Global health sys­tem is as strong as its weak­est link

Weekly Trust - - View - Ellen John­son Sir­leaf Satur­day, Oc­to­ber 27, 2018

The West African Ebola out­break started in a small vil­lage in Guinea. It shows the value of in­vest­ing in grass­roots health­care

In the city of Beni, in the north­east corner of the Demo­cratic Repub­lic of the Congo, an out­break of Ebola is sim­mer­ing. Fear of this lethal dis­ease and all that goes with it - grief over lost loved ones, ex­hausted emer­gency re­sponse work­ers and on­go­ing in­se­cu­rity might once have felt dis­tant, for­eign, un­know­able. But, trag­i­cally, these emo­tions are all too fa­mil­iar.

Al­most five years ago, a two-yearold boy from Melian­dou - a tiny ru­ral vil­lage in south­ern Guinea, bor­der­ing Liberia and Sierra Leone - fell sick with a strange ill­ness. His symp­toms were the stuff of night­mares: in­ter­nal bleed­ing, black stools, vomit­ing and a high fever. Just two days later, he died.

At the time, no one in the vil­lage knew what the cause of death was; no one could an­tic­i­pate the chain of con­se­quences that was about to rip through the re­gion and fuel a global panic.

From Melian­dou, the dis­ease slipped across Guinea’s por­ous bor­der and spread un­abated through west Africa for four months, be­fore it was cor­rectly iden­ti­fied as Ebola. The world watched in hor­ror as the largest Ebola out­break in his­tory en­gulfed my coun­try and the rest of the re­gion, in­fect­ing over 27,000 peo­ple in to­tal and killing more than 11,000.

Ebola con­sumed ev­ery as­pect of daily life. The econ­omy fal­tered as in­ter­na­tional trade halted, schools were shut and hard-fought progress on child and ma­ter­nal mor­tal­ity was wiped out overnight. Be­yond west Africa, iso­lated out­breaks around the world spread panic and re­flected the darker con­se­quences of how in­ter­con­nected global health has be­come.

Health work­ers trans­port the body of a sus­pected Ebola vic­tims in Port Loko, on the out­skirts of the Serra Leonean cap­i­tal Free­town, in Oc­to­ber 2014.

We learned that the world’s health sys­tem is only as strong as its weak­est link. In­vest­ing in pri­mary health­care is the best way to de­tect and stop lo­cal out­breaks be­fore they be­come global pan­demics.

Lo­cal health­care ser­vices are a per­son’s first and main point of con­tact with the health sys­tem - the place in their com­mu­nity where they can go to see a provider able to ad­dress the ma­jor­ity of their health needs. When this pri­mary sys­tem is strong, pa­tients de­velop trusted re­la­tion­ships with their health­care providers, who can en­cour­age them to seek the care they need, in­clud­ing in times of cri­sis. Pri­mary health­care providers are also best po­si­tioned to spot the early warn­ing signs of out­breaks - and sound the alarm bell when needed.

In Liberia, we saw that com­mu­ni­ties with strong pri­mary health­care were bet­ter able to stem the spread of Ebola. We are now ap­ply­ing these lessons to more ef­fec­tively pro­tect the health of our peo­ple should an­other out­break strike. We have pri­ori­tised in­vest­ments in pri­mary health­care to en­sure that ci­ti­zens can se­cure es­sen­tial health ser­vices free of charge and see pri­mary health­care providers in their own com­mu­ni­ties, even in the most re­mote parts of the coun­try.

Liberia’s na­tional com­mu­nity health as­sis­tant pro­gramme was launched in July 2016 and will serve more than 4,000 re­mote com­mu­ni­ties in the hard­est to reach ar­eas of our coun­try by 2021. Each com­mu­nity health as­sis­tant is crit­i­cal to the health of their com­mu­nity, and is trained, paid and su­per­vised to de­liver com­mon screen­ing, treat­ment and pre­ven­tive health ser­vices.

The 3,000 com­mu­nity health as­sis­tants de­ployed to date have iden­ti­fied more than 1,700 warn­ing signs of out­breaks in the past year alone, and have been in­stru­men­tal in ad­dress­ing these be­fore they spin out of con­trol. They are crit­i­cal links to keep­ing com­mu­ni­ties across re­mote Liberia healthy, en­sur­ing that we are bet­ter pre­pared to weather the next storm.

But I know we do not have the com­plete blue­print to build stronger health sys­tems on our own. Coun­tries must learn from each other - and not just in times of cri­sis. I am closely watch­ing the work of the pri­mary health­care per­for­mance ini­tia­tive, which is part­ner­ing with coun­try gov­ern­ments to mea­sure the strengths and weak­nesses of ex­ist­ing health sys­tems. The ini­tia­tive’s new “vi­tal signs pro­files”, which are launch­ing this week, are de­signed to help lead­ers pin­point op­por­tu­ni­ties for max­i­mum im­pact when in­vest­ing in the sys­tems that guard the health of our peo­ple.

West Africa still feels the last­ing ef­fects of Ebola, while our broth­ers and sis­ters in DRC are work­ing ur­gently to bring an end to the cur­rent out­break be­fore it spi­rals out of con­trol. Un­less we learn the hard lessons, the global health sys­tem will re­main like a house with­out a foun­da­tion. En­sur­ing that every­one, ev­ery­where, has ac­cess to es­sen­tial health ser­vices is our best shot at avoid­ing the all too fa­mil­iar cy­cle of health emer­gen­cies. Now is the time to act with con­vic­tion.

Sir­leaf is a for­mer Pres­i­dent of Liberia (Culled from The Guardian UK)

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