The cancellation of international flights seriously hampered the distribution of personal protective equipment to countries affected by the Ebola virus. Pictured: A health worker hands an orphaned baby to a neighbour for health as a global public good. The capacity of the WHO to respond to global health emergencies was also influenced by politicised appointments of staff, and poor and disjointed coordination between head office and regional and country offices. The WHO itself, according to its website, sees its role as ‘convener and conduit … providing information and services and mobilising partners to agree on standards and courses of action’ in international health emergencies. The policies of new players with significantly larger budgets than the WHO, pursuing vertical programmes relating to specific diseases such as HIV, tuberculosis and malaria, completely undermined commitments to horizontal health system strengthening. Additionally, Wilkinson and Leach (ibid) point out that international donations to the Ebola relief fund of the United Nations were poor from both governments and the private sector. They comment that the need for international governance systems that conceive of health as a properly funded global public good, enabling rapid responses to crises when they do emerge, has been undervalued for too long. Compromised health systems and development policy Health outcomes in Sierra Leone were already poor before the Ebola outbreak (see page 258 for facts, figures and an explanation E b o l a of the structure of Sierra Leone’s health system). A history of political stability, corruption, and civil wars in Liberia and Sierra Leone left essential infrastructure neglected or destroyed. Wilkinson and Leach (ibid) note that, in the three countries worst affected by EVD, there was a ‘pervasive’ lack of resources, equipment, money and health workers, and what was there was likely to be inappropriate or inadequate. The structural adjustment programmes promoted by the World Bank and the International Monetary Fund require as a condition of loans that poor countries pursue deregulation, privatisation, market competition and wage suppression; and reduce public spending, government provided services and social spending. As a consequence, there were reduced resources for, and capacity to, strengthen health systems. Health became a commodity and an individual responsibility. Countries relied heavily on donor aid to meet essential health services and were captured by the priorities of the donor rather than the needs of the community. The lack of services led to a loss of confidence in the system by the community, who turned to traditional healers and traditional medicine to meet their health needs. Assumptions and myths The first misleading assumption on the management of the Ebola epidemic addressed by Wilkinson and Leach was that Ebola could be contained within national borders; that closing borders would Commonwealth Health Partnerships 2015 61 CC BY-ND 2.0 MSF/Martin Zinggl
Commonwealth Health Partnerships 2015
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