From Ebola to COVID-19: Lessons in Digital Contact Tracing in Sierra Leone

An Interview with Vamba Lolleh, Partners In Health

Vamba Lolleh is no stranger to using digital health tools for infectious disease response and contract tracing. As an electronic health officer for Partners In Health (PIH), Sierra Leone, he and his organization were instrumental in responding to the 2014 Ebola outbreak. Yet as COVID-19 spreads, Vamba filled us in on how many of the lessons learned haven’t been as seamless to carry out as hoped.

Early in the COVID-19 response, Sierra Leone, alongside other West African countries, implemented infection control measures that were used during Ebola. Successful programs to stop the spread of misinformation through the use of radio and TV were quickly adapted for COVID-19. An aptly named policy called ‘less touching,’ aimed at reducing contact points between people was resurrected, and ‘selective quarantine’ was put in place for high-risk individuals. Yet as the government took steps to mitigate the spread of COVID-19, unprecedented challenges emerged.

According to Vamba, contact tracing, for example, has proved more difficult. During Ebola, it was one of the most effective strategies for identifying and controlling new cases. Through the use of CommCare, a digital platform developed by Dimagi, Vamba and his team were able to collect, store, and manage critical data in real-time. The tool was lauded as an essential aspect of the response; it was widely used by those on the front lines of the epidemic, and its lack of reliance on internet connectivity meant that it had utility in all parts of the country. 

Yet despite the success of CommCare during the Ebola outbreak, digital engagement hasn’t been as central in the COVID-19 response. According to Vamba, there are no digital tools being used for COVID-19 contact tracing in Sierra Leone.  

The Ministry of Health and Sanitation (MoHS) has taken steps to identify potential digital health solutions for their COVID-19 response, largely through the creation of an E-Health Technical Working Group, which Vamba is participating in. During these meetings, it became clear that the barriers to swift decision making and adoption of a digital contact tracing tool have been high, which is leading to delayed data collection on the ground and incomplete reporting. While the country is currently using a paper-based contact tracing system, Vamba believes that CommCare could still have potential. As he explains, “we have used this tool for five years now, we have over 100 Community Health Workers who know how to use it [CommCare].”

We asked Vamba why the digital response to COVID-19 was so different from that of Ebola. One of the biggest factors, he explained, was that as soon as the Ebola outbreak was controlled, many of the international NGO’s that used digital tools, quickly left Sierra Leone. “All the organizations that came to support the Ebola response, they brought lots of good programs and tools. But when they left, the programs were not handed over to the MoHS. The tools that existed during Ebola are not here anymore,” he noted. While Vamba believes the MoHS should be the organization leading the pandemic response, he acknowledges that they were left to start from scratch. “There are a lot of lessons that were learned during the Ebola response that could help with COVID-19 but those lessons were not shared with the Ministry,” Vamba said.  

As the government tries to get a handle on the burgeoning health crisis, a lack of essential resources is hampering their efforts. Sierra Leone continues to battle shortages in personal protective equipment and testing-kits, and their laboratory diagnostics capabilities are limited. Healthcare personnel have gone on strike, a situation that mirrors difficulties faced during Ebola. The pandemic has only exacerbated healthcare challenges that existed before the crisis; including a weak healthcare infrastructure, limited funding for the health sector, and a shortage in medical personnel.

While organizations like PIH continue to carry out their existing programs while supporting the COVID-response, Vamba says they are eager to continue to work with MoHS on a shared mission of reducing suffering and saving lives. Collaboration, both regionally and within government agencies, was critical in ending the Ebola outbreak; a lesson that can and should be applied to fight the COVID-19 pandemic. Vamba’s biggest takeaway after working and living through Ebola and now COVID-19? “The sustainability of the programs is what is actually important.” 

To get in touch with Vamba Lolleh, you can email him at: vlolleh@pih.org

To learn more about Partners in Health – Sierra Leone, follow them on Twitter @pihsierraleone