In September and December 2014 the UK International Development Select Committee held enquiries into the Ebola response. They are currently looking at what the international community is doing to improve the international response for future disease outbreaks.
Ebola, Neglected Tropical Diseases (NTDs) and Liberia
To support the Committee, COUNTDOWN, hosted by LSTM, submitted written evidence based on their experience in Liberia. COUNTDOWN has partners in Ghana, Nigeria, Cameroon and in Liberia our work is led by the Ministry of Health.
That the Ebola outbreak became so significant in post-conflict countries is no surprise. COUNTDOWN's donor DFID has made a commitment to better understanding and supporting the health system development of states which have been affected by conflict and crisis as evidenced by their support of the ReBUILD research programme consortium. COUNTDOWN research in Liberia enables us to complement this learning through the lens of NTDs.
Pre-existing health investments in Ebola-affected countries should be used to lever system-wide improvements in health. As we move from an emergency response to one that is focussed on building the long-term sustainability of the health and other systems these foundational investments become more critical to progress and support for national leadership. We should not scale back support to under-funded and weakened health systems such as those in Liberia. Rather existing government led health programmes – such as the programme for Neglected Tropical Diseases - can provide an entry point for strengthening areas of the system outside their mandate. For example in the deployment of community health workers.
Research into implementation is critical during and post-crisis
Alongside the implementation of health programmes we need a strengthened focus on research, both to guide implementation and to provide lessons on post-Ebola health system reconstruction for other countries.
A DFID co-funded post-Ebola Programmatic Assessment suggests people at all levels want the NTD programme to roll out. The DFID funded Filarial Programme Support Unit has conducted a mapping with MAP International, Sight Savers and APOC at the national level, in two districts in each county, two communities in each district (one that had Ebola and one that didn’t) and in five health centres per county. Formal findings from the study will be published soon. Initial analysis shows that there is commitment and demand for the NTD programme at all levels. Indeed colleagues have pointed to the importance of intensified social science inputs into the NTD programme post-Ebola. For example there will need to be intensified social mobilisation in relation to Mass Drug Administration for schistosomiasis as community members have become wary of treatment as the side effects (occasional vomiting and diarrhoea) are known to be reminiscent of Ebola symptoms. Parents are understandably keen to protect their children from potential Ebola-stigma and work is needed to allay these fears.
Support to enable Ebola-affected countries to share lessons, through learning platforms and financing for meetings and longer-term partnership and dialogue is also vital. Through these processes appropriate capacity exchange can take place which is nationally owned rather than donor mediated.
Leave no one behind
As countries emerge from the Ebola crisis it is beholden on us as researchers, donors and policy makers to work in solidarity to strengthen health systems and communities which have experienced traumatising and sometimes devastating shocks. Disasters, crises, and revolutions all happen in real life and it is difficult to predict where they might occur. This is not a reason for ceasing operations. Rather implementation research in Liberia (and settings like it) can provide models for the health system response when similar problems emerge elsewhere in Africa.
Read the evidence in full by clicking here