Universal health coverage - ebola reveals the gaps

IRIN: West Africa's Ebola epidemic has cruelly exposed the weaknesses of health systems in the countries where it struck. It was understandable that they were not prepared for Ebola, which has never been reported in the region before, but the director of the World Health Organization (WHO), Margaret Chan, says what they lacked was a robust public health infrastructure to deal with the unexpected.

“This requires good background data on the usual,” she says, “so that the unusual stands out. [It means] making good quality care accessible and affordable to everyone, and not just to wealthy people living in urban areas; having enough facilities available in the right places with enough well trained staff and uninterrupted supplies of essential medicines; diagnostic capacity that returns rapid and reliable results; and information systems that pinpoint gaps and direct strategies and resources towards unmet needs.”

Chan was speaking on what had been designated as the first Universal Health Coverage Day (on 12 December), setting out an ambitious check-list for health systems which can cope with whatever is thrown at them. This is clearly a challenge in any developing country, but much more of a challenge in fragile states like those currently affected by Ebola.

Nick Hooton is a research, policy and practice adviser with the ReBuild Consortium which works on how to strengthen health systems in post-conflict states. He told IRIN that although research still had to be done, the post-conflict environment was almost certainly a reason why the disease spread so fast. “Undoubtedly the systems are very poor,” he says, “and the staffing levels are very low, but there are also subtler factors at work, issues about trust and things like that. This is a disease which has been well controlled in other places, and yet got massively out of control. If you look at the DRC [Democratic republic of Congo] and northern Uganda, there is no great supply of health professionals there either. So we are talking about things like a breakdown in the links between the communities and the public services which take a long time to build up again.”...

Ebola virions, from Charting the Path of the Deadly Ebola Virus in Central Africa. PLoS Biol 3/11/2005: e403 doi:10.1371/journal.pbio.0030403 (apparently via Ayacop), Wikimedia Commons, nder the Creative Commons Attribution 2.5 Generic license