Ismail Ould Cheikh Ahmed, special representative of the secretary-general and head of the U.N. Mission for Ebola Emergency Response, meets with UNMEER staff at the Ebola Operation Center in Bamako, Mali. Should EOCs be retained post-Ebola? Photo by: Pierre Peron / UNMEER / CC BY-ND

Emergency operation centers have been critical in stemming potential Ebola outbreaks in several West African countries like Nigeria and Mali, but there remain doubts about whether countries would keep them post-Ebola.

This is largely because of its potential to cause “institutional turf wars” within the government structure, according to Madji Sock, partner at global development advisory firm Dalberg.

EOCs provide critical services during crises. Their quick coordination and decision-making processes and immediate deployment of health personnel and lifesaving tools and equipment enable rapid response to public health threats. In the United States, the EOC, managed by the U.S. Centers for Disease Control and Prevention’s Office of Public Health Preparedness and Response, is staffed round-the-clock and can transport personnel anywhere in the world within hours of receiving emergency notification.

But the structure is missing in many West African countries, as evidenced by the Ebola crisis. It took months for authorities to detect and confirm the spread of Ebola in Guinea, where it all started, and by that time, the virus has already affected hundreds, making immediate containment difficult.

However, when the World Health Organization announced the outbreak and eventually labeled it a public health emergency, neighboring West African countries took notice. Nigeria, having in place an incident management system for its polio eradication response that would later be transformed to an EOC to handle the threat of Ebola in the country, shared its experience with neighboring countries. This helped Mali, for example, to be prepared when it had its first Ebola case in October. Authorities knew better and set up their own EOC almost immediately.

“That’s probably why a country like Mali was able to stop the spread of Ebola,” Sock told Devex. “Mali could have very easily become the same story as [Guinea, Liberia and Sierra Leone], especially as it shares a border with Guinea and opted not to shut down its borders.”

But now that the threat of Ebola is subsiding, the question has turned to whether governments should retain EOCs. If they do, what will be the EOCs’ mandate and how will they be formally structured?

The pros and cons

Sock notes the debate over keeping EOCs or not is not unusual. There is always the challenge, she said, of establishing a new institution or creating a new structure within an existing one.

But in order for the EOC to be effective — and the key word here is acting “very, very quickly” — the global development adviser suggests the structure must have one individual empowered to make decisions without having to go through a long bureaucratic process.

“They don’t have to go through five different people and ask for five different signatures before anything can happen,” she said.

The need to retain the structure is clear to most of the countries, Sock argued, as even if there is no longer an emergency, the threat is very much present — and this extends to other public health threats beyond Ebola.

Keeping EOCs in place is also something various stakeholders — from nongovernmental organizations to donors — support. The ultimate goal is to prevent a paralysis of the entire health system and allow countries to respond to emergencies quickly and adequately. In the case of the Ebola crisis, the outbreak disrupted the affected countries’ health systems, leaving treatment for other health issues like malaria, a leading cause of death in the continent, on the side.

But in order for EOCs to work, Sock underscored the importance of having everyone involved understand clearly their roles and mandates.

“That takes time to bring people around the table and come through those agreements without anyone feeling their mandate is being taken away or the message is they are unqualified to take on the mandate,” she said.

In most of the countries where an EOC has been set up, the person heading the EOC is not the health minister.

Regional recovery

The EOCs are part of growing discussions on post-Ebola recovery and reconstruction efforts. And donors, including the European Union, are now reviewing their aid allocations for the heavily affected countries to see whether adjustments need to be made and where.

Under the 2014-2020 European Development Fund, its main funding mechanism for low-income economies in Africa, the Caribbean and the Pacific and several overseas countries and territories, the European Union will be providing Guinea, Liberia and Sierra Leone 244 million euros ($259.9 million), 279 million euros and 376 million euros, respectively.

But Sock argued that any discussions of post-Ebola assistance by the international community should take a regional, not country-specific, approach.

“Reconstruction will have to be a West African story, not just the three,” she said, explaining that the countries are very closely connected to each other. When Ebola happened, neighboring countries also felt the impact of the decline in foreign direct investments and the closing of borders. Small and midsize enterprises that rely on these trade routes struggled in terms of supply.

The outbreak also halted the region’s plans to address its energy crisis. Sock said a big portion of the energy supply is meant to come from Guinea, but with the country heavily affected by Ebola, it wasn’t able to move forward with the agenda and therefore “the agenda for energy in West Africa is also put on hold.”

Sock hopes this will be put on the table when stakeholders finally settle on the reconstruction agenda. For now, discussions are very “ad hoc” in nature, focusing mainly on getting to zero Ebola cases and ending the crisis in the region.

What are your thoughts on keeping emergency operation centers in Ebola-affected countries in West Africa? Let us know by leaving a comment below.

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About the author

  • Ravelo jennylei

    Jenny Lei Ravelo

    Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.