GPI has talked to Dr Gisela Schneider, Director of DIFAEM, about the learnings from Ebola for COVID-19 and the need for community engagement. The German Institute for Medical Mission (DIFAEM) is a non-profit association that has been working for health in the One World for over 100 years.
The social and economic consequences of the Ebola outbreak on the African continent were devastating. What lessons can be learned from the fight against Ebola that could help to prevent Corona from spreading across African countries?
The economic consequences of Ebola were detrimental, but did not affect the whole continent, nor did Ebola really affect the world – although it woke everybody up, as Ebola is much more dangerous than COVID-19.
During that epidemic, we saw a tremendous impact on other health issues: women had to deliver at home because they did no longer have access to health services, vaccinations were interrupted leading to measles outbreaks that killed many more than the entire Ebola outbreak itself, and many children died of malaria and other illnesses.
In addition to the health impacts, there were many social and economic consequences. In all affected regions, Ebola led to an economic breakdown. People did not have enough to eat, markets did not work as it would have been necessary, and all external investment stopped.
There are lessons to be learnt: We learnt in West Africa, that community engagement was the key to breaking the infection cycle. For example, with regular hand washing, hygiene etc. In order to ensure hand washing is practised, investment in water, water sources, and access to running water will make a big difference.
In the present outbreak, many of the African countries have seen the pictures from Italy and Spain, and they closed their borders and started a “lockdown” policy in countries, where people live on their daily work. If you cannot go to the market or do your small business, you have nothing to eat. If you just stop everything, this will affect people’s livelihood, their nutrition, and ability to survive.
People see that we are using the protection suits, PPE, produced in China. It would be feasible to create local solutions with protective clothing. This will support the local industry and will involve local communities.
Key will also be to do case and contact tracing. With support from Bread for the World (BfdW), we trained more than 4.000 volunteers in Sierra Leone to be community supporters for such times. During the Ebola epidemic, each of them looked after 40 households. By doing so, you may get more support than if you send soldiers or police to reinforce measures of quarantine.
At the same time, it is necessary to strengthen local health systems. At least the provision of oxygen should be possible. In bigger units, one may be able to strengthen intensive care units, and train staff in caring for people suffering from a severe disease.
What should international partners like Germany do to strengthen African health systems in the fight against Corona? Do you consider it wise to reallocate funds from other health programs and focus on Corona control?
There is a lot that can be done to strengthen health systems. We should be careful to take away funds from other programs and invest them in Corona control. Rather, hospitals and health centres need to be strengthened in providing quality care and doing so in a safe environment: patient safety – starting from good IPC (infection prevention and control) concepts that should be kept going way beyond Corona.
Concerning access to drugs, we will be facing a huge lack of essential medicines if the supply chain is not re-opened. At the same time, local production of essential supplies, e.g. of disinfectant or soap, can be established, and that will, in the long run, make those health systems more robust and resilient.
In the matter of investment in personnel, staff training, and capacity building, DIFÄM now offers e.g. Webinars for our partners, so that they are better informed and able to deal with the situation.
At the end of the day, we will see that many more people will die, for example of diseases such as measles due to interrupted vaccination campaigns, mothers will die because they do not have access to good care due to Corona. So it is essential to look at the services and the system as a whole.
Even if purchasing power exists, the negotiating position of many African countries on the global market has often prevented them from obtaining protective materials against Corona. What does this tell us about international cooperation on Global Health? What do you think should change, also with regard to the next possible pandemic?
It is essential that we think GLOBALLY when we look at the Sustainable Development Goals (SDGs). We have SDG3 as a sustainable development goal for health, but all the other 16 goals indirectly also affect health, and health affects those goals.
193 heads of state have signed the SDG declaration of “leaving no-one behind” – Corona shows us whether we really mean it. Europe is affected at its core in this pandemic, but we see how even here, countries are fending for themselves, let alone countries in Africa, South Asia, or South America.
Acting coherently, so that everyone will benefit, will be so important. If Corona will lead to a collapse of an already weak economy, it will lead to a massive increase in poverty, hunger, and eventually also political instability. Therefore, the EU as a whole and Germany with its very robust economy have a responsibility to strengthen countries in the south, strengthen their health systems, and allow the development of local ideas and markets, to strengthen the economy. Africa is a young continent. The communities will be able to get up after this pandemic, but they need to be fostered and strengthened so that local economies can grow and develop.
Recently, we have heard from the German Federal Ministry for Economic Cooperation and Development (BMZ) that they want to reduce their engagement in health. I hope that Corona was a strong enough warning to the German government not to go ahead with such plans, but instead strengthen their engagement in this field.
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