Ebola: Time to strengthen health systems and global health governance
Learning from the recent Ebola outbreak in West Africa is imperative if we are to stand any chance of preventing or at least managing any future epidemic. The Ebola outbreak not only illustrates the immensity of the challenge ahead to strengthen pandemic preparedness across the world but also the need to invest in strengthening health systems.
What is the challenge?
The combination of rapid urbanisation and the growth of largely unregulated peri-urban settlements, major economic and social inequalities and large scale ecological changes substantially increase the likelihood of epidemic outbreaks. This information is not new and efforts to strengthen global health security have long focused on establishing international institutions, surveillance systems and developing new drugs and vaccines. However, the response to the Ebola crisis has highlighted a weakness. Local and national health systems in low income countries, where outbreaks are most likely to occur, do not have the means or resilience to respond to an infectious disease outbreak like Ebola.
The world is only as secure as its weakest link. Strengthening national health systems therefore has to become an integral part of global health governance, linking efforts to improve global health security with international development. If global governance is to fully reflect the ‘global’ the perspectives of new players will also have to be taken into account. For example, China has been active in the Ebola crisis, and will continue to have influence in the ongoing response.
Building a resilient health system
Building a resilient health system over the longer term requires time, hard work, and political will. Humanitarian health responses in countries with weak health systems have limitations. A focus on reducing maternal or infant mortality is important and delivers short term benefits, but it is inadequate in terms of efforts to build a health system resilient to shocks like Ebola. What are some points to bear in mind for longer term building, and ‘building differently’?
- Resources need to be invested in basic public health measures that strengthen disease surveillance and reduce the risk of transmission of infections. Zoonotic spillover events (when a human is infected by a virus or bacterium that normally affects another animal) can be contained if there is capacity for early detection, tracing of contacts and quarantine measures that are appropriate.
- Rebuilding trust will be key. Much has been spoken about mistrust of the health system pre-Ebola, and also in the context of the current epidemic. Efforts at rebuilding must create institutions for trust, and explore partnerships with other sectors and formal and informal actors to provide services.
- Attention must be paid to ensuring safe and quality care. This means putting in effort and resources to train and supervise and pay health workers, and to give access to safe drugs.
- Engagement of local stakeholders and communities is also key, not only to future policy for epidemic preparedness, but also for the long term effort of building a resilient health system.
Actors in the post Ebola setting will need to prioritise efforts for building local and national communities’ capacity to respond to outbreaks but also to provide basic public health and improve conditions of life. The focus of future research should be on how to achieve this longer term resilience in the health system, especially in post conflict settings.