Ebola in Africa: What Are We Learning?

 Please click this link to download (for free) an Ebola emergency response plan created by Nnamdi Ezeanochie MBBS, MPH, Professor Sheana Bull & I including simple, clear cut instructions on how to enhance responses to Ebola with mobile health. It is currently being implemented in a rural area in Nigeria and we hope to make it available to more communities so please distribute this post widely and strategically.

 

For the very first time, West Africa has been hit, and incredibly hard by the Ebola virus. This is the worst ever epidemic of Ebola seen and the fatality rate is equally alarming.

A very important question has to be asked in the face of this crisis- what are we learning from this emergency for the future?

Interestingly, there are many parallels between the outbreak of Ebola in Africa and the non-communicable disease (NCD) epidemic that hold many lessons for us in acting and responding to health issues in Africa.

For starters, you may say that both epidemics are so simple to contain. Isn't NCD prevention largely a matter of controlling the risk factors like smoking, alcohol use, unhealthy diets, and physical activity? Isn't controlling Ebola as easy as isolating exposed individuals, raising awareness and educating at-risk communities on prevention? If it is so easy why hasn't it been done yet? This is a worthwhile question. There are many reasons for this and the importance of these factors cannot be overstated as they cut across the two epidemics. I will share a few below.

Firstly the issue of fragile and incapacitated health systems:

Across most African countries the gap between current health realities and the public health capacity keeps widening. In an era of largely preventable diseases and more long-term health issues like non-communicable diseases, African health systems (due to colonization among other factors) are still stuck with an infectious diseases orientation that is simply inadequate to respond to the growing epidemic of non-communicable diseases and the need for preventative and not just curative care even when infectious diseases are concerned. There are many infrastructural issues ranging from scarce health personnel, to poor infrastructure, to outdated policy, poor surveillance and a huge need for scholarly literature on health and the health systems on the continent.

In the absence of these structures and data, it is hard for any proactive and effective action in preventing the rise of epidemics to be taken. Some key intervention areas for a better response to epidemics will include strengthening the health infrastructure, developing, increasing and adequately incentivising health workers, improving access to health in rural areas, protecting health workers and investing in infrastructure, funds and financing options to sustain the system.

Next, the overload of actors on the African health landscape:

Of course this does not have to be a problem, but given that there is very poor coordination and leadership among these actors, the opportunity that they present is largely wasted. There are newer and newer actors on the scene- from the World Health Organization which is seen as the technical leader for all intents and purposes to private corporations, philanthropic organizations, civil society groups, political leaders, ministries and local actors who are simply not talking to each other. As a result there is no clarity in direction and there is often a waste of resources, competing motives, strategies, poor continuity and simply- chaos. 

Due to poor coordination there is often a lag in responding to these issues although there is a multiplicity of actors who if adequately organized can see to substantial increments in health on the continent. For example, with the Ebola epidemic, while some nonprofits responded immediately the WHO only convened a collaborative meeting with key leaders in July which is very late considering that the outbreak begun in March. There is a key leadership gap that could save lives, time and resources if there is coordination between governments, health agencies and other stakeholders. 

Inadequate empowerment of the 'everyday' person:

Regardless of the pining and opining of people at the helm of affairs, if everyday people are not empowered, with their opinions informed, their rumours strategically corrected and their fears dispelled then people will keep dying of things they do not need to die from. Diabetics will keep taking concotions instead of treating themselves properly. Hypertensive patients will keep eating foods that worsen their condition. Communities, instead of taking the right steps to fight Ebola will bathe with salt water.

There is a need to raise awareness and think seriously about how to effectively compete with rumours, fears, misinformation, and other unreliable yet widely believed sources of information in the African context. What does it look like to change behaviours in the African context? How do we move ideas along to the point of acceptance and adaptation? These are important issues which lead to unnecessary loss of lives because the grassroots are simply not empowered and actors therefore do not know how to effectively act. This leads to internationally funded projects aimed at urban development infact endangering the lives and sustenance of the urban poor. This leads to health promotion projects that simply do not work in the long term and to communities reacting enmasse to fear and false information in the case of crises like these instead of taking steps to truly protect themselves.

Africa's health is largely supplied through an international rather than local supply chain:

Instances like this outbreak show us why this is simply problematic. A key reason why the response to Ebola in Uganda was successful was due to the establishment of a viral research institute in Uganda by the CDC years prior to the Ebola outbreak there. However, in West Africa countries are having to use laboratories outside their shores in confirming whether or not people are indeed infected. This time lag owing to the limited availability of laboratory testing wastes money and time and lives. People go to India for medical treatments for chronic diseases and lab work is sent outside the countries to detect Ebola. We need investments in our own health and health affiliated resources. We need to be able to source what we need from within our borders or else lives remain at stake. 

A government that has yet to effectively organize its response to urgent issues:

Whether we may blame it on decadence and irresponsibility once and for all, or more leniently on miseducation, African leaders are yet to act responsibly in times of crises and citizens understand this.West African country leaders have made threats to prosecute people who harbour Ebola patients in a supposed bid to encourage health seeking behaviour. Some have invested millions if not billions on buying hand sanitizers. But does this work? If they do not invest in basic services and in quality of care, in a calculated rather than simply garish response how can they promote health seeking behaviours that do infact reach grassroots? Governments need systems and services that are ready for epidemics like these, yet it is not the case. 

Poor long-term control mechanisms:

Projections indicate that there will be an 85% rise in cancer rates on the continent by 2030 and that even in the next decade, about 28 million lives will be lost due to non-communicable diseases. For the few that do survive the largely fatal Ebola, it is possible that they have to deal with complications like infections, loss of blood, dehydration, low blood pressure and chronic inflammatory conditions that could affect their eyes and can also cause blindness. So we have to talk about control in the wake of being hit by epidemics whether chronic or infectious. Sadly the same factors- misinformation, fear mongering, poor health systems and infrastructure, poverty that keep people in poor health still play a limiting role in controlling the consequences of these conditions. 

At Engage Africa Foundation (EAF) we hope to play our own part in containing the Ebola epidemic through this collaborative development of an emergency response plan. 

Still, we need to think long term. At EAF we take all these considerations seriously by making sure to inform our acting with strong grassroots collaborations, knowledge sharing & as much as possible empowering individuals to be change agents hence our Health is Wealth Competition- a first step to gradually building and sustaining local and proactive health capacity.

Ebele Mogo,

President, Engage Africa Foundation