Building resilience in health systems in Africa Despite the continent’s wealth of natural and human resources, the Ebola crisis has challenged the ‘Africa rising’ narrative. If we are to show the world the great promise and potential of our beloved continent, we must learn the lessons from this terrible human tragedy. Chief among these is the importance of strong and resilient health systems that can withstand the shock of an epidemic such as Ebola and continue to provide basic health services (Kieny and Dovlo, 2015). On 29 November 2014 I chaired a high-level breakfast meeting hosted by the Planet Earth Institute (PEI), an international charity and non-governmental organisation (NGO) of which I am a trustee. We were joined by a number of African ambassadors and leading academics, amongst them Professor Peter Piot, one of the codiscoverers of the Ebola virus in 1976 in what was then Zaire. The theme for discussion that day was ‘Scientific development and resilience to health crisis in Africa: Ebola in focus’. As the spread of this disease mercifully shows signs of slowing, there are a few more important agendas that must be pursued. It’s perhaps unsurprising that Ebola was able to spread so rapidly in Sierra Leone, Guinea and Liberia, given that these nations were struggling to rebuild their social and economic infrastructures, which had been weakened by years of civil conflict (WHO, 2014). What made the situation worse, however, was that these countries had to divert all their resources towards containing the epidemic, disrupting the provision of basic health services (Boozary et al., 2014), from neonatal care and vaccination to treatment for persistent killers in Africa, such as malaria, tuberculosis and HIV/AIDS. Fragility in health systems More worryingly still, a new report from Save the Children (2015) shows that almost 30 more countries around the world have dangerously fragile health systems, placing them at risk of devastation by a similar epidemic. This is just one of the reasons why the Planet Earth Institute is championing resilient health systems as one of our priorities for 2015. The Save the Children report argues that years of under-funding across Africa have meant that countries lack the resources, staff and training needed to implement effective daily health care and infection control measures. For example, 46 per cent of African countries have been unable to adopt the recommendation of the International Taskforce on Innovation Financing to spend at least US$44 per person per year on health (Sambo and Kirigia, 2014). The hesitation and lack of co-ordination in the international communities response to the Ebola crisis suggest that the first priority is to re-evaluate regional disease surveillance systems in West Africa. Such systems have already been established in other parts of the world, such as East Africa, South-East Europe, Southern Africa and Asia (Save the Children, 2015). But a more urgent long-term requirement is to build a workforce of trained health care professionals who can respond to future disease outbreaks while providing basic health care (Boozary et al., 2014). Before Ebola struck, Liberia had only 50 doctors for a population of 4.3 million people (Save the Children, 2015). This shocking statistic speaks of the chronic disinvestment in science in Africa, something the Planet Earth Institute is campaigning to redress. Not only does Africa have the world’s lowest tertiary enrolment rate – of seven per cent compared to a world average of 30 per cent (British Council, 2014) – but science is often further underrepresented and overlooked by students, with only around one in ten choosing STEM (science, technology, engineering and mathematics) subjects at university (WB, 2014). Even fewer have the opportunity to study medicine. Workforce at community level More doctors are needed, but resilient health systems can’t rely on them alone. Successful integration and prevention efforts related to viruses such as Ebola and also non-communicable diseases, such as type two diabetes, require a comprehensive strategy that includes developing a network of competent health managers at subnational level and strengthening community health worker (CHW) capacity (House of Commons IDC, 2014). The Global Health Workforce Alliance estimates that more than seven million additional health workers are required to deliver basic services (WHO, 2013). This number could rise as high as 13 million by 2035 in line with projected population growth. The Ebola outbreak Commonwealth Health Partnerships 2015 57 Lord Paul Boateng The Ebola pandemic has left a trail of human and financial devastation in its wake. So far, there have been more than 20,000 cases reported and a death toll of more than 9,000. As of 22 February 2015 there had been 837 new reported cases among health care professionals in Guinea, Sierra Leone and Liberia, the worst affected countries, and 490 deaths – an unprecedented number that has further weakened already fragile health care systems (Save the Children, 2015). Ebola has also fractured the economies of these three West African countries, with the World Bank estimating that they will lose at least US$1.6 billion in forgone economic growth in 2015 as a result of the epidemic (WB, 2015). What’s more, the Center for Global Development predicts that continued negative economic impact on the region could be in the range of $30 billion to $35 billion over just two years – a consequence of eroded consumer and investor confidence.
Commonwealth Health Partnerships 2015
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