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Ebola: the cost of poor governance in the health sector
François Grünewald

It is now accepted that, despite its scale, the response to the 2014-2015 Ebola fever epidemic in West Africa did not measure up to the gravity of the situation. Though a few organisations showed that they had learned from past crises, the majority of international institutions who should have shown leadership in such circumstances failed in their responsibilities by reacting too late, too slowly and in an inadequate manner. As a result, the number of victims was much higher than it should have been, as was the overall cost of operations.

At a time when aid resources are overstretched due to a large number of protracted crises and regular, significant, rapid-onset disasters, it is essential to achieve the highest level of efficiency. An inadequately managed crisis that goes partly out of control will always result in extremely high costs to contain it.

The objective of this paper is to analyse how better management of the Ebola Haemorrhagic Fever (EHF) outbreak in West Africa could not only have significantly reduced the impact on the population and on the national health system, but also could have helped to save a great deal of resources for the aid community.

The article does not claim to include a complete economic appraisal of the response to the 2014-2015 West Africa EHF outbreak, nor a comprehensive evaluation of its different impacts. Many more publications and evaluations are being produced and will contribute to understanding of these issues and will help to identify ways for the aid community and national authorities to move forward and prepare for the next high-risk, deadly outbreak, which is sure to take place, but we just do not know when. The article simply highlights the fact that in this type of situation, decisiveness, anticipation, leadership and courage are essential ingredients for a timely and effective response which manages to keep a dramatic situation under control.

Improving the response for any significant epidemiological risk means designing and implementing mechanisms and systems that make it possible to contain the disease rapidly so that an epidemic does not reach proportions that are either uncontrollable or very expensive to control. Previous crises have made it possible to establish a series of critical steps that need to be implemented in order to manage epidemiological outbreaks effectively. In West Africa, these steps were not followed by humanitarian organisations, with one or two exceptions such as MSF and the Red Cross.


Key steps in responding to Ebola: lessons learnt from the past

Alert: This implies that there is at least a minimum of health infrastructures covering the area with a basic health information system able to trigger the alert and to rapidly activate confirmation mechanisms;

Circumscribe and manage the area of concern: This involves identifying people, tracing cases, conducting safe burials, isolating victims and controlling movements with a specific focus on helping health institutions to limit their potential as contamination hubs;

Treat (caring for people and caring for responders): As there is no treatment available yet, this means supporting the capacity of cases to combat the disease and limiting the occurrence of additional diseases that could further weaken the patients;

Prevent: (communicating with public health messages, preventing the disease from spreading to other countries, and implementing preparedness measures);

Ensure a minimum of systemic stability: (food/nutrition, essential services, recovery, psychosocial care, providing support to the regular health system to prevent it from deteriorating as a result of the Ebola epidemic);

Coordinate: Coordinating the response and its different components, including multi-purpose logistics;

Prepare: In particular, this involves supporting national health authorities in epidemiological surveillance, alert systems and the development of a rapid intervention capacity;

Rehabilitate the health system and help it to recover a positive reputation: It is often significantly disenfranchised and weakened at the end of the outbreak.