Responding to Ebola
The Ebola outbreak in West Africa is causing concern all over the world. Unlike previous outbreaks of the disease, limited to villages and rural settings, this outbreak is spreading to more populous urban areas. It has captured global attention by killing more than 50 percent of those who get infected, and swiftly. More than 2,000 deaths have been reported so far, and those numbers are likely to grow. Beyond the need for an emergency response, the Ebola outbreak is also drawing attention to the longer-term need for health systems strengthening. The Global Fund is not a key organization in WHO’s Ebola Response Roadmap but we are closely monitoring the outbreak and engaging with our partners in affected countries.
Programs that are supported by the Global Fund in Guinea, Liberia and Sierra Leone have been put under strain by the outbreak. Fear of infection from the Ebola virus, which can spread to anyone coming into physical contact with the blood or bodily fluids of infected people, is holding back some patients from seeking care for other diseases at hospitals and health clinics. Many health professionals are themselves afraid to report for work, with more than 240 healthcare workers infected, reducing the already low capacity of health systems and forcing some clinics to close. Strict travel restrictions are also preventing Global Fund country teams from visiting West Africa, where monitoring and oversight of grants has been affected and preparations for the new funding model delayed.
Liberia’s Health Ministry and Sierra Leone’s country coordinating mechanism have informed the Global Fund that they will be formally asking for flexibility and possible reprogramming of Global Fund grants to help them respond to the Ebola epidemic. The Global Fund will respond swiftly to such requests and will seek to provide support to countries affected by Ebola within the mandate of the organization. It will try to support continuity of essential HIV, TB and malaria services and retention of people on treatment. It will share public health information and also provide services, following WHO guidelines, which educate partners and protect them from contracting the Ebola virus.
The Global Fund’s actions will follow the lead from each affected country, from WHO, and from other organizations with expertise in Ebola. In affected countries, there are several areas where the Global Fund may be able to contribute to the response: providing protective gear for staff in programs supported by the Global Fund; training of staff on how to protect themselves from Ebola; assigning available people or equipment in HIV, TB or malaria programs to temporarily assist in controlling the Ebola virus; providing special travel allowances to enable Global Fund beneficiaries to be reached. Extraordinary outbreaks call for extraordinary measures. We can all benefit by focusing on necessary tasks, under the guidance of leading agencies and experts.
A Need to Strengthen Systems
Since the Global Fund began, it has been working with countries and partners to support health system strengthening as a way to maximize impact of its core investments in HIV, TB and malaria. The Ebola outbreak is highlighting the critical role of this work.
By their nature, investments in health systems strengthening, known as HSS, are cross-cutting and aimed at bolstering national systems to benefit multiple disease program outcomes. With better health systems, the current Ebola outbreak in West Africa could have been easier to control and contained in rural areas.
The countries affected by Ebola experience acute shortage of qualified health workers. In Liberia, for instance, there are fewer than one health worker per 1,000 people, far below the minimum threshold recommended by WHO. A lack of routine data collection, ineffective logistics and supply chain, and insufficient healthcare infrastructure are common. With the Ebola outbreak, things only get worse, with health professionals failing to report to work.
The long-term solution for preventing, detecting and responding to disease outbreak is to strengthen health systems. The Global Fund has been reinvigorating its focus on HSS work this year, encouraging all grant applicants to include a significant HSS component in any application. Such investments are key in helping maximize the impact of disease-related interventions, increasing value for money, and in contributing to sustainability of health programs. Through country dialogue, partners are identifying many gaps and weaknesses in health systems, before investing strategically under the same platform. Investments can be most effective when needs are assessed well, as part of a country’s national health strategy and disease-specific plans, said George Shakarishvili, Senior Advisor for HSS at the Global Fund. The new funding model allows flexibility in reprogramming funds to invest in areas of emerging concerns in HSS.
Guinea, the country where the first case of the current Ebola outbreak was recorded, is seeking funds to invest in strengthening its information and procurement systems. To increase the benefits of our HSS investments under the new funding model, the Global Fund’s country team will seek the opportunity to work with Guinea’s Ministry of Health and partners to create a coordination platform for HSS investments in the country. Lyne Soucy, Fund Portfolio Manager for Guinea, said it will allow strategic investments in health systems for better responses to all diseases, including Ebola. “A stronger health system is part of the solution to win the fight against Ebola and all the other diseases in countries like Guinea,” Soucy said. “We are keen on working with all partners to support stronger health systems as a real way to respond to HIV, tuberculosis and malaria and many other health concerns.”
Treatment and Prevention
As many countries advance their ability to increase impact against HIV, TB and malaria by focusing interventions on specific geographic areas and communities, partners in global health are taking steps to pursue both treatment and prevention. In a recent presentation at the Global Fund offices in Geneva, experts from Kenya outlined new efforts in that country on a combination prevention approach that can further reduce HIV infection by a significant degree.
Dr. Nduku Kilonzo, Director of Kenya’s National AIDS Control Council, and Dr. Martin Sirengo, Head of the National AIDS & STIs Control Program, joined by Dr. Sarah Masyuko, described current conditions in Kenya and detailed a combination prevention initiative. It includes a focus on outcomes, improved surveillance, using research for local solutions and taking advantage of new prevention technologies and treatment regimens. The initiative greatly expands efforts in two specific counties, Homa Bay and Mombasa, where the HIV epidemic is worst. With that focus, the initiative aims to avert 1.1 million HIV infections and 760,000 AIDS-related deaths by 2030.
Mark Dybul, Executive Director of the Global Fund, attended the presentation and commented: “It’s a partnership led by the government and people in the country and that’s why it’s worked.” Dr. Dybul added: “It’s focused on how to end an epidemic, not how to distribute resources. You’re going where the epidemic is and fighting it there. You’re not treating people differently; you’re fighting the disease where the need is.”
After reviewing the Concept Notes submitted so far this year to apply for support from the Global Fund, the Technical Review Panel recommended that efforts continue to find an appropriate balance between prevention and treatment. The TRP suggested that Concept Notes will be most effective where they fully consider the current epidemiological situation, existing health system capabilities and coverage and effectiveness of prevention efforts, treatment programs and resource availability.