Emergencies preparedness, response

Essential health services situation reports: Background

Ebola: Health systems recovery

The Ebola virus disease (EVD) outbreak in West Africa has had a devastating impact on the health status and the health systems in Guinea, Liberia, and Sierra Leone. In addition to the human suffering and deaths caused by Ebola, there have been significant increases in both morbidity and mortality from other priority diseases.

A multitude of factors, such as inadequate infection prevention and control (IPC) measures, poor availability of essential drugs and supplies, a shortage of skilled health workers, and in some cases even the closing of routine health facilities, all led to the underutilization of health services. This came alongside an increasing mistrust in the safety and quality of health services by the wider community. The outbreak undoubtedly disrupted vital ongoing programmes focused on immunization, maternal & child health and malaria control in a profound way.

“Getting to zero” and “staying at resilient zero” remains a critical focus of the post-Ebola national health sector recovery plans of the three affected countries in West Africa. As the numbers of new EVD cases decline and the coordinated response effort enters into Phase 3, countries have increasingly started to focus on the recovery of health services at the central and district level, in full alignment with their national health sector recovery plans.

These national recovery plans have been developed by each of the three countries with the support of WHO and international partners. This came alongside efforts through a multi-sectoral approach to recovery. The national recovery plans constituted the basis for several recovery discussions, including the high-level meeting in Washington, DC, in April 2015 and then again in July 2015 at the UN Secretary-General’s pledging conference held in New York City, where donor countries and organizations pledged their contributions to support the recovery plans of the three affected countries.

The governments of the three countries, their ministries of health, WHO and other international partners are all committed to ensuring an accelerated recovery of essential health services, activities and the building of resilient health systems. Areas of focus for early recovery work include: infection prevention and control (IPC) and patient safety; surveillance; health workforce and reinvigorating an essential package of health services. This early recovery work is underpinned by a wide range of cross-cutting technical areas including: integrated people-centred services; institutional twinning partnerships; information, communication & technology (ICT); supply chain; health financing; and knowledge harvesting.

WHO has launched a cross-departmental taskforce to develop an Early Recovery Toolkit to support a safe reactivation of these essential health services. The toolkit aims to gather together all of the relevant technical expertise and resources on safe, essential services into a single source to support countries in the implementation of their recovery & resilience plans.


The governments of the three countries, their ministries of health, WHO and international partners all agree on the need for a monitoring tool to track trends and monitor the provision of essential health services. This will allow for a timely monitoring of progress in health services and health system recovery, in order to identify challenges and bottlenecks requiring attention and corrective action.

Developed with the affected countries, the Essential Health Services (EHS) Situation Report aims to provide a standardized reporting mechanism related specifically to health service recovery. It aims to periodically report on priority disease trends, as well as health service and health systems provision.

The primary audience for the EHS Situation Report includes those responsible for leading, supporting, managing and delivering essential health services and working on health services recovery.


The EHS Situation Report covers a selection of indicators coming from the national recovery plans. The indicators included in the EHS Situation Report have been developed in order to shed light on the risk factors, health status, service coverage and health systems in each country. The evolution in maternal & child health, immunizations, communicable diseases, the availability of safe water and the number of outpatient visits will be reported upon.

Most of these indicators are already collected routinely through existing national health management information systems and surveillance systems in the affected countries. Some indicators are collected through other national monitoring mechanisms such as IPC assessments and routine supervision visits by health authorities.

The EHS Situation Report will contain national level aggregated data. Geographically disaggregated data will not routinely be available. While aiming for standardized operational definitions, the EHS Situation Report indicator definitions are country-specific and differ from country to country due to the specificities of national standards and data collection mechanisms. Some countries do include private health-care facilities and/or community level data, while others do not. Due to differences in data collection and a multitude of contextual reasons, the EHS Situation Report does not aim, nor does it allow, comparison of progress or of performance across the three countries.

While the selected indicators provide an overview of the situation and trends, this does not replace detailed disease programme reporting or surveillance mechanisms.


The coordination of the EHS Situation Report is undertaken by WHO in collaboration with ministries of health and other partners. The ministries of health complete the EHS Situation Report reporting template and share it with WHO for verification of completeness and data consistency, before publishing these data on the EHS Situation Report website. Observed inconsistencies are discussed and refined with the respective ministry of health (MOH). Presently, the EHS Situation Report process does not foresee external validation of the data. For indicators that depend on quarterly or yearly supervisions or assessments or sample-based monitoring, asterisk-linked remarks will provide supplementary information on the period and sample. Each EHS situation report produced will only be considered final when 100% of data has been received and reported on from the participating health-care facilities. It may not always be possible to obtain 100% of the data at the at the end of each reporting period, thus the EHS Situation report for each period will be updated as the data becomes available. Health-care facility reporting completeness is one of the EHS Situation Report quality indicators.

In addition to monthly data reporting, the EHS Situation Report will be translated into quarterly and annual reports in order to provide trend analysis and interpretation, also considering baseline data and recovery plan targets when available. The analytical and interpretative work will be conducted in close collaboration with the respective MOH. Supported by different partners, the ministries of health are in the process of strengthening their Health Management Information System (HMIS), Integrated Disease Surveillance and Response (IDSR) and other monitoring systems.

It is expected that this will be reflected in the evolution of the completeness, timeliness and quality of the data provided. The utility and functionality of the EHS Situation Report and its indicators will be assessed throughout the early recovery period and refined based on need.