Weaknesses in Health Systems and the Need for a United Front against Communicable Diseases

Posted by Gabriel Armas-Cardona on January 7, 2015

Going off of Ban Ki-moon’s November statement that the Ebola outbreak should end by mid-March, there have been promising signs that the disease is coming under control. Liberia plans to reopen schools next month. The US is lifting Ebola screenings requirements for travelers from Mali. While positive notes, the tragedy remains that this was an “avoidable crisis.”

Different groups are scouring all available information to figure out what went wrong. The New York Times has an in-depth report on what happened month-by-month country-by-country during the April/May lull. It was at this time when the number of reported Ebola cases was decreasing and the disease could have been contained. In Liberia they thought they had contained it. Unfortunately, complexities on the ground allowed the disease to become an epidemic.

The reasons for the failure are complex. Lack of sufficient local doctors, lack of cultural knowledge of the foreign experts, lack of local knowledge about Ebola—which is more common in central Africa—all played a role. West Africa is home to a number of least-developed States, making it unsurprising that their health systems were not up to the task of containing Ebola.

However, the issue is not only about staff levels and the availability of protective gear but about the health system as a whole. Lack of trust by the community, including chasing away foreign aid workers, and the lack of useful background data, especially in rural areas, made it impossible to provide effective health care. Good provision of health requires operating on multiple fronts, which means strengthening the health system as a whole.

One of the challenges of improving health systems is there are no measurable outcomes or photo-ops, in contrast to single disease interventions. Donors’ focus on clearly defined goals and measurable outcomes prioritizes discrete projects and sidelines the needed system-wide improvements.

All of this emphasizes the importance of States’ obligation to provide international support. States, especially least developed States, are often not able to quickly contain disease outbreaks without outside help. Outside expertise as well as financial resources should be available, at the very least to ensure salaries of medical workers are paid.

The fear of Ebola in the United States, while unreasonably disproportionate to the actual risks, makes clear the point that when it comes to communicable diseases, we’re a single integrated world community. Operating without a united front will cause stunted and delayed responses and untold unnecessary deaths.

Gabriel Armas-Cardona is a Legal Officer at Lawyers Collective.