Once again, disease in Africa is making headlines. The 10-month-long Ebola outbreak in the Democratic Republic of Congo (DRC), the second-largest, is ringing alarm bells across the world.
This latest outbreak is yet another testament to the inability of a weakened health system to contain the spread of epidemic disease.
Hospitals and clinics in the DRC have had insufficient health workers and equipment in the past few decades and crucial medicines run out frequently. About 70% of its citizens have little to no access to healthcare.
Health systems in many African countries are simply not prepared to cope with the daily health needs of their citizens, let alone emergency outbreaks.
New research by the Mapungubwe Institute for Strategic Reflection (Mistra), titled Epidemics and the Health of African Nations, addresses this problem and explores solutions to it.
The publication challenges the perception that our continent is cursed with an unavoidable burden of disease; that we are stuck with distasteful broadcasts about deadly epidemics in Africa.
Rather, authors argue that the continent is already equipped with the knowledge and capacity to save the many lives lost to epidemics in Africa.
Scientists, researchers and practitioners in the field (nurses and community health workers, as well as doctors) come together to explore Africa’s vulnerability to disease and the structural drivers behind it, while bringing to light the effective measures that have been taken on the continent.
Authors review scenarios similar to the one playing out in the DRC, such as those in Guinea, Liberia and Sierra Leone in 2014, when these countries were caught unprepared and vulnerable to an Ebola attack.
In previous years these countries were faced with catastrophic civil wars which resulted in the collapse of those countries’ health system infrastructures. They were left with the weakest healthcare system infrastructures in the world.
Thus, these west African countries lacked the necessities required to manage and contain the spread of the Ebola virus.
To put it into context: The minimum health workforce required to provide the most basic health coverage is 22.8 per 10 000 population. Guinea has less than 1.5 health workforce density per 10 000 population; Sierra Leone has 2.2 and Liberia has less than 3.7. Per capita government expenditure on health offers a similar picture:
It sits at $9 for Guinea, $12 for Sierra Leone and $13 for Liberia, whereas the minimum required to provide the most basic health coverage is $44.
It is thus a tall ask to require these countries to contain an outbreak with resources that do not even allow for the provision of basic, day-to-day health requirements.
In Sierra Leone 14 124 Ebola cases were recorded with 3 956 deaths; 10 675 cases were recorded in Liberia, with 4 809 deaths; and Guinea recorded 3 811 cases, with 2 543 deaths.
In essence, a lack of resources is a huge problem which compromises the effective training of healthcare workers and the maintenance of adequate infrastructure, efficient supply chain management and effective community engagement.
The lack of resources means that treatment of, and vaccinations against, other infectious diseases become less of a priority, which can lead to additional outbreaks. Debilitated health systems can thus cause unprecedented calamities.
With that said, leadership and governance play a huge role in managing health outcomes, even within weakened and underresourced health systems.
Epidemics and the Health of African Nations offers an illuminating account of Nigeria’s experience of the 2014 Ebola outbreak: It was different to that of the other three West African countries even though its health system was itself not particularly prepared for the outbreak.
Decisive leadership, once patient zero had been swiftly diagnosed with Ebola, was the difference between containing an outbreak and facing a catastrophe.
The Nigerian government offered a timely and precise response to the Ebola outbreak by efficiently rallying the country’s health workforce to prevent the spread of the disease.
Prompt and thorough control measures were taken to deter the disastrous effect of an Ebola outbreak in Nigeria’s two large cities: Lagos, with about 20 million people, and Port Harcourt, with more than 1 million people.
Patient zero was accurately and rapidly diagnosed by Dr Ameyo Stella Adadevoh at the First Consultant Medical Centre, which allowed for implementation of a much more strategic process of containing the virus across the country.
Although she eventually succumbed to the disease, her efficiency ensured that healthcare workers were mobilised and deployed to carry out fast and thorough tracing of all potential contacts, to monitor all these contacts continuously and to immediately confine potentially infectious contacts.
Nigeria had a small fraction of Ebola the incidence compared with the other west African countries, with 20 recorded cases and eight deaths.
Nigeria’s Ebola experience can be seen as a success story and many lessons can and should be learnt from it. Various steps taken by the Nigerian government and relevant stakeholders contributed to the timeous containment of the virus.
These steps included public enlightenment programmes that were carried out to create awareness about Ebola and how it could be prevented.
At the peak of the Ebola emergency, the government banned the transportation of corpses because some burial ceremonies involve direct contact with the body of the deceased which can contribute in the transmission of Ebola.
Additionally, the government instructed all schools, public and private, to remain closed until competent tactics had been established to prevent the spread of the disease.
All Nigerians were advised to wash their hands habitually with soap and running water.
A bucket with a tap was used for regular handwashing – a strategy initiated in areas without running water. The country’s entry and exit points were put under health surveillance and certain airlines were suspended from transporting passengers to Nigeria.
Importantly, funds were released by the government to assist in containing the outbreak. Moreover, the private sector contributed considerable financial resources towards the containment of Ebola.
Case studies like the one above point to what can and should be done in the face of a potential epidemic. For too long the health challenges that beset Africa have been narrated by experts and donors from other continents. Mistra’s new book aims to change that. It draws on African expertise for an honest and rigorous exploration of the challenges faced by the continent, with the objective of finding long-term solutions for the control and elimination of epidemics in Africa.
Mazibuko is senior researcher at the Mapungubwe Institute for Strategic Reflection and editor of Epidemics and the Health of African Nations, which was launched on Monday at the FNB conference centre in Sandton.