Investing in preparedness for rapid detection and control of epidemics: analysis of health system reforms and their effect on 2021 Ebola virus disease epidemic response in Guinea

Abstract

The 2014–2016 West Africa Ebola Virus Disease (EVD) Epidemic devastated Guinea’s health system and constituted a public health emergency of international concern. Following the crisis, Guinea invested in the establishment of basic health system reforms and crucial legal instruments for strengthening national health security in line with the WHO’s recommendations for ensuring better preparedness for (and, therefore, a response to) health emergencies. The investments included the scaling up of Integrated Disease Surveillance and Response; Joint External Evaluation of International Health Regulation capacities; National Action Plan for Health Security; Simulation Exercises; One Health platforms; creation of decentralised structures such as regional and prefectural Emergency Operation Centres; Risk assessment and hazard identification; Expanding human resources capacity; Early Warning Alert System and community preparedness. These investments were tested in the subsequent 2021 EVD outbreak and other epidemics. In this case, there was a timely declaration and response to the 2021 EVD epidemic, a lower-case burden and mortality rate, a shorter duration of the epidemic and a significant reduction in the cost of the response. Similarly, there was timely detection, response and containment of other epidemics including Lassa fever and Marburg virus disease. Findings suggest the utility of the preparedness activities for the early detection and efficient containment of outbreaks, which, therefore, underlines the need for all countries at risk of infectious disease epidemics to invest in similar reforms. Doing so promises to be not only cost-effective but also lifesaving.

How has Guinea learnt from the response to outbreaks? A learning health system analysis

“…Learning truly occurred in the response to outbreaks. This led to improved health system’s functions, 84 increased adaptivity and innovation and greater self-reliance, resulting in better response outcomes, including for haemorrhagic disease outbreaks that followed the 2014–2016 EVD, in terms of outbreak spread, response duration, infected cases and deaths. For instance, the 2014–2016 EVD outbreak spread over 30 out of 38 health districts and lasted about two years and half, with 3811 infected cases and 2543 deaths, 42 while the subsequent 2021 EVD outbreak was contained within one health district and within four months, with 16 confirmed cases recorded overall, of which five deaths, and the Marburg virus disease was controlled within 42 days, with only one confirmed case/death.…”

Prospective Strategies to Enhance Resilience for Public Emergencies Preparedness: A Human Resources Management Perspective

“…Governance & leadership Integrated structures, partnerships and responsibilities with clear leadership to support a coordinated and interoperable system [16,[20][21][22] Emergency plan and practices and experiences dissemination for preparedness Develop a plan through a dynamic, collaborative planning process; invest in testing and practicing plans and processes; Gather rules, regulations, unity of purpose and priority for change and action [16,[21][22][23] Risk analysis Consolidated knowledge of community hazards and risks, systematics and dynamics of risk events, disasters and emergencies [16,24] Surveillance and monitoring Timely information to provide situational awareness and guide action [16,21,22,24] Resources Ensure dedicated resource capacity and mobilization capability [16] Communication and dissemination…”

Outbreak of the Ebola Virus

“…The emergence of outbreaks of Ebola virus disease (EVD) has profound implications for global health security, emphasizing the need for meticulous preparation and intervention strategies (Keita et al 2023).…”