'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 Ebolacamarazeinab@hotmail.com

www.africa2point0.orgwww.wimguinee.org

Facebook: https://www.facebook.com/#!/pages/ZeroEbola-Ntodi/1566419193586979 Twitter: @zero_ebola

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Q&A

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