health impact of ebola crisis - mdsr...
TRANSCRIPT
Health Impact of Ebola Crisis Presentation for LSHTM / Options - Chris Lewis
Outline
• Introduction
• Ebola outbreak
• Impact of the crisis
• Opportunities arising from crisis
Timeline • Early December 2013 - little boy in southern Guinea caught a mysterious
disease. He had fever, vomiting and blood in his stool. A midwife caring for him was hospitalised in Guekedou, a city of 200,000 people on the Guinea, Liberia and Sierra Leone border
• March 2014 - the disease spread to four cities
• May 2014 – WHO report disease appears to be slowing down
• June 2014 – MSF say the epidemic is out of control. Second wave of epidemic gathers pace
• 8 Aug 2014 – Global Public Health Emergency declared
• 17 Sept 2014 - UK committed to taking leading role in Sierra Leone
• Oct 2014 – epidemic peaks & reduces in Liberia
• Dec 2014 – epidemic peaks in Sierra Leone
• Jan 2015 – epidemic reduces in SL, and peaks & reduces in Guinea
• October 2015 – confirmation of first case of sexual transmission
• 7 November 2015 – Sierra Leone declared free Ebola transmission
• 29 December 2015 – Guinea declared free of Ebola transmission
• 14 January 2016 – Liberia declared free of Ebola transmission
• December 2016 – New vaccine provides substantial protection against Ebola
Experience – First few weeks of September 20 September
The current life in Freetown appears normal, far from what I usually see in humanitarian crises. There are no collapsed buildings, no camps, no conflict, no multiple meetings, and no plethora of international personnel. It has made me realise – we are not responding to a humanitarian crisis here – we are preventing one of the most devastating humanitarian crises in recent years. However the urgency and scale need to be the same if not more as if we were responding to it. I feel that we need a carefully thought out, effective, fast, large scale, multi-pronged approach to prevent this crisis – there is not one solution and each intervention needs to be done very carefully.
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500
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2500
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Wee
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ase
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Central predicted weekly reported casesUpper and lower predicted weekly reported casesConfirmed, probable & suspected cases
Modelled Ebola scenarios from October 2014, with actual cases
superimposed Adapted from model by Imperial College, MRC Centre for Outbreak Analysis and Modelling
UK Response • £427 million
• DFID / MoD / DoH / PHE / NHS / FCO / Cabinet office
• 6 treatment facilities
• 1,400 treatment beds and other safe isolation beds
• 1,600 NHS volunteers
• 3 PHE laboratories
• Social mobilisation
• Over 100 burial teams
• 4000 staff trained
• NERC/DERC coordination
• New research - diagnostics, therapeutics, vaccines, epidemiology, anthropology
Impact and Opportunities from Ebola ……..or
Snakes and
ladders
Needs developing in post disaster contexts (URD)
Mortality/morbidity
timeT0 +48h + 1 week
DISASTER
Water-borne diseases
Vector-borne diseases
+ 1 month
post- disaster epidemic: does it really exist ?
Psychosocial
Acute respiratorydiseases
Mortality/morbidity
Snakes Impact of Emergencies on Mortality
Taken from Evaluation of Haiti response
Initial understanding – Impact on Utilisation UNFPA. (2015). Rapid Assessment of Ebola Impact on Reproductive Health Services and Service Seeking Behaviour in Sierra Leone. Freetown: UNFPA.
We now know more about impact Options, VSO/WaterAid/LSTM, ReBUILD
• 22-30% increase in maternal deaths.
• 24-25% increase in newborn deaths.
• Institutional deliveries fell by 23%
• Children treated for malaria fell by 39%
• Children receiving basic immunization (penta3) fell by 21%.
• Loss of health workers, breakdown in trust between communities and health workers
• Ebola not a useful example as we look at how to effectively integrate maternal and newborn care into response to crises going forward, due to the tension of disease control vs. service delivery
• Importance of early detection and response is clear, and should be a
priority.
• There is an argument that the Ebola outbreak would have
overwhelmed the health systems of most low-income countries
• Every country and system experiences shocks, although a catch 22 is
that the poorest most vulnerable countries, experience the most
shocks and have the least evidence for addressing these
• What are the factors that enable systems and maternal and newborn
services to be (exceptionally) resilient to shocks or (exceptionally)
vulnerable?
How do we reduce the length of the snakes? Resilience / Preparedness
Ladders - Opportunities post crisis
• Evidence shows crises present opportunities for health system reform
– Strengthening of neglected areas (eg. mental health)
– Can lead to better availability of information for planning
– General health system reform
– Reprioritisation of health policies
• Reform most effective when planned during a crisis and implemented towards the end of a crisis or start of early recovery (window of opportunity)
• Mental health sector have demonstrated this evidence most effectively (Build Back Better, WHO)
What are the opportunities / ladders?
• Maternal and Newborn – We know maternal and newborn
health will always be an issue in crises
– We need to be better at integrating MNCH into primary health care, & health systems approach to crises
– How can maternal and newborn care build from the excellent work in mental health, in establishing the evidence on “Building Back Better” following crises?
• Sierra Leone – Heightened interest in the functioning of the health sector
– Potential for new ways of working.
– Leadership and high level interest, with health as a political priority in Sierra Leone
Key Points • Open data is critical to enable effective response to future
crises
• How do we enable resilient health systems, and resilient maternal and newborn services?
• How can maternal and newborn services develop evidence on “building back better”, taking opportunities arising from crises?