Can WHO learn the lessons from Ebola?

An independent panel described the response of the World Health Organization (WHO) to the Ebola outbreak in West Africa as “delayed” and “inadequate,” so what systemic changes need to be made to ensure future crises are handled better?

Barbara Stocking, who chaired the panel, called it a “defining moment,” not just for WHO but also for member states, who have just pledged an additional $3.4 billion to boost recovery efforts in Guinea, Liberia and Sierra Leone over the next two years.

WHO has declared the rebuilding of health systems in Guinea, Liberia and Sierra Leone a “critical priority” and announced plans to help make them more resilient, but the recommendations last week of Starking and her colleagues went much further.

WHO must: devise a system that would allow the alarm bell to be rung sooner; create a new body combining emergency response and humanitarian need; and generally cooperate and coordinate more efficiently with its health and humanitarian partners, the panel said.

Matshidiso Rebecca Moeti, WHO regional director for Africa, told IRIN that the world health body welcomes the recommendations and has already begun moving forward on some, including the development of a global health emergency workforce and a contingency fund.

“The report stated quite strongly that WHO did not have the resources, even now, to adequately respond to an epidemic, to emergencies,” Moeti said.

“It’s clear that the capacity of WHO over the years has been taken away as resources become less and less available...The organization needs to do better. We know that… and I think we learned our lesson… I’m quite confident that WHO can do the job effectively in the future.”

But the road to change won’t be easy. There are a number of deeply entrenched systems within WHO that will have to be overhauled and other new components that will have to be implemented. 

IRIN spoke with five health experts about what needs to come next.

Rebecca Sutton, campaign manager for Oxfam UK’s Ebola Response and Recovery programme

“We are pleased to see that WHO will continue to be the lead agency responding… but a significant overhaul is needed in terms of culture… WHO needs to be much less bureaucratic and much more able to respond quickly and in a coordinated and fast and effective way, because that was not the case with Ebola.”

“Community engagement has been crucial to dealing with Ebola so far and it’s crucial going forward with recovery and dealing with a broader range of diseases… [Interagency cooperation] is also very important and I think the key here is to have better coordination at the district level, which needs a lot more capacity building. It’s at that levels that agencies need to come together.”

Ilona Kickbusch, director of the global health programme at the Graduate Institute of International and Development Studies in Geneva and panel member of the WHO assessment report

“The WHO is as strong as three key dimensions: how strong it is in its technical excellence, how strong the support of its member states is – in terms of both political and financial support – and, thirdly, the strength and determination of the director general.”

“We need a strong WHO… We need an organisation that can respond to the health challenges of 21st century and is truly accountable for that. And that means leadership by the director general and member states.”

“Internally, the WHO secretariat needs to make clear and tough decisions on how International Health Regulations and humanitarian sections of the secretariat are now brought together… it should have a board that does independent oversight… it also need to address staffing, organisational culture… and the issue of financing.”

Philip Ireland, emergency medical physician at the John F. Kennedy Medical Centre in Monrovia, Liberia, and Ebola survivor 

“For the most part, I agree with the critics: The response of the international community was not as fast as it should have been because there were was a lag time. If they [WHO] had come in a little earlier and provided all the stuff that they provided later on, we might not have the epidemic we have now, it might have not been as bad as it was.”

Ireland said training doctors and nurses and growing local capacity would be key to rebuilding West Africa’s health systems.

“If WHO and other NGOs just continue to come in and do quick fixes, at the end of the day it won’t be sustainable. It’s like having a cancer on your foot ¬– if you put a plaster over it to cover it, that wouldn’t work for very long time because the underlying condition hasn’t been dealt with.”

Franklin Gregory, head of the West and Central Africa office for UN emergency aid coordination body OCHA

“[We] subscribe to the recommendation for establishing more clarity [as to] how a public health emergency fits into the wider humanitarian system and at what point an outbreak becomes a humanitarian emergency that requires a broader United Nations-wide response, as highlighted in the July 2015 Ebola Interim Assessment Panel report.”

“There is, at the same time, the need [for] a better understanding by health organisations [in] the humanitarian system, with enough investment in operational capacity and crisis coordination skills in health emergency response and preparedness to ensure a better collaboration with humanitarian partners.”

Unni Krishnan, head of Plan International’s Disaster Preparedness and Response program

“During a big crisis, someone needs to be in charge and act as an authority, and that’s what WHO needs to demonstrate that it can do, before, during and after outbreaks… We also need to recognise the need for speed and flexibility. During an emergency, it’s about moving from first gear to top gear very quickly and if that ability is lost then it won’t be able to deliver.”

“There needs to be continuous dialogue between WHO and the UN and non-UN agencies… to galvanise that collective capacity that is crucial. Coordination is not easy, but cooperation is possible and the first step is information-sharing.”

“There is no question that the 11,000 lives that have been lost should be a constant reminder for WHO and the global health community to reform and perform better in the future. WHO isn’t the only agency responsible for what happened… but transformative changes are clearly needed within WHO.”

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