Ebola: Impact and lessons for West Africa

25 octobre 2018Wathinotes systèmes de santé

Thomas Jaye is the deputy director of the Faculty of Academic Affairs and Research (FAAR) at the Kofi Annan International Peacekeeping Training Centre.

November 2014

Link to the original document

Introduction

Once described as the epicenter of West Africa’s conflict system, the Mano river basin has now become the epicenter of West Africa’s Ebola pandemic. Guinea, Liberia and Sierra Leone are the worse hit by the virus that has claimed the lives of more than 5000 people. Other countries with Ebola cases are Nigeria, Mali, Senegal, United States and Spain but they managed to contain the spread. So far the response to the pandemic has been relatively good but could have been earlier.

The crisis exposed the weaknesses in the health systems of the three countries: Liberia, Guinea and Sierra Leone; and has shown the flaws in post-conflict peace building in relation to setting the wrong priorities. This policy brief does not trace the origins of this virus. Rather it focuses on three basic issues: impact of the virus; lessons learned and recommendations.

Ebola and its Impact

Ebola has had political, economic and socio-cultural impact on the people and societies. For example, individual citizens, particularly the poor have been affected by the spread of the virus. The disruption in income generation activities has forced many to deplete their meager savings. The Unique experiences of women is worth mentioning because many were infected and subsequently died because they served as careers of relatives and loved ones during this crisis.

At the macro political levels, the pandemic has exposed the fragile and weak nature of the affected states: they lacked preparedness to provide leadership in dealing with such emergencies when they were most needed; rather they abrogated their duties to INGOs and other governments outside Africa. Nigeria and Senegal are an exception. As Ebola crisis has shown, health pandemics do have the potential of threatening the survival of the state and therefore lead to state failure.

By responding late and outsourcing their responsibilities, the legitimacy of these states were undermined because public confidence and trust was eroded. Both the formal and informal sectors of the economies of these countries in particular and the region in general have been severely affected. Commerce, tourism, transportation, agriculture, mining, and petty trade including cross-border are the most affected. For example, in Sierra Leone consumer prices have risen: prices of staple foods such as rice increased by nearly 30 percent in some market outlets.

Similarly, world bank reports indicate that the export sector in Guinea, which has been the so-called ‘engine’ of growth (but not necessarily development) has suffered severely with coffee production tumbling by half (from 5736 to 2671 tons); cocoa production declining by a third and oil palm production dropping to as low as 75 percent.

Things like the closure of borders, travel bans, restriction of movement, community quarantines, panic buying, shipping insurance and abandoned farms do impinge on the economies of these countries. The informal sector, which remains the largest private sector in the region, has also been severely affected because of limited trade. As Fatu Kamara, the deputy chairwoman of the Poro Loko central market stated: “Since the emergence of the Ebola crisis people are afraid to come and sell to us and they are also afraid to come and buy”.

In Lofa county, which has been the bread basket for Liberia, food prices have risen by 30-40% since August with families having to spend 80% of their 5 income on food. Nigeria has also witnessed a 40% drop in demand for goods and services in its largest economic hub Lagos. Even countries like Ghana and Cote d’Ivoire with no reported cases have experienced some economic impact. Several international conferences have been cancelled, fewer and fewer passengers and tourists are frequenting these countries, and flights have equally reduced significantly. The taxes that could have been accrued to these economies as a result of these activities have been lost.

Importantly, if the virus is not controlled by December 2014, the economic cost to the region could rise as high as $32.6 billion dollars with the effect growing by “eight-fold” especially in those three worst affected countries.

Finally, there are Socio-cultural effects: psychological, emotional, loss and traumatic stress. The deaths of more than 5000 people to the virus and burial rituals have changed as people cannot care for let alone bury their relatives. Imagine the sense of guilt for not being able to care for your loved ones; the sense of community that has eroded and replaced with individualism. Schools have closed down; large social gatherings are banned; and people do not shake hands anymore.

Lessons for the future

The Ebola crisis has offered some lessons for the future: exposed state of health systems; lack of preparedness for disaster management, Structural adjustment program (SAP) and challenges of rolling back the state; and failure to match ‘early warning’ with early response.

*State of health system

The appalling state of the health systems of these countries contributed to the rapid increase in the number of cases; the communities did not understand the nature of the outbreak nor did they believe that the governments were telling the truth. Then there was lack of basic health awareness and infrastructure as well as acutely limited trained personnel.

The wars in Liberia and Sierra Leone may have destroyed the available health infrastructure but the fact of the matter is that for a protracted period of time, these countries did not pay serious attention to health care. The sort of conditionalities imposed under SAP contributed largely to the lukewarm attitude that governments in the region adopted towards the provision of social services: ‘reduced social spending’ meant privatizing education and health in impoverished societies.

In countries where people are impoverished and the private sector cannot fill in the vacuum created by the rolling back of the state, one should not be surprised by the appalling state of the health system.

*Lack of Preparedness for Disaster Management

Ebola has reinforced the need to build and strengthen the capacity for disaster management agencies in West African countries. Many countries do not have such agencies and even where they exist, they do not have the appropriate capacity and resources: human, material and financial.

*Structural adjustment program and rolling back the State

One of the lessons learned is that the reduction in social spending since the 1980s has undermined the role of the state in the provision of basic social services like health and education. Despite criticisms by African academics and left-wing activists in the 1980s, African governments went ahead to pursue this suicidal path. Today, the reality has caught up with them, particularly at a time that their countries are facing challenges from the Ebola outbreak.

*Early Warning and Early Response

ECOWAS (Economic community of West African states) is credited for having the foresight of creating not just an early warning unit within its commission but also establishing zonal bureaus throughout the region. The overall mandate of these bureaus is to provide information on the security situation in the region. In order to work effectively, such organs need two inter-related things: conceptual clarity on what constitutes security; and early warning to be matched with early response.

Recommendations

West African leaders should take the health system, health education, infrastructure and personnel, seriously by investing in it. West African governments should prioritize social spending as opposed to reducing them because the latter has been disastrous.

* Health issues should be raised to the level of regional security concerns; it should be prioritized because of its human security relevance; securitize but do not militarize health issues;

* ECOWAS should ensure that its member states take medical research and training seriously. The establishment of the West Africa health organization (WAHO) based in Burkina Faso is a major step in the right direction but in order for it to perform its tasks; there is the need to put money into scientific research. Through research the region will be able to know what other pandemic to expect for the future and be prepared for it;

* The shift in security thinking from regime to human security as contained in the ECOWAS Conflict prevention framework (ECPF) should incorporate health issues;

* ECOWAS Standby force should develop capacity to deal with future pandemics; and

* Finally, disaster management bodies should be strengthened with funds, infrastructure and personnel. These agencies should be incorporated into the security architecture of each country; and they must have research units that will provide early warning through research and analysis.

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Ebola: Impact and lessons for West Africa

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