Via The New York Times, an important op-ed by Judith Rodin, president of the Rockefeller Foundation, and Bernice Dahn, health minister-designate of Liberia: Ebola-Free, but Not Resilient. Excerpt:
Certainly, Liberia was not the only place where the epidemic severely challenged the health system. From Sierra Leone to Texas, the public health response was inadequate and uncoordinated.
One of every three dollars invested in development progress is lost when a crisis hits. In this new reality, all facets of the global health system, from local health teams to global organizations, must work in a coordinated way to build a system that doesn’t break under pressure.
A resilient health system combines active surveillance mechanisms, robust health care delivery system and a vigorous response to disease. When the first signs of contagion appear, a system should be able to act quickly to stop it in its tracks — all without compromising its core functions.
Resilience is well understood in fields like biology and engineering. Resilient systems share several characteristics. One is awareness, which in the case of health systems means, first and foremost, strong disease surveillance.
A second characteristic is the ability to adapt to changing conditions. We saw this in Nigeria: When Ebola first surfaced, leaders redeployed polio eradication teams to focus on Ebola. With polio “season” over, G.P.S. tracking and contact-tracing were deployed to monitor Ebola, while traditional, religious and community leaders were on the front line raising awareness.
A third characteristic is diversity: the ability to address a broad range of challenges. A good primary care system can help do so and is most feasible in countries that have prioritized universal health coverage, because they are more likely to have health workers, facilities and other capacities that span the country, and services that are affordable and accessible — which can make the difference between life and death at the earliest stages of an outbreak.
Finally, resilient systems are integrated: information is shared across different levels of government. For example, New York City, which in this century alone has experienced a terrorist attack, a blackout, and Superstorm Sandy, prepared for Ebola far in advance of an actual case. With each crisis, the city has enhanced its resilience.
So when a volunteer doctor returning from West Africa checked himself in, city leaders quickly mobilized, freely sharing information with the public to explain their Ebola management plan, providing guidance as well as assurances of public safety. This integration allowed for the single case to be successfully treated.
When a resilient system is in place, cities and countries alike are prepared to yield what we call a “resilience dividend” — benefits that are independent of crises. Building trust with the public, enhancing access to quality care, and investing in public health are all wise investments at any time, helping to increase productivity and growth.
Liberia faces new threats in Ebola’s aftermath, including a rise in malnutrition and outbreaks of highly contagious yet preventable diseases, such as whooping cough and measles. It would be easy to slip back into old patterns and treat these challenges as individual problems.
But with its ambitious Post-Ebola Health Investment Plan, the Liberian government is focusing on recruiting and training health workers, particularly at the local level; building up infrastructure; and investing in labs needed to quickly detect and identify dangerous diseases as soon as they emerge. Last month, the World Bank announced an additional $650 million toward rebuilding in Liberia, Sierra Leone and Guinea. The United Nations secretary-general, Ban Ki-moon, will hold a conference in July to get countries to pledge even more.
One lesson from Ebola is clear: in a resilient health system, the whole is greater than the sum of its parts. Liberia not only reminds us of the necessity to create such a system, but also can help to show the path forward.
