Pro seminar: Ebola, health systems and development
The Heller School for Social Policy and Management, Brandeis University, Graduate Program in Sustainable International Development, MS in International Health Policy and Management.
March 20-21, 2015
Instructor: Elizabeth Glaser, MS’08, MA’11, PhD candidate in Global Health and Development concentration, Heller School for Social Policy and Management, Brandeis University.
Course Description
From 1976-2012, outbreaks of Ebola virus disease (EVD) were sporadic, visiting relatively isolated communities along the forests of the Congo Basin. Despite high mortality, EVD outbreaks were usually of short duration, limiting the overall impact of the disease on the general population.
In December 2013, an EVD outbreak began in Guinea, smoldering in more remote communities for months, yet unlike previous outbreaks, the disease broke out into widespread and intense transmission in three countries with limited disease activity in at least in 6 more.
The current outbreak has resulted in an attack on livelihoods, shutting down all school and universities, and bringing virtually all non-Ebola related health system activities to a halt. Indirectly, the outbreak is thought to have contributed to increased morbidity and mortality from lack of access to treatment and care, and has reversed the regional economic gains of the past 5 years.
This course will first examine the tipping points, investigating the interactions between health systems and development in post conflict governments that may have contributed to the West African EVD outbreak of 2013-2015 and then to suggest factors that might contribute to rebuilding the health systems and economies of the region.
We will focus on four broad intersecting factors: economic systems, environment, human resources, and health, as contributors to the outbreak. From this framework we will examine the roles of various actors, particularly political, social, civil, financial, and regulatory institutions, as stakeholders in creating policy post-outbreak.
The goals of this course are (i) to be able to understand and explain precursors to the current humanitarian crisis, (ii) demonstrate proficiency in analysis of country responses, and (iii) to formulate policies, programs, and funding mechanisms for country or regional responses based on an integrated approach that advances both health and development. Those taking the pro seminar for credit will submit a short paper. The pro seminar is structured such that the final paper could be submitted in a relevant journal for correspondence, commentary, or a brief paper.
Preparation
Prior to class, please review the following materials listed below. There are also optional readings offered for those who wish more information, but the following readings are required for class. While reviewing the video(s) and readings, keep in mind the following questions:
Ebola may have been circulating at low levels in West Africa for up to a decade before the current outbreak (see Boisen and Schoepp in optional materials); this raises questions as to what factors led to an epidemic in these three countries as opposed to other countries in West Africa with evidence of an animal reservoir for EVD (see Hayman in optional readings). What biological, social, ecological, and economic factors contributed to the Ebola outbreak? What factors, if any, were unique to this area and how might these factors influence the choice of a post-outbreak policy framework?
Required materials:
Piot, P. (2014) Ebola's Perfect Storm London School of Hygiene and Tropical Medicine, Global Health Lecture Series, 11 November 2014.
Pooley, S., Fa, J. E., & Nasi, R. (2015). No conservation silver lining to Ebola. Conservation Biology. Vol: early view, ISSN: 1523-1739. http://onlinelibrary.wiley.com/doi/10.1111/cobi.12454/pdf
Sack, K., Fink, S., Belluck, P., Nossiter, A., & Berehulak, D. (2014). How Ebola Roared Back. The New York Times.
http://www.nytimes.com/2014/12/30/health/how-ebola-roared-back.html?_r=0
WHO (2014) High level meeting on building resilient systems for health in Ebola-affected countries (Background document) Geneva, Switzerland, 10-11 December 2014.
http://www.who.int/entity/csr/disease/ebola/health-systems/health-systems-background.pdf?ua=1
Wilkinson, A., & Leach, M. (2014). Briefing: Ebola–myths, realities, and structural violence. African Affairs, adu080. http://afraf.oxfordjournals.org/content/early/2014/12/04/afraf.adu080.full.pdf+html
World Bank. 2014. The economic impact of the 2014 Ebola epidemic : short and medium term estimates for Guinea, Liberia, and Sierra Leone. Washington, DC : World Bank Group. http://documents.worldbank.org/curated/en/2014/09/20214465/economic-impact-2014-ebola-epidemic-short-medium-term-estimates-guinea-liberia-sierra-leone.
Optional materials:
LSHTM faculty. (2014) Ebola Today: What are we learning from the West Africa outbreak? London School of Hygiene and Tropical Medicine, Ebola Seminar, 22 September November 2014. https://vimeo.com/106926446
Allafrica (2014) Liberia: S/Leone & Liberia - Next Door Neighbors Battle Road Woes. http://allafrica.com/stories/201405150311.html
Boisen M L, et al. (2015)Multiple Circulating Infections Can Mimic the Early Stages of Viral Hemorrhagic Fevers and Possible Human Exposure to Filoviruses in Sierra Leone Prior to the 2014 Outbreak. Viral Immunology . Volume 28, Number 1, 2015. DOI: 10.1089/vim.2014.0108
Foster V, Pushak N.( 2010) Liberia’s Infrastructure: A Continental Perspective .The World Bank
Hayman DTS , et al (2012) Emerging Infectious Diseases Vol. 18, No. 7, July 20 2012
Leow JJ. et al.(2012) Scarcity of healthcare worker protection in eight low- and middle-income countries: surgery and the risk of HIV and other bloodborne pathogens. Tropical Medicine and International Health volume 17 no 3 pp 397–401 March 2012
Leroy EM, Kumulungui B, Pourrut X, Rouquet P, Hassanin A, Yaba P, et al. Fruit bats as reservoirs of Ebola virus. Nature. 2005;438:575-6. [PMID: 16319873
Mupapa, K., Massamba, M., Kibadi, K., Kuvula, K., Bwaka, A., Kipasa, M., ... & Muyembe-Tamfum, J. J. (1999). Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. Journal of Infectious Diseases, 179(Supplement 1), S18-S23.
Piot. P. (2012) No Time to Lose A Life in Pursuit of Deadly Viruses (Unabridged) . WW Norton & Company.
Schoepp RJ, Rossi CA, Khan SH, Goba A, Fair JN. (2010) Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone. Emerging Infectious Diseases • Vol. 20, No. 7, July 2014
Friday 6-9pm
6:15-6:30pm: Review plan for weekend + Form groups
6:30-7:15pm: Ebola
Primer
Epidemiology
Signs and symptoms
Clinical management
Prevention
7:15-8:00pm: Precursors for vulnerability
Conflict history
Civil war, political and civil unrest
Liberia
Sierra Leone
Guinea
The tipping points
Environment
Transport
Health systems
Culture
8:00- 8:30 – BRAINSTORMING and Notes Session
It is January 2014, you are a consultant for World Bank, there to evaluate regional or country gains since receipt of funding for health and development in 2009.
What was the state of the country or region prior to 2009? What progress has occurred? What would you recommend for the next 5 years?
8:30-9:00 pm: Current outbreak
Personal observations
Saturday, March 21st, 2015
9-9:15am: Review Friday, questions, comments etc.
9:15-10:20am
What reform goals would you set?
WHO roadmap – goals & critique
Development - Where does it fit in the response to a health crisis ?
How do we measure progress?
10:30 – 11:30am: Human Resources for Health
Policies for rebuilding HRH in Ebola effected countries (10:30-11:30am)
Anne Sliney
Chief Nursing Officer
Clinton Health Access Initiative (CHAI).
11:30 – 12pm: Breakout - Discussion and brainstorming (groups)
Write up /Discussion on HRH -
Is WHO framework relevant?
If not, what framework would you use?
How do you propose HRH policy be funded?
What role might expats play in HRH and health systems strengthening?
12 – 12:40 pm: Lunch
12:40pm – 1pm: Group discussion and review working paper
1 – 2pm: Development
Education: Constraints, post conflict, opportunities
Environment/Agriculture: Food insecurity, Rice production, Mining, forestry,
Economic advancement: Donors, Trade, Partnerships, Vulnerabilities, & Opportunities
2 – 2:30pm: Small Group Discussion
2:30-3pm: Financing
Who finances effort?
Donors: USAID, DFID, China, WB, IMF, ADB
Other mechanisms
Leveraging country assets
Trade agreements
Development agreements
Public Private Partnerships
Corruption: How do we deal with mismanagement of funds?
3 – 3:30pm: BREAK
3:30 – 5pm: Bringing it together
Breakout
What reform goals would you set?
What polices & programs might be implemented to meet reform goals?
How might these polices and programs be financed?
Monitoring and evaluation– what measures matter most and to whom?
General discussion:
What have we learned? What other countries might be at risk for similar crises?
How can we be proactive rather than reactive?