By Thokozani Kalua
It has been a year since the Ebola outbreak was declared by the Guinean government on March 21 2014. Over 24 700 cases and 10 194 deaths later (as of March 18 2015), the outbreak seems to be getting under control. All the 150 new confirmed cases in the week prior to March 18 2015 were from Guinea and Sierra Leone only. This is tremendous progress considering that at the peak of the outbreak, there were hundreds of new cases every week.
Since the discovery of Ebola in 1976, there have been over 20 outbreaks. The current outbreak is the largest and most complex. It has involved major urban areas, affected over one country and persisted for as long as it has.
Several reasons have been proposed as responsible for the magnitude of this outbreak. One reason, which has been echoed over and over, is the fragile health systems at the onset of the outbreak in the most affected countries of Guinea, Liberia and Sierra Leone. A health system is comprised of health services; health workforce; health information; medical products, vaccines and technologies; health financing and leadership and governance. In the most affected countries there was inadequate health workforce, poor infrastructure and weak systems for logistics, health information, surveillance, governance and drug supply systems.
However, these challenges are not unique to those three countries. They are common to many African countries, including Malawi. In our country, there are tremendous shortages of healthcare workers with less than 50 percent of the required number of nurses and doctors. Many people live far from a healthcare facility. Drug shortages are not uncommon. Running water and electricity are absent or unreliable in many facilities. Hospitals are filled beyond capacity with patients sometimes sharing beds. Infection prevention and control measures are not adequately upheld. Despite Ebola preparedness efforts that the country has done, Malawi’s health system is ill-prepared to handle a public health threat of the nature of Ebola.
As the Ebola threat diminishes, we need to learn some lessons to help us build a resilient health system which can prevent and withstand such public health threats. One lesson is that we ought to strengthen partnerships across the borders in matters of public health. An outbreak anywhere can be a risk everywhere, especially with the ease of travel in the global village we currently live in. This is truer between neighbouring countries. Coordinated interventions between affected countries and their neighboring countries have prevented further spread of the outbreak in western Africa.
Another lesson is that we need to make substantial investments in broader health systems strengthening strategies. It is not enough to channel aid or resources towards disease-specific interventions without also developing the overall health system. It is not adequate to make investments in health through non-governmental organisations without considerable use of the public institutions so that they too can be strengthened.
One more lesson is that we should strive to uphold international agreements in health that we are part of. One important agreement is the 2005 International Health Regulations (IHR). The IHR proposes core capacities which when achieved will enable the country to detect, assess, report and respond to events of public health concern. It came in force in 2007 and all 194 member countries were obligated to achieve the core capacities by 2012. By the deadline only 42 countries had achieved them, none of them in Africa. It is only now years after the deadline that Malawi is doing an assessment of the core capacities for IHR. Another important agreement in health is the 2001 Abuja Declaration. This was a pledge that the countries signatory to it would allocate at least 15 percent of the national budgets to the health sector.
Upholding agreements in health such as the IHR and the Abuja Declaration would enable the country to build a robust health system. This is of benefit to the country and also to the global community, as the global public health is only as strong as its weakest link.
Previously, there have been threats such as severe acute respiratory syndrome, avian influenza, and now Ebola. This may pass but it is only a matter of time before there is a reemergence of such a threat or emergence of a new threat. It is imperative that when that happens as a country we should be prepared to protect our population. I believe the answer is in a strengthened healthcare system. n
The author is deputy coordinator of the Ebola Coordination Unit. The opinions expressed in this article are solely his own