Health Impact of Ebola Crisis. Presentation for LSHTM / Options - Chris Lewis

Transcription

1 Health Impact of Ebola Crisis Presentation for LSHTM / Options - Chris Lewis

2 Outline Introduction Ebola outbreak Impact of the crisis

3 Timeline Early December little boy in southern Guinea caught a mysterious disease. He had fever, vomiting and blood in his stool. A midwife caring for him was hospitalised in Guekedou, a city of 200,000 people on the Guinea, Liberia and Sierra Leone border March the disease spread to four cities May 2014 WHO report disease appears to be slowing down June 2014 MSF say the epidemic is out of control. Second wave of epidemic gathers pace 8 Aug 2014 Global Public Health Emergency declared 17 Sept UK committed to taking leading role in Sierra Leone Oct 2014 epidemic peaks & reduces in Liberia Dec 2014 epidemic peaks in Sierra Leone Jan 2015 epidemic reduces in SL, and peaks & reduces in Guinea October 2015 confirmation of first case of sexual transmission 7 November 2015 Sierra Leone declared free Ebola transmission 29 December 2015 Guinea declared free of Ebola transmission 14 January 2016 Liberia declared free of Ebola transmission December 2016 New vaccine provides substantial protection against Ebola

4 Experience First few weeks of September 20 September The current life in Freetown appears normal, far from what I usually see in humanitarian crises. There are no collapsed buildings, no camps, no conflict, no multiple meetings, and no plethora of international personnel. It has made me realise we are not responding to a humanitarian crisis here we are preventing one of the most devastating humanitarian crises in recent years. However the urgency and scale need to be the same if not more as if we were responding to it. I feel that we need a carefully thought out, effective, fast, large scale, multipronged approach to prevent this crisis there is not one solution and each intervention needs to be done very carefully.

5 Weekly reported cases Modelled Ebola scenarios from October 2014, with actual cases superimposed Adapted from model by Imperial College, MRC Centre for Outbreak Analysis and Modelling Central predicted weekly reported cases Upper and lower predicted weekly reported cases Confirmed, probable & suspected cases

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7 UK Response 427 million DFID / MoD / DoH / PHE / NHS / FCO / Cabinet office 6 treatment facilities 1,400 treatment beds and other safe isolation beds 1,600 NHS volunteers 3 PHE laboratories Social mobilisation Over 100 burial teams 4000 staff trained NERC/DERC coordination New research - diagnostics, therapeutics, vaccines, epidemiology, anthropology

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10 Impact and Opportunities from Ebola..or Snakes and ladders

11 Snakes Impact of Emergencies on Mortality Taken from Evaluation of Haiti response Needs developing in post disaster contexts (URD) Mortality/morbidity post- disaster epidemic: does it really exist? Water-borne diseases Acute respiratory diseases Vector-borne diseases DISASTER T0 +48h + 1 week + 1 month Psychosocial time

12 Initial understanding Impact on Utilisation UNFPA. (2015). Rapid Assessment of Ebola Impact on Reproductive Health Services and Service Seeking Behaviour in Sierra Leone. Freetown: UNFPA.

13 We now know more about impact Options, VSO/WaterAid/LSTM, ReBUILD 22-30% increase in maternal deaths % increase in newborn deaths. Institutional deliveries fell by 23% Children treated for malaria fell by 39% Children receiving basic immunization (penta3) fell by 21%. Loss of health workers, breakdown in trust between communities and health workers Ebola not a useful example as we look at how to effectively integrate maternal and newborn care into response to crises going forward, due to the tension of disease control vs. service delivery

14 How do we reduce the length of the snakes? Resilience / Preparedness Importance of early detection and response is clear, and should be a priority. There is an argument that the Ebola outbreak would have overwhelmed the health systems of most low-income countries Every country and system experiences shocks, although a catch 22 is that the poorest most vulnerable countries, experience the most shocks and have the least evidence for addressing these What are the factors that enable systems and maternal and newborn services to be (exceptionally) resilient to shocks or (exceptionally) vulnerable?

15 Ladders - Opportunities post crisis Evidence shows crises present opportunities for health system reform Strengthening of neglected areas (eg. mental health) Can lead to better availability of information for planning General health system reform Reprioritisation of health policies Reform most effective when planned during a crisis and implemented towards the end of a crisis or start of early recovery (window of opportunity) Mental health sector have demonstrated this evidence most effectively (Build Back Better, WHO)

16 What are the opportunities / ladders? Sierra Leone Heightened interest in the functioning of the health sector Potential for new ways of working. Leadership and high level interest, with health as a political priority in Sierra Leone Maternal and Newborn We know maternal and newborn health will always be an issue in crises We need to be better at integrating MNCH into primary health care, & health systems approach to crises How can maternal and newborn care build from the excellent work in mental health, in establishing the evidence on Building Back Better following crises?

17 Key Points Open data is critical to enable effective response to future crises How do we enable resilient health systems, and resilient maternal and newborn services? How can maternal and newborn services develop evidence on building back better, taking opportunities arising from crises?