West African countries affected by the Ebola outbreak are shifting the scope of health systems strengthening to build resilient health systems that can deal with a variety of challenges, said panelists at a CSIS forum last week.
Affected countries are developing recovery plans that put health systems strengthening at the forefront, but are pushing for strengthening areas that are not typically part of the traditional framework, which focuses on strengthening governance, finance, human resources, health service delivery, and information, among other areas. “Countries are not talking about things that just take them back to the way they were before Ebola,” said Karen Cavanaugh, Director of Health Systems at USAID.
Liberia, Sierra Leone, and Guinea are looking at things we haven’t talked about in devising their recovery plans, including having a broader vision for who constitutes human resources for health, she said. “In Liberia after their civil war, a lot of physicians left but nurses and midwives didn’t,” Cavanaugh said. “Now the focus is on cadres that are faster to train and more likely to stay in country.”
“It’s not the matter of simply retraining people to fill the positions of people who died and going back to business as usual,” she said.
Community health work forces should be national and unified, and linked to the official health system, according to country plans. Countries also want community health workers to be adequately compensated, Cavanaugh said. Countries also recognize the importance of “ruthlessly reporting results,” wanting increased data collection for both accountability and developing programs.
Most importantly, however, strengthening basic infrastructure should be prominent in health systems strengthening, according to country plans. That includes making sure health facilities have running water, electricity, laundry facilities and good sanitation practices, including waste disposal.
Country plans include much higher levels of per capita spending for health, Cavanaugh said. Guinea now spends just $9 per capita on health, but officials are planning to increase that to $42 per capita. Liberia plans to go up to $50 from the current $20 and Sierra Leone plans to go up to $20 from $6 per capita. These plans imply global support, Cavanaugh said, because although plans to increase health spending are reasonable, it’s not doable with domestic resources alone.
“The United States is in it for the long run,” Cavanaugh said. “The president sees this as an opportunity to help countries build long term capacity.”