The Ebola crisis of 2014-15 has brought questions around the roles of communities and health systems into sharp relief – both in relation to crisis response, and to the challenges of post-crisis recovery and building resilience to future epidemics. The Institute of Development Studies is pleased to make this submission to the APPG inquiry on these crucial questions. This submission draws upon this work and highlights the need for developing health systems and health crisis response mechanisms that actively seek, engage and adapt to local Continue reading →
It took the threat of a global health crisis to illustrate the failings of Africa’s health systems. Resilient health systems, free at the point of use, are evidently a global public good. They are essential for the provision of universal health coverage and for a prompt response to outbreaks of disease. Resilient health systems require long-term investment in the six key elements that are required for a resilient system: an adequate numbers of trained health workers; available medicines; robust health information systems, including surveillance; appropriate Continue reading →
A component of the Ebola epidemic control policy in Sierra Leone is triage and isolation in decentralised Community Care Centres (CCCs) or Holding Units, from where transfer to Ebola treatment units (ETUs) is arranged for those diagnosed as positive. The epidemic is currently waning, there are sufficient beds in the ETU, yet new micro-epidemics emerge, raising questions about the future role and relevance of the CCC. This briefing summarizes the preliminary findings of a formative evaluation conducted by the UK based Ebola Response Anthropology Platform Continue reading →
We propose that the point of discharge of someone who has survived Ebola virus disease (EVD) should become a staged transition back into the community, linked to a social contract that ties targeted support to adherence to infection control practices. This offers important benefits to how people perceive the infectious risk of survivors, improved social cohesion through collectively agreed stages of re-integration, and a mechanism for directing psychosocial and material support to those who most need it.
‘Stigma’ is an umbrella term for the direct and indirect consequences of a number of processes that brand someone as different in ways that result in discrimination, loss of status and social exclusion. It can be short-term or evolve into a long-term and life-long issue. Who and how people are being socially labelled – plus the material, political, social and moral consequences of this labelling – often change rapidly throughout the course of an epidemic, particularly from the early stages of an emerging outbreak to Continue reading →
The limited evidence available on age-disaggregated fatality rates of Ebola Virus Disease (EVD) consistently highlights the poor survival rates of older people compared with young adults. The particular roles that older people play in societies put them at differing patterns of risk of contracting EVD compared with younger adults. While many older people will be less likely to undertake at-risk care and burial practices, those with for example fostering or non- formal caring roles may be at increased risk of transmission. Older people, in particular Continue reading →
Current Ebola epidemic control policy in Sierra Leone focuses on (a) triage and isolation in decentralised, ideally community-based Ebola Care Units (ECUs), leading to (b) transfer to Ebola treatment units (ETUs) for those diagnosed as positive. Increasing early presentation to ECUs is essential for this strategy to be effective in reducing Ro. This note outlines ways in which improved and socially-appropriate care – in ECUs, and at home – can assist this.
Some attention has been paid to the alleged role of funerals in spreading Ebola Virus Disease in Upper West Africa. This has led to attempts to control funerals, causing both distress and active resistance. Critical examination of the role of the funeral event as a mechanism of Ebola transmission seems in order. In this paper, it is argued that funerals are inseparable from care for the sick, as far as Ebola transmission is concerned. The focal issue then becomes not control of funerals but reduction Continue reading →
Informal health workers are important care providers in the region and continue to be so during the current Ebola Virus Disease (EVD) outbreak. Many are well respected and trusted members of the community who can mobilise large numbers of people for a particular activity and lend legitimacy to a particular programme.
‘The Ebola epidemic ravaging parts of West Africa is the most severe acute public health emergency seen in modern times. Never before in recorded history has a biosafety level four pathogen infected so many people so quickly, over such a broad geographical area, for so long’ (Margaret Chan, 26th September 2014, WHO). This report focuses on the local beliefs and practices around illnesses and death, the transmission of disease and spirituality, which affect decision-making around health-seeking behaviour, caring for relatives and the nature of burials. Continue reading →