Introduction

The following text was translated from French to English by Dalberg.

Dr. Abdoulaye Bousso is a medical doctor who specializes in orthopedic and trauma surgery, and an expert in disaster management and health emergencies. He is the Director of the Senegalese Public Health Emergency Operations Center, and also serves as an International Health Regulations and Health Emergency Operations Center expert for international organizations such as WHO, the African Union and Resolve to Save Lives (RTSL). As a member of Médecins Sans Frontières, Dr. Bousso has worked as a surgeon in different operation theatres in Nigeria, Ivory Coast and Haiti, in addition to occupying senior positions in Senegal as a Technical Adviser to the Minister of Health, Vice-President of the Senegalese Medical Council and Secretary-General of the Senegalese Physicians’ Union. He currently is the incident manager for the COVID response in Senegal.

Dalberg teams have been grateful to work alongside Dr. Bousso since late 2015, when Dalberg supported the design of the first strategic plan that contributed to the creation development of COUS (Centre des Opérations d’Urgence Sanitaire), the Senegalese Public Health Emergency Operations Center (PHEOC). Dalberg teams collaborated with Dr. Bousso on the Rockefeller Foundation-funded project in West Africa aimed at strengthening PHEOCs, after having first been introduced through work with the The Bill and Melinda Gates Foundation that helped establish the country’s PHEOC. Both partnerships draw on Dr. Bousso’s leadership and experience at the country level as well as the development of regional cooperation.

In this interview, Elias El Daif, an Associate Partner at Dalberg, sits down with Dr. Bousso to discuss his work at the Senegalese Public Health Emergency Operations Center (PHEOC), utilizing existing crisis response structures, and the lessons learned from the Covid-19 pandemic.

Please tell us about the mission of the Public Health Emergency Operation Center (PHEOC) in Senegal and your role as Director.

I have led the Centre des Opérations d’Urgence Sanitaire (COUS), which is the Senegalese Public Health Emergency Operations Center (PHEOC) since its creation on December 1, 2014. We are a team of 20 people. I am responsible for the administrative and financial operations of the COUS. 

The PHEOC is at the heart of health emergency management. We respond to all phases of the health emergency. Our missions are very broad. Many see our presence and our work only at the time of a crisis, but we must be aware that we intervene mainly before a crisis occurs.

The preparation phase is indeed one of the most important and critical phases. In our countries, this is a phase that is not often developed. During the preparation phase, work is done on the identification of risks and available resources, the development of emergency procedures, the training of personnel and the organization of simulation exercises. 

We must absolutely change the paradigm. Often in our countries we wait for the crisis to happen before we react, but we must not wait for the health emergency to arrive to respond.

 

There are a lot of risks that are predictable, and good preparedness makes it possible to better respond to emergencies, and to mitigate their impact, which is extremely important. The speed of the response is critical, and you need to be able to quickly confirm whether there is a risk or not. It is the preparation that makes it possible to act quickly. 

During the 2014 Ebola outbreak, the first signs of the disease appeared in January, but the warning was not given until March. This three-month delay has resulted in all the consequences we have seen on the ground. My focus is on the reaction, that is to say rapid identification, rapid reaction, which makes it possible to specify and assess the risks and to immediately start a rapid management, to limit the effects and spread of pandemics.

During the current Covid-19 health crisis, we were able to benefit from a staff that was already operational and well-prepared, capable of training other staff. The response structures were already in place, which allowed us to react quickly. All the infrastructure and tools that are already in place have allowed us to respond effectively. Having the right infrastructure in place has also allowed us to better respond to the current crisis. We already had an operational headquarters with all the necessary computer tools, and an operations room, which allowed us to monitor all operations in real time.

Can you tell us how you handled the first wave of Covid-19 in Senegal?

The center was activated by the Ministry of Health when the first case was discovered on 2 March 2020. We immediately put in place the health emergency management system. This is a modular and multi-disciplinary system that helps manage the good collaboration and coordination between the different actors that respond to the health emergency (ministries and national and international institutions). 

Long before the crisis, we had already been able to train different actors from the Ministry of Health as well as other governmental agencies. Their knowledge of the incident management system was a real asset and communication was easy. 

What has been most helpful in managing this crisis is communication.

We already had an operations room, a headquarters where we could meet, a set of databases hosted at the center and a mapping system which has facilitated not only the monitoring of the evolution of the pandemic but also the management of our material and human resources. 

We also already had in place high-performance logistics services that were able to quickly deliver all the personal protective equipment that were used at the beginning of this crisis. 

What has especially helped in the management of this crisis is the communication. It has made it possible to reach the population quickly. People practiced self-isolation when sick, adopted the masks as well as the barrier gestures. We’ve been able to use the things we’ve learned before in the fight against multidrug-resistant Tuberculosis.

Is there a regional collaboration to respond to the Covid-19 crisis?

For this crisis there was no real collaboration. It is true that the West African Health Organization has supported countries and tried to set up a weekly exchange platform, but unfortunately countries do not really talk to each other. There has been a very practical collaboration between Senegal and The Gambia initiated by the Heads of State. The Senegalese teams went into the field to help respond to the health crisis, but no collaboration with other countries was really implemented. 

What are the most urgent changes to be made to the health system in Senegal (and in other West African countries)? What lessons have you learned from this pandemic?

With regard to this crisis, we have learned that funding for preparedness is extremely important. In Senegal, we were lucky enough to have a preparation, which, though not perfect, allowed us to not grasp for what we needed, and to have an elaborate strategy and a clear action plan. 

Emergency preparedness in Africa today is primarily funded by external partners and not by states themselves. In my opinion, states should think about not reacting only at the time of the crisis, but investing in real preparation before the crisis. 

We also learned to contextualize our response to the health crisis. The WHO is a guide that gives recommendations, but as actors in the field we have a duty to adapt these recommendations to our local contexts. We cannot copy and paste solutions. Each country faces different realities and must take them into account in the development of plans to respond to  health emergencies. 

The last thing I would like to see change is the dependence of our countries on the international supply of pharmaceuticals and medical equipment.

We must develop the pharmaceutical industry in Senegal.

As we saw during this crisis, several countries nationalized the production of some products, such as masks, hydro-alcoholic gel, anesthesia equipment, and certain drugs. I think it’s important to strengthen the pharmaceutical industry and to produce essential pharmaceutical products in our countries. This is a matter of national security. Masks must be produced locally. Essential drugs must be produced locally. We must develop the pharmaceutical industry in Senegal. 

Some countries do not make the establishment of a health emergency operations center a priority. They prefer to focus their efforts elsewhere, such as on infant mortality, vaccination or the fight against endemic diseases such as malaria, what are your thoughts about this? 

Endemic diseases are real burdens for African countries, they are priorities and they are emergencies.

If we take malaria or maternal and infant mortality, a PHEOC has the ability to modulate, adapt and respond to these diseases or events. All strategies implemented to manage the emergency can be used to manage other “non-emergency” events that continue to be a burden to our countries. Just consider them emergencies. Through the PHEOC we can offer coordinated, concerted, multi-sectoral and multidimensional responses that clearly define the responsibilities of each of the actors of the health sector. 

Today we are experimenting with this approach with the national malaria programme and we also hope to collaborate with the Directorate for Maternal and Child Health in the fight against maternal and infant mortality. We also hope to work with the Tuberculosis program.

Can you explain in more depth what your collaboration with the national malaria program is? 

The national malaria control program is working towards the complete eradication of malaria in Senegal. The program has mapped elimination zones where malaria is a real health emergency. It is in this context that the PHEOC offers to implement its strategies of rapid interventions to fight against the disease. 

The malaria project is a three-year pilot project that also covers The Gambia. We have an incident management system in place, and we have decentralized operations rooms that allow us to process information quickly and hold all the meetings necessary to coordinate the response. With this innovative pilot project, we hope to learn more about the management of endemic diseases and develop new strategies that can be deployed in other regions. 

Many wonder what the PHEOC does when there is no emergency. I think we can really work to make our health care system more effective by working with other public health programs. Laos has already worked on a similar project and has achieved very good results. I am optimistic about the results we will get in Senegal.