Improvements to the Ebola Response Structure
MOHSW developed plans to further refine the command and control structure; develop an IMS general staff section to support the scientific response section with logistical, administrative, and planning components; identify how best to link the national IMS to the county-level response and external partners; and improve the organization of IMS meetings to ensure response objectives had clearly identified action items and that these action items were acted upon. Where possible, efforts were made to work within the existing MOHSW framework to facilitate implementation of the changes (Figure 2).
Ministry of Health and Social Welfare Ebola response incident management system — Liberia, August 2014
* Including the World Health Organization, CDC, Medécins Sans Frontières, UNICEF, and the U.S. Agency for International Development.
Regarding command and control, on August 10, 2014, the Minister of Health and Social Welfare appointed an incident manager (IM) responsible for only the Ebola response, chairing a 9:00 am incident management meeting, and establishing, following-up, and adjusting the response priorities and objectives. This allowed the deputy health minister/chief medical officer to focus on other pressing, non–Ebola-related public health activities. In terms of organizational structure, a deputy IM, operations chief, and planning chief were identified. The deputy IM had the authority to step in and function as the IM, to ensure the response continued to have command and control when the IM was in higher level coordination meetings related to the response. The deputy IM also convened and guided a regular logistics meeting attended by MOHSW and partners with logistical interests or resources and chaired a subcommittee to address county level issues. This county-specific subcommittee served as the forum where technical, administrative, and logistical needs for the county responses could be raised. The deputy IM and all technical and general staff committees reported directly to the IM. With respect to IM meetings, each key Ebola response committee was instructed to have the chair (or an alternate with decision-making authority) attend. An agenda was implemented that focused meeting discussions on the key actions completed during the previous 24 hours, actions to be completed during the next 24 hours, and major challenges being faced. The meetings also included a representative from the logistics and finance section (responsible for keeping track of the financial resources available to MOHSW for the managing the response). These changes allowed for more regular reporting of key logistical items to the IM, such as availability of personal protective equipment and regular budget status reports. A task listing was implemented assigning responsibility and due dates for action items as they were identified, and more detailed meeting minutes were prepared and issued the same day as the meeting. The addition of logistical and financial/administrative general staff facilitated completion of the objectives identified by the IM. When expertise did not exist within MOHSW, assistance was sought from other response partners (e.g., logistics support was sought from the United Nations Mission in Liberia, given the mission is a well-resourced organization in Liberia with a track record of timely and efficient movement of personnel and equipment across the country). To facilitate the ability of MOHSW to reach out to external partners, the IMS included liaisons with key external stakeholders involved in the coordination of international partners and provision of essential supplies and technical expertise, such as WHO, CDC, Medécins Sans Frontières, UNICEF, and the U.S. Agency for International Development (Figure 2).
The revised IMS structure did not replace the national task force, which consists of a higher-level interministerial coordination group and key external partners. Thus, ongoing work is need to integrate the MOHSW response structure into this overarching national Ebola response framework. Also, the current "planning horizon" is about 24 hours. Continued development of a planning section in the IMS, to look beyond this limited timeframe, is required to anticipate potential problems and develop contingency plans.
Morbidity and Mortality Weekly Report. 2014;63(41) © 2014 Centers for Disease Control and Prevention (CDC)