The emergence and re-emergence of infectious diseases are now more than ever considered threats to public health systems. There have been over 20 outbreaks of Ebola in the past 40 years. Only recently, the World Health Organization has declared a public health emergency of international concern (PHEIC) in West Africa, with a projected estimate of 1.2 million deaths expected in the next 6 months. Ebola virus is a highly virulent pathogen, often fatal in humans and non-human primates. Ebola is now a great priority for global health security and often becomes fatal if left untreated. This study employed a narrative review. Three major databases – MEDLINE, EMBASE, and Global Health – were searched using both ‘text-words’ and ‘thesaurus terms’. Evidence shows that low- and middle-income countries (LMICs) are not coping well with the current challenges of Ebola, not only because they have poor and fragile systems but also because there are poor infectious disease surveillance and response systems in place. The identification of potential cases is problematic, particularly in the aspects of contact tracing, infection control, and prevention, prior to the diagnosis of the case. This review therefore aims to examine whether LMICs’ health systems would be able to control and manage Ebola in future and identifies two key elements of health systems strengthening that are needed to ensure the robustness of the health system to respond effectively.

In this paper we present approaches to problem structuring that have been employed to derive planning guidelines as part of a comprehensive strategic planning process. The approaches were developed for use in the context of a developing country, where quantitative data is particularly scarce. They rely heavily upon the informed judgement of technical planning officers. We discuss ways of ensuring that the approach remains flexible and participative.

A thematic analysis resulted in the identification of four themes: (1) visibility; (2) interpersonal relationships; (3) leadership; and (4) systems/professional boundaries. Patients enjoyed being seen as a whole and family carers appreciated the coordination aspect of the role. Difficulties arose from the limited understanding of the CM role and from a lack of a shared vision across healthcare professionals concerning the role and its goals.

Recent years have seen a focussing of attention on the social and geographic variations that exist in the need for health care in the U.K., the social and geographic variations that exist in the provision of health care and the tendency for these variations to coincide inversely. Of the two sides of the needs-provision equation it has, necessarily, been the former that has proved most difficult to determine with any measure of general agreement. Over the last year, the British Medical Journal has published two competing census-based indices, each of which claims to measure the . level of need for primary care. This paper reviews and assesses the merits of each and suggests that a more illuminating analytic approach might be found by applying clustering techniques.

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