For many of us, the month of August was probably when we realized that we were dealing with an epidemic without precedent. As time goes by, the nightmare just continues to unfold in Liberia, Sierra-Leone, Guinea and in the most remote areas of DRC. In Liberia, from September 1-7, almost 400 confirmed and probable cases of Ebola were reported – a figure which represents almost double the number of newly reported cases the preceding week. Just in Liberia, the transmission of the virus is increasing at an exponential rate, and we know that reported cases within the health system are most likely an underestimation of the total number of cases in reality. The heavy toll paid by healthcare workers makes this epidemic even more frightening. On September 9 in DRC, 35 Ebola deaths were registered, of which 7 were healthcare personnel. By September 14th in Guinea, 60 healthcare personnel had been infected by the virus, of whom,30 succumbed to the disease. Last week, a researcher from Guinea shared his experience with us about how an obstetrician, two midwives and a young trainee got infected with the virus while attending a delivery. The truth is that the entire health system is blocked by this crisis, and is barely functioning in Liberia and in Sierra Leone. As a result, many are dying of malaria or during childbirth.
We have all observed the delays and the insufficient scale of the response from the international community. Ebola is even overwhelming the many international actors who are adept at assisting in humanitarian crises. Doctors Without Borders, an organization that has been at the forefront of the fight against this epidemic, has been calling for help: they are overburdened. In the North, we are also seeing reactions inspired by fear or by selfishness: some even saying “keep these sick individuals far away from us!”
What can we do?
The situation is of great concern to our communities of practice. We know that some of our CoP members are based in the countries heavily affected by this epidemic. We also know that in neighbouring countries, many health specialists are already preparing a response to bolster the health system in case Ebola reaches them. Other members may be further away from the battlefield, but we anticipate that all of us will soon be more involved in the struggle against Ebola as the situation is only getting worse.
Our message is simple: the CoPs are ready to engage in the fight against Ebola. But we want to engage only insofar as it is useful. We are aware of our limitations, and we do not wish to add to the chaos. But if those of our members involved in the struggle against Ebola on a daily basis believe we can constructively play a role, we are open and ready to help.
One positive role we can have is to listen to the needs of those actors directly involved on a daily basis within the health system, especially the needs of healthcare workers. We can help to communicate and share messages, needs and experiences. Our conviction is that today more than ever the voices of those who are on the ground need to be heard, loud and clear. What challenges do you face on a daily basis? What are you observing on the ground? What best practices have been identified in the various contexts you work in? How is the response against Ebola currently organized and implemented in your districts and in your hospitals? Is there any need to improve the response of international partners (for example by reducing or avoiding wastage)? We believe that the online forums we have established could be useful for this purpose.
Another way we could engage is to draw on the expertise of the 3000+ health professionals in our CoPs. For example, an expert working with an international organization contacted us recently to request support in preparing a concept note on motivating health personnel in Liberia (Liberia’s health staff recently went on strike because of the risks they face with this epidemic). We rapidly contacted several senior experts of the PBF CoP. They gave their inputs on the initial memo, and helped to clarify what is possible through financing mechanisms, and what should be done through other means. We stand ready to offer this sort of expertise to others, particularly Ministries of Health.
This quick consultation among CoP members also revealed that many have concrete and hands-on experience in the Ebola response. We invited some members to share their experiences on our forums and we hope to post their contributions in the coming weeks. This could be a third type of contribution to the Ebola response. We are especially concerned about mobilizing community health responses. How can we ensure the voices of the population are heard? How can we help them mobilize their local resources and plan and implement their own response strategies?
Last but not least, we want to ensure that our forums serve as places for discussing and sharing key technical documents. On the “Health Systems Planning & Budgeting” CoP’s on-line forum, health experts have been weighing whether to organize national immunization days in Cote d’Ivoire, a country that borders the epidemic’s epicentre. The Health Service Delivery CoP has already published several blog posts on the issue, and recently published a list of 5 useful articles on the topic (in French).
We will surely maintain such efforts. Several of us will be in Cape Town for the “Health Systems Research Symposium”. During our satellite session on Monday September 29, we have set aside time to discuss the Ebola situation and our response. In the meantime, we invite you all to respond and share your views on this initiative. If you believe that the CoPs have a role to play, and if we can clearly delineate this role, the first step will be to create an inter-CoP task force. We will then seek volunteers to strengthen the coordination of this initiative.
We look for your guidance, please leave a comment or react on your online forum.