Ebola spending: will lack of a positive legacy turn dollars to dolour?
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Version 0 of 1. While it is still too early to call time on the Ebola outbreak, a sense that the worst may have passed is tentatively taking root in west Africa, alongside an acute realisation of the need to ensure a positive long-term legacy for battered healthcare systems. The international community might have taken too long to react initially but the arrival of hundreds of soldiers and volunteer health workers, backed up by millions of dollars from donors, stopped the crisis from becoming even worse. A dire forecast of a possible 10,000 cases a week, for example, was never realised. Now the challenge is to stamp out the disease – the incidence of new cases had fallen at the beginning of the year, but that decline has stalled in the past few weeks – while simultaneously rebuilding health systems so decrepit that they contributed to the rapid spread of Ebola across Sierra Leone, Guinea and Liberia last year. Aid workers and health officials say that without a sustainable, long-lasting donor commitment to health systems, there will be little or no positive legacy from the millions of dollars already spent. Tom Dannatt, the founder of UK charity Street Child, said donors risked lagging behind events in the recovery as they had done during the emergency response. “The flat-footedness of the entire [aid] structure has been dramatically exposed by almost every stage of this crisis,” Dannatt said. “As to the investment made in the past six months, it doesn’t have any longevity beyond Ebola. “The ETCs (Ebola treatment centres) and holdingcentres and all the rest are viewed with ambiguity by locals because they are almost all temporary structures … When this outbreak is over, they will be folded down, burnt down or knocked down. “I don’t understand why we invested so much in a hardware-based response when it seemed quite obvious that the key things were behavioural, and attitudinal and educational … That has basically been proven because, by the time all these clinics became operational, they weren’t needed”. Dannatt is not alone in his analysis. Claudia Evers, the emergency Ebola coordinator in Guinea for Médecins Sans Frontières, told Reuters that the aid group had made a mistake by focusing on the need for more treatment beds early in the epidemic instead of dedicating greater resources to raising awareness of the disease. More than 9,100 people, mainly in west Africa and including 488 health workers, have died from Ebola. Up to 10,000 children have lost one or both parents, and the World Bank estimates the outbreak will cost the three countries – among the poorest in the world – $1.6bn (£1m) in forgone economic growth this year. There are other, less quantifiable losses: the number of people who died because they were afraid to go to hospital for non-Ebola related illnesses; the number of children who will die from preventable illnesses exacerbated by poverty caused when Ebola closed local markets; the number of farmers who have been unable to plant their crops, and now do not have any money to send their children to school. There are also psychological scars. Some people now see hospitals as cursed places. Some children do not want to go back to school because their classrooms were used as Ebola treatment units. “Many people in Sierra Leone … will not go to a hospital because that has become synonymous with dying,” said Paul Valentin, international director for Christian Aid. “People are really afraid, women are no longer going for prenatal visits. “A lot of other health problems are surfacing … there is still a fear of using the very limited health system that was there.” So far, donors have naturally focused on the immediate emergency rather than on the systemic failings of health systems in the three countries. “It’s too early to say there’s been a positive legacy [from the international response],” said Professor John Ashton, president of the UK-based Faculty of Public Health. “History teaches us that when these immediate emergencies are over, everybody disappears and the money dries up … Somehow we have to keep the pressure on.” Dozens of Ebola treatment units have been built, but many were only finished late last year, when the disease was already claiming fewer victims. Some of these units are now being closed – and some were only ever going to be temporary – while some are running at reduced capacity. Médecins Sans Frontières has cut the number of beds at its Elwa 3 Ebola treatment centre in Monrovia from 200 to 60, with the number expected to fall to 30 this month. It has started a clinic for survivors offering them psychosocial support and primary health care. Britain and the US have been particularly active in building clinics in Sierra Leone and Liberia, where they have historical ties. History teaches us that when these immediate emergencies are over, everybody disappears and the money dries up The US has built 15 treatment units – 10 through its defence department and five through international partners – as part of a strategy to provide isolation and treatment capacity in every county in Liberia. On Tuesday, the White House said President Barack Obama was set to bring back nearly all the 1,300 troops deployed in west Africa by 30 April. At the height of the epidemic, about 2,800 US military personnel were deployed to fight Ebola ; roughly 100 would remain to help, the administration said. Britain’s Department for International Development (DfID) said: “Britain’s help means that Sierra Leone now has enough beds for Ebola patients; enough labs to test for the virus quickly; enough trained burial teams to ensure bodies are buried safely and with dignity; and a command structure that has made the response more efficient and more effective.” A DfID spokesman added: “It is clear this strategy is working. There are signs that the infection rate is falling across Sierra Leone. This is cause for cautious optimism, but we cannot afford to be complacent.” Britain is working with the government of Sierra Leone and the World Health Organisation (WHO) to determine what should happen to the treatment and isolation beds once they are no longer needed. In a report issued by the House of Commons public accounts committee on Wednesday, British MPs said the lack of health infrastructure in Sierra Leone inhibited a quicker response to the crisis. It noted that, at the outset of the outbreak, there were only 120 doctors in the country and one virologist, who died at an early stage. The report said: “The lack of health infrastructure not only hampered the response to the Ebola outbreak, but has probably led to an increase in fatalities as a result of other health problems as the system was overwhelmed.” In its conclusions the committee recommended that DfID “should prioritise investment in local health infrastructure of developing countries in receipt of UK Aid so that there is a better capability to respond quickly to emerging public health emergencies.” The presidents of Sierra Leone, Guinea and Liberia will meet other governments, multilateral agencies and NGOs in Brussels on 3 March to present plans to rebuild their devastated economies, including healthcare systems. According to Abdulai Bayraytay, a government spokesman, Sierra Leone hopes to set up its own centre for disease control to help stem any future outbreaks of Ebola or other diseases. “One point that has been established by the WHO is that the governments in west Africa, including Sierra Leone, that were hardest hit by the virus were not adequately prepared because we lacked infrastructure,” he said. Tom Frieden, director of the US Centers for Disease Control and Prevention, said that if the Ebola epidemic did not convince the world that investing in public health was crucial, nothing would. “Strengthening public health is not a vague thing, it is very specific,” he was quoted as saying in the Global Ebola Response’s outlook for 2015. “Do you have a laboratory network? Do you have an emergency operating centre that can mobilise quickly? These are core, straightforward public health functions that weren’t in place before and they are why we have an epidemic.” Ashton said maintaining the momentum in the absence of a clear global threat from Ebola might be challenging. “We need to keep the pressure on the politicians. Politicians are notoriously short-term and this is a medium, five-year, 10-year, 15-year agenda of building infrastructure. We need political leadership that’s visionary and value-based.” |