The Hunt for Ebola: Building a Disease Surveillance System in Liberia, 2014–2015

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Abstract 

When the first cases of Ebola virus disease appeared in Liberia at the end of March 2014, a critical first step in preventing an epidemic was to identify those who had contracted the virus. However, Liberia’s disease surveillance capacity remained feeble in the wake of a 14-year civil war that had weakened the health system, and citizens’ distrust of the government sometimes raised risks for public health teams dispatched to carry out that vital surveillance function. In August, as the number of new infections began to escalate, the government and its international partners shifted to a proactive strategy. Rather than wait for families to call for help, they began to engage local leaders and community health workers in hunting the disease. They also developed data management practices to more effectively track and analyze the evolution of the epidemic. By year-end, most of the new Ebola infections involved Liberians who were already under observation. In another important measure of success, the time between patients’ onsets of symptoms and their medical isolations shortened markedly. The ability to hunt down Ebola slowed the spread of the disease and helped bring an end to the epidemic in May 2015.

Leon Schreiber and Jennifer Widner drafted this case study based on interviews conducted in Monrovia, Liberia, in April and May 2016 and with international organizations from June to August 2016. Béatrice Godefroy provided initial guidance.

Princeton University’s Health Grand Challenge supported the research and development of this case study, which is part of a series on public management challenges in the West African Ebola Outbreak response.

 

Timeline: West African Ebola Outbreak (infographic)

Keywords 
contact tracing
emergency response
disease outbreak
epidemiological modeling
pandemics
data management
quarantine
infection control
incidence management system
Focus Area(s): 
Ebola Response
Critical Tasks: 
Action plans
Aligning policy and budget
Community policing
Consensus building
Coordination
Donor coordination
Follow-up & monitoring
High-yielding varieties
Inter-ministerial coordination
Monitoring
Organization and staffing
Priority setting
Scenario building
Core Challenge: 
Capacity (capability traps)
Coordination
Credibility (trust)
Country of Reform: 
Liberia
Type: 
Case Studies
Author: 
Leon Schreiber and Jennifer Widner