Preparing for Ebola Virus Disease in West African countries not yet affected: perspectives from Ghanaian health professionals

Abstract

BackgroundThe current Ebola Virus Disease (EVD) epidemic has ravaged the social fabric of three West African countries and affected people worldwide. We report key themes from an agenda-setting, multi-disciplinary roundtable convened to examine experiences and implications for health systems in Ghana, a nation without cases but where risk for spread is high and the economic, social and political impact of the impending threat is already felt.DiscussionParticipants’ personal stories and the broader debates to define fundamental issues and opportunities for preparedness focused on three inter-related themes. First, the dangers of the fear response itself were highlighted as a threat to the integrity and continuity of quality care. Second, healthcare workers’ fears were compounded by a demonstrable lack of societal and personal protections for infection prevention and control in communities and healthcare facilities, as evidenced by an ongoing cholera epidemic affecting over 20,000 patients in the capital Accra alone since June 2014. Third, a lack of coherent messaging and direction from leadership seems to have limited coordination and reinforced a level of mistrust in the government’s ability and commitment to mobilize an adequate response. Initial recommendations include urgent investment in the needed supplies and infrastructure for basic, routine infection control in communities and healthcare facilities, provision of assurances with securities for frontline healthcare workers, establishment of a multi-sector, “all-hazards” outbreak surveillance system, and engaging directly with key community groups to co-produce contextually relevant educational messages that will help decrease stigma, fear, and the demoralizing perception that the disease defies remedy or control.SummaryThe EVD epidemic provides an unprecedented opportunity for West African countries not yet affected by EVD cases to make progress on tackling long-standing health systems weaknesses. This roundtable discussion emphasized the urgent need to strengthen capacity for infection control, occupational health and safety, and leadership coordination. Significant commitment is needed to raise standards of hygiene in communities and health facilities, build mechanisms for collaboration across sectors, and engage community stakeholders in creating the needed solutions. It would be both devastating and irresponsible to waste the opportunity.

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...…”

“…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;Thiam et al, 2015) . Traditional healers trained in infection control and public health messages (Alexander et al, 2015;McPake...…”

“…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) .…”

“…Adequate transport for patients (Buseh et al, 2015;Forrester et al, 2014;Lapao et al, 2015;Thiam et al, 2015) . Adequate medical equipment (including personal protective equipment for health workers) (Adokiya & Awoonor-Williams, 2016;Bhatnagar et al, 2016;Boozary et al, 2014;Buseh et al, 2015;Cancedda et al, 2016;Espinal et al, 2016;Forrester et al, 2014;Jacobsen et al, 2016;Lapao et al, 2015;McGillis Hall & Kashin, 2016;McPake et al, 2015;Mulinge & Soyemi, 2016;Nyarko et al, 2015;Parsons & Naeem Ahmad, 2015;Regmi et al, 2015;Siekmans et al, 2017;Stoto et al, 2013;Thiam et al, 2015) . Available essential medicines and vaccines; effective medicines supply chain (Buseh et al, 2015;Lapao et al, 2015;Mulinge & Soyemi, 2016;Purohit et al, 2017;Siekmans et al, 2017;Stoto et al, 2013) .…”

Infection prevention and control in health facilities in post-Ebola Liberia: don't forget the private sector!

“…4 At the beginning of the outbreak, HCWs did not have the ability to practise and maintain a safe working environment, and infection prevention and control (IPC) measures were limited; no IPC policies or guidelines existed and no routine evaluations of IPC were conducted in health facilities prior to the EVD outbreak. [5][6][7][8] Due to the large number of deaths among health staff and the loss of community confidence in the health system, many health facilities closed completely during the outbreak. 9 The EVD outbreak and the ensuing breakdown of the health system, the high burden of EVD among HCWs, the fact that health facilities acted as drivers of EVD transmission during the outbreak, 10 and the closure of health facilities, all highlighted the importance and the necessity of IPC as the only measure capable of protecting patients, visitors, care givers, frontline HCWs and crucial health facilities in the face of a deadly outbreak.…”