In Africa: Ebola Epidemic Exposes Underlying Cracks in the Health System

The outbreak demonstrates the critical need to strengthen health systems overall and dramatically increase the number of health workers, particularly in poor and rural areas where diseases can thrive undetected.
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With the number of cases exceeding 2,200 and the death toll surpassing 1,200, Ebola has captured news headlines for the last few weeks, and with good reason. The health emergency has hit some of the world's most impoverished nations, none of which has sufficient resources to control the outbreak. This crisis should not be a surprise to anyone, as it only exposes well-known vulnerabilities in weak public health infrastructures and over-taxed health systems. These are critical concerns as Africa continues to battle a multitude of other health challenges, not the least of which is a growing chronic disease epidemic.

But it is important to keep in mind that Africa as a whole is on the upswing, and widely considered by many in the business community as an important set of emerging markets. To realize its potential fully in the long run, we need to mobilize public and private investments in Africa, and continue to facilitate creative partnerships to tackle some of the continent's continuing challenges.

The Ebola emergency has shone a bright light on underlying problems of the African health system, opening a Pandora's box of neglected issues that need priority attention. The outbreak demonstrates the critical need to strengthen health systems overall and dramatically increase the number of health workers, particularly in poor and rural areas where diseases can thrive undetected. Weak health infrastructures lack the capacity and resilience to support a swift response to public health crises because they lack the mechanisms, money and manpower to do so. Nor are they equipped sufficiently to tackle both acute crises like Ebola and the on-going health needs of other infectious diseases (including HIV/AIDS, TB and malaria), maternal mortality, child survival and chronic illness. This often translates to higher disease transmission and lower patient survival rates. Health workers who do not have the tools to protect themselves from harm are at consequently greater risk of getting infected, further depleting an already sparse health workforce.

The primary risk factor for ill health in Africa is still poverty. This fact is best illustrated by the pervasiveness of neglected tropical diseases (NTDs) in the region. Often referred to as diseases of poverty, NTDs such as river blindness, lymphatic filariasis, schistosomiasis and Guinea Worm are the result of poor living conditions and inadequate access to clean water. By nature, NTDs cause tremendous disability and prevent adult patients from working and children from going to school. With an estimated 90% of the 1 billion people affected by an NTD living in Africa, these diseases pose a barrier to economic growth.

Likewise, Africa is facing an explosion of noncommunicable diseases (NCDs), including cancers, cardiovascular disease, diabetes and asthma. The burden of chronic illness in the region is anticipated to increase by 27% in the next decade, claiming 28 million lives over the course of the next 10 years. Cancer rates in Sub-Saharan Africa are expected to rise by 85% by 2030, and estimates indicate that there will be 41.5 million diabetics living in Africa by 2035. Aside from the direct health costs of treating NCDs, the indirect economic toll of chronic diseases on countries is immense, further challenging broader development goals.

The intersection of health and economic development was one theme of the recent U.S.-Africa Leaders Summit in Washington, D.C., which reiterated that the region's success was contingent upon the well-being of its people. U.S.-based corporations have long made significant contributions to improve health in Africa. Chief among these have been robust drug donation programs to control NTDs, which have helped treat nearly half a billion people in the last seven years alone. Likewise, public-private partnerships such as Together for Girls and Saving Mothers, Giving Life are strong examples of how companies are contributing to multisectoral collaborations toward empowering and improving the health of women and girls.

U.S. Government institutions such as the U.S. Agency for International Development and the President's Emergency Program for AIDS Relief work collaboratively with a host of other organizations by providing funding and technical support and advancing research and polices to launch initiatives and scale-up programs to reduce the burden of disease in Africa. The response to the Ebola outbreak is an excellent example of U.S.-Africa collaboration, with the Centers for Disease Control and Prevention on the front lines of combating the epidemic in West Africa, working side-by-side with local public health officials, the World Health Organization, Doctors without Borders and others.

But we need to think more critically about the role that companies, NGOs, academe and research institutions can play in supporting countries as they seek to provide effective means for providing greater health equity. For example, governments can leverage the knowledge of U.S. industry on growing programs, developing efficient mechanisms to improve performance, reducing duplication and building the workforce. African Ministries of Health can collaborate with organizations funded by USAID, the Bill & Melinda Gates Foundation and others to expand the breadth and reach of programs as well as strengthen health systems. Research centers in Africa can also tap the knowledge banks of American think tanks and academic institutions to advance discourse on major challenges.

In the two decades I've worked in Africa, I have seen important and encouraging progress in strengthening the public health response and saving lives. But more must be done to sustain gains in both health and economic development. Ensuring the success of African countries is crucial for overall global economic growth, and safeguarding the health of its people is critical to achieving that goal. The Ebola crisis has heightened awareness of these concerns. Let's work together to learn from the experience - and not have to replay it the hard way the next time the virus strikes.

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