Ebola in LiberiaAcknowledging that Ebola Virus Disease (EVD) is frightening invokes concern over the slow progress the Government of Malawi is making towards the planning for, and response to Ebola Virus Disease. Since the first cases of Ebola were notified in March 2014 in Guinea, it has been unclear whether Malawi is ready to deploy its plan to respond to the threats of Ebola Virus Disease.

While it is acceptable that planning is a continuous process, the public are yet to see the finalised proposal of the Preparedness Plan or be notified of any Ebola drills, exercises and simulations. Preparedness and responses to the avian H5N1 in 2006 and pandemic influenza H1N1 in 2009 in Malawi were not as slow, but they were clumsy and incomplete, raising serious concerns whether Malawi is able to be prepared for the current Ebola outbreak. There is a great deal more to preparedness than just acquiring resources. Planning should be about responding effectively in preventing and mitigating the disease threat with the means available. The effectiveness of preparedness is not just a matter of having a plan, but of having one that maps out core issues and finds legitimate solutions in their own context. Such plans need to be fully supported by political and social structures. 

 

If Malawi is to respond effectively, the “know-do gap” between what gets planned and gets done must be connected with evidence of what works effectively. To fight Ebola in the event an outbreak occurring, and in order to bend the “epi curve” in the right direction, we need to strengthen the health operation systems. Ebola outbreak will make additional demands on health facilities and any response actions in the implementation plans must provide the best ways to minimize costs and maximize health service benefits. The practical elements, such as shortage of doctors, nurses and volunteers to work at the frontline, must be addressed. Communicating the response plan prior to the outbreak is not only good public health practice but also helps overcome the problem of social order, panic, fear, myths and staff absenteeism. If Ebola preparedness plans are to illicit successful responses it will be necessary to delve more into participatory approaches that address cultural problems associated with increased risk of Ebola transmission. National and local decisions ought to be well informed with epidemiological and public health information so as to address practical difficulties, such as ethical problems, priority setting hiccups and collaboration riddles. All Ebola actors should play a key role at the community level in providing essential services to ensure business continuity and public order. The National EVD Preparedness Plan needs to consolidate and identify the alternative care sites for the delivery of health care in the event that hospitals are overwhelmed with scores of patients. 

Background

The effects of Ebola upon rates of mortality are clear, as gathered from the ongoing outbreak in West Africa. As of 25 October, a total of 4922 deaths and 10141 suspected cases have been reported in Guinea, Liberia, Nigeria and Sierra Leone [1]. The case-fatality rate (i.e. the number of infected people who die) from the disease in West Africa is about 64% [2]. The rate of transmission has overwhelmed West Africa with cases climbing at an unexpected pace, making the disease the largest ever reported epidemic in the region. The outbreak is moving faster than it is being controlled with new reports showing that the USA, Spain and Mali are affected [1]. The geographical distribution of Ebola Virus Disease in three continents, and a further involvement of human cases on a larger scale cannot be understated. With increasing globalization and ease of international travel, it appears to be inevitable that we will eventually see cases in Malawi. The threats of Ebola to Malawi are real and the control of the disease would be equally difficult to manage due to an inadequate public health infrastructure, overcrowding, poor sanitation, cultural practices and living conditions. Without a fully functional health system, limited capacity in surveillance and weak disease control strategies most needed to prevent and mitigate the Ebola outbreak raise serious concerns for Malawi. The purpose of this paper is to assist in highlighting some of the key areas of preparedness needed  to prevent the disease from occurring in the country by keeping it out (border management) and addressing the consequences and effects of the disease by stamping it out (cluster control). This paper also serves as an impetus for action and it is intended to complement the preparedness efforts currently being prepared by the Ministry of Health. 

Ebola preparedness situation in Malawi

A brief historical context of planning for, and responses to, avian and pandemic influenza in Malawi suggests the country may still be unprepared to handle an Ebola outbreak. There is plenty of evidence suggesting that very little has been done to enhance initiatives and mobilisation of activities that would be more important priorities for managing and addressing the consequences of the Ebola Virus Disease. Doctors, nurses and health-care assistants are yet to be adequately informed of the disease. Coordination on roles and responsibilities to identify risks and implement mitigation strategies among stakeholder groups are yet to be announced in many priority areas. Previously, the response plans have operated at national level in the proposal draft form without the full participation of sectors at the regional, district and community levels. The lack of involvement of local communities in the MoH is not new and will only be a setback to the epidemic roles and responsibilities that ensure advanced preparations are timely and consistent in safeguarding population health. 

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