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Ebola and health systems: Now is the time for change

Dr Marie-Paule Kieny
Assistant Director-General, Health Systems and Innovation

Commentary
12 December 2014

About the current Ebola outbreak

Portrait of Marie-Paul Kieny, Assistant Director-General - Health Systems and Innovation.

The current Ebola epidemic in West Africa is unlike any we have seen since the disease was first identified in the 1970s. It is by far larger in terms of numbers, geographic spread, but also more unpredictable in the behaviour of its spread than any other previous outbreak. WHO and its partners have, in turn, had to adapt to a new and uncertain terrain with flexibility and innovation, mobilizing construction of treatment centres, fast tracking vaccine development, creating new guidelines to respond to a fast changing situation, implementing a global Ebola preparedness plan, all at an unprecedented speed and scope.

Ebola became epidemic in Guinea, Liberia, and Sierra Leone in large part because of their weak health systems. Particular weaknesses included insufficient numbers of qualified health workers, and inadequate surveillance and information systems. Other weaknesses include the absence of or weak rapid response systems, few laboratories - all located in cities - unreliable supply and procurement systems for PPEs and other supplies, lack of electricity and running water in some health facilities, few ambulances, and limited public health education, community outreach and engagement.

Health services diverted to Ebola

When the outbreak started, existing public health services – which were already quite limited – were diverted to Ebola. In addition, many health workers became ill and died from the virus. The net result is that people have encountered significant barriers in accessing needed care, whether for Ebola or for other, more typical health conditions. And the impact of this outbreak spans well beyond health: economies have been affected, food has become scarce, and development has stalled.

The answer to stopping Ebola outbreaks of this amplitude is strengthening health systems, yes. But more importantly than simply strengthening existing capacity for Ebola, countries need to create resilient integrated systems that can be responsive and proactive to any future threat.

Meeting on strengthening health systems in Ebola-affected countries

This week WHO has hosted with Member States and partners a meeting to discuss exactly this, and we have agreed to a new approach which in some fundamental ways demands a paradigm shift in the way we look at health systems strengthening.

"More importantly than simply strengthening existing capacity for Ebola, countries need to create resilient integrated systems that can be responsive and proactive to any future threat."

Dr Marie-Paule Kieny, Assistant Director-General - Health Systems and Innovation

1st and foremost, we agreed that integrated care rather than siloed programmes is the best approach to strengthening health systems, and that Universal Health Coverage, where it has been achieved, has made such integrated approaches practical and affordable.

Secondly, there was consensus that strong lab and surveillance systems, and capacity to comply with the requirements of the International Health Regulations in all countries, should be considered as an essential element of health systems strengthening. The scope and complexity of the epidemic would have been much more manageable if more effective surveillance and health information systems were in place.

And lastly, to achieve this, we must ensure national ownership, local action and full support of development partners.

It is fitting that this meeting’s conclusion coincides with the anniversary of the UN General Assembly resolution calling for Universal Health Coverage. There is one more lesson that the Ebola crisis has taught us: Universal Health Coverage, and the people-centred approach it represents, is not just a vision, it is a practical and achievable necessity for all, and its absence anywhere, weakens all of us.