Strong Health Systems are Key to Successful Response to Ebola and other Infectious Outbreaks

{Photo credit: Katy Doyle}Photo credit: Katy Doyle

Management Sciences for Health (MSH) stands with the global health community mourning the hundreds of lives lost during the current Ebola outbreak in Liberia, Guinea, Sierra Leone, and Nigeria. As health workers and international partners work together to end the current crisis, MSH calls on governments, donors, and international agencies to renew their commitment to holistically strengthening  the health systems of vulnerable countries  to enable them to respond effectively to such emergencies, as well as to meet the day-to-day health needs of their populations.

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Dr. Fred Hartman, MSH’s global technical lead for malaria and communicable diseases, says, “countries need strong health surveillance systems to provide early warning of an unusual event such as an Ebola outbreak.”

“That triggers a containment mechanism so that the health authorities respond and contain what is happening and don’t let it get out of the geographic area,” Hartman says. “In this case, people traveled to the capitals and the genie was out of the bottle. Strengthening health systems at the outset will prevent this.”

Dr. Hartman says the global community learned a great deal in its response to avian influenza and was able to stop its spread.  As a partner on the USAID-funded STOP-AI Project (Stamp Out Pandemic and Avian Influenza), MSH worked globally to halt the spread of both avian and human highly pathogenic influenza.

“MSH was very much a part of that response,” Hartman says. “We did a lot in terms of surveillance, early detection, rapid response, containment, and infection prevention - one package to train people in. But that unfortunately hasn’t carried over to other diseases as easily. Once the threat of the avian influenza pandemic ended, countries turned their attention and resources to other, more pressing health problems and disease surveillance was not always one of those priorities. This is why we continue to work with countries around the world, but especially in Africa, to implement integrated disease surveillance and response (IDSR) systems to detect and contain new outbreaks. Hopefully, the key lesson learned from this tragic outbreak will be the need to focus resources on developing strong and viable IDSR systems.”

Building on its experience in smallpox eradication, and earlier outbreaks of hemorrhagic fever in Africa, avian influenza, and successful control of cholera in multiple countries, MSH has worked with ministries of health to support the implementation of the WHO’s Integrated Disease Surveillance and Response (IDSR) framework. It guides the response of ministries to outbreaks of infectious disease and has been implemented in South Sudan, Ethiopia, Uganda, and Botswana.

Most recently, MSH’s USAID-funded African Strategies for Health (ASH) project worked with Botswana’s Ministry of Health to develop a methodology to evaluate the country’s IDSR system. In partnership with the US Centers for Disease Control and Prevention (CDC) and the WHO Regional Offices for Africa (WHO/AFRO), ASH successfully implemented the methodology in Botswana and plans to develop an approach that countries can implement with minimal external support. In November 2013 ASH co-hosted an IDSR workshop at the 5th Scientific Conference of the African Field Epidemiology Network. The session brought 53 participants from 11 countries together to share tools and learn from others’ experiences implementing IDSR systems.

In some situations, however, IDSR systems are not sufficient to contain an outbreak of a disease as virulent as Ebola. In May 2014, WHO/AFRO issued new guidance on emergency responses, Public Health Events of Unknown Etiology: A framework for response in the African region. Developed in close collaboration with USAID, CDC, and the Global Outbreak Alert and Response Network (GOARN), the framework is designed to supplement the 2012 IDSR Technical Guidelines and offers guidance to policymakers on how to intensify their preparedness, enabling them to best contain outbreaks.

MSH supports this approach as the next stage of early detection and rapid containment of outbreaks of unknown etiology, thus preventing further spread.  Widespread implementation of this framework will help to prevent spread of high mortality diseases like Ebola and Severe Acute Respiratory Syndrome (SARS). 

“This is going to be a recurring theme,” Hartman says. “Novel pathogens or emerging infectious diseases are common now for whatever reason, and we just have to work with countries to prepare them to detect and respond.”

He says the lessons learned through the Ebola outbreak can, and will, be applied to other countries to prevent similar outbreaks by improving early detection and containment.

“In the meantime, however, Ebola is killing some of the leading health authorities in the country – people that are hard to replace,” Hartman says.

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