From Thompson Reuters Foundation, this is the third of three blogs written by Plan International USA CEO Tessie San Martin following her trip to the front lines of the Ebola outbreak in West Africa.
The Community Care Center I visited recently in Sierra Leone had had no new confirmed patients for a few days. CCIs are still being built in Liberia, even as the number of new Ebola cases is dropping dramatically.
When do we get to declare victory?
When should we start to dismantle the considerable infrastructure that governments and their partners have built to stop the transmission of this dreaded disease?
What new activities are necessary to support an effective transition to early recovery and long-term rehabilitation of the communities, health systems, and economies, decimated by the epidemic?
And what do governments and their partners need to put in place to reduce the likelihood of another epidemic and ensure a more effective response when another such epidemic strikes?
The conversation about "what next?" is in full swing with frontline country governments, donors, and partners on the ground. Let me offer 5 quick observations, based on my visits and discussions with colleagues in the Plan Liberia and Sierra Leone country offices and our West Africa regional office:
- Focus on child protection. I say this not just because keeping children safe is the mission of Plan but because inevitably children are among the most affected and vulnerable in any emergency-- and never more so than in this Ebola crisis. Many children are now single or double orphans. The economic toll of this epidemic is considerable, leaving families with reduced, and in too many cases, depleted sources of income. Stresses on family income may increase the likelihood that children are kept out of school to help earn income and put food on the family table. It may reduce their access to food. In these circumstances girls are often the most vulnerable. Protection programs need to be put in place now.
- Focus on sanitation. There has been unprecedented progress increasing awareness about and changing hygiene behavior. It is important that these gains not be lost. Not only is continued hygiene behavior critical to ensuring Ebola transmission is stopped but behaviors around hand-washing are critical to reducing the incidence of diarrheal disease, traditionally a leading cause of childhood death, malnutrition, and stunting. As children go back to school, ensuring school-based hygiene and sanitation facilities (e.g. easy access to water for hand-washing and eventually access to latrines) is also critical and needs to be put in place now.
- Strengthen health systems. As has been noted repeatedly, the Ebola crisis exposed the weakness of the health systems in the most affected countries. The epidemic has also extracted an additional toll, as hundreds of health workers, including nurses and doctors already in short supply before the epidemic, lost their lives to the disease. In some cases clinics have been decommissioned as Ebola-infected bedding, instruments, and equipment were destroyed in an effort to stop the spread of the virus. These facilities need to be rehabilitated and new staff needs to be trained and deployed. There is now discussion about the feasibility of and the approach to repurposing CCCs as replacement or additional health facilities. Protocols are needed to do this as soon as possible.
- Don't forget psychosocial support. The epidemic has frayed the fabric of communities. The disease has stigmatized families. Children are traumatized by the loss of parents and siblings. Resentment and distrust towards community leaders about what seem to be draconian approaches to transmission control have emerged.
- Emergency staff demobilization will need a transition plan. Many local health professionals in the affected countries are getting a pay premium which will go away when the emergency work stops. Even as the epidemic caused the loss of jobs it also created new ones. Youth have been the beneficiaries of many of the new jobs created by this epidemic: they have been hired and trained to help with CCC disinfection, with burial teams, and household decontamination and replacement efforts. They have gained some skills and acquired income during the emergency. Once the emergency is over those jobs will go away. What does a transition for all these emergency responders look like? In the longer term, as economies recover, they will find new jobs and/or better pay. But in the immediate and medium term, governments, donors and partners will need to think about creating a soft landing.
What does all this mean?
It means that even as we see the number of cases come down, we cannot disengage. There is much work that needs to be done. Resources will be needed to invest in the recovery. Child protection and water and sanitation work in schools will be particularly important. Livelihood programs need to be put in place soon. Money must be put into the hands of families that have lost many, if not most, of their sources of income to provide the means to those caring for orphaned children and to provide a transition for those being demobilized from Ebola frontline work.
The time to start investing in and mobilizing resources for this is now, while we finish the emergency phase. Finally, investing in rigorous research to better evaluate what is working well and what needs to be improved is not a luxury. It is a necessity.