This blog is part one of a two-part series on Ebola, highlighting two critical challenges in global health which have hindered the ability of the world to effectively respond to this emerging health threat. In the first blog we look at how weaknesses in health systems have undermined efforts to fight the disease. In the second, we explore how a lack of investment in research and development (R&D) for poverty-related diseases can have devastating consequences. The first blog comes from RESULTS UK’s Child Survival Advocacy Officer, Megan Wilson-Jones. 

The year of Ebola

Christmas is a time for reflection. As we prepare for 2015, we can’t help but think of the year that has gone by. What went well? What didn’t? What stands out in our memory?

For many working in global health, Ebola has dominated the last year. To date, there have been 17,942 cases of the Ebola virus disease and 6,388 deaths recorded, as reported on 10 December by the World Health Organisation. Almost all cases and deaths are isolated to just three countries in West Africa: Guinea, Liberia and Sierra Leone. Ebola has caused substantial fear and stigma around the world due to its high case-fatality rate, killing on average about half of those it infects. Perhaps most unsettling, however, is the lack of an effective cure or preventative vaccine.

Photo: EC/ECHO/Anouk Delafortrie
Photo: EC/ECHO/Anouk Delafortrie

While Ebola has grabbed the attention of the world, the harsh reality is one in which Ebola kills less people than many other poverty-related diseases. Malaria alone has caused 70 times more deaths this year, while HIV/AIDS in the African continent has killed more people than malaria and Ebola combined. As the global health community grapples to understand why different diseases or public health emergencies get more attention than others, Ebola serves to highlight a fundamental issue around the critical importance of strong national health systems that are within reach of every person. The social and economic repercussions of not investing in these systems to respond to emerging threats, and other existing health challenges, are devastating.

Investing in health systems

The three countries facing the largest burden of Ebola are amongst the poorest countries in the world, and have some of the most fragile health systems. Insufficient investments in the infrastructure, healthcare workforce, health information systems and medical supplies and equipment over decades have undermined the ability of these countries to effectively respond to Ebola. In neighbouring countries such as Nigeria, Mali and further afield in the USA, the virus was rapidly contained and controlled as a result of comprehensive primary care in place.

Strong health systems are not simply about ensuring sufficient financial resources. However health financing, whether from foreign or domestic sources, is a key building block for developing resilient health systems around the world. The high-level Taskforce on Innovative International Financing for Health Systems in 2009 recommended that a minimum of US$60 per capita spending on health by 2015 would allow provision of a basic package of essential services. This is well above the average of US$31 per capita spent in low-income countries, of which on average less than half comes from government sources. Until governments in low-income countries move towards financing the majority of health, donors such as the UK need to prioritise investments in health systems alongside more targeted and vertical disease-specific support. This is also important for large multilaterals, such as the Global Fund to Fight AIDS, TB and Malaria, and Gavi, the Vaccine Alliance which channel significant amounts of funding for global health.

Lessons learnt

Ultimately it is the responsibility of national governments, with support from external partners, to develop and implement strategies to build resilient health systems which are able to respond to all the health needs of the population; be that Ebola, malaria or the next public health emergency. However, in the short-term international partners including donors, multilaterals and civil society, have a critical role to play in supporting and building national health systems, in coordination and in-line with national plans and strategies. This is not only essential to control and contain Ebola, but also to mitigate the risks Ebola poses to routine services.

Investing in health and health systems is unquestionably one of the most cost-effective approaches to drive economic and social development in poor countries. Ebola is a harsh reminder of how a lack of investment in health systems is undermining our ability to respond to not only today’s threats but also tomorrow’s health challenges. As we prepare to enter 2015 the key question still remains, will the lessons from Ebola finally turn into meaningful action?