By Aurelien Chu and Mareme Gaye
The West Africa Ebola outbreak of 2014-2016 showed the weakness of national emergency management systems, and the danger of depending on international humanitarian and health actors to compensate for national gaps. Over 11,000 people died, primarily in Guinea, Liberia and Sierra Leone, and the economic impact in those three countries is estimated to be $359 million. Very limited public health capacity and resources in all three countries worsened the outbreak – Liberia has only 1 doctor per 100,000 inhabitants, and Sierra Leone has barely twice that amount. In addition, the initial international response was slow and ineffective; men and women at the front-line of the response reported feeling “abandoned and isolated in their daily struggle”.
The post-crisis response offers an opportunity to reassess emergency management practices, and to re-envision stronger and more resilient national, regional and continental systems. Dalberg has been working with the Bill and Melinda Gates Foundation (BMGF) to support several countries to develop Emergency Operations Centers (EOCs) – national agencies responsible for preparing for public health crises and coordinating national responses. EOCs establish “real-time” biosurveillance laboratory networks, train multi-sectoral rapid response teams, and maintain staff capable of activating a coordinated emergency response within 120 minutes of a public health emergency.
Nigeria’s effective and large-scale response to Ebola shows the distinct advantage of EOCs. When Ebola appeared in Nigeria in July 2014, the country established an EOC, utilizing staff and systems from the country’s polio eradication campaign and partner organizations. Nigeria’s EOC coordinated contact tracing and testing of thousands of people, and isolated anyone with multiple Ebola related symptoms. As a result of this rapid, coordinated national response, the impact of Ebola in Nigeria was limited, with only 19 confirmed cases, and 8 deaths.
Following this success, and other successes in Senegal, governments, donors and private foundations are investing heavily in building better national and regional emergency management systems. The US Centers for Disease Control (CDC) and African Union (AU) are collaborating to establish a continent-wide EOC in Addis Ababa, with regional sub-centers. In addition, other countries are working to establish national EOCs – Kenya launched its EOC last week.
In our experience, the success of an EOC is dependent on a strong organizational model, high functioning governance that allows for rapid decision making and deployment of resources, successful collaboration with other state and non-state actors, and adequate financing. These cross-cutting requirements are not unique to epidemics, and Senegal’s EOC (which Dalberg supported), already deals with other emergencies. Senegal’s EOC is responsible for the management of all major health-related incidents, including infectious disease risks, technological risks (e.g., industrial accidents), natural disasters (e.g., droughts), and social risks (e.g., public unrest and terrorism).
As EOCs continue to be at the heart of the Global Health Security Agenda, Dalberg and BMGF are hosting a side-event at the World Humanitarian Summit, to discuss how to transition from public health EOCs, to all-hazards EOCs, with a broader mandate and new institutional models.
For more information, attend our WHS event on Emergency Operations Centers, or read our primer.
For more information on Dalberg’s EOC work, contact Madji Sock: Madji.Sock@Dalberg.com