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1. Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Author:
Bilal Siddiqi, Maarten Voors, Johannes Haushofer, Oeindrila Dube, and Darin Christensen
Publication Date:
03-2020
Content Type:
Working Paper
Institution:
Empirical Studies of Conflict Project (ESOC)
Abstract:
Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine efforts aimed at improving health worker performance in the context of the 2014–15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mortality from Ebola—particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.
Topic:
Health, Infectious Diseases, Health Care Policy, Mortality, Public Health, and Pandemic
Political Geography:
West Africa and Sierra Leone

2. Global Health Security

Author:
Gro Harlem Brundtland
Publication Date:
09-2019
Content Type:
Video
Institution:
Columbia University World Leaders Forum
Abstract:
This World Leaders Forum program features an address on global health and preparedness by Dr. Gro Harlem Brundtland, followed by a moderated panel discussion and question and answer session with the audience. As we approach the five-year anniversary of the historic UN Security Council resolution on the Ebola outbreak in West Africa, the goal of this panel discussion is to assess global preparedness as the World Health Organization and World Bank deliver their first set of recommendations on the margins of UNGA 2019.
Topic:
Development, Health, United Nations, World Health Organization, and Health Care Policy
Political Geography:
New York, United Nations, and West Africa

3. The Security Sector’s Role in Responding to Health Crises: Lessons from the 2014–2015 Ebola Epidemic and Recommendations for the Mano River Union and Its Member States

Author:
Jonathan Sandy, Albrecht Schnabel, Haja Sovula, and Raphael Zumsteg
Publication Date:
01-2017
Content Type:
Special Report
Institution:
Geneva Centre for Security Sector Governance (DCAF)
Abstract:
This report is informed by the two-day roundtable-style workshop entitled "The Security Sector and Global Health Crises: Lessons from the 2014 Ebola Epidemic in West Africa" in Freetown, Sierra Leone. The workshop's main discussions, outcomes and recommendations are expected to facilitate better preparedness to mitigate future epidemics through collaborative and coordinated efforts between health and security sector communities, and directed at local, national and regional actors as well as the international donor community engaged in West Africa.
Topic:
Security, Health, International Cooperation, Regional Cooperation, and Health Care Policy
Political Geography:
Africa, Liberia, West Africa, Sierra Leone, and Guinea

4. Preparedness Rather Than Response: A Strategy to Prevent the Next Ebola Crisis

Author:
Andrew Koltun, Brittany Mcnena, and Nawroos Shibli
Publication Date:
07-2015
Content Type:
Policy Brief
Institution:
Centre for International Governance Innovation
Abstract:
The 2013 West African Ebola crisis exposed two weaknesses: the inability of the international community to rapidly mobilize an effective response and a lack of adequate domestic health care systems for epidemic preparedness response. While a number of proposals have addressed gaps in the international response, none have yet addressed the remaining issue of building adequate domestic health systems. Although the World Health Organization’s (WHO’s) 2005 International Health Regulations require that all member countries develop and implement a core set of health system capacities, funding constraints have prevented many low-income countries from meeting these requirements. This brief proposes that the World Bank, in collaboration with the WHO, should develop a Pandemic Prevention Program to assist low-income countries in building strong and robust health systems. This program would assist low-income countries in meeting their international obligations, while ensuring sustainable national ownership in order to prevent the next infectious disease epidemic.
Topic:
Health, Infectious Diseases, and World Bank
Political Geography:
West Africa

5. Ebola and the Private Sector: Bolstering the response and West African economies

Publication Date:
12-2014
Content Type:
Working Paper
Institution:
Oxfam Publishing
Abstract:
The current Ebola outbreak in West Africa is unprecedented. The increasing number of cases, the poor health infrastructure, the shortage of skills, knowledge and personnel, and the fear surrounding the disease are proving a huge challenge to affected governments and to the international community as they battle to bring the epidemic under control.
Topic:
Disaster Relief, Health, Human Welfare, and Infectious Diseases
Political Geography:
Africa and West Africa

6. Turning the Tide on Ebola: Scaling up public health campaigns before it's too late

Author:
Debbie Hillier
Publication Date:
10-2014
Content Type:
Policy Brief
Institution:
Oxfam Publishing
Abstract:
The current Ebola outbreak in West Africa is totally unprecedented. The accelerating number of cases, the poor health infrastructure in affected countries, the short supply of skills, knowledge and personnel, and the fear surrounding this disease are providing a huge challenge to affected governments and the international community as they battle to bring the epidemic under control.
Topic:
International Relations, Security, Health, Humanitarian Aid, Foreign Aid, Health Care Policy, and Ebola
Political Geography:
Africa and West Africa