What lessons can development learn from the Ebola crisis?
What lessons can the development community learn from the Ebola crisis? In order to understand the causes and consequences of this particular outbreak, and to increase resilience, we must look at why such outbreaks occur, why they have devastating impacts in some situations and not others, and what responsibility development may bear.
There is a vital need to look beyond the immediate disease control and containment needs of the Ebola crisis and to consider the broader lessons which can be learnt by the development community. This was the focus of the event hosted this week: Ebola and Lessons for Development: Inequality, Structural Violence and Zoonotic Disease hosted by IDS and the Wellcome Trust.
Whilst it was widely acknowledged that a coordinated and well resourced humanitarian response to such crises is needed, this event explored the historical and current patterns and styles of development and how they can be to blame for how the disease spreads and the epidemic of fear and distrust. From this perspective, there was a call to think deeply about what comes next, and rebuild and build differently and taking the opportunity for the reframing of development.
Global health systems
Health, in recent decades has become a very political issue and one of international security concern. The speakers and participants argued that we need to build systems that are able to respond to global disease outbreaks and that is a key lesson we can learn from this outbreak. Crises are often found in areas where the most marginalised people live and this explains how the Ebola outbreak expanded in the way it did. Ebola is a typical infectious disease, it occurs randomly and can be stopped rapidly by finding and isolating patients and those been in contact with them.
One of the most important things is community understanding and making sure village elders and chiefs are involved in the response and providing safe transport systems. This has stopped outbreaks which could have occurred in Mali, Senegal and Nigeria and an outbreak in DRC was stopped by rapidly responding. This has also been the case for past outbreaks. If we are to learn anything, it is that we need to focus on global health systems. Ebola has demonstrated the interconnectedness of systems, and how it affects the economic and cultural fabrics. One of things we should take away from this is our failure to take the time to build the capacity of health workers, educators and others to be able to care and respond in crisis.
Livelihoods, Resources and Conflicts
At the core of this event, was how development over recent decades has contributed to the crisis we have seen.
Ultimately, policies and other actions often introduced by development agencies, such as the Structural Adjustment Programs (SAPs) of the 1990s, forced countries into a position where their focus was about economic growth and not the welfare of citizens. In turn, affected countries have weak governments and very poor welfare which have left communities unable to prevent conflict, sustain livelihoods and build strong health systems. For the future, we need to focus on not reproducing inequalities. And importantly, we need to understand and see the relationship between social, cultural and health responses.
Society, Community and Trust
This crisis affected men and women differently. It is often the case that women risk their own health to care for family members. In this scenario, it is easy to blame culture, but in actual fact, it is more likely that wider institutional failings may be more to blame. The lack of health centres meant that caring role inevitably fell to others, and they were the women. In future, acknowledging cultural structures and working with women is the key to preventing such an outbreak.
The role of women in this crisis is just one component of the ramifications of the outbreak. An effective response is difficult when the people who are getting sick are considered irrational and stubborn. Understanding, respecting cultural norms and listening to the views and inputs of local communities is the only way to build a resilience and sustainability for future health systems.
Alongside all of this, is the recent unprecedented urban growth. Peri urban and informal settlements have been neglected by planning. They lack basic hygiene, people share beds, live in confined spaces and cannot isolate or avoid bodily fluids and are areas for epidemics to thrive. Epidemics are endemic in these regions, and they have been for a long time.
Who should do what differently in the future?
An epidemic is a disease of society. We must bring people at the social and economic margins of urban societies to the forefront of development planning. Local knowledge and perspectives must be at the heart of the political, public health and biomedical responses to development planning and crisis response.
There is a need to reinvest in global health and national health systems to support the development of sustainable rapid response programs and build trust across sectors. Disease can be spread by people going to health centres to look for care. Bad health systems are no good, and can be worse for public health than nothing at all as they can help to spread disease if they don’t know what to do. We also have to improve the timeliness of global health response when outbreaks occur and invest in neglected diseases before outbreaks happen.
We need to think big, reduce inequality and increase sustainability and safe societies in an uncertain world. Ebola is a valuable lens but broader work that cuts across all areas is important and will influence where zoonotic disease outbreaks continue.