In this presentation Barbara McPake, the Research Director of ReBUILD, talks about Ebola in the context of conflict-affected states and health systems with a focus on West Africa – in particular comparing responses to Ebola outbreaks in Northern Uganda and Sierra Leone. The ReBUILD Consortium is a research partnership funded by the UK Department for International Development, working in Cambodia, Sierra Leone, Uganda and Zimbabwe to explore how to strengthen policy and practice related to health financing and staffing.
Professor McPake describes how the learning from the ReBUILD programme over the last three years is relevant to questions that are arising with regard to the current Ebola outbreak impacting Guinea, Liberia, and Sierra Leone. According to her, Ebola is a particular risk in conflict-affected settings because the displacement of populations leads to generalised risks for infectious disease, there is livelihood disruption and food and water shortages and people are forced to more marginal subsistence, including bush meat, and short term exposure to forest-based subsistence for active combatants and refugees fleeing war zones involves a heightened health risk. Professor McPake begins this presentation by defining conflict-affected and post-conflict states and poses questions about what, if anything, is different about health systems in post-conflict states. She then compares what happened in Northern Uganda in 2000-2001 with what happened in Sierra Leone in 2013-2014 and offers some thoughts about why there were such different outcomes in each country context. ReBUILD briefings on the two cases are available here: Uganda and Sierra Leone. By and large, the response in Northern Uganda was more coordinated and more effective than in Sierra Leone, and thus Uganda was able to curb the spread of the virus to a much greater extent than Sierra Leone.
Professor McPake draws the following conclusions:
– Conflict and its aftermath increases the chance of an Ebola outbreak and reduces the ability to control it
– Problems are worsened if international support is fragmented and poorly coordinated or directed by people without understanding of local context
– More stable governance arrangements in Uganda seemed to be one factor supporting greater success
For an introduction to ReBUILD’s work, click here to watch the HEART Talk on Introducing ReBUILD: A Consortium Building Resilient and Responsive Health Systems in Conflict-Affected States.
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