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At IntraHealth International, we are disheartened by recent Ebola-related news from West Africa, and call on the world community, including ministries of health, donor agencies, and other stakeholders, to urgently renew and strengthen their efforts to provide systematic, sustained investment in frontline health workforces and health systems around the world.
Just as IntraHealth was preparing to join the world in celebrating victory over Ebola in Liberia, the country confirmed a new case on March 20 near the country’s capital, Monrovia. The World Health Organization’s (WHO) top Ebola official, according to the New York Times, called the nurses who identified the new case heroes, saying, “They may have protected the whole country by finding the needle in the haystack. It was because they were searching that haystack for the needle.”
In early 2015, transmission rates appeared to be slowing not only in Liberia but also in Guinea and Sierra Leone. Reports from Guinea, however, indicate that transmission has not abated; in fact the number of suspected Ebola patients there more than doubled over the past month. Guinean health officials said that as of March 19, treatment centers reported 91 suspected and confirmed Ebola cases to date in March, compared with 39 in February, according to Reuters News Agency. Transmission also continues in Sierra Leone, which has the most cases of the three countries—more than 11,000 to date.
The WHO is preparing to announce new guidelines for when a country may be declared Ebola-free. The WHO will ask for continued “heightened surveillance” for an additional 90 days after the currently recommended 42 days from the last confirmed case.
Since March 2014, according to the WHO, Ebola has killed more than 10,000 people and infected more than 25,000. Almost 500 health workers have died from Ebola in the three most affected countries. This outbreak, which continues to grow, is the largest ever recorded. Its magnitude and velocity are due in large part to weak health systems and inadequate investments in the affected countries’ health workforces.
Guinea, Liberia, and Sierra Leone all suffer from severe health workforce shortages. The three countries also are among the world’s poorest, their health systems weakened by civil war and unrest. Urgent action is necessary to ensure that health workers on the ground have access to the supplies and information they need to protect themselves and to have the capacity to continue “searching that haystack for the needle,” especially as transmission rates decrease.
An independent analysis released earlier this month and commissioned by the Frontline Health Workers Coalition found that scaling up the local health workforce in West Africa is a cost-effective investment to help end the Ebola epidemic, restore essential health services, and build a workforce resilient enough to tackle future threats. The analysis used publicly available data to estimate the cost—approximately $573 million over five years (or less than $115 million annually on average—to double the skilled health workforce and ensure a comprehensive community health worker program in Guinea, Liberia, and Sierra Leone.
While emergency aid is crucial, we also need long-term, sustainable solutions. Individual countries must be prepared to prevent, detect, and respond to emerging disease outbreaks. The WHO’s International Health Regulations outline steps each country must take to maintain global health security, including disease surveillance and reporting, verification of public health events, and coordination of international response. Although the regulations have been in place since 2007, only 20% of the 194 countries that are WHO member states have achieved compliance with the core capacities required within the regulations.
“The new case in Liberia and rise of cases in Guinea illustrate, once again, the need for ongoing diligence and strong health systems,” says Pape Gaye, president and CEO of IntraHealth International. “The work is far from over. We need more robust investment in strengthening health systems and in larger and better supported national health workforces. Frontline health workers are part of the communities in which they serve. We call upon the global health community and countries around the world to recognize, train, and equip them to handle emerging issues. When these health workers are part of the formal health system, their clients have greater trust in them and communities can become stronger and more resilient when faced with emerging health threats like this epidemic.”