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A Preliminary Assessment of the African Ebola response

By on December 17, 2014

PhD, EV 2014

(2nd part of two-part communication – you find the first part here )

 

Let’s now try to come up with an early analysis of the overall African response till now, after our – admittedly – ‘quick & dirty’ mapping effort (see the first part of this communication). A very preliminary analysis, obviously, as the Ebola outbreak is far from over, and also based on incomplete information. We are sure that in the future, scholars will ponder the same question, based on better and more comprehensive (including also more inside information) sources. But this is the blogosphere, so let’s try to kick off the debate already, in spite of all these caveats. We invite you to comment below this blog.

To begin, we might as well start with the obvious truth that there is no one, single coordinated “African” response to ebola. “The” African response does not exist. It’s a very diverse picture instead.

 

Unprepared?

 

It’s already been said – Ebola hit a continent that had not even scratched the basics of implementing the international health regulations – essential requirements for national health systems to control outbreaks. But Ebola had hit Africa before, and previous outbreaks were contained relatively easily. The current crisis blindsided West Africa, hitting countries that were clearly unprepared for several reasons, including poor governance, low levels of public trust in the government, no previous experience dealing with ebola, and weak health systems (see the WHO high level meeting on building resilient health systems in ebola-affected countries for more details). We won’t belabor the point.

So it’s true – Africa (especially West Africa) was unprepared for this. But it is also fair to say that Africa did a rather poor job in terms of agenda setting – Ebola surfaced on the global health agenda months too late and African actors (like WHO Afro, and country offices in the affected zones) seem at least partly responsible for this delay, as were global health stakeholders (who were equally slow to respond to MSF warnings). Whether you can really “blame” African actors for this delay is less clear. Check out the media frenzy over foreign health workers who contracted the disease while volunteering in affected countries. If that is anything to go by, even if it seems unfortunately, news of Western casualties seems necessary before our global media ‘discover’ a story. In addition, many seasoned global health experts (including Peter Piot) didn’t think at the time that the Ebola outbreak would get so out of control, after a relative lull earlier this year, when it appeared that the outbreak was subsiding. In sum, there were some mitigating circumstances, but there was failure too.

As for the response, all in all, African governments and regional institutions reacted too slowly, and sometimes even wrongly at first. Again, there were mitigating circumstances. Governments in the three most affected countries had to go through a learning curve in dealing with a new disease like Ebola – not unlike the US government, but then several times worse. The needed response was also made difficult due to reasons spelled out earlier – weak governance, low levels of trust, collapsing health systems, … you name it. It was a perfect storm. Neighboring countries like Nigeria and Senegal did quite well in containing the response – they had some assets and did many things right, but perhaps they also had God or luck on their side? Neighboring countries were not always constructive, for example by simply sealing off their borders. But again, Canada and Australia were no different with policies going way beyond what is scientifically reasonable – perhaps, overreactions are to some extent unavoidable in a tragedy like this. Overall, it appears African countries in the broader region are getting their act together now, with some help from the international community. Touch wood.

 

Jockeying and geopolitics

 

As for African regional institutions and organizations, and some of the big countries, one has to wonder whether at least some saw this unfortunate situation as an opportunity to jockey for prominence and leadership in the response to the crisis (and in the African (health) governance architecture), not unlike at the global level (with WHO, CDC, World Bank and others all aligning themselves, strategically, if we may add). The African equivalent of this kind of institutional bickering obviously involves organizations like the African Union, ECOWAS, WHO Afro, …. By way of example, one has to wonder why Ethiopia with no prior experience in dealing with a disease like ebola  (and not present at the emergency meeting in Accra to launch the strategic ebola response earlier this year) seems determined to play a key role in a lot of these Ebola response efforts. African solidarity, yes,  but probably also something else.   Granted, timing was of course also an issue, in relative contributions of other African countries, with the DRC for example ready to give a hand at some point when it suddenly had to deal with its own Ebola outbreak.

Probably African geopolitics (including the threat of terrorism in Northern Nigeria and parts of North Africa, China’s involvement & respective allies in Africa, …) are also playing a role in the background. Like other regions in the world, parts of Africa are ‘catching fire’, sadly. We invite your comments and feedback on this factor. Already, there is an apparent lack of a coordinated ‘regional’ response, where country governments could complement each other’s efforts, with the overall shortfalls being met by bigger institutions that can better absorb the financial pressure involved in an immediate and effective response.

An interesting but somewhat downplayed aspect of the Ebola response till now has been the near-‘colonial’ carving up of the response in the main three affected countries. France is supporting response efforts in Guinea, the United States in Liberia, and the UK in Sierra Leone. Not very “21st century-esque” and neither does it fit well with the ‘Africa rising’ narrative. Also, the fact that a lot of the funding from the international community seems to be channeled through US- and EU-based agencies and other international agencies (including the CDC, WHO, UNICEF, MSF, Partners in Health, …) isn’t very encouraging. The official story is that governments in the three countries are coordinating the response, together with their many international friends and partners (including under an UNMEER umbrella). But where are the equivalent African organizations that can accountably manage, disburse and allocate these funds to champion the fight against ebola? Whether there is really country ownership, is thus an open question.  It’s probably rather limited. But the hope is that, if for now ownership is too hard, in the future the governance and health systems in West-Africa will be boosted to make them more resilient.

Which takes us back to some of the criticisms from prominent African voices, of gross mismanagement of national assets being one of the fueling factors of collapsing health systems in Africa. On a side note, the Ibrahim Index of African Governance (though a debatable system of indicators) is as close to the ground as it gets with trends in governance, policy outputs and outcomes in Africa. Yet there are several years with no winner of the coveted Ibrahim Prize for (transformative and progressive) national governance.

In comparison to other stakeholders, perhaps the African business response has lagged a bit behind. As supporters keep emerging from the woodworks, the hope is that they will also find their wind and step in with timely support to maintain momentum and even boost morale for those battling the deadly disease on the ground.

 

Silver linings

 

It’s not all a doleful story, though. The grassroots and societal response in Africa has been strong. Actually, it’s been much more. It is innovative, makes apt use of social media, new media platforms (like Ebola Deeply), has tech entrepreneurs seizing opportunities to raise public awareness and Africans in the diaspora playing a positive role (see Africa Responds for example), engaging media, stars, communities and more. There are many silver linings here. Communities had (and sometimes still have) to go through a learning curve too, a painful one, as social relations had to change, but they got plenty of help from within their own communities to aid in this transition. Trust and community buy-in are key to overcome crises like these, and African grass roots initiatives have so far been very instrumental in this, although, more is certainly needed in Sierra Leone.

So even if the African response didn’t quite fit the ‘Africa rising’ narrative, if only because there is no such thing as an ‘African’ response – it’s a very nuanced picture – the general feeling is definitely not one of ‘powerless Africans’ either. This is also part of the reason why Band Aid 30 is now widely considered rather toxic and paternalistic, and an ill-fit for today’s society. Both the messenger and the message matter in the 21st century (even if we still hear way too often the Peter Piots, Thomas Friedens and other famous Western global health voices in our global media, and not enough African global health voices on this crisis in West Africa). Africa is certainly not sitting on the fence as some may have believed. There is still some way to go here, but we’re getting there.

The true ‘African response’ if one exists is best displayed at the front line. The real heroes, when all is said and done, are African health workers and burial workers. Often with insufficient equipment, and sadly, also in many cases a lack of sufficient hazard pay, they have placed themselves in harms’ way, for months already, and still counting. Like most people, we are humbled when thinking of their bravery and heroism.

 

Moving forward

 

It’s clearly a very diverse story. The hope now is that Ebola will turn out to be a game changer for health systems & infectious disease control in Africa: (1) perhaps suffering from a bad conscience (?), the WHO seems eager to turn the crisis into an opportunity to strengthen health systems in the region (with follow-up ‘health systems resilience’ conferences in the respective countries planned in March next year for example) – ‘The health facilities and infrastructure put in place to help Sierra Leone, Liberia, and Guinea contain the Ebola virus disease epidemic should form the basis of a new health system’ the WHO urged last week at its event in Geneva;  (2) an ‘African CDC’ will now perhaps finally see the light; (3) maybe African countries can push more for international co-financing of UHC (implementing a future SDG health UHC goal/target), to help prop up weak health systems in poor countries in Africa. Weak health systems are obviously a problem for the whole world, as can been seen in this crisis, even if it shouldn’t be the key reason for global solidarity.

So it would be good if African countries & regional institutions could make use of the Ebola crisis to strategically place HSS in Africa much higher on the SDG agenda, having previously failed at least to some extent during the agenda setting stage of this global health crisis. It’s the least they can do to commemorate all (unnecessary?) Ebola victims so far and to honour the heroism of health workers engaged in the fight.

This won’t be easy, though. Little by little, Ebola already seems to be slipping off the global media radar, climate change (funding) will most likely take the spotlight in the coming year (with ODA health budgets being magically ‘reoriented’), and quite some powerful global health voices seem to be arguing for a global pandemic response fund (with the risk that HSS in Africa gets somewhat placed on the backburner?).

As for the massive economic impact of the Ebola crisis, let’s hope the international community will also lend a hand – and maybe here the African business community can also step up.  This crisis threatens to wipe away the health systems, economic, political, and social rubric of West Africa and to rob future generations of any gains made from international development initiatives to date. There is an urgent need for decisive leadership and wholehearted commitment to win the fight against Ebola, and the will to emerge strong when the storm blows over. Success however, is often worn on the shoulders of responsibility.

Africa’s future might be written – and its history rewritten – based on how the continent responds to the Ebola crisis today. Let’s follow the example of the real heroes in this story, health workers, burial workers, community advocates – selflessness in action. We owe it to them to overcome this crisis and re-build up the countries that many of them have died to save.

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4 Responses to “A Preliminary Assessment of the African Ebola response”

  1. Siphiwe Thwala

    In a way however, i’d say Africa is responding and has risen to the challenge rather well. Lets not forget the development background this continent has, and how developed countries have always patronised Africa when it comes to approaches to health care and especially responses to disease outbreaks. Africa has had to learn to take the time to learn new ways of dealing with disease, to think like the westerners to be exact. Such a transformation does not take overnight. i’d say well done Africa. you are learning fast and coming of age

    Reply
    • Merawi Aragaw

      Thank you Thwala!

      We, Africans,are trying our level best to catch up with with the demands of such outbreaks in just few years. Where were these countries in just 10 years ago? is that not the economic, political and social backlogs that we are fighting now? Are we really responding only to the outbreak???

      Reply
      • Siphiwe Thwala

        Absolutely Merawi. We will get there as Africa eventually. We may not be where we need to be yet but we are not where we were either (totally complacent and wholly reliant on external bodies to help us out). That s a cause for celebration. Lets pick ourselves up, encourage one another, and hold hands marching forward from here

        Reply
  2. Nana Yaa Boadu

    Thanks for your insightful comments, Siphiwe and Merawi! I certainly commend the efforts of all who have selflessly given of themselves and their resources to bring this scourge called ebola under control. I also agree we (as Africa) have a ‘developmental history’ whose influence we cannot remove from the seeming lag between us and the global north as far as health systems capacity and general development al infrastructure are concerned. In like manner, we must be vigilant of poor governance and resource management that often occurs within our borders, that sometimes jeopardizes our very health care systems more than the patronization of western players ever could. If we don’t prioritize our own value, by not putting illicit gains before the needs and rights of all our citizens, who can we really expect to do that for us without patronizing us in the process? Just a thought I want to throw in, to encourage more accountable governance, that allows efficient, but also equitable health care delivery, so that our entire socio/cultural and politico-economic systems don’t crumble when hit hard in one area. On the other hand, this really does point out that health budgets should probably not be as marginalized as they are in some of our beloved African states. This unfortunate crisis proves how relevant health is to the very national integrity of a people. God help us all to move past this and once again proudly raise our African heads in the Sun!!

    Reply

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