Q&A: Liberia's minister of health on lessons learned from the Ebola crisis

“West Africa is sitting on a ticking time bomb,” Bernice Dahn, Liberia’s minister of health, said at an event last week.

“Global Health: Next Decade, Next Generation” celebrated the 10th anniversary of the department of global health at the University of Washington, her alma mater.

After her panel about pandemic disease preparedness and response, Dahn caught up with Devex to expand on some of the topics discussed onstage.

I want to start by asking about your comment that West Africa is sitting on a ticking time bomb. Can you expand on that and what can be done about it?

We all learned a lot of lessons from the Ebola outbreak. At least one lesson that we have learned is that an epidemic... could quickly become a pandemic.

Now, looking at where we are today, it is obvious that globally, we are not really that prepared [to] address any events that might affect human health.

The WHO did a review and in that review there were 55 different outbreaks in the last decade. Forty-two of those outbreaks were in West Africa. Besides those outbreaks, West Africa is also disproportionately affected by TB, malaria, HIV, and other tropical diseases. And with the growing burden of increasing resistance to medicines and insecticides that could also pose a big public health threat.

Now knowing from the experience from the Ebola outbreak, it is likely that any outbreak or any threat might not be confined within the region or within one country. It could affect multiple countries. It could leap from one continent to the next. Because of that it is necessary, since the burden is within the West African region, to focus on it and address it.

I have worked in a very challenging environment. My country was... rebuilding after 15 years [of] civil crisis. And then Ebola struck. That drew us back and we had to start rebuilding again.

Now, being a minister is a big responsibility for a country that is rebuilding or building from scratch. Because there are no systems in place. The second thing is there’s also budgetary constraints, considering the fact that we are rebuilding the entire country, and so there are multiple challenges and priorities that need to be addressed locally. The third thing is that there is a lot of international support… The intent is good, but the way it is channeled often also does not yield the required results.

Drawing on lessons learned from the Ebola crisis, what would be your main message for global development professionals?

Most often people who put the money on the table have the loudest voice, and so sometimes national systems are bypassed. Support is given directly to implementing NGOs, and sometimes those NGOs do not even touch base with the local government.

So they enter communities and start working. Often the ministry of finance will not be able to capture exactly how much support came from outside in total to support the health sector, for example. And that is not an efficient way of using resources…

Often donor partners, because of history, might not trust government institutions. And so the funding is channeled through other partners. But those partners are [not transparent either]. And so it is not solving the problem.

If we continue to run away from governments because we think governments are corrupt, we are only perpetuating the corruption… To be able to move forward it is necessary to help big countries build the systems, including financial management systems, internal audit systems, procurement systems, those systems that will help to build the confidence…

One reason why it is good to support through the government is because it also puts the government in the driver’s seat. The government makes a plan.

[Yet] the government [must] realize that... governments [cannot do everything] and there is need for partnership. And so what you can contract out to other partners like NGOs you do that, and [you] play your policy role and the monitoring and evaluation role. That way you know exactly what an NGO is supposed to be doing for you, you know how you can monitor it, and you are able to guide the process. So I think going that route will help.

Another problem is because we have these multiple health organizations, they tend to also fragment the way we build systems. So the building of the systems is not whole.

For example, if you have a partner who is helping with immunization: if you support a country to build an immunization supply chain and the supply chain to deliver malarial drugs, for example, is weak, you could be saving the life of a child from vaccine preventable diseases and that child could still die because the malaria drugs are in a warehouse and they cannot be delivered to the health facility. So there’s a need to work together with both domestic and external resources and support systems development in whole and not in pieces.

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