Strengthening Post Ebola Health Systems

The Ebola virus outbreak ravaged parts of West Africa during 2013†“16, particularly in Guinea, Liberia, and Sierra Leone. The epidemic had very high human, social, and economic costs; food became scarce, schools were shut down, and ongoing development programs shifted to support the immediate response efforts. The rapid spread of the disease demonstrated the urgent need to invest in health systems and to establish surveillance and preparedness programs for long-term resilience. Strengthening Post-Ebola Health Systems was initiated when Ebola was still raging, in 2015. The book focuses on some of the most critical needs for public health resilience and emergency preparedness: adequate fiscal space, an effective health workforce, and ongoing disease surveillance. Drawing on the Post-Ebola Planning Strategies of Guinea, Sierra Leone, and Liberia, the book highlights key strategies and investment opportunities that governments and partners might leverage to make health systems more efficient, resilient, and sustainable. The lessons from this book are expected to help guide efforts to rebuild the health systems of Guinea, Liberia, and Sierra Leone, but they can also be applied to other low-income countries in Sub-Saharan Africa. This book will be of interest to policy makers, health practitioners, and development partners who support pandemic preparedness and health-system-strengthening efforts around the world.

Addresses the challenge of enabling the development of viable, resilient, and fiscally sustainable health system in Guinea, Liberia, and Sierra Leone. Initiated while Ebola was still raging in all of the three most-affected countries in West Africa, the study identifies the requirements for strengthening the health systems in these countries to go beyond just getting the number of Ebola cases to zero. The overall goal of this study is thus twofold: To assess the capacity of the health systems of the three most-affected countries in terms of their ability to deliver quality health services to their populations, perform core public health functions on a routine basis, and to respond to public health emergencies; and To identify the highest impact strategies to help these countries to strengthen their health systems to be more effective and resilient, drilling down into three key aspects of the health system-- that is, fiscal space for universal health coverage (UHC), development and deployment of an effective health workforce, and continuous disease surveillance.--

The most recent Ebola epidemic that began in late 2013 alerted the entire world to the gaps in infectious disease emergency preparedness and response. The regional outbreak that progressed to a significant public health emergency of international concern (PHEIC) in a matter of months killed 11,310 and infected more than 28,616. While this outbreak bears some unique distinctions to past outbreaks, many characteristics remain the same and contributed to tragic loss of human life and unnecessary expenditure of capital: insufficient knowledge of the disease, its reservoirs, and its transmission; delayed prevention efforts and treatment; poor control of the disease in hospital settings; and inadequate community and international responses. Recognizing the opportunity to learn from the countless lessons of this epidemic, the National Academies of Sciences, Engineering, and Medicine convened a workshop in March 2015 to discuss the challenges to successful outbreak responses at the scientific, clinical, and global health levels. Workshop participants explored the epidemic from multiple perspectives, identified important questions about Ebola that remained unanswered, and sought to apply this understanding to the broad challenges posed by Ebola and other emerging pathogens, to prevent the international community from being taken by surprise once again in the face of these threats. This publication summarizes the presentations and discussions from the workshop.

As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a "highest-priority" essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.

“Paul Farmer brings his considerable intellect, empathy, and expertise to bear in this powerful and deeply researched account of the Ebola outbreak that struck West Africa in 2014. It is hard to imagine a more timely or important book.” —Bill and Melinda Gates "[The] history is as powerfully conveyed as it is tragic . . . Illuminating . . . Invaluable." —Steven Johnson, The New York Times Book Review In 2014, Sierra Leone, Liberia, and Guinea suffered the worst epidemic of Ebola in history. The brutal virus spread rapidly through a clinical desert where basic health-care facilities were few and far between. Causing severe loss of life and economic disruption, the Ebola crisis was a major tragedy of modern medicine. But why did it happen, and what can we learn from it? Paul Farmer, the internationally renowned doctor and anthropologist, experienced the Ebola outbreak firsthand—Partners in Health, the organization he founded, was among the international responders. In Fevers, Feuds, and Diamonds, he offers the first substantive account of this frightening, fast-moving episode and its implications. In vibrant prose, Farmer tells the harrowing stories of Ebola victims while showing why the medical response was slow and insufficient. Rebutting misleading claims about the origins of Ebola and why it spread so rapidly, he traces West Africa’s chronic health failures back to centuries of exploitation and injustice. Under formal colonial rule, disease containment was a priority but care was not – and the region’s health care woes worsened, with devastating consequences that Farmer traces up to the present. This thorough and hopeful narrative is a definitive work of reportage, history, and advocacy, and a crucial intervention in public-health discussions around the world.

Building communication capacity is a critical piece of preparing for, detecting, and responding to infectious disease threats. The International Health Regulations (IHR) establish risk communicationâ€"the real-time exchange of information, advice, and opinions between experts or officials and people who face a threat to their survival, health, and economic or social well-beingâ€"as a core capacity that World Health Organization member states must fulfill to strengthen the fight against these threats. Despite global recognition of the importance of complying with IHR, 67 percent of signatory countries report themselves as not compliant. By investing in communication capacity, public health and government officials and civil society organizations facing health crises would be prepared to provide advice, information, and reassurance to the public as well as to rapidly develop messages and community engagement activities that are coordinated and take into account social and behavioral dynamics among all sectors. To learn about current national and international efforts to develop the capacity to communicate effectively during times of infectious disease outbreaks, and to explore gaps in the research agenda that may help address communication needs to advance the field, the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine convened a 1.5 day workshop on December 13 and 14, 2016, in Washington, DC. Participants reviewed progress and needs in strengthening communication capacity for dealing with infectious disease threats for both outbreaks and routine challenges in the United States and abroad. This publication summarizes the presentations and discussions from the workshop.

Since the 2014 Ebola outbreak many public- and private-sector leaders have seen a need for improved management of global public health emergencies. The effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. Education, child protection, commerce, transportation, and human rights have all suffered. The consequences and lethality of Ebola have increased interest in coordinated global response to infectious threats, many of which could disrupt global health and commerce far more than the recent outbreak. In order to explore the potential for improving international management and response to outbreaks the National Academy of Medicine agreed to manage an international, independent, evidence-based, authoritative, multistakeholder expert commission. As part of this effort, the Institute of Medicine convened four workshops in summer of 2015 to inform the commission report. The presentations and discussions from the Workshop on Research and Development of Medical Products are summarized in this report.

Following on from 2015’s Healthcare Reform, Quality and Safety: Perspectives, Participants, Partnerships and Prospects in 30 Countries, this book encompasses a global perspective on healthcare while shifting the focus from reform to showcasing success stories of healthcare systems worldwide. It provides explanations of why various facets of healthcare systems work well in different contexts and offers the reader alternative models for consideration. The book features contributions from 60 countries, going much further than the common practice of focusing on affluent Western nations, to provide a comprehensive exploration of the success of healthcare systems globally. The majority of literature on health-sector improvement attempts to address the problems within systems, relating the errors that can and do occur, for example, and offering solutions and preventative strategies. This book of country case studies will approach the enhancement of health systems, patient safety and the quality of care in a new and innovative way, comprehensively surveying and synthesizing the success stories of healthcare systems around the world, utilizing Hollnagel’s Safety-II approach to acknowledge the importance of exploring what goes right, what works well, and why it works. These success stories may include reference to macro, meso or micro levels of healthcare systems, various sectors (e.g., aged care, acute care or primary care), or specific programs or projects. Health System Improvement Across the Globe: Success Stories from 60 Countries is unprecedented in terms of both reach and positive emphasis, and as such will be instrumental in changing ways of thinking about and guiding health-sector improvement.