How can health systems be strengthened to control and prevent an Ebola outbreak? A narrative review

Abstract

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.

Health system preparedness for emerging infectious diseases: A synthesis of the literature

“…This led to a series of surveillance training workshops and creation of an Ebola incident management system which is thought to have enhanced preparedness and reduced Ebola case burden in the region compared to other areas of the country. (Jacobsen et al, 2016;Kaufman, 2008;Zumla et al, 2016) − Indicator based surveillance (Balajee et al, 2016;Kruk et al, 2015;Lapao et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015) − Event based surveillance (Adokiya & Awoonor-Williams, 2016;Balajee et al, 2016;Espinal et al, 2016;Forrester et al, 2014;Garcia Serpa Osorio-de-Castro, Silva Miranda, Machado de Freitas, Rochel de Camargo, & Cranmer, 2017;Kruk et al, 2015;Lapao et al, 2015;McPake et al, 2015;Nyarko et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015;Stoto et al, 2013;Thiam et al, 2015), with use of community health monitors (Balajee et al, 2016;Jacobsen et al, 2016;Martineau, 2016;McPake et al, 2015;Nyarko et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015;Scott et al, 2016;Thiam et al, 2015) − Verification of reported signal events (Balajee et al, 2016;Espinal et al, 2016;Lapao et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015;Siedner et al, 2015) − Appropriate referral of suspected cases (Siekmans et al, 2017;Thiam et al, 2015...…”

“…Epidemiologists to define/validate signal events and translate data into public health interventions (Balajee et al, 2016;Siedner et al, 2015) . Adequate staff numbers: doctors, nurses, CHWs (Adokiya & Awoonor-Williams, 2016;Boozary et al, 2014;Cancedda et al, 2016;Espinal et al, 2016;Forrester et al, 2014;Gostin & Friedman, 2015;Kieny et al, 2014;Kruk et al, 2015;Lapao et al, 2015;McPake et al, 2015;Mulinge & Soyemi, 2016;Regmi et al, 2015;Siedner et al, 2015;Siekmans et al, 2017); also at sub-regional level (Gostin & Friedman, 2015;Kruk et al, 2015;Regmi et al, 2015) . Health worker training and continuing education (Adokiya & Awoonor-Williams, 2016;Boozary et al, 2014;Cancedda et al, 2016;Espinal et al, 2016;Forrester et al, 2014;Gostin & Friedman, 2015;Kruk et al, 2015;Lapao et al, 2015;McPake et al, 2015;Mulinge & Soyemi, 2016;Nyarko et al, 2015;Regmi et al, 2015;Siedner et al, 2015;Siekmans et al, 2017;Thiam et al, 2015); understanding of community knowledge and beliefs (Buseh et al, 2015;Dhillon & Kelly, 2015;Martineau, 2016;Regmi et al, 2015;Scott et al, 2016;…”

“…Traditional healers trained in infection control and public health messages (Alexander et al, 2015;McPake et al, 2015) . Trained laboratory technicians able to collect, analyse, package specimens (Adokiya & Awoonor-Williams, 2016;Balajee et al, 2016;Bhatnagar et al, 2016) (Continued ) (Alexander et al, 2015;Buseh et al, 2015;Cancedda et al, 2016;Dhillon & Kelly, 2015;Forrester et al, 2014;Garcia Serpa Osorio-de-Castro et al, 2017;Jacobsen et al, 2016;Kruk et al, 2015;Li, Xie, Yang, & Frost, 2016;Martineau, 2016;McGillis Hall & Kashin, 2016;McPake et al, 2015;Nyarko et al, 2015;Nyenswah et al, 2016;Omole & Folaranmi, 2016;Ozawa et al, 2016;Purohit et al, 2017;Qiu et al, 2018;Regmi et al, 2015;Scott et al, 2016;Siedner et al, 2015;Siekmans et al, 2017;Thiam et al, 2015) Infrastructure & medical supplies (Boozary et al, 2014;Cancedda et al, 2016;Espinal et al, 2016;Purohit et al, 2017;Regmi et al, 2015) . Adequate number of hospital beds (Cancedda et al, 2016;McPake et al, 2015;Purohit et al, 2017) .…”

“…Accessible healthcare facilities (Buseh et al, 2015;Kaufman, 2008;Siekmans et al, 2017) . Isolation centres: adequate number (Adokiya & Awoonor-Williams, 2016;Bhatnagar et al, 2016;Espinal et al, 2016;Regmi et al, 2015;Thiam et al, 2015) . Isolation centres: adequate beds (Adokiya & Awoonor-Williams, 2016;McPake et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015;Thiam et al, 2015) .…”

“…Isolation centres: adequate number (Adokiya & Awoonor-Williams, 2016;Bhatnagar et al, 2016;Espinal et al, 2016;Regmi et al, 2015;Thiam et al, 2015) . Isolation centres: adequate beds (Adokiya & Awoonor-Williams, 2016;McPake et al, 2015;Nyenswah et al, 2016;Regmi et al, 2015;Thiam et al, 2015) . Adequate transport for patients (Buseh et al, 2015;Forrester et al, 2014;Lapao et al, 2015;Thiam et al, 2015) .…”