A man at Texas Health Presbyterian Hospital in Dallas tested positive for Ebola September 30th, the first case of the disease to be diagnosed in the United States. According to many experts, it was only a matter of time.
Health officials in the U.S. have been preparing since summer in case an individual traveler arrived here unknowingly infected. With stringent isolation protocols in place, infection-control steps to prevent the virus from spreading in health facilities, and efforts to trace people who have had close personal contact with the ill person, the director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, was confident addressing media, saying “I have no doubt that we will contain this.”
But in West Africa, the Ebola epidemic is a sobering reminder of the lethal consequences of limited infectious disease surveillance and response capacities, and the vast development needs that persist in some of the region’s poorest countries despite rapid economic growth and investment.
At the heart of the Ebola epidemic sweeping across Africa, is a matter of health systems.
Health workers in personal protective equipment (PPE) wait to enter the hot zone at Island Clinic / Morgana Wingard
Much like cholera preys on weak water systems after a disaster, Ebola is preying on a weak public health system after years of conflict and upheaval in Liberia. And health system performance in many partner countries is challenged by critical health worker shortages, inadequate ﬁnancing, poor or disjointed information systems, lack of essential information on public health threats, and inexperienced leadership.
Countries that already have limited ability to provide health care for their citizens can ill-afford to lose health care workers to sickness and death, close health facilities, or redirect resources for other development priorities to battle this epidemic.
As Ebola spreads, citizens are impacted not just by the virus itself, but also by the loss of other critically needed services. As hospitals and clinics become overwhelmed by the epidemic, they are unable to provide necessary maternal and child care and life-saving treatment for malaria, tuberculosis and other diseases.
Dr. Ariel Pablos-Mendez, USAID’s Assistant Administrator for Global Health, said, “The state of the health workforce and health systems has hampered the ability of these countries to respond to the Ebola epidemic – but these countries are hardly alone in having inadequate training, support and numbers of health workers.”
Zaira Alonso, a finance and administration director for USAID’s Rebuilding Basic Health Services project in Liberia implemented by John Snow International, paints a bleak picture. “The entire Liberian landscape has changed dramatically in just a matter of weeks. Many government ministries are practically empty, as non-essential staff were placed on 30 days compulsory leave. Roads are empty, as many Liberians are staying at home to remain safe, and a large part of the expatriate community has left the country. Most people are just simply scared.”
The U.S. Government, including USAID and Centers for Disease Control and Prevention, the World Health Organization, and others are using a broad disaster management approach to contain the epidemic. Since the spring of 2014, the United States has been providing health equipment and emergency supplies, training and supporting health care workers on infection control and case management, supporting public outreach campaigns and helping build the capacity of local health care and emergency response systems.
As part of the overall U.S. Government response effort, the United States recently provided support to the African Union’s urgent deployment of trained and equipped medical workers to West Africa to help combat the Ebola epidemic. This support is helping transport doctors, nurses and other essential personnel to manage and run Ebola treatment units that isolate and treat those affected by the disease, helping minimize the spread of Ebola. It will also provide urgent emergency supplies and health equipment to help these medical workers respond.
A health care worker checks on patients admitted to the Ebola Treatment Unit in Island Clinic. / Morgana Wingard
And President Obama earlier this month announced a major surge in U.S. assistance in West Africa to help recruit, organize and train new health care workers and build treatment clinics.
Adding qualified and trained health workers will make a big difference. Guinea, Liberia and Sierra Leone are among 83 countries worldwide that the WHO last year reported to have below the minimum ratio of doctors, nurses and midwives (22.8 per 10,000 people) needed to provide basic health services to a population. WHO and the Global Health Workforce Alliance estimate at least 7.2 million doctors, nurses and midwives are currently needed globally – a gap that could creep to nearly 13 million by 2035 if we keep with the status quo.
Dr. Larry Barat, senior advisor with the U.S. President’s Malaria Initiative said one distinguishing factor of countries in Africa that have controlled malaria from those who still struggle to do so is the functionality of their health systems and their skilled human capacity. “Countries like Rwanda, Senegal, Ethiopia and Zambia have successfully reduced malaria burden, in part, because their health systems are able to deliver essential commodities to all parts of their countries, and people can access health services, with trained personnel.”
Haja Wurie, of COMHAS and the ReBUILD Consortium in Sierra Leone, where she has been working on health systems research, painted a vivid picture of a health system already weakened by years of war. Ebola first hit isolated, remote communities with limited access to health services. Their reliance on traditional healers and informal providers of health care may have exacerbated the spread of the illness. “Health staff face a very uncertain future as they bravely respond to Ebola,” she said. “They have inadequate supplies of the commodities they need to protect themselves. Many have watched their colleagues succumb to the illness die. They need urgent support and solidarity from the international community to motivate and incentivise them to face the tough times ahead.”
The Ebola epidemic reminds us that our global efforts to build the capacity to prevent, detect, and rapidly respond to infectious disease threats like Ebola have never been more vital. If we use all of our might to ramp up the response to Ebola while also investing in strengthening critical health care systems (including the components that prevent, detect, and respond to infectious diseases), we can help bring the current epidemic under control and reduce the possibility of future outbreaks.