The debate was coordinated by Claire Hédon, journalist at RFI. The speakers were Rony Brauman, former President of Doctors without Borders (MSF) and Research Director at the MSF Foundation; Jean-François Delfraissy, French coordinator for the Ebola response; Dominique Marcon, responsible for the SIDI (International Solidarity for Development and Investment) partnership for Guinea and Christophe Paquet, Head of AFD’s Health and Social Protection Division.
The Ebola epidemic is not over yet. It is well under control in Liberia and there has been a marked improvement in Sierra Leone. The situation continues to give cause for real concern in Guinea. The three countries face a threefold challenge. They need to simultaneously eradicate the virus, get their respective economies back on their feet and learn lessons from this health crisis to avoid it happening again.
Change approach to address the new epidemiological situation
The 20th Ebola fever epidemic recorded has entered its final phase. It is characterized by “smaller and more scattered outbreaks, as is the case with endemics” (Christophe Paquet). The Ebola treatment centers and other specialized treatment structures are no longer an appropriate solution, especially because we now have specific tools to control the last infectious outbreaks on a case-by-case basis: “rapid tests, vaccines with a significant therapeutic potential” (Rony Brauman). Consequently, it is necessary to redeploy the means used in the response at local level, before gradually integrating them into crosscutting surveillance and monitoring programs. This crisis has been exceptionally serious, but we must expect worse: Ebola must “serve to rebuild health systems in view of a more serious crisis in the future” (Jean-François Delfraissy).
Essential need to strengthen local health systems
“The causes of the Ebola epidemic […] lie in the breakdown of health systems” in the affected countries (Sakoba Keita), which are still paying the price of drastic structural adjustment. Hospitals in the region were unable to deal with the influx of patients. Worse still, they accelerated the spread of the virus through nosocomial transmission. While the vertical aid plans implemented by international organizations limited the damage, their overall cost “is huge compared to the service provided” (Rony Brauman). Faced with a more diffuse risk, it is essential for local facilities to take over. To be effective, a care policy must be accessible to as many people as possible, even if this requires the allocation of a high proportion of the State budget. “Health must be considered as an investment by politicians and international organizations, not as a cost” (Christophe Paquet).
Confidence: The key to the success of all health policies
The virus was identified by MSF in March 2014. In the following months, the local Ministries of Health “dragged their feet in declaring an epidemic” and WHO “did not prove to be exemplary” (Rony Brauman). Yet a “contract of confidence” is required between populations and the institutions responsible for responding to a health crisis: it is “a crucial base to draw upon […] whatever the level of sophistication of the planned health system” (Christophe Paquet). Without it, the fears generally related to the disease take over and hinder an effective implementation of the response. Cultural factors are a fundamental element that needs to be taken into account. Isolation of the patient, safe burial, lack of information on vaccination… “practices which go against a cultural and religious history […] continue to give rise to misunderstanding” (Jean-François Delfraissy). Consequently, research efforts also need to focus on human sciences.
Revitalize the informal sector, the economic engine of affected countries
The World Bank estimates that Guinea, Sierra Leone and Liberia lost 5% of their GDP in 2014 and they are expected to lose 12% in 2015. To save their economies, which have already been weakened, “the three countries are calling for a Marshall Plan” (Dominique Marcon). Whatever the financial aid plan implemented, it will need to take a highly developed informal sector into account. In Guinea, the bulk of economic activity escapes State control. Guinea Rural Credit (CRG) is a cooperative credit organization recognized by the World Bank. It is the main donor for Guinea’s informal economy. Like its regional equivalents, it has been hard hit by the epidemic. “It is necessary to give it the means to survive, i.e. meet the demand for credit that should be resuming” (Dominique Marcon). Without this, there is the risk that the informal economy will collapse, taking the whole country with it.