly by UNFPA
k) Increase information and M&E resources or negotiate for more relaxed reporting requirements
d)
e)
f)
g)
Management Response
a)
Accepted
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Finalise SDB protocols. Strengthen technical capacity for supervision at field level. Recruit
more technical health advisers
SDB protocols
almost ready. 2
health advisers
recruited in
DecemberJanuary
Regional Technical
SDB Coordinator and
Technical Ebola
Advisor
b) Accepted
Conduct assessment ASAP and train new volunteers. Double numbers of volunteers.
December,
completed
Operations manager
a.i. and country
representative
c)
Recruitment of field coordinator asap, support GRC filling field middle management positions
at field level
ASAP
Country
Representative and
GRC
d) Accepted
Activate passive volunteers and mobilise for Ebola operations. Double number of volunteers
Completed
GRC and Operations
Manager
e)
Recruit technical health delegate and BC delegate to work with new and existing partners to
improve social mobilisation and communication strategies
Experienced BC
delegate in place
since October:
Recruit health
delegate
December ,
completed
Country
Representative and
Operations Manager
Accepted
Accepted
IFRC Real Time Evaluation of Ebola Operations - Management Response
Completed
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f)
g)
Accepted
Accepted
Conduct Recovery Assessment to address recovery needs at the same time as adapting
response for rapid response
January-February
Pushed to MidMarch
Regional Ebola
Management Unit
and Country
Representative
Same as above in b)
In process
See b)
h) Accepted
Same as c)
i)
Accepted
Increase capacity for M&E and on-going management support
On-going
Country
Representative
j)
Partially accepted
Re-craft operation and repurpose volunteers to engage in active contact finding instead of
SDB.
February
Operations Manager
and GRC
k)
Accepted
Strengthen information management capacity on the ground to complement PMER and
produce more robust data
Recruit IM
delegate January
Country
Representative
See c)
complete
Comments: j. leaving management responsibilities and supervision to UNFPA could potentially be compromising the principle of independence, and would not be
acceptable
IFRC Real Time Evaluation of Ebola Operations - Management Response
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4.2. Sierra Leone - response detailed recommendations (pages 60-61)
a) Invest in resources to capture and maintain a strategic epidemiological view of the epidemic to get the Red Cross activities proactive and ahead of the curve
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Partially accepted
Strengthen epidemiological technical capacity, recruiting more epidemiologist delegates and Asap
Operations manager
training and quality assurance supervisor
Training
and Regional Ebola
supervisor
Management Unit
recruited January
Comments: This recommendation applies to all countries to some extent, not only Sierra Leone. IFRC in general should strengthen its capacity within Public Health in
Emergencies.
b) Strengthen Red Cross capacity to take the long-term view in making predictions and scenarios and prepare responses
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Partially accepted
See a.
See a)
See a)
Comments: This recommendation applies to all countries to some extent, not only Sierra Leone. IFRC in general should strengthen its capacity within Public Health in
Emergencies.
c) Where arrangements can be coordinated with local response management, involve volunteers in more comprehensive contact tracing and active case finding.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Accepted
Scale up within contact tracing and case surveillance capacity of NS, train more volunteers
On-going
Operations Manager
and SDB Coordinator
with SLRCS
Comments:
d) Initiate provision for assistance to households affected by loss of family members and loss of assets in the decontamination process.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
response
IFRC Real Time Evaluation of Ebola Operations - Management Response
Responsibility
Page 17
Accepted
Review existing guidelines for compensation of lost household items destroyed in disinfection and
revise support for household recovery. Conduct recovery assessment
Asap
Recovery
Assessment in
February
Operations Manager,
and SDB coordinator,
Comments:
e) Improve volunteer and staff personal safety from Ebola Refresher courses and Red Cross identification for volunteers and timely payment of incentives.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Accepted
Revise volunteer conditions and safety guidelines and review schedule and content of refresher January-February Operations Manager
trainings
with SLRCS
Comments:
f) Plan a long term support and recognition activity for the volunteers who have been engaged in the Ebola operation
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
response
Accepted
Review plans for retraining and repurposing volunteers as a part of a long-term volunteer
retaining strategy
Comments:
Timeframe
Responsibility
February
Operations Manager
with SLRCS
g) Strengthen information analysis and management for use in decision making starting from branch to the regional level. E.g. use a data dashboard.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Partially accepted
See above a. and b.
IM Coordinator to Country Representative
be recruited asap
completed
Comments: This recommendation applies to all countries to some extent, not only Sierra Leone. IFRC in general should strengthen its capacity within Public Health in
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 18
Emergencies.
h) Due to large amount of funds involved and the complex, changing nature of the operation and for the protection of program staff, consider an interim internal
audit.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Rejected
Comments: IFRC carries out regular audits according to the annual financial procedure. Regular monitoring of programmes lead to programme adjustments as per need.
i) Establish a rapid response team to manage a possible flare up in areas that are showing a decline in new cases and possibly after the end of Ebola incidence.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Accepted
Establish agile rapid response capacity for new transmission hotspots
On-going
since Operations Manager
November 2014
Comments:
j) Review the communications strategy at the regional level the secretariat and the SLRCS to see how this can be made more effective now and in future disasters.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Accepted
Include review of communication strategy as part of NS preparedness within the recovery plan
February
Communications
Delegate and Country
Representative
Comments:
k) Organize regular refresher rouses and reviews with an incident reporting system for any potential inadvertent exposure to Ebola virus
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
response
Accepted
See above e.
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
Responsibility
See e.
Page 19
l) Document clinical management at Kenema including a detailed assessment of patient characteristics and outcomes
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Rejected
Comments: Documentation has been done throughout. Suggesting improvements at the time of scaling down Kenema ETC is not relevant, nor timely, but will be taken
as a recommendation for the future running of ETCs
m) Improve on the payments of incentives for the staff and volunteers engaged in the Ebola operation.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
response
Accepted
Increase IFRC support for NS financial management at HQ and in the field
Comments:
n) Branches need to improve timely paperwork and returns to ensure payments are not held up.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
response
Accepted
Increase IFRC support for NS financial management at HQ and in the field
Timeframe
Responsibility
On-going
Timeframe
Responsibility
On-going
Operations Manager
and Finance
Coordinator
Timeframe
Responsibility
December,
completed
Operations
and SLRCS
Comments:
o) Process and distribute volunteers ID cards or t-shirts identifying them with the Red Cross
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
response
Accepted
Distribute items to strengthen Red Cross volunteer identity and visibility
Manager
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
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p) Review activities which are underspent to determine how resources could support additional initiatives to hasten elimination efforts.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
response
Accepted
See above m. and n.
Responsibility
Operations Manager
and Finance
Coordinator
Comments:
q) Initiate regular staff and volunteer counselling or at least debrief activity for staff and volunteers, especially those in physically exhausting and stressful situations.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Partially accepted
Make PSS debriefings available for volunteers and staff in a systematic way
ASAP
PSS delegate, supported
by Regional PSS
Coordinator
Comments: Counselling on a one-on-one basis may not be appropriate. This needs to be explored further and evidence of appropriateness provided
r) The Red Cross in Freetown should look for some additional office space to accommodate functions during the duration of the Ebola response.
Management
Key follow-up action/deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
response
Accepted
IFRC should support SLRCS in identification and financing of bigger and functional workspaces to February-March
Country Representative
host the Ebola response
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
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4.3. Liberia – response to full list of recommendations (pages 80-81)
Recommendations based on the three control principles (1. Recognition of the Ebola infection, 2. Infection prevention and control measures, 3. Treatment of those
suspected and confirmed)
1) The Red Cross in Liberia has contributed substantially to the first two elements through contact tracing, communications and social mobilization. These should be
strengthened and reinforced.
2) The hub strategy for rapid response is a sound concept and should be implemented in a timely manner
3) Further information is needed about the communities served. Survey data need to be collected and analysed in a robust manner.
4) Information systems should be strengthened so that there is a better understanding of implementation and results data being generated by the project.
5) The Community risk reduction strategy is a sound strategy and should be implemented, particularly in the hot spots where there is not easy access to treatment
beds.
6) The ”duty of care” responsibilities toward volunteers should be strengthened
9.4 DETAILED RECOMMENDATIONS FOR LIBERIA
a)
The SDB activities have been carried out in an exemplary manner and are a great credit to the dedication and commitment of the volunteers and the support of the
LRCS and the technical direction from the IFRC; this is transitioning to a new phase from cremation to burial. At the end of this process, the IFRC should develop a
manual building on the experiences and lessons learnt from the SDB program
Management response
Accepted
Key follow-up action/deliverables
Develop SDB manual on the experiences gained from the SDB programme in Liberia
Timeframe
Manual: JanuaryFebruary
Lessons learned
workshop May-July
Responsibility
Regional Technical Ebola
Advisor, SDB Coordinator,
SDB Manager
Comments:
This will be a regional SDB manual, covering all three countries
b) Strengthen the project information system, and making better use of the data collected for analysis of pattern and trends. An example would be the analysis of
contact tracing data to better understand the behaviour of the epidemic at the community level.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Strengthen epidemiological technical capacity, recruiting more epidemiologist delegates and
training and quality assurance supervisor.
December –
January, Ongoing
Operations Manager
Strengthen general IM capacity all across the Ebola operations
December –
Regional Ebola
IFRC Real Time Evaluation of Ebola Operations - Management Response
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January,
Completed
Management Unit
Comments:
c)
The insufficient collection and use of information further emphasizes the need for at least regional epidemiological capacities to help country programs get ahead
of this evolving epidemic, rather than just being reactive. While the epidemic will most certainly be eliminated, and probably first in Liberia, enhancing systems to
more effectively respond will shorten this time.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
DecemberRegional
Ebola
Strengthen general IM capacity all across the Ebola operations
January,
Management Unit
completed
Comments:
d) Consider a humanitarian assistance component to help recovery of Ebola survivors and affected household members. Now that the epidemic is ebbing out in
Liberia, many steps can be taken within the context of the current Appeal to relieve suffering and reduce stigmatization. This would strengthen connectedness.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Revise support for household recovery. Conduct Recovery Assessment and develop
strategies for improving the social-economic status of the households affected by EVD. (See
also 7b)
February - April
Country
Representative and
Operations Manager
With LNRCS
Comments:
e) Beneficiary communications have been very effective, but these have been largely unidirectional. There seems little up-communication from the beneficiaries.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Strengthen beneficiary communication activities, including KAP surveys and follow up,
On-going
Beneficiary
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 23
ensuring strengthening two-way communication and beneficiary feed-back. (See also 5c)
Communication
Delegate
Comments:
f)
Needs assessment is stressed in the IFRC approach to emergency management, and as part of this community surveys are a standard for needs assessments and
understanding beliefs, knowledge, attitudes and practices. This seems to have been omitted in the Liberia Ebola response, but help the planning for moving
forward.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Strengthen beneficiary communication activities, including KAP surveys and follow up,
ensuring strengthening two-way communication and beneficiary feed-back. (See also 11 and
5 c above)
On-going
Beneficiary
Communication
Delegate
Comments:
g)
Much of the Ebola work has focused on the SDB. As the epidemic has entered a new phase of small localized outbreaks the Red Cross can make some shifts toward
volunteers participating with the County Health Teams more fully in community based surveillance and active case finding. This would be moving up from the
Contact Tracing now on going, but using the same structures and resources. Enhanced surveillance is an important need at this stage.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Scale up within contact tracing and case surveillance capacity of NS, train and repurpose
more volunteers. (see 5b above)
On-going
SDB Manager, Health
Coordinator
Establish agile rapid response capacity for new transmission hotspots
On-going
Comments:
h) A major recommendation is to reassess what support can be provided to volunteers. This falls in several categories:
a.
The safety of volunteers from infection must be strengthened. This will require refresher training for those coming into contact with contamination.
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 24
b.
c.
d.
e.
Quality control elements are needed for volunteers.
Physical safety of the volunteers in some places is a concern. The RTE team were not able to determine what physical safety monitoring and response
capacity is in place, but this should be reassessed
Volunteers working in other areas need regular refresher training and regular supervision as well, something that is being done, but could be
strengthened.
Psychological support is needed for volunteers working in particularly hazardous or stressful situations through an established system. Many are feeling
the effects of the stressful work, and some ad hoc arrangements exist for psychological support of volunteers, but this should be regularized.
The success of the Red Cross efforts is due to its dedicated network of volunteers. A plan for formal recognition of volunteers when Ebola is eliminated
should be developed. As many volunteers were students before schools closed, scholarships were frequently suggested.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
a.-c.. Accepted
Improve volunteer training, including refresher. Review schedule and content of refresher
courses. Revise volunteer conditions and safety guidelines
On-going
Operations Manager
with LNRCS
d. Accepted
Make PSS available to the volunteers
ASAP
PSS Delegate
e. Accepted
Provide gifts, medals and certificates for appreciation of all volunteers (and staff) involved in
Ebola response and organise recognition events at national level. Plan in Recovery
Assessment for financial and non-financial incentives for reintegration of volunteers into
society.
February- March
Country
Representative with
LNRCS senior
management
Comments:
i)
The Hub Strategy which will concentrate Red Cross response capacities in key areas is an excellent move which should be encouraged moving forward. The
community protection kits, assisted by UNICEF, need to be pushed forward where the situation is appropriate.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Speed up the Hub Strategy and align it with the country plan for Zero transmission. Revise
the focus of the Hubs from urban to rural and address new hotspots.
January - February
Operations Manager
Comments:
IFRC Real Time Evaluation of Ebola Operations - Management Response
Page 25
j)
The Psychosocial Support program has been an important success. Thinking beyond the Ebola outbreak, this could be adapted to provide psychosocial support for
the many other everyday events happening in the communities.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Include PSS as part of the Recovery Assessment and develop community based PSS strategies
for improving the well-being of the households affected by EVD.
February - April
Country
Representative, PSS
Delegate with LNRCS
counterparts
Comments:
k)
Financial management seems sound. The Ebola response is underspent, so this provides an opportunity for expansion of initiatives in several areas noted here.
Alternatives should be sought to transferring large amounts of money in Red Cross vehicle on predictable dates to pay incentives to volunteers.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Appeal revision, and speed up financial expenditure according to plans
On-going
Operations Manager
Identify alternative ways to transfer funds to the field offices to reduce risk of transporting
large cash amount in Red Cross vehicles.
February
Finance Coordinator
Comments:
l)
Improvements in relevance of TORs for IFRC delegates in some areas should be improved. Handovers also could be improved in some cases.
Management response
Key follow-up action / deliverable (specify responsibility for implementation of action)
Timeframe
Responsibility
Accepted
Ensure all positions in the team have an updated job description that matches the revised
plan of action.
February
Operations Manager
February
Regional HR
Coordinator
Strengthen HR guidelines for debriefing and handover notes.
Comments:
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