MSH Calls for Systems Strengthening in US Ebola Response
The current Ebola epidemic in West Africa is unprecedented in its scope and devastating effects. The health systems of Liberia, Guinea, and Sierra Leona were not adequate to the task of containing the outbreak; while the international community responded slowly at first, it has accelerated its contributions and helped these countries slow the rate of new infections. Management Sciences for Health (MSH) commends the US government for the key role it has already played. The US continues to be a critical source of financing, expertise and other resources. Health systems strengthening has been, and will remain, the most important role for the US government and its international partners.
MSH recommends that the US and other donors focus on long-term recovery and preparedness, as well as emergency response.
First, a coordinated emergency response at the source of the outbreak remains the most critical activity to address Ebola: as long as the outbreak rages in West Africa, people around the world will remain at risk. Significant resources must go toward rapid detection of cases, early treatment, and contact tracing. In addition to setting up Ebola Treatment Units—which are absolutely necessary for effective response—the health system must be strengthened at the community level. Community care centers can provide a safe place for suspected and confirmed patients, which will facilitate case detection and treatment. Heightened awareness and improved trust are essential for stopping the spread of Ebola, each of which relies on community-level engagement.
Once Ebola care is moved out of general health facilities, the capacity to provide non-Ebola care must be restored. Ultimately, more people will die from complications during pregnancy and delivery, malaria, and other preventable causes, than from Ebola itself. Restoring essential services must be a core component of the emergency response.
Second, the donor community must support long-term investments in health system capacity, not only in West Africa, but in other at-risk countries. This epidemic was preventable. In this case, political instability contributed to weak health infrastructure and a susceptible health system that allowed the outbreak to spread. It will not be enough to simply stop the outbreak; we must remain vigilant in our investments for the future. This includes efforts to build laboratory capacity, train and retain health workers, and to strengthen supply chains for medicines and commodities. These efforts can help ensure that health workers are sufficient in numbers and capabilities, and that they are equipped with personal protective equipment and life-saving oral rehydration and other supportive care measures.
Finally, the US government and its partners should support long-term investments in research and preparedness, so that we will have the tools necessary to combat the world’s next public health challenge. Medicines, vaccines and technologies take time to develop, test, and scale. The Ebola epidemic has demonstrated pointedly the need for investments in research before prevention and treatment are desperately required. Additionally, the international community should redouble its efforts toward implementation of the International Health Regulations and other preparedness measures. As has been demonstrated by influenza, AIDS, SARS, MERS-CoV, and other pathogens, there will be outbreaks and public health challenges in the future.