Tackling Ebola calls for effective and rapidly-operationalized decentralization: As we still grapple with how to end this epidemic in our country before WHO’s projected number of victims come to past or even worse, it’s clear that we are still not adopting the right strategies and our implementation prioritization is enormously flawed. Whether the strategy teams are not good enough, or the implementation capacity is lacking in the core teams, or whether this is just a manifestation of our classical principal-agent problem are questions we need to address, and now! The only good thing about Ebola is the fact that knowledge of how it can be contained can be readily accessed by any government, agency or unit. It’s no rocket science! You don’t have to go to Mars and back. All you have to do is effectively and efficiently isolate and care for the infected, thoroughly trace their contacts, and raise awareness. I know it’s not as easy as it sounds, but the divergence in the current efforts and what’s required is sickening. Are we really focusing on the important things and taking the required actions? What are the current “real and true” challenges? Should we go about this a bit differently? What needs to be done? Here’s my take: The key challenges: 1. Too few and inadequate Ebola centers: consequently resulting in: Poor care for patients; Movement of patients across the country to access treatment in far off centers increasing risk of spread; Status confirmation period too long (by the time your sample goes to the lab and back you’re dead); 2. Inadequate man power and resources to effectively care for the infected; 3. Poor working conditions and insufficient motivation for health workers; 4. Poor tracing of potential and suspected cases as well as their contacts; 5. Poor integration strategy for survivors; My Recommendations: The fight against Ebola can best be won through effective decentralization. This must be incorporated and reflective in every required output necessary to tackle this epidemic as thus: 1. The government must endeavor to build centers in at least every Provincial headquarters. Had it not been for my financial-sensitivity, I’d would recommend one center in every District, especially those that are, or stand a risk to be, hot spots/epicenters. Spending on “software” programs like sensitization are necessary but must not be the core of our approach as it would take tangible “hardware” actions to tackle the spread. With decentralized and multiple centers we can achieve the following: Less pressure and congestion in the few existing centers giving enough leverage to health workers in attending to the infected; Eliminate movement of patients across the country and thus reduce the risk for further spread; The status of suspected patients would be confirmed faster and treatment could commence immediately; Reduce the tendency for unrest in host communities of the current few centers as well as their exposure to the virus; Locational proximity to families can psychologically support the recovery of patients; Fallen victims would be buried in their localities or at least close (I know how that feels; it’s very important). 2. Recruit health workers from their hometowns/Districts. There is nothing wrong with people coming from afar to work; in fact it’s a beautiful plus. But amid reluctance from people to join the frontline medical teams, effective decentralization can go a long way to overcome the challenge. There would be more incentives from competent locals to help secure their localities. Koinadugu is currently an awesome case study, the level of vigilance and sacrificial spirit from the locals on the ground in fantastic. 3. The alleged late payment of the allowances of frontline nurses is unthinkable. This must not happen! But what is more important is the safety of our frontline workers. It is understandable that choosing to work in the Ebola front poses a high level of risk even with PPEs and observation of precautionary measure you can get unlucky. But the response rate to saving infected health workers is just not good enough…we must do more. Losing four doctors already and too many valuable and patriotic nurses and support staffs is as bad as this can ever get. We must endeavor to go the extra ten miles to save these workers and boost their confidence and trust in the system. Health workers might be patriotic, but no one wants to go to their certain death. The government must show that they are willing to explore the last option and sacrifice whatever resources to save health workers so they don’t feel caught up behind enemy lines without a reinforcement platoon on the way. There must be, by law, and made public, a reasonable compensation for the beneficiaries of health workers in the frontline in case they fall in the fight to rescue their beloved country from Ebola. Some funds generated for the Ebola fight must be put-up for this purpose, as the motivation of health workers is as important as winning this battle itself. 4. Decentralize the tracing of suspected and potential cases. This is where the MPs, Councilors and local authorities can do a great job. Recruit people, preferably agile youths, at this level to serve as tracers. In most of our communities, almost everyone knows everyone, so an organized tracing at this level would be very effective. Of course, this has to come with some amount of training and personal protective equipment (PPEs) for the tracers at some level. That sense of ownership they have with regards their communities would trigger their vigilance and sustain their motivation, not forgetting good working conditions though…lol. 5. I’m not clear about the procedure for discharging survivors at the moment, but the fact that they still pose a certain level of risk for a couple of months is worrying. And the stigma they face in their communities is also a cause for concern. But my focus here is on the fact that in survival they’ve built immunity against the virus and biologically they cannot be re-infected. This presents a perfect opportunity for some of them to be integrated through recruitment as frontline workers and support staffs. I can imagine that the trauma of surviving Ebola doesn’t go away overnight, and thus it’s easy to think you must send survivors home. But with some counseling, most of them would be happy to help: the survived British nurse is planning to come back and help. If the recruitment of survivors succeeds then we’d have vibrant personnel in the frontline working at zero risks. Let’s hope this lockdown has a positive effect. May God Almighty be with us all and save the land that we love, our Sierra Leone.
Posted on: Thu, 18 Sep 2014 15:22:20 +0000
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