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Mulenga-Cilundika P, Ekofo J, Kabanga C, Criel B, Van Damme W, Chenge F. Indirect Effects of Ebola Virus Disease Epidemics on Health Systems in the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia: A Scoping Review Supplemented with Expert Interviews. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13113. [PMID: 36293703 PMCID: PMC9602680 DOI: 10.3390/ijerph192013113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Ebola Virus Disease (EVD) epidemics have been extensively documented and have received large scientific and public attention since 1976. Until July 2022, 16 countries worldwide had reported at least one case of EVD, resulting in 43 epidemics. Most of the epidemics occurred in the Democratic Republic of Congo (DRC) but the largest epidemic occurred from 2014-2016 in Guinea, Sierra Leone and Liberia in West Africa. The indirect effects of EVD epidemics on these countries' health systems, i.e., the consequences beyond infected patients and deaths immediately related to EVD, can be significant. The objective of this review was to map and measure the indirect effects of the EVD epidemics on the health systems of DRC, Guinea, Sierra Leone and Liberia and, from thereon, draw lessons for strengthening their resilience vis-à-vis future EVD outbreaks and other similar health emergencies. A scoping review of published articles from the PubMed database and gray literature was conducted. It was supplemented by interviews with experts. Eighty-six articles were included in this review. The results were structured based on WHO's six building blocks of a health system. During the EVD outbreaks, several healthcare services and activities were disrupted. A significant decline in indicators of curative care utilization, immunization levels and disease control activities was noticeable. Shortages of health personnel, poor health data management, insufficient funding and shortages of essential drugs characterized the epidemics that occurred in the above-mentioned countries. The public health authorities had virtually lost their leadership in the management of an EVD response. Governance was characterized by the development of a range of new initiatives to ensure adequate response. The results of this review highlight the need for countries to invest in and strengthen their health systems, through the continuous reinforcement of the building blocks, even if there is no imminent risk of an epidemic.
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Affiliation(s)
- Philippe Mulenga-Cilundika
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa 3088, Democratic Republic of the Congo
- School of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Joel Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa 3088, Democratic Republic of the Congo
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa 3088, Democratic Republic of the Congo
| | - Bart Criel
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa 3088, Democratic Republic of the Congo
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Wim Van Damme
- Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Faustin Chenge
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa 3088, Democratic Republic of the Congo
- School of Public Health, Faculty of Medicine, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
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Hemingway-Foday JJ, Diallo BI, Compaore S, Bah S, Keita S, Diallo IT, Martel LD, Standley CJ, Bah MB, Bah M, Camara D, Kaba AK, Keita L, Kone M, Reynolds E, Souare O, Stolka KB, Tchwenko S, Wone A, Worrell MC, MacDonald PDM. Lessons learned for surveillance system strengthening through capacity building and partnership engagement in post-Ebola Guinea, 2015-2019. Front Public Health 2022; 10:715356. [PMID: 36033803 PMCID: PMC9403137 DOI: 10.3389/fpubh.2022.715356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/27/2022] [Indexed: 01/21/2023] Open
Abstract
The 2014-2016 Ebola outbreak in Guinea revealed systematic weaknesses in the existing disease surveillance system, which contributed to delayed detection, underreporting of cases, widespread transmission in Guinea and cross-border transmission to neighboring Sierra Leone and Liberia, leading to the largest Ebola epidemic ever recorded. Efforts to understand the epidemic's scale and distribution were hindered by problems with data completeness, accuracy, and reliability. In 2017, recognizing the importance and usefulness of surveillance data in making evidence-based decisions for the control of epidemic-prone diseases, the Guinean Ministry of Health (MoH) included surveillance strengthening as a priority activity in their post-Ebola transition plan and requested the support of partners to attain its objectives. The U.S. Centers for Disease Control and Prevention (US CDC) and four of its implementing partners-International Medical Corps, the International Organization for Migration, RTI International, and the World Health Organization-worked in collaboration with the Government of Guinea to strengthen the country's surveillance capacity, in alignment with the Global Health Security Agenda and International Health Regulations 2005 objectives for surveillance and reporting. This paper describes the main surveillance activities supported by US CDC and its partners between 2015 and 2019 and provides information on the strategies used and the impact of activities. It also discusses lessons learned for building sustainable capacity and infrastructure for disease surveillance and reporting in similar resource-limited settings.
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Affiliation(s)
| | | | | | | | | | | | - Lise D. Martel
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Claire J. Standley
- Center for Global Health Science and Security, Georgetown University, Washington, DC, United States
| | | | | | | | | | | | | | | | | | | | - Samuel Tchwenko
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Abdoulaye Wone
- International Organization for Migration, Conakry, Guinea
| | - Mary Claire Worrell
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Pia D. M. MacDonald
- RTI International, Durham, NC, United States,Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, United States
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Eggers C, Martel L, Dismer A, Kallay R, Sayre D, Choi M, Corvil S, Kaba A, Keita B, Diallo L, Balde MM, Bah M, Camara SM, Koivogui E, Montgomery J, Keita S. Implementing a DHIS2 Ebola virus disease module during the 2021 Guinea Ebola outbreak. BMJ Glob Health 2022; 7:bmjgh-2022-009240. [PMID: 35589157 PMCID: PMC9121429 DOI: 10.1136/bmjgh-2022-009240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022] Open
Abstract
In 2017, the national agency for health security (L'Agence Nationale de Sécurité Sanitaire-ANSS) in Guinea implemented the District Health Information Software (DHIS2) as the Ministry of Health national surveillance system to capture and report aggregate disease data. During 2019, the ANSS started using DHIS2 Tracker to collect case-based (individual-level) data for epidemic-prone diseases. In 2020, the capability was expanded, and it was used during the COVID-19 pandemic to capture data relevant to the COVID-19 response. When an Ebola virus disease (EVD) outbreak was announced in February 2021, the Tracker module was updated, and enhanced functionalities were developed to meet the needs for the emerging epidemic. This novel EVD module has components to capture information on cases, contacts, alerts, laboratory and vaccinations and provides a centralised site for all EVD outbreak data. It has since been expanded for use with future viral haemorrhagic fever outbreaks.
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Affiliation(s)
- Carrie Eggers
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lise Martel
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Conakry, Guinea
| | - Amber Dismer
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ruth Kallay
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dean Sayre
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Choi
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Almamy Kaba
- African Field Epidemiology Network, Conakry, Guinea
| | - Bakary Keita
- Agence Nationale de Sécurité Sanitaire, Conakry, Guinea
| | | | | | - Mariama Bah
- African Field Epidemiology Network, Conakry, Guinea
| | | | | | - Joel Montgomery
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sakoba Keita
- Agence Nationale de Sécurité Sanitaire, Conakry, Guinea
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Brown GW, Bridge G, Martini J, Um J, Williams OD, Choupe LBT, Rhodes N, Ho ZJM, Chungong S, Kandel N. The role of health systems for health security: a scoping review revealing the need for improved conceptual and practical linkages. Global Health 2022; 18:51. [PMID: 35570269 PMCID: PMC9107590 DOI: 10.1186/s12992-022-00840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Practical links between health systems and health security are historically prevalent, but the conceptual links between these fields remain under explored, with little on health system strengthening. The need to address this gap gains relevance in light of the COVID-19 pandemic as it demonstrated a crucial relationship between health system capacities and effective health security response. Acknowledging the importance of developing stronger and more resilient health systems globally for health emergency preparedness, the WHO developed a Health Systems for Health Security framework that aims to promote a common understanding of what health systems for health security entails whilst identifying key capacities required. METHODS/ RESULTS To further explore and analyse the conceptual and practical links between health systems and health security within the peer reviewed literature, a rapid scoping review was carried out to provide an overview of the type, extent and quantity of research available. Studies were included if they had been peer-reviewed and were published in English (seven databases 2000 to 2020). 343 articles were identified, of those 204 discussed health systems and health security (high and medium relevance), 101 discussed just health systems and 47 discussed only health security (low relevance). Within the high and medium relevance articles, several concepts emerged, including the prioritization of health security over health systems, the tendency to treat health security as exceptionalism focusing on acute health emergencies, and a conceptualisation of security as 'state security' not 'human security' or population health. CONCLUSION Examples of literature exploring links between health systems and health security are provided. We also present recommendations for further research, offering several investments and/or programmes that could reliably lead to maximal gains from both a health system and a health security perspective, and why these should be explored further. This paper could help researchers and funders when deciding upon the scope, nature and design of future research in this area. Additionally, the paper legitimises the necessity of the Health Systems for Health Security framework, with the findings of this paper providing useful insights and evidentiary examples for effective implementation of the framework.
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Affiliation(s)
- Garrett Wallace Brown
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | - Gemma Bridge
- grid.4868.20000 0001 2171 1133Institute of Population Health Sciences, Centre for Clinical Trials & Methodology, Queen Mary University London, London, E1 2AD UK
| | - Jessica Martini
- grid.4989.c0000 0001 2348 0746School of Public Health, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Jimyong Um
- grid.1013.30000 0004 1936 834XDepartment of Government and International Relations, The University of Sydney, Sydney, Australia
| | - Owain D. Williams
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | | | - Natalie Rhodes
- grid.9909.90000 0004 1936 8403School of Politics and International Studies (POLIS), University of Leeds, Leeds, LS2 9JT UK
| | - Zheng Jie Marc Ho
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
| | - Stella Chungong
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
| | - Nirmal Kandel
- grid.3575.40000000121633745World Health Organisation, WHO Health Emergencies Program, 1211 Geneva, Switzerland
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Martel LD, Phipps M, Traore A, Standley CJ, Soumah ML, Lamah A, Wone A, Asima M, Barry AM, Berete M, Attal-Juncqua A, Katz R, Robert A, Sompare I, Sorrell EM, Toure Y, Morel-Vulliez A, Keita S. Public health emergency management capacity building in Guinea: 2014-2019. INTERNATIONAL JOURNAL OF EMERGENCY MANAGEMENT 2021; 16:179-200. [PMID: 39156078 PMCID: PMC11328550 DOI: 10.1504/ijem.2020.112302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Before the Ebola virus disease (EVD) outbreak of 2014-2016, Guinea did not have an emergency management system in place. During the outbreak, Global Health Security Agenda (GHSA) 2014-2019 funds made it possible to rapidly improve the country's capacity to manage epidemics through the development of public health emergency operation centres (PHEOCs) at the national and district levels. Since the end of the response, the infrastructure, staff, and systems of these PHEOCs have been further reinforced and well-integrated in the daily activities of Guinea's National Agency for Health Security, the entity responsible for the management of epidemics. The development of PHEOCs as emergency management tools for epidemics in Guinea would not have been possible without a strong endorsement within the Ministry of Health. Guinea's PHEOC network is well-positioned to serve as a model of excellence for other Ministries in Guinea and Ministries of Health of other countries of West Africa.
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Affiliation(s)
- Lise D. Martel
- US Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Michael Phipps
- US Centers for Disease Control and Prevention, Atlanta, GA, 30333, USA
| | - Amadou Traore
- National Agency for Health Security (ANSS in French), Ministry of Health, CKRY001, Guinea
| | - Claire J. Standley
- Center for Global Health Science and Security, Georgetown University, Washington DC, 20057, USA
| | | | | | - Abdoulaye Wone
- International Organization for Migration, Conakry, CKRY001, Guinea
| | - Michael Asima
- International Organization for Migration, Conakry, CKRY001, Guinea
| | - Alpha M. Barry
- Center for Global Health Science and Security, Georgetown University, Washington DC, 20057, USA
| | - Mahawa Berete
- International Organization for Migration, Conakry, Guinea
| | - Aurelia Attal-Juncqua
- Center for Global Health Science and Security, Georgetown University, Washington DC, 20057, USA
| | - Rebecca Katz
- Center for Global Health Science and Security, Georgetown University, Washington DC, 20057, USA
| | - Alexandre Robert
- International Organization for Migration, Conakry, CKRY001, Guinea
| | - Idrissa Sompare
- International Organization for Migration, Conakry, CKRY001, Guinea
| | - Erin M. Sorrell
- Center for Global Health Science and Security, Georgetown University, Washington DC, 20057, USA
| | - Yakaria Toure
- National Agency for Health Security (ANSS in French), Ministry of Health, CKRY001, Guinea
| | | | - Sakoba Keita
- National Agency for Health Security (ANSS in French), Ministry of Health, CKRY001, Guinea
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Moolenaar RL, Cassell CH, Knight NW. Lessons Learned in Global Health Security Implementation. Health Secur 2020; 18:S4-S7. [PMID: 32004134 DOI: 10.1089/hs.2019.0157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ronald L Moolenaar
- Ronald L. Moolenaar, MD, is Associate Director for Science; Cynthia H. Cassell, PhD, is Lead for Applied Research; and Nancy W. Knight, MD, is Division Director; all in the Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Cynthia H Cassell
- Ronald L. Moolenaar, MD, is Associate Director for Science; Cynthia H. Cassell, PhD, is Lead for Applied Research; and Nancy W. Knight, MD, is Division Director; all in the Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Nancy W Knight
- Ronald L. Moolenaar, MD, is Associate Director for Science; Cynthia H. Cassell, PhD, is Lead for Applied Research; and Nancy W. Knight, MD, is Division Director; all in the Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
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