The Ebola crisis of 2014–16 mobilized unprecedented financial assistance for West Africa to strengthen outbreak surveillance to prevent another crisis. The region has developed an ambitious blueprint over the last two years, but the effort has now reached a tipping point for success. Careful and transparent transition planning, and sensitivity to the unique diversity of the region, will be key to realizing the potential and offering an excellent model for Africa in the future.
The West African region is recognized by the global public health community as being particularly vulnerable to infectious disease outbreaks, including those caused by diseases that jump the species barrier from animals. This is critically important both to the region and rest of the world. The challenge in the wake of Ebola has been to ‘build back better’, that is not only to replace the frail systems that failed the community in the past, but to reinforce them to assure the health security of the population for the years to come.
Both financial resources and political will were abundant immediately after the Ebola crisis. Among the extensive international funding, the World Bank made a notable contribution of more than $400 million to improve infectious disease surveillance. This funding is dedicated to enhancing surveillance in the region to improve detection, alert and response to outbreaks in the 15 countries of the Economic Community of West African States (ECOWAS). The money is unique in that it is directed only towards building public health surveillance systems and not the usual disease-focused approach. It is brokered through the health arm of ECOWAS — the West African Health Organization (WAHO).
During extensive consultations across the region, led by the WAHO, an ambitious blueprint evolved. Each country with a national coordinating institute is to share surveillance data systematically with a regional hub. All 15 countries are to be networked into a Regional Centre for Disease Surveillance and Control (RCDC), located in Abuja, Nigeria. The countries, in turn, are to benefit from enhanced resources in data analysis, laboratory services, rapid response and disease investigation and ‘One Health’ expertise from the RCDC. This regional centre is part of a pan-African system of five centres linked to the African Union Centres for Disease Control and Prevention in Addis Ababa, Ethiopia. West Africa currently provides the most advanced of these centres.
Prospects for long-term success
As global attention on West Africa wanes, this effort is reaching a tipping point. National governments must move quickly to designate and empower their coordinating institutes, but at the last report, just nine of the 15 countries had designated their national coordinating institute.
At the core of the vision is the new RCDC. The plan is for it to be fully staffed in early 2018. However, the management challenge in the context of West Africa is complex and should not be underestimated. For example, donor agencies often have their own agendas, some favouring approaches that are not entirely aligned with the overall regional planning by WAHO. In addition, within WAHO each line of work tends to be carried as an independent brief. Therefore, integration under the RCDC by the end of this year presents a serious challenge.
Consultations over the past two years have invited extensive country input into the planning process. This has helpfully produced a plan tailored to the culture and national interests of West Africa — one of the most diverse regions in the world. Informal disease surveillance networks from around the world have been included in discussions. It is now time to move from words to action.
In November, Chatham House partnered with the RCDC to convene a roundtable in Abuja on information and material sharing. The immediate nature of the challenge of operationalizing the network was a key driver of these discussions. Participants from across the region were eager for more transparency in the process and strongly advocated the inclusion of informal as well as formal networks to ensure success and sustainability. This informal participation, including regular communication using both technology and physical meetings, is essential to build trust.
Challenges are legion, but the approach is feasible. However, careful and transparent transition planning on the part of WAHO and its national and regional partners will be important, and complex management of this kind has not historically been a particular strength of WAHO. Above all, sensitivity to the unique diversity of the region will be vital.
The opportunity to build a system that protects a very vulnerable part of the world from threats such as that posed by the 2014–16 Ebola crisis must be seized. Success would provide an excellent model for Africa in the future. The coming months will define whether it arrives.
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