<div class="title-block" style="border-bottom-color: #628bb3"><h1><img class="title-image" src="http://www.heart-resources.org/wp-content/themes/heart/images/health.svg">Communicable Diseases</h1><div class="post-type-description"></div></div> – Health and Education Advice and Resource Team http://www.heart-resources.org Providing DFID staff and other development actors with health, education and nutrition knowledge and expertise from around the world Fri, 02 Mar 2018 13:10:49 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.4 Ebola and beyond: social dimensions of epidemic preparedness and response http://www.heart-resources.org/announcements/ebola-and-beyond-social-dimensions-of-epidemic-preparedness-and-response/ http://www.heart-resources.org/announcements/ebola-and-beyond-social-dimensions-of-epidemic-preparedness-and-response/#respond Wed, 13 Jan 2016 15:47:44 +0000 http://www.heart-resources.org/?post_type=announcements&p=28515 Read more]]> In the wake of recent epidemics, and amidst growing threats from emerging and re-emerging infectious diseases, building systems that can prepare and respond effectively is a vital imperative to safeguard the health and well-being of local, national and global populations. Yet such systems cannot rely on bio-medical, public health and humanitarian science and action alone. The Ebola virus epidemic fundamentally underlined the importance of embedding social science expertise and local community knowledge into response strategies if they are to be appropriate, acceptable and therefore effective.

Join Future Health Systems on Thursday, January 28, 2016 from 3:00 PM to 5:00 PM (EST) as Melissa Leach, the Director of the Institute for Development Studies, UK, walks through the kinds of architectures and capacities that could strengthen the social dimensions of epidemic preparedness and response, across activities from foresight, anticipation and contextual research to developing rapid response networks and strengthening trust in health systems. She will draw on the experiences of IDS under the R2HC-funded Ebola Response Anthropology Platform (ERAP), the Ebola: Lessons for Development initiative, and related work on the multiple drivers of zoonotic disease.

DISCUSSANTS:

Lauren Sauer, Dept. of Emergency Medicine and Center for Refugee and Disaster Response, Johns Hopkins Univerisity

Susan Shepler, School of International Service, American University

MODERATOR:

Shan Soe-Lin, Program Director at Results for Development Institute

WHEN:

Thursday, January 28, 2016 from 3:00 PM to 5:00 PM (EST)

WHERE:

Results for Development – 1111 19th Street, NW, Suite 700 Washington, DC 20036

Please visit the Future Health Systems website for more details.

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Two evaluations of community Ebola interventions, two different results http://www.heart-resources.org/blog/two-evaluations-of-community-ebola-interventions-two-different-results/ http://www.heart-resources.org/blog/two-evaluations-of-community-ebola-interventions-two-different-results/#respond Tue, 04 Aug 2015 11:37:00 +0000 http://www.heart-resources.org/?post_type=blog&p=27324 Read more]]> This spring, when my team from the Ebola Response Anthropology Platform evaluated Community-Based Ebola Care Centres (CCCs) in Sierra Leone, one thing we constantly heard complaints about was human-resource management. Residents of the communities where the Centres were located grumbled about favouritism: well-paying jobs in the Centres were given to friends and family of the local paramount chiefs. Local health authorities questioned the medical competency of CCC staff. Staff in primary health units complained about unequal pay and benefits. We focused on the views on the development, implementation and relevance of the CCCs from the perspective of the communities next to and near where they were located. Meanwhile, a different evaluation team which focused on the quality of care in the Centres was coming to a very different conclusion. They did report that the Ministry of Health and Sanitation, implementing partners, staff at Community Care Centres, and community members agreed that the initial intention to hire local laypeople had been abandoned. But they concluded that the human-resource management model that had been used was acceptable and feasible. Both evaluations found that the medical care, the provision of food for patients and the attention and skills of medical staff in the CCC were highly appreciated by the residents.

How can these different findings be understood? It is perhaps useful to start with a distinction between the process of establishing the CCC and the result. The CCCs were developed at an uncertain time when predictive models warned of potentially millions of new cases transmitted in communities. There was a perceived possibility of a system-wide shortage of beds. In response to this threat, the UK Department for International Development (DFID) and its international and national partners supported the development of new care centres located in communities. Local people could come forward voluntarily to be isolated if they suspected that they had the disease. Communities in Sierra Leone had low levels of trust in government authorities and services before Ebola. The Ebola response used traditional hierarchical political structures to reach communities, in consultation with District Ebola Response Centres that were specially set up in parallel to existing district-level state systems. Some of these district-level facilities were still functioning, while others had collapsed.

The selection of the site for the CCC went through the traditional paramount chiefs, who govern several chiefdoms with different levels of traditional authority. When our evaluation team asked different groups of people living in these communities about how the CCC was developed, it was natural for them to express their discontent over how the site and staff were selected. We also heard grievances about the use of land and water. But for a team discussing only the quality of care inside the CCC, the topic might not have come up. CCC workers were offered hazard pay and free meals, at a time when few jobs were available due to a severe recession. It is natural for those in the community who do not receive such jobs (or who do not have relatives who do) to be envious, even if they may simultaneously be gladdened by the free health services the centres provide. In a context with such inequality this is not surprising.

Most CCCs saw few or no Ebola patients, which may have made the jobs in the CCC especially attractive. By the time most CCCs were implemented several Ebola Treatment Units (ETU) had been put in place, offering high-quality medical care. Ambulance services expanded rapidly, meaning that suspected Ebola cases could be sent directly to the ETU, bypassing the CCC. With few Ebola cases to treat, and with the local population having lost its access to medical care (the already-weak health system with fees for service having collapsed), medical staff in many CCCs started to provide free health care beyond Ebola treatment. This could be seen as a form of mission creep that raised false hopes and expectations about the post-Ebola health system. It is also—as many international non-government organisations and policy makers pointed out to both evaluation teams—a parallel system. But the provision of health care to people in need is arguably in line with medical professional ethics and duties.

The positive evaluation of the care and staff in CCCs demonstrates that people appreciate good and affordable (i.e. free) health services even when these are provided in an Ebola care centre. It also suggests that some of the reports about people’s fear of Ebola and distrust of health staff may be exaggerated. Communities had already taken innovative actions such as using plastic bags as makeshift protective gear and adapted traditions to meet biomedical concerns. Our evaluation team found that many people of different ages in affected communities have detailed knowledge of case-management and transport procedures, and accept that some special measures were needed. What is important in relation to people’s compliance with Ebola-specific rules is that they feel that the facilities are safe and that they and their loved ones, living or dead, are treated fairly and with respect.

The CCCs were supposed to be a temporary emergency response. But as there are still small outbreaks, they have not been closed. Their role is now unclear, which is potentially confusing for Ebola suspects and a stumbling block for the recovery of the health system.  Now that the CCCs exist, people want their materials and staff to be used to improve public health and educational services in their communities. What people don’t want to see are the CCCs packed and stored far away until the next big outbreak.

Meanwhile, the fact that the two evaluation teams had such different findings highlights the need to make sure that evaluations look at the political economy and history in which interventions are developed and ask beneficiaries to offer feedback about the process of the intervention, not just the results.

By Pauline OosterhoffPauline Oosterhoff is a Research Fellow at the Institute of Development Studies with over 20 years of international experience in public health research and advisory services and media production.

The formative evaluation of the Community-Based Ebola Care Centres was conducted by Pauline Oosterhoff (Institute of Development Studies), Esther Yei Mokuwa (Njala University College, Sierra Leone), and Annie Wilkinson (Institute of Development Studies) as members of the Ebola Response Anthropology Platform.

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Assessment of the patient, health system, and population effects of Xpert MTB/RIF and alternative diagnostics for tuberculosis in Tanzania: an integrated modelling approach http://www.heart-resources.org/doc_lib/assessment-of-the-patient-health-system-and-population-effects-of-xpert-mtbrif-and-alternative-diagnostics-for-tuberculosis-in-tanzania-an-integrated-modelling-approach/ http://www.heart-resources.org/doc_lib/assessment-of-the-patient-health-system-and-population-effects-of-xpert-mtbrif-and-alternative-diagnostics-for-tuberculosis-in-tanzania-an-integrated-modelling-approach/#respond Thu, 07 May 2015 10:54:56 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26904 Read more]]> Several promising new diagnostic methods and algorithms for tuberculosis have been endorsed by WHO. National tuberculosis programmes now face the decision on which methods to implement and where to place them in the diagnostic algorithm.

We used an integrated model to assess the effects of different algorithms of Xpert MTB/RIF and light-emitting diode (LED) fluorescence microscopy in Tanzania. To understand the effects of new diagnostics from the patient, health system, and population perspective, the model incorporated and linked a detailed operational component and a transmission component. The model was designed to represent the operational and epidemiological context of Tanzania and was used to compare the effects and cost-effectiveness of different diagnostic options.

Among the diagnostic options considered, we identified three strategies as cost effective in Tanzania. Full scale-up of Xpert would have the greatest population-level effect with the highest incremental cost: 346 000 disability-adjusted life-years (DALYs) averted with an additional cost of US$36·9 million over 10 years. The incremental cost-effectiveness ratio (ICER) of Xpert scale-up ($169 per DALY averted, 95% credible interval [CrI] 104–265) is below the willingness-to-pay threshold ($599) for Tanzania. Same-day LED fluorescence microscopy is the next most effective strategy with an ICER of $45 (95% CrI 25–74), followed by LED fluorescence microscopy with an ICER of $29 (6–59). Compared with same-day LED fluorescence microscopy and Xpert full rollout, targeted use of Xpert in presumptive tuberculosis cases with HIV infection, either as an initial diagnostic test or as a follow-on test to microscopy, would produce DALY gains at a higher incremental cost and therefore is dominated in the context of Tanzania.

For Tanzania, this integrated modelling approach predicts that full rollout of Xpert is a cost-effective option for tuberculosis diagnosis and has the potential to substantially reduce the national tuberculosis burden. It also estimates the substantial level of funding that will need to be mobilised to translate this into clinical practice. This approach could be adapted and replicated in other developing countries to inform rational health policy formulation.

This document may be accessible through your organisation or institution. If not, you may have to purchase access. Alternatively, the British Library for Development Studies provide a document delivery service.”

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Beyond accuracy: creating a comprehensive evidence base for TB diagnostic tools http://www.heart-resources.org/doc_lib/beyond-accuracy-creating-a-comprehensive-evidence-base-for-tb-diagnostic-tools/ http://www.heart-resources.org/doc_lib/beyond-accuracy-creating-a-comprehensive-evidence-base-for-tb-diagnostic-tools/#respond Thu, 07 May 2015 10:36:01 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26902 Read more]]> The need for a strong and comprehensive evidence base to support decision making with regard to the implementation of new and improved diagnostic tools and approaches has been highlighted by a number of stakeholders; these include members of the New Diagnostics Working Group (NDWG) and the Subgroup for Introducing New Approaches and Tools of the Stop TB Partnership. To compile such evidence in a systematic manner, we have developed an impact assessment framework (IAF) which links evidence on inputs to outcomes.

The IAF comprises five interconnected layers: effectiveness analysis, equity analysis, health systems analysis, scale-up analysis and policy analysis. It can be used by new diagnostics developers and other interested research teams to collect as much policy-relevant data as possible prior to, during and after the demonstration phase of tool development. The evidence collated may be used by international and national policy makers to support adoption, implementation and scale-up decisions. The TREAT TB (Technology, Research, Education and Technical Assistance for TB) initiative uses the IAF in its operational research and field evaluations of new tools and approaches for TB diagnosis. It has also been incorporated into the NDWG’s recent publication: ‘Pathways to better diagnostics for tuberculosis: a blueprint for the development of TB diagnostics’. This article describes the IAF and the process of improving it and suggests next steps in overcoming the challenges in its implementation.

This document may be accessible through your organisation or institution. If not, you may have to purchase access. Alternatively, the British Library for Development Studies provide a document delivery service.

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REACHOUT contributes to Ebola enquiry http://www.heart-resources.org/blog/reachout-contributes-to-ebola-enquiry/ http://www.heart-resources.org/blog/reachout-contributes-to-ebola-enquiry/#respond Fri, 01 May 2015 13:09:20 +0000 http://www.heart-resources.org/?post_type=blog&p=26882 Read more]]> The recent call for more of a focus on people centred health systems and the devastating effects of Ebola in West Africa have brought communities to the forefront of the attention of decision makers. REACHOUT, along with our sister consortia ReBUILD and COUNTDOWN, are part of a growing group of health systems researchers who are trying to provide guidance to those grappling with health systems strengthening in Ebola-affected countries. Most recently we have provided written evidence to the UK All Party Parliamentary Group on Africa under their call for inputs on community-led health systems and Ebola.

Why focus on communities?

Communities play a largely unrecognised, unrewarded and unsupported role in health systems around the world. There are many families and community structures (such as local governments and schools) which perform tasks which are central to good health. Yet they are rarely factored into health system planning and their views tend not to influence policy and practice in this area.

Close-to-community providers of health care (such as community health workers (CHWs)) live and work within their communities, visiting people in their homes and workplaces every day, they can have a vital role in informing realistic healthcare policies that deliver results at community level. However even when their health promotion and delivery activities are recognised, for example in some CHW initiatives, they are often working in sub-optimal circumstances and are poorly linked to, and managed by formal health programmes. This has led to a disconnect between healthcare policy and the workers delivering healthcare services directly to individuals, families, and communities. This disconnect has resulted in loss of motivation and problems with health worker retention and ultimately an additional disconnect between service users in the community and health facilities resulting in a decrease in service utilisation. In Ebola-affected countries this is exacerbated by poor infrastructure, inadequate skilled health workforce which was further depleted by loss of health care workers to the illness, health systems which were already struggling and unresponsive in a post-conflict context, and Ebola-stigma against front-line workers.

Our submission to the enquiry in a nutshell

  • Community structures and close-to-community providers of health care have the potential to improve health system functioning and health outcomes in Ebola-affected countries and beyond. They are vital to rebuilding trust between communities and health systems. Yet their (potential) role and responsibilities are poorly understood and supported. There is an urgent need to gather more information which can better integrate their work into the larger health system. This is a body of research that the UK Government should support.
  • There is much that we can learn from the response to Ebola. Yet platforms and information sharing mechanisms are inadequate. The UK Government could play a key role in financing multi-stakeholder platforms to this end.
  • Community-level health work is reliant on the robustness of the overall health system. In Ebola-effected countries (which were also post-conflict settings) the overall system had critical weaknesses. Efforts to strengthen the whole system under the leadership of national government are sorely needed.
  • The lack of appropriately trained, remunerated, and incentivised health workers is of particular concern to Ebola-affected countries.
  • Improving health needs to be a multi-sectoral endeavour. Infrastructure, telecommunications networks, and roads as well as urban regeneration are also important to the response.
  • A body of evidence on both community action on health and system strengthening post-conflict and crisis already exist and should not be overlooked as we rebuild in the post-Ebola era.
  • The UK Government develop a strategy that specifically addresses the role of communities and CHWs in supporting better health.
If you are interested in what else we wrote you can read the full evidence paper. If you want to contribute to the enquiry yourself it is still possible, the deadline is the 20th May 2015. We’d like to encourage as many people as possible to provide evidence on what is a vitally important area.

By Kate Hawkins, Managing Director of Pamoja Communications, @PamojaUK
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Ghana malaria prevention programme, Annual Review http://www.heart-resources.org/assignment/ghana-malaria-prevention-programme-annual-review/ http://www.heart-resources.org/assignment/ghana-malaria-prevention-programme-annual-review/#respond Thu, 23 Apr 2015 12:30:06 +0000 http://www.heart-resources.org/?post_type=assignment&p=26840 Read more]]> The Health and Education Advice and Resource Team (HEART) was contracted to undertake the first Annual Programme Review (APR) of the DFID-funded Ghana Malaria Prevention, Diagnosis and Data Programme. This review was undertaken between 24 July and 20 August 2014 by a team of two external consultants. The Review Terms of Reference (TOR) posed questions relating to progress in implementing the project since it commenced in August 2013. The review was carried out primarily through a secondary analysis of project reports and other relevant documents, supplemented by key stakeholder interviews both in Accra and during a field trip to Central Region.

The components for this project are:

  • Procurement of long lasting insecticidal nets (LLIN) for routine distribution under the continuous distribution strategy
  • Social marketing of LLIN
  • Seasonal Malaria Chemoprevention (SMC) trial in Northern Region
  • Provision of rapid diagnostic tests (RDTs) for the private health sector
  • To increase use of LLINs
  • To increase uptake of RDTs
  • Improving data with Malaria sentinel sites and recruitment of an epidemiologist
  • Enhancing finance with support to the National Malaria Control Programme (NMCP) resource mobilisation officer

 

Impact:

  • Reported mortality attributed due to malaria, for both the under-five population and the general population – two of the project impact indicators – fell in both 2012 and 2013 from the programme’s baseline figures. If this trend continues, these programme milestones and targets should be achieved by the end of the programme.
  • The third impact indicator, ‘the proportion of children under five admitted with fever attributed to malaria’, is not behaving in the anticipated way and is rising. This is likely to be a result of external complicating factors. It is recommended that this indicator be reviewed.

 

Lessons learned:

  • The three programme components involving the procurement of malaria commodities worked well and evaluators learned that the Ministry of Health procurement system has the capacity to undertake such significant procurements. For the other components, the time required to tender and contract the implementing organisations has taken around six months and so there was only limited time available for implementation in the first year.
  • Government of Ghana financial systems have taken much longer than anticipated to transfer funds for several components’ activities to the NMCP. This has resulted in some activities not having yet started.
  • The programme procured the SMC drugs for Output 2 (Delivery of four doses of SMC per year to 556,000 children in Northern Region) but implementation was to be funded from another source. This did not eventuate. It is not clear that due consideration was given to this risk in project preparation.
  • One of the programme’s impact indicators and one outcome indicator have been affected by developments external to the project, and so they are not performing as anticipated.
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An outbreak of Ebola in Uganda http://www.heart-resources.org/doc_lib/outbreak-ebola-uganda/ http://www.heart-resources.org/doc_lib/outbreak-ebola-uganda/#respond Fri, 07 Nov 2014 08:57:14 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26246 Read more]]> An outbreak of Ebola disease was reported from Gulu district, Uganda, on 8 October 2000. The outbreak was characterised by fever and haemorrhagic manifestations, and affected health workers and the general population of Rwot-Obillo, a village 14 km north of Gulu town. Later, the outbreak spread to other parts of the country including Mbarara and Masindi districts.

Response measures included surveillance, community mobilisation, case and logistics management. Three coordination committees were formed: National Task Force (NTF), a District Task Force (DTF) and an Interministerial Task Force (IMTF). The NTF and DTF were responsible for coordination and follow-up of implementation of activities at the national and district levels, respectively, while the IMTF provided political direction and handled sensitive issues related to stigma, trade, tourism and international relations.

The international response was coordinated by the World Health Organization (WHO) under the umbrella organisation of the Global Outbreak and Alert Response Network. A WHO/CDC case definition for Ebola was adapted and used to capture four categories of cases, namely, the alert, suspected, probable and confirmed cases. Guidelines for identification and management of cases were developed and disseminated to all persons responsible for surveillance, case management, contact tracing and Information Education Communication (IEC).

For the duration of the epidemic that lasted up to 16 January 2001, a total of 425 cases with 224 deaths were reported countrywide. The case fatality rate was 53%. The attack rate (AR) was highest in women. The average AR for Gulu district was 12.6 cases/10 000 inhabitants when the contacts of all cases were considered and was 4.5 cases/10 000 if limited only to contacts of laboratory confirmed cases. The secondary AR was 2.5% when nearly 5000 contacts were followed up for 21 days. Uganda was finally declared Ebola free on 27 February 2001, 42 days after the last case was reported.

The Government’s role in coordination of both local and international support was vital. The NTF and the corresponding district committees harmonized implementation of a mutually agreed programme. Community mobilization using community-based resource persons and political organs, such as Members of Parliament was effective in getting information to the public. This was critical in controlling the epidemic. Past experience in epidemic management has shown that in the absence of regular provision of information to the public, there are bound to be deleterious rumours. Consequently rumour was managed by frank and open discussion of the epidemic, providing daily updates, fact sheets and press releases. Information was regularly disseminated to communities through mass media and press conferences. Thus all levels of the community spontaneously demonstrated solidarity and response to public health interventions. Even in areas of relative insecurity, rebel abductions diminished considerably.

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Seven things we can learn from the Ebola Epidemic in Uganda in 2000 – 2001 http://www.heart-resources.org/blog/seven-things-can-learn-ebola-epidemic-uganda-2000-2001/ http://www.heart-resources.org/blog/seven-things-can-learn-ebola-epidemic-uganda-2000-2001/#respond Thu, 06 Nov 2014 15:17:18 +0000 http://www.heart-resources.org/?post_type=blog&p=26244 Read more]]> Diseases such as Ebola highlight the importance of a holistic focus on health systems, as opposed to assuming that health is the preserve and concern of health professionals alone. This was the lesson Uganda learnt very quickly in managing the Ebola outbreak in 2001. Until the current epidemic in West Africa, Uganda held the unfortunate record for the greatest number of infections, with 425 recorded cases of Ebola, of which 224 people sadly died.

Gulu district, in the north of the country, bore the greatest brunt of the epidemic, with 393 people falling ill and 203 deaths (Kinsman 2012). But it was not the only affected district. Mbarara district in the south west, recorded five cases of people contracting Ebola of whom four died and Masindi district in the west recorded 17 deaths.

Essential elements of the Ugandan Ebola response:

  1. Partnerships with communities
  2. Community-based disease surveillance
  3. Work with the Media
  4. Technology for quick field diagnosis of new infections
  5. Infection control and hospital waste management
  6. Work on the legal, ethical and social issues
  7. National and international collaborations


Ebola causes community panic and mistrust in the health system

Initially, the epidemic caused a lot of fear, panic, and anger within communities. As is the case in West Africa now, communities: stigmatized the sick; stormed Ebola isolation units (in Masindi) causing the unit to seek another site; and scared off relief burial teams, forcing them to abandon work (Kinsman 2012). Elsewhere in the country, fear and stigmatization grew, causing those who suspected that they had Ebola to hide and patients to flee hospitals once they knew Ebola treatment was being carried out there. In Kampala, religious leaders held prayer rallies against the epidemic, while in nomadic Karamoja anti-Ebola rituals were carried out.

Very quickly, the Uganda Directorate of Health Services learnt that they needed to do something to restore community trust if they were going to tackle the epidemic. Treatment alone was not enough. They needed the community to understand that those treating Ebola patients and burying the dead meant well and needed the community’s support.

Seven measures taken to tackle Ebola in Uganda

Measures were undertaken to gain the trust of the community and help them fight the epidemic. Okware et al (2002) and Omaswa (2014) provide a list of the interventions undertaken by Uganda’s Ministry of Health, which included the following:

1. Partnerships with communities

Upon realizing that they could not do everything by themselves, the Ministry of Health decided to build partnerships with other actors within the community, such as non-governmental organisations like the Red Cross and World Vision. These partnerships were crucial for mobilizing communities, information dissemination, and early case detection. Okware et al (2002) even state that anti government rebels stopped fighting and supported the anti-Ebola efforts.

2. Community-based disease surveillance

The Ministry of Health trained community members to provide a network for surveillance and public information. These community members rapidly reported suspected cases from households, who were rapidly assessed using history of contact and clinical assessment. This strategy was important in that it was not very costly to manage.

3. Work with the Media

Realising the role of the media in informing and misinforming the masses, given their previous role in propagating myths and rumours about Ebola, the Ministry of Health learnt very quickly that they needed to partner with the media to provide prompt and factual public information. Information dissemination could no longer be the preserve of health workers. The media was trained in Ebola and barrier nursing to protect themselves, after which they were charged with providing factual updates about the disease on a daily basis. This way, the media helped curb rumours, myths and risks associated with the disease.

4. Technology for quick field diagnosis of new infections

Because there was no special laboratory for testing Ebola in the country, a field laboratory for spot screening was provided with help from the Centre for Disease Control (CDC) and the World Health Organization. The South African Institute of Virus Research helped customize certain procedures to make them simpler and less costly. This helped with early detection, while those suspected but found to be negative were able to return to their normal lives. This helped reduce stigma and re-build trust between the communities and the health facilities managing Ebola.

5. Infection control and hospital waste management

While health facilities should routinely manage waste professionally, this is not the case, especially in rural communities. Moreover, no one had been prepared for the kind of waste management that accompanied an Ebola epidemic. Sometimes, health workers thought that ensuring that isolating people with Ebola was all they needed to do. In addition, there was need to protect non-health workers in the Ebola response, such as drivers. The Ministry of Health developed a programme to promote infection control in hospital and health facility settings. However, this training was not restricted to health workers, but to others such as drivers who transported cases to referral centres.

6. Work on the legal, ethical and social issues

One of the biggest challenges in combating infectious diseases arises from people’s traditions and cultural norms. Such traditions, with respect to the Ebola epidemic, relate to burials in ancestral grounds, funeral ceremonies, and the handling of the dead. People were provided with information about the dangers of touching those who had died of Ebola and encouraged to leave burials to the specially trained burial committees.

In addition, there were issues of disclosure and confidentiality, which posed ethical challenges to medical workers, and the several children (about 500) orphaned by Ebola. To address these, the government enacted the Workman Compensation Act which entitled infected health workers and their close kin some form of compensation. Individual confidentiality was suspended for public information sharing and counseling services provided to the orphans. In addition, a Post-Ebola Association and a special clinic opened to provide services to survivors.

7. National and international collaborations

One thing that has been associated with Uganda’s success in combating epidemics such as HIV and Ebola is the leadership and commitment from government. With the suspicion of Ebola in Uganda, despite meager finances, the government embarked on a process of providing essential resources to help combat the epidemic. These essentials included but were not limited to; supplies, funding, expertise, communication, and information. Where resources became a challenge, the government called on the international community to help. Some of these, such as CDC, provided the expertise in field testing. All external actors were coordinated by the National Task Force. In addition, other tasks forces were established at the district (DTF) and between ministries (IMTF). These task forces included policy makers, such as district leaders, Members of Parliament, religious leaders, and the police along with people from the health sector.

By Sarah Ssali, Senior Lecturer, School of Women and Gender Studies, Makerere University

References:

Kinsman John (2012), “A Time of Fear”: Local, National, and International Responses to a Large Ebola Outbreak in Uganda, in Biomed Central 8 (15), Pgs 1-12

Okware S. I et al (2002), An Outbreak of Ebola in Uganda, Tropical Medicine and International Health, 7(12), Pgs. 1068-1075

Omaswa Francis (2014), Regaining Trust: An Essential Prerequisite for Controlling the Ebola Outbreak, The Lancet Global Health Blog, 11th August 2014.

This blog also appears on the Rebuild website posted on

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“A time of fear”: local, national, and international responses to a large Ebola outbreak in Uganda http://www.heart-resources.org/doc_lib/time-fear-local-national-international-responses-large-ebola-outbreak-uganda/ http://www.heart-resources.org/doc_lib/time-fear-local-national-international-responses-large-ebola-outbreak-uganda/#respond Thu, 06 Nov 2014 13:50:26 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26245 Read more]]> This paper documents and analyses some of the responses to the largest Ebola outbreak on record, which took place in Uganda between September 2000 and February 2001. Four hundred and twenty five people developed clinical symptoms in three geographically distinct parts of the country (Gulu, Masindi, and Mbarara), of whom 224 (53%) died. Given the focus of previous social scientific Ebola research on experiences in communities that have been directly affected, this article expands the lens to include responses to the outbreak in local, national, and international contexts over the course of the outbreak.

Responses to the outbreak were gauged through the articles, editorials, cartoons, and letters that were published in the country’s two main English language daily national newspapers: the New Vision and the Monitor (now the Daily Monitor). All the relevant pieces from these two sources over the course of the epidemic were cut out, entered onto a computer, and the originals filed. The three a priori codes, based on the local, national, and international levels, were expanded into six, to include issues that emerged inductively during analysis. The data within each code were subsequently worked into coherent, chronological narratives.

A total of 639 cuttings were included in the analysis. Strong and varied responses to the outbreak were identified from across the globe. These included, among others: confusion, anger, and serious stigma in affected communities; medical staff working themselves to exhaustion, with some quitting their posts; patients fleeing from hospitals; calls on spiritual forces for protection against infection; a well-coordinated national control strategy; and the imposition of some international travel restrictions. Responses varied both quantitatively and qualitatively according to the level (i.e. local, national, or international) at which they were manifested.

The Ugandan experience of 2000/2001 demonstrates that responses to an Ebola outbreak can be very dramatic, but perhaps disproportionate to the actual danger presented. An important objective for any future outbreak control strategy must be to prevent excessive fear, which, it is expected, would reduce stigma and other negative outcomes. To this end, the value of openness in the provision of public information, and critically, of being seen to be open, cannot be overstated.

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Global tuberculosis report 2014 http://www.heart-resources.org/doc_lib/global-tuberculosis-report-2014/ http://www.heart-resources.org/doc_lib/global-tuberculosis-report-2014/#respond Thu, 23 Oct 2014 11:06:43 +0000 http://www.heart-resources.org/?post_type=doc_lib&p=26113 Read more]]> This is the nineteenth global report on tuberculosis (TB) published by WHO in a series that started in 1997. It provides a comprehensive and up-to-date assessment of the TB epidemic and progress in implementing and financing TB prevention, care and control at global, regional and country levels using data reported by over 200 countries that account for over 99% of the world’s TB cases. The report is accompanied by a special supplement that marks the 20th anniversary of the establishment of the Global Project on Anti-TB Drug Resistance Surveillance. The supplement highlights the latest status of knowledge about the epidemic of multidrug-resistant TB (MDR-TB) and the programmatic response.

The three annexes of the report include an explanation of how to access and use the online global TB database, one-page profiles for 22 high TB-burden countries and one page regional profiles for WHO’s six regions.

The data in this report is updated annually. The current year supersedes all previous reports.

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