From catchphrase to action: Learning lessons on Ebola

John Whiteside wears protective gear before receiving a patient suspected of having Ebola at a medical unit in Monrovia, Liberia. To bring an end to Ebola and prevent a similar outbreak in future, the international community must address the health worker shortage and fragile health systems in the three most-affected countries. Photo by: Neil Brandvold / USAID / CC BY-NC

From water cooler chats to congressional hearings and from Monrovia to Geneva, there has been one phrase voiced consistently about the West African Ebola crisis: “We must learn lessons from this.”

It is of course well and good that the world seems determined to understand how this crisis came to be, how it was able to explode in previously unforeseen ways, and how we can prevent it from happening again. But I’m increasingly worried that the collective repeating of this phrase is lulling us into complacency, as if simply saying it enough times will eventually make it so.

Complacency about the post-Ebola response is particularly worrisome because there is no shortage of issues that require urgent action. Depending on who you ask, you might hear about the need for smarter disease surveillance systems, World Health Organization funding and reform, improved governance, or more robust accountability measures — all subjects worthy of attention. But if we’re looking for one clear place to start acting, we must begin by acknowledging — and then quickly remedying — a foundational challenge: the drastic health worker shortage and fragile health systems in the three most affected countries, especially in the remote areas where the outbreak first took hold.

How do we know that this is such an essential and immediate priority? Because Guinea, Liberia and Sierra Leone, along with many of their peers across sub-Saharan Africa, had a health workforce crisis before the first cases of this Ebola outbreak emerged. Each of these countries had less than three doctors, nurses and midwives per 10,000 people — far less than the WHO-recommended 23 per 10,000 needed to deliver basic health services. Ebola has only further compounded this crisis, claiming the lives of nearly 500 health workers as they sought to treat and care for others.

The influx of volunteer health workers from around the world (and from within the affected countries themselves) to the region in recent months has been nothing short of heroic, even earning them the title of TIME Magazine’s Person of the Year. But relying solely on an emergency, ad hoc system to mobilize international health workers is, by definition, not sustainable. Going forward, sound policy would be to systematically recruit, train, incentivize, and retain more local health workers who are equipped to do the job day in, day out — leaning on external health expertise only to bolster capacity in rare moments of crisis.

Encouragingly, new analysis out today commissioned by the Frontline Health Workers Coalition shows that increasing the health workforce in the Ebola-affected countries is not just the right thing to do — it’s also affordable. In fact, doubling the skilled health workforce in Guinea, Liberia and Sierra Leone, as well as expanding health coverage through a comprehensive community health worker program, could cost an average of just under $115 million a year for the next five years. Put into perspective, that full five-year cost would represent just 10 percent of the $5.4 billion recently authorized in U.S. supplemental resources to fight Ebola.

Building up a health workforce would do more than just help fight Ebola or the other threats we can barely even conceive of yet. In fact, doing so as part of a broader effort to strengthen health systems would have equal if not greater impact on the more mundane but deadly challenges faced by citizens in the region. It could mean more children reached by health workers with vaccines to fight against pneumonia or diarrhea; more pregnant women attended to at birth; or an extended geographic reach of health workers into more remote communities.

Of course, money alone will not solve the health workforce challenge. The 83 countries facing severe health workforce shortages each need to take the lead on developing transparent plans for remedying this problem. Such plans must account for the reality that health workers cannot exist in a vacuum — they need salaries, supplies, medicines and infrastructure built around them to ensure that their health systems are functioning properly. We need donors to develop their own health workforce strategies, demonstrating accountably how their investments in global health, both vertical and horizontal, will make real, targeted contributions to the health worker shortage and countries’ fragile systems. Underpinning all this work, we need far better data to understand health workforce trends and gap — the latest reliable data on health workforce in Guinea, for instance, is a decade old.  And it all needs to come together in a post-2015 strategy with a clear, bold vision for ensuring all communities have access to competent health workers and functioning health systems.

Fortunately, there are plenty of global moments ahead that will allow for meaningful contributions to this issue, should leaders choose to step up to the plate. Starting tomorrow in Brussels, the European Union will host a high-level Ebola meeting, with focus split between the ongoing emergency response and the planning for longer-term recovery in the region. Soon thereafter, we’ll see a cascade of meetings where Ebola will likely emerge as a consistent theme: the April World Bank spring meetings, the May World Health Assembly, the June German G-7 conference — Chancellor Angela Merkel has already said health workers and systems are priorities — and the July financing for development conference, which is a critical part of ongoing post-2015 negotiations.

In the months ahead as we measure the success of these meetings, we must remember that any further delay can be devastating. More than 560,000 ONE members around the world have called on our leaders to act. What we need is the political will, dedicated planning and targeted investments to begin strengthening health workforce and the surrounding systems now, so that “learning lessons” is more than just a catchphrase and can have a transformative effect for millions of people.

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About the author

  • Erin Hohlfelder

    Erin Hohlfelder is policy director for global health at the ONE Campaign, where she leads health policy analysis and manages relationships with technical partners across global markets, focusing on infectious diseases, maternal and child health, and financing mechanisms. Before joining ONE, Hohlfelder worked for the Global Network for Neglected Tropical Diseases at the Sabin Vaccine Institute.