Liberia has met 73% of its target of having 1733 beds for Ebola patients. This target bed capacity counts the spaces at ETUs and does not include space at Community Care Centers (CCCs). As of December 2nd there were 657 free beds across Liberia, from a total of 12 Ebola Treatment Units (ETUs). There is a focus on building ETUs in the underserved counties, with 19 ETUs and 21 CCCs scheduled to be built, but recent declines in Ebola cases leave us wondering if this is still the best strategy.
While ETUs are staffed by medical personnel, the CCCs are staffed by the family members of patients. The CCCs are often built in places where an ETU is not easily accessible and serve primarily as a temporary care site until patients can be moved to an ETU. They are designed to get patients into isolation quickly in order to reduce transmission by limiting their contact with family to the single person that has agreed to care for them.
Current ETU and CCC Locations
Bomi County currently has one active ETU with a capacity of 20 beds. A CCC is planned to be built in order to support the ETU.
Bong County has a single ETU that has a capacity of 51 beds. One CCC is planned.
Lofa County has one 40 bed capacity ETU in operation. Two new ETUs and one CCC are planned to help support the ETUs.
Margibi has two ETUs that combined can handle 51 patients. Additionally they have one CCC. A third ETU is planned.
Montserrado County currently has 5 ETUs including those in Monrovia, totaling 552 beds. There are four more ETUs planned in Montserrado and one ETU that has been completed and is intended to open as a training site. In addition, there are four CCCs that are scheduled to be built.
Nimba County has one 36 bed ETU in operation. Two ETUs are planned. In addition there are three CCCs that are scheduled to be built.
River Gee has no ETUs but one functioning CCC. There is one ETU and one CCC scheduled to be built.
Grand Bassa has no ETU but one CCC. There is one ETU and one CCC planned for the county.
Gbarpolu currently has no ETU or CCC but there is one ETU and two CCCs planned.
Sinoe County currently doesn’t have an ETU or CCC, but there are two CCCs that are planned.
Grand Cape Mount, Grand Gedeh, Maryland, River Cess, and Grand Kru, counties all don’t have an ETU or a CCC. However, there is plan for one ETU and one CCC in each of these counties.
Locations for ETUs are chosen based on a number of factors including the size of the population, the intensity of the epidemic in an area, and their accessibility to vehicle transportation. The map below shows the population information of different counties in Liberia based on a survey in 2005. The map details the differences in population density across the counties, and helps us to understand how the development of some of the ETUs and Clinics have been prioritized, and the challenges of setting up ETUs in some counties, like River Cess, where population density is lower.
Is Building New ETUs The Best Strategy?
There is a need to guarantee that all counties are able to properly treat Ebola patients, but we want to ensure that the Ebola response is being flexible and actively addressing the highest needs. Rates of admittance to the ETUs have been dropping over the last several weeks. ETUs take 1 to 2 months to complete, but the construction is just a small part of the time it takes for a facility to open because it’s dependent on negotiations with NGOs and international partners, trained health workers availability, adequate incentives and benefits, medical supplies, equipment, transportation, and accommodation for international staff. As a result opening a CCC is much faster than opening an ETU because one medical provider can monitor multiple facilities.
When looking at the distribution of ETUs and CCCs and then comparing it to data on Ebola cases we found that the majority of cases are coming from counties that have multiple ETUs, with the exception of Sinoe. On December 1st it was reported that there were 12 new cases in Montserrado County, 5 new cases in Margibi, 3 in Bong, 2 in Grand Bassa, and 1 in Sinoe. The southern portion of Liberia doesn’t have an ETU and Maryland and River Gee counties both have large population centers but there were no reported cases there for Dec 1st.
There is no question that areas that currently have no active CCC or ETU need assistance in dealing with Ebola patients; However the decisions to build these facilities were in part based on data of the number of cases in an area which is now outdated. The time delay in establishing ETUs makes us question whether the establishment of the ETUs is still the best way to assist communities at this point. Additionally, the reported cases being confined primarily to areas with ETUs has us question what reporting processes are set up to report Ebola cases outside the established clinics? Are there really no new cases in some counties areas? Or is the lack of facilities limiting the accuracy of the data? Is the continued focus on establishing ETUs in part to more accurately gauge the Ebola rates in these areas? And if the Ebola reporting is accurate across the counties, then what is the plan for the ETUs that are being built and will likely go unused?