looking ahead: post-ebola strategy in west africa webinar october 22, 2014
DESCRIPTION
"Looking Ahead" Post-Ebola Strategy in West Africa is the first in a series of planned webinars, where we invite knowledgeable individuals and participants to join the post-Ebola strategy in West Africa discussion. During the webinars, experts from different backgrounds, will outline their view on the Ebola Crisis and most importantly, share their vision on what needs to be done now, and post-Ebola, to ensure aversion of further political and economic disturbances. The fast spread of the Ebola virus has major consequences on the African countries it has hit the hardest: Guinea, Liberia, and Sierra Leone. Besides the death tolls and associate losses, the countries are also facing great danger because of the economic consequences the virus carries. Sierra Leone and Liberia, two of the most hit countries, have both recently come out of more than a decade of gruesome civil wars and the set back of the disease does not help with the stabilization of the economies. Their democracies are fragile and the deprivation from the Ebola crisis could be a trigger for political disruption. The youth played a major role in those conflicts as a result of economic and social marginalization. Without a post-Ebola strategy to ensure the youth a future of economic and social stability, there may be unforeseeable instabilities. ABOUT THE ORGANIZER: Twenty-First Century African Youth Movement, (AYM) empowers and mobilizes Africa’s youth through employment. The AYM is dedicated to developing new and exciting enterprise opportunities for young people in Sierra Leone, to help provide young people with the confidence, power and skills they need to get themselves into employment and out of poverty. Mobilizing Africa’s unemployed and underemployed youth is the key to the continent’s economic growth and stability. AYM works to mobilize marginalized youth through education, training, and employment, creating entrepreneurial opportunities to help move communities away from poverty, disease, and hunger. AYM aims to establish personal empowerment and community resilience by energizing the continent’s youth population, its most critical resource in the reversal of social and economic stagnation. For more information, visit: http://www.aym-inc.org/ebola-looking-ahead/. AYM’s call for action: Dr David J Baumler’s AYM Pepper Challenge: http://youtu.be/iU1Ot60mT7ITRANSCRIPT
'Looking Ahead' Post-Ebola Strategy in West Africa
22 October 20141pm EST
Agenda Points
• Short term strategy: containment strategy & humanitarian aid - Speaker
• Long term strategy: improvement of (social) health care & international assistance - Speaker Rachel Glennerster, Executive Director of the Abdul Latif Jameel Poverty Action Lab (J-PAL) and Researcher at International Growth Center
• The importance of micro programmes: Engagement, voicing the right people, AYM’s call for action - Speaker: Zeinab Camara, Global Lead on Ebola at Africa2.0 and Tutu Fellow
Planning for Post Ebola in West AfricaRachel GlennersterExecutive Director, Abdul Latif Jameel Poverty Action Lab, MITLead Academic for Sierra Leone, International Growth CenterOctober 22, 2014
Planning under uncertainty
• Planning is challenging given enormous uncertainty about:– The final extent of the outbreak and timing of its conclusion– The economic damage caused by the knock on effects of Ebola– The status the health care system will be in by end of outbreak
• Reliable information has been a casualty of the outbreak– Health facilities are overwhelmed and travel is restricted– Incentives are skewed for individuals, journalists, and agencies
Overview
• Some evidence on economic impacts and importance of restoring confidence
• Challenges in rebuilding the post Ebola health care system including coping with weaknesses in the pre Ebola system
• Caveat: I have worked on Sierra Leone for 10 years but I don’t have data or experience in Liberia or Guinea
The economic cost of fear• Most economic costs will be indirect: people putting off
purchases, investment, activity that involves meeting others
Number of Traders of Domestic Rice in 2012 and 2014
Source: Glennerster and Suri, 2014 www.theigc/country/sierra-leone
Restoring economic confidence is key• Govt can support this by improving reliability and
transparency in government pronouncement and actions
• Macroeconomic stability, esp exchange rate stability, essential to restoring confidence
• Government expenditures can help prime the pump – Reduce payment delays for govt purchases relieves credit shortages– Big announcements followed by delays undermines confidence
• Ebola has exposed the costs of low trust in government– Medium term objective needs to be more transparent and
accountable government
Rebuilding health care
Challenges in rebuilding the health care system• Immediate: restoring confidence in/utilization of health
system– Getting children immunized, mothers delivering in clinics etc
• Short run: recruiting and training new health workers
• Medium: Limited budget means making difficult choices– Investments that have most impact on health might not be those
that would have prevented Ebola– There may be a short run influx of donor money for “rebuilding”
health systems but need to plan for a realistic medium term
• Medium to long run: Improving accountability
Immediate: Judicious use of nudge incentives
• Substantial evidence that small nudges (incentives) can have big impact on behavior, including preventative health
• Small incentives linked to immunization in other contexts to increase immunization rates dramatically
• More cost effective to have nurse at clinic with incentive than have the nurse do outreach to remote communities– Mothers willing to walk to get child immunized for small incentive
• This is particularly true when health workers are in short supply, as is tragically the case in West Africa post Ebola
Recruiting and training health workers
• Need to experiment with new ways to recruit, train and utilize health workers to fill a large gap rapidly– What roles don’t need a fully qualified nurse?– What can be done by someone carefully trained on a narrow set
of protocols?
• Recruitment is key– Zambia experiment with different ways to recruit health workers– Those attracted by potential for a career were better educated
and worked much harder– Recruiting the right people had big impacts on the quality of
service delivered. (Ashraf, Bandiera and Lee, 2014)
Difficult tradeoffs• In 2013 SL government spent $40million on health i.e $7 per capita per year. (WB estimates
$20 public, $80 private)
• Local public clinics are focused almost entirely on maternal and child health and preventative health
– Most cost effective investments in health esp for a poor country– But clinics not seen as place for men or nonchild bearing women
• Investments that would have helped reduce severity of outbreak (more diagnostic labs and inpatient facilities) not the most cost effective in a nonEbola world
• Important not to fight the last war
• Only one RCT in South Asia not Africa• Program conducted by NGO not government
Accountability• Health care workers are experiencing the largest toll from
Ebola. They are working under enormous stress in difficult conditions and are the heroes of this crisis
• However, part of the medium term challenge is improving accountability in the health care system– Although malaria treatment is meant to be free, 60% of people
who received malaria treatment at public clinic reported paying– In 2008 survey, 18% of clinics were closed despite prior warning– 44% of health workers on roster were absent
• Improved accountability is essential to improve trust and ensure investment in rebuilding is used effectively
ZeroEbola-Ntondi
Africa 2.0 Global Response on EBOLAMicro Level programs in Post-Ebola Strategy
African Youth MovementWebinar
22 October 2014
OVERVIEW• The 2014 outbreak of Ebola is the largest in history. As of today, more than 9000 cases with more than
4000 deaths ( half are women and the youth).
• The Center for Disease Control predicts s as many as 1.4 million case by January 2015, with 10 000 cases a week in the affected countries.
• Countries will lose 13 billions USD in revenue and feel the impact of Ebola for the next 10 years (UNDP)
• Multinational companies are reducing their footprint in affected countries, farmers are leaving their farms to go to unaffected areas , creating more unemployment, and a revenue gap in the countries GDPs, predicted food shortages and many more.
• The social-economic and political impact have been enormous. The notion of African unity has been damaged by several African states closing their borders to the affected countries, isolation a large number of the African Youth, women.
• The crisis, as we know, will last long after Ebola is contained, because the affected countries social and economic fabric will be decimated. The Communities have been the most hit by the crisis
• All efforts are made to contain the disease, few reflection are been done to look ahead and define the post-Ebola Strategy.
• Post-Ebola Healthcare Strategy- Community Based-approach- Strategic plan for more resilient communities?
Guinea Country Response Strategy• Inter-ministerial Committee to oversee all the crisis committee activities.• Crisis Committee established by the Government of Guinea, with the UN agencies under the leadership of the
World Health Organisation, the EU, Embassies, Doctors without Borders, the Red Cross and other partners. A country Strategy was developed with key components:
• In order to oversee all the partners efforts, a Presidential decree was published which established a National Coordination Unit to oversee actions on the ground.
CommunicationSensibilisationMedia Engagement
Follow contacts
Monitoring & Evaluation
Prevention Community Involvement
Healthcare Mgts
National Coordination
Early preventionManagement of corpsesTreatment centres
Logistic mobilisationNutritional assistance
Traditional leadersCommunity healthcare professionals
Inter-ministerial Crisis CommitteeNational Coordination Unit
CDCGoG
UnicefInternational NGOs
MSFRed CrossCDC
UNFPAWFPRed Cross
Religious LeadersLocal authorities Committee
National Coordination UnitWHO
CDCGoG
• Sierra Leone- Liberia: decisive measures taken cases are still increasing• All the management structures in place- increase number of cases- Containment not prevention• All agree that we should adopt Community- based approach to contain and prevent more cases• Social mobilisation helped to contain cases in some areas: Success story Telimele
Guinea Healthcare System1. State Led healthcare System (9% National Budget), health structure every 5 km (objective)2. Decentralised system: University Hospital, Regional Hospitals, Community Hospitals, District Health centres,
local health clinics3. Well distributed healthcare infrastructures in the country
Why not functional:4. Failure of Communication channel5. Resources (financial, human, equipment)6. Governance
Ministry of HealthUniversity Hospitals
Regional Hospitals
Community Hospitals
District Health centres
Local health centres
Doctors/ Professors
Regional Hospital Director
Community Hospital Director
District HealthcareWorkers
Community HealthcareAgents
Local Health and hygiene Committee
Post-Ebola Strategy
• Re-enforce Healthcare system• Capacity building of local structures• More investment in Infrastructures in rural areas• Decentralized healthcare system• Good Governance• Increase revenues for better healthcare services (minimise traditional healers)
• Country Brand restructuration• Improve and Re-enforcement of existing Health Systems• Education• Decentralisation (more revenues to Local Structures)• Increase investment in R&D• Information Management System
M ACROM ICRO Community Based
Approach
Regional
Govt
Capacity BuildingIncrease revenueGood GovernanceImproved Communication channel
Training and EducationSpecialisationRegulationR&DIncrease % in National Budget
Conclusion- Resilient Communities• Ebola could have been controlled by a more resilient Community• Capacity Building needed for a resilient Community to be able to absorb shocks and pandemic• Community based Approach for a better and improved Healthcare System• More Investment in local healthcare structures• Social structures empowered in the decision-making of their health and communities
Improved Resources
More confidence
in the system
More revenues to reinvest in the system
Better healthcare
service
Better health of
population
ZeroEbola N’TODI Campaign• Africa2.0 positioning:
Local Civil Society Partner of Choice for the execution of the Social Mobilisation Strategy working with the Government and Key Partners. Our approach will be based on 4 axes:1. Prevention: distribution of preventive kits and equipment2. Communication: Sensibilisation and awareness campaign3. Logistics: facilitation and coordination of donations from the Diaspora
• The campaign will be conducted in: GUINEA, SIERRA LEONE, LIBERIA, CONGO DRC, ANGOLA, MOROCCO AND BENIN. • Community Based Approach
Government
United Nations Agencies- UNICEF/UNFPA/WFP
Orange
Diaspora
International NGOs
Communication & Sensibilisation
Distribution & Logistics
Regional Awareness
Youth
Women
Community Healthcare Professionals
Civil Society
Local Media
Women
Youth
Community healthcare Professionals
Media
Execution-Community based NGOs Beneficiaries
Local Partner- ZeroEbola Ntondi-
Af2.0Partners
Schools
Orphanages
Local healthcare centres
Contact
Zeinab Camara- AF2.0 Global Lead on [email protected]
www.africa2point0.orgwww.wimguinee.org
Facebook: https://www.facebook.com/#!/pages/ZeroEbola-Ntodi/1566419193586979 Twitter: @zero_ebola
WE ARE THE ONES WE HAVE BEEN WAITING FOR!
African Youth Movement
AYM empowers and mobilizes Africa’s youth through employment in technology, agriculture, education, ecotourism, entrepreneurship, and the arts.
Q&A
Thank you for your time.
Hands at Work, Minds in Motion