Bil­lions now re­quired to save de­pleted healthcare sys­tems

Ebola’s most af­fected coun­tries lobby for fund­ing for hos­pi­tal in­fra­struc­ture

Africa Renewal - - CONTENTS - By Kings­ley Igho­bor

On 10 May 2015, a day af­ter the World Health Or­ga­ni­za­tion de­clared Liberia Ebola-free, stern-faced health of­fi­cials were hold­ing marathon meet­ings in dif­fer­ent rooms at the coun­try’s health min­istry. Their busi­ness-like mood con­trasted with the cel­e­bra­tory at­mos­phere on the streets of the cap­i­tal, Mon­rovia.

Newly ap­pointed health min­is­ter, Ber­nice Dahn, Liberia’s for­mer Chief Med­i­cal Of­fi­cer, told Africa Re­newal in an in­ter­view that Liberia’s healthcare sys­tem con­tin­ued to face dan­ger­ous head­winds and her staff was fran­ti­cally fi­nal­iz­ing a blue­print to avert another catas­tro­phe.

To ad­dress Liberia’s prob­lem­atic healthcare sys­tem, Dr. Dahn had a long wish list of so­lu­tions. They in­cluded the build­ing of new health fa­cil­i­ties, en­hance­ment of di­ag­nos­tic ser­vices, an emer­gency pre­pared­ness and re­sponse struc­ture, the hir­ing of qual­i­fied per­son­nel to work in health fa­cil­i­ties and a com­mit­ment of more money to the sec­tor. “Our healthcare in­fra­struc­ture was not built to re­spond to in­fec­tious dis­eases,” ex­plained the min­is­ter. Be­fore Ebola, for ex­am­ple, Liberia had a sig­nif­i­cant short­fall of med­i­cal per­son­nel – only about 50 doc­tors, which was ap­prox­i­mately one doc­tor per 100,000 per­sons.

“Be­fore Ebola, we needed about $20 mil­lion an­nu­ally for drugs but we were get­ting only $2 mil­lion,” said Dr. Dahn. Liberia cur­rently needs more than $30 mil­lion an­nu­ally to re­vamp its health sys­tem and the min­is­ter is hop­ing that with Ebola lessons fully learned, fu­ture healthcare bud­gets might not suf­fer the “un­der­bud­get­ing” as in ear­lier times.

Another Mar­shall Plan

Liberia, Sierra Leone and Guinea—coun­tries most af­fected by Ebola—share borders but, in large mea­sure, share the same dys­func­tional healthcare in­fra­struc­ture sit­u­a­tions. With Liberia now free of the virus and Sierra Leone and Guinea poised to de­feat it, pres­i­dents Ellen John­son Sir­leaf of Liberia, Ernest Bai Koroma of Sierra Leone and Al­pha Condé of Guinea are jointly can­vass­ing for global fi­nan­cial as­sis­tance to re­vamp healthcare in­fra­struc­ture and re­store so­cial ser­vices in their coun­tries. Their core mes­sage is that qual­ity healthcare en­ables so­cioe­co­nomic de­vel­op­ment.

The three pres­i­dents team up at dif­fer­ent fo­rums to ar­gue for se­ri­ous healthcare fi­nanc­ing. In March, they at­tended a sum­mit in Brus­sels with the Euro­pean Union and par­tic­i­pated in the April meet­ings in Washington with Pres­i­dent Barack Obama and with the World Bank Group that was at­tended by top UN and In­ter­na­tional Mon­e­tary Fund of­fi­cials. The UN is also or­ga­niz­ing a donor con­fer­ence in July in New York.

Pres­i­dent John­son Sir­leaf told a gath­er­ing in Washington that in­cluded UN Sec­re­tary-Gen­eral Ban Ki-moon, World Bank Group Pres­i­dent Jim Yong Kim and IMF Man­ag­ing Di­rec­tor Chris­tine La­garde, as well as rep­re­sen­ta­tives of donor coun­tries and in­ter­na­tional de­vel­op­ment or­ga­ni­za­tions, that an $8 bil­lion “Mar­shall Plan” was needed, re­fer­ring to the huge in­ter­na­tional ef­fort to re­build Europe af­ter the Sec­ond World War.

It could have been an eye­brow-rais­ing mo­ment in Washington but the Liberian pres­i­dent quickly de­fended the $8 bil­lion fig­ure say­ing: “Is this ask­ing for too much? We say no… Our health sys­tems col­lapsed, in­vestors left our coun­tries, rev­enues de­clined and spend­ing in­creased.”

Why a Mar­shall Plan? Pres­i­dent Condé clar­i­fied: “The Mar­shall Plan was the con­se­quence of a war. Ebola was like a war for our coun­tries.” Their goal is to set up healthcare de­liv­ery sys­tems that are strong

enough to ab­sorb the shocks of any fu­ture epi­demic.

The trio’s Mar­shall Plan ear­marks $4 bil­lion of the $8 bil­lion for build­ing a subre­gional re­cov­ery pro­gramme. Ad­di­tional funds will be chan­neled to strengthen the health sys­tems and front­line care, and to sec­tors such as agri­cul­ture, ed­u­ca­tion, energy, roads, wa­ter and san­i­ta­tion. The plan also in­cludes the cre­ation of a West African dis­ease sur­veil­lance sys­tem.

Bas­ket­ful of good­ies

Speak­ing at the Washington meet­ing, the UN sec­re­tary-gen­eral backed the plan but warned: “The full re­cov­ery of Ebo­laaf­fected coun­tries is only pos­si­ble when the out­break has ended and safe­guards have been put in place to pre­vent re-in­tro­duc­tion of the dis­ease.”

The three lead­ers have al­ready re­ceived a run­ning start. In April, the World Bank an­nounced a $650 mil­lion sup­port pro­gramme. Be­fore then, the bank had com­mit­ted nearly $1 bil­lion for re­sponse and re­cov­ery ef­forts and had also an­nounced a $2.17 bil­lion in debt re­lief, which will save the three coun­tries about $75 mil­lion an­nu­ally. The Euro­pean Union es­ti­mates its fi­nan­cial con­tri­bu­tion so far at about $1.37 bil­lion. Other coun­tries and or­ga­ni­za­tions are pledg­ing var­i­ous amounts.

Fur­ther, “fund­ing is al­ready in the hands of im­ple­ment­ing part­ners,” said Liberia’s health min­is­ter, adding that the chal­lenge could be “get­ting them to co­or­di­nate it bet­ter, to de­clare what they have used, what is left and what it can be used for.”

Tense re­la­tion­ship

Sierra Leone’s health min­is­ter, Dr. Abubakarr Fo­fanah, called on in­ter­na­tional part­ners to be more trans­par­ent in their deal­ings. “I have a let­ter which was writ­ten to the World Bank by Au­dit Ser­vice Sierra Leone,” said Dr. Fo­fanah, which claims that 30% of in­ter­nal Ebola funds were not prop­erly ac­counted for. Both pres­i­dents Condé and Koroma had urged ac­count­abil­ity for Ebola funds re­ceived by in­ter­na­tional non-gov­ern­ment or­ga­ni­za­tions. “As we have done our own part [au­dit], we are also ex­pect­ing in­ter­na­tional ac­count­abil­ity. This is ac­count­abil­ity through and through,” said Pres­i­dent Koroma.

State­ments like these from top gov­ern­ment of­fi­cials un­der­score un­easi­ness in the re­la­tion­ship be­tween gov­ern­ments and their in­ter­na­tional part­ners. Dr. Dahn al­luded to the dif­fer­ent per­spec­tives that her gov­ern­ment and donors have re­gard­ing how to use the re­main­der of Ebola’s re­sources in Liberia. “We need to align re­sources that came for Ebola with our health sys­tem plan… A lot of re­sources, fi­nan­cial and ma­te­rial, have come in. Ma­te­rial re­sources are eas­ier to align; fi­nan­cial re­sources are tied to emer­gency re­sponse and donor poli­cies may be against mov­ing money into other projects.”

Dr. Dahn im­plored donors to con­sider the Ebola re­sponse within a broader con­text. “Im­me­di­ate restora­tion of healthcare is also an emer­gency: Chil­dren were not vac­ci­nated dur­ing Ebola. Women didn’t have ac­cess to ba­sic ma­ter­nal ser­vices – these are like emer­gen­cies.” Some healthcare ex­perts are in­sist­ing that with the epi­demic ended in Liberia and a glut in treat­ment in Sierra Leone and Guinea, the po­ten­tial ex­ists to re­pur­pose un­used Ebola re­sources and fa­cil­i­ties.

Ex­am­ples of donor-built phys­i­cal in­fra­struc­ture that can sup­port healthcare sys­tems in these coun­tries in­clude 11 treat­ment units built by the US gov­ern­ment in Liberia, the 50-bed treat­ment cen­tre built by the Bri­tish in Sierra Leone, the three clin­ics es­tab­lished by the French gov­ern­ment in Guinea as well as health fa­cil­i­ties set up by the In­ter­na­tional Com­mit­tee of the Red Cross, the Chi­nese gov­ern­ment, the African Union and other hu­man­i­tar­ian or­ga­ni­za­tions in the three coun­tries.

Some of these fa­cil­i­ties ar­rived late in the game and were un­help­ful. For ex­am­ple, only 28 pa­tients were treated in the cen­tres built by the US gov­ern­ment; in fact nine of the 11 cen­tres did not re­ceive a sin­gle pa­tient, ac­cord­ing to a re­cent story in the

New York Times.

Although the pres­i­dents of the three most af­fected coun­tries are united in their ap­peals, the World Bank notes that dif­fer­ences ex­ist in their in­di­vid­ual coun­tries’ eco­nomic sit­u­a­tions. The Bank re­ported ear­lier in the year that Sierra Leone’s econ­omy will con­tract at an un­prece­dented -23.5% in 2015 com­pared to a pre-Ebola growth of 15.2%, which is ef­fec­tively a re­ces­sion; Liberia’s econ­omy will grow at 3% com­pared to 6.8% preEbola; and Guinea’s will de­cline by - 0.2% com­pared to a 4.3% be­fore Ebola.

Losses suf­fered

Also, all three coun­tries have suf­fered ma­jor GDP declines. The to­tal GDP losses for the three coun­tries were es­ti­mated by the World Bank at $2.2 bil­lion: $1.4 bil­lion for Sierra Leone, $535 mil­lion for Guinea and $240 mil­lion for Liberia.

Be­cause Sierra Leone’s min­ing sec­tor has col­lapsed as global prices of iron ore, one of its main­stay min­er­als, have crashed, the coun­try faces acute in­fra­struc­ture fi­nanc­ing needs. What this means is that all three coun­tries will re­cover at dif­fer­ent speeds.

Amidst Ebola’s doom and gloom, there is hope that long-needed im­prove­ments will fi­nally take place. “I tell you, it is this [Ebola] out­break that will trans­form Sierra Leone’s health sys­tem to a ro­bust and func­tional one,” said Dr. Dong Xiaop­ing, di­rec­tor of the Chi­nese Cen­ter for Dis­ease Con­trol in Sierra Leone. An­to­nio Vig­i­lante, Deputy Spe­cial Rep­re­sen­ta­tive of the Sec­re­taryGen­eral in the UN Mis­sion in Liberia says, “There is a golden op­por­tu­nity to have a dif­fer­ent start... It’s a very del­i­cate stage, full of op­por­tu­ni­ties, which should not be missed.”

Clearly the in­ter­na­tional com­mu­nity is look­ing se­ri­ously at these health in­fra­struc­ture fi­nan­cial needs. The Ebola out­break in­jected ur­gency into the need for qual­ity healthcare sys­tems; and the new pro­posed Sus­tain­able De­vel­op­ment Goals (SDGs), which will re­place the Mil­len­nium De­vel­op­ment Goals by year end, also add mo­men­tum with SDGs goal num­ber three be­ing to “En­sure healthy lives and pro­mote well-be­ing for all at all ages.”

“Many of us have ac­knowl­edged that the in­ter­na­tional com­mu­nity was slow to re­act to Ebola,” re­marked the World Bank pres­i­dent. “Let’s show that we have learned this les­son.”

$2.2 bil­lion is es­ti­mated by World Bank as the to­tal GDP losses for Liberia, Guinea and Sierra leone

USAID/Mor­gana Win­gard

Health work­ers clean hos­pi­tal scrubs and pro­tec­tive gear at the Is­land Clinic for Ebola treat­ment cen­tre in Mon­rovia, Liberia, dur­ing the 2014 Ebola out­break.

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