Comment la résilience post-Ebola en Guinée contribue à la gestion de la COVID-19 ?

Introduction : The case of Ebola in Guinea (2013-2016) revealed weaknesses in the resilience of the health system and highlighted the challenge of coordinating all actors in the response. After the epidemic, national authorities and their international partners began to strengthen the health system. In 2021, Guinea faced COVID-19 simultaneously with the resurgence of Ebola and other diseases with epidemic potential.Purpose of research : The objective of this article is to analyze the evolution of the five characteristics of health resilience of Kruk et al. (2015) in the Guinean context. To do this, data triangulation was carried out through a literature review, 41 semi-structured interviews with international, national and local stakeholders, and 37 events observed in the post-Ebola period.Results : Our results show that the characteristic of integration was the most important in our study. This is because of the importance of coordination, communication and information sharing among stakeholders during crises. Then, diversity exposes the need to be able to face several health challenges simultaneously. Efforts were focused on Ebola during the first outbreak, but since the COVID-19 pandemic, Guinea has been able to cope with several health challenges. Raising awareness, on the other hand, necessitates an understanding of the context, its strengths, and weaknesses. Guinea learned lessons from Ebola and implemented a program to strengthen the emergency response system. On self-regulation, the speed of the response relies on mechanisms for early detection, notification, and response. The country is now well resourced and has proven information and response mechanisms. Finally, constant adaptability by taking into account lessons learned allows us to set course and prepare for other potential crises and this is what is being done constantly.Conclusions : Given Guinea’s ubiquitous fragility before Ebola, the health system is still not fully resilient. However, gains in each of the characteristics of resilience improve the response to COVID-19.

The lasting influence of Ebola: a qualitative study of community-level behaviors, trust, and perceptions three years after the 2014-16 Ebola epidemic in Liberia.

The majority of disease transmission during the 2014-16 West Africa Ebola epidemic was driven by community-based behaviors that proved difficult to change in a social paradigm of misinformation, denial, and deep-seated distrust of government representatives and institutions. In Liberia, perceptions and beliefs about Ebola during and since the epidemic can provide insights useful to public health strategies aimed at improving community preparedness. In this 2018 study, we conducted nine focus groups with Liberians from three communities who experienced Ebola differently, to evaluate behaviors, attitudes, and trust during and after the epidemic. Focus group participants reported that some behaviors adopted during Ebola have persisted (e.g. handwashing and caretaking practices), while others have reverted (e.g. physical proximity and funeral customs); and reported ongoing distrust of the government and denial of the Ebola epidemic. These findings suggest that a lack of trust in the biomedical paradigm and government health institutions persists in Liberia. Future public health information campaigns may benefit from community engagement addressed at understanding beliefs and sources of trust and mistrust in the community to effect behavior change and improve community-level epidemic preparedness.

Interdisciplinary Collaboration in International Crisis Medical Relief: A Look at the Nepal Earthquake and Ebola Relief Efforts.

OBJECTIVE: This study explores interprofessional collaboration among medical and non-medical personnel planning and implementing international crisis health and medical relief efforts, and how disciplinary and professional background influences these activities. METHODS: This study analyzes semi-structured interviews with individuals involved in organizations medical or health services to the Ebola epidemic in West Africa (2014-2016) or the 2015 Nepal earthquake. RESULTS: Disciplinary background, sometimes coupled with organization role, shaped how relief workers engaged in the process of planning and implementing crisis medical relief. There were 3 thematic areas where these differences emerged: issue focus, problem -solving approaches, and decision-making approaches. Solutions from the field emerged as a fourth theme. CONCLUSIONS: The study demonstrates medical relief required collaboration across medical and non-medical professions and highlights the importance of relief workers' disciplinary background in shaping the planning and implementation of crisis medical relief. Successful collaboration requires that people involved in crisis relief communicate the relevance of their own expertise, identify limits of their own and others' disciplinary perspective(s), seek out strengths in others' expertise, and can identify/ respond appropriately to others who do not see their own disciplinary limits, as well as learn these skills before engaging in relief.

How has Guinea learnt from the response to outbreaks? A learning health system analysis.

INTRODUCTION: Learning is a key attribute of a resilient health system and, therefore, is central to health system strengthening. The main objective of this study was to analyse how Guinea's health system has learnt from the response to outbreaks between 2014 and 2021. METHODS: We used a retrospective longitudinal single embedded case study design, applying the framework conceptualised by Sheikh and Abimbola for analysing learning health systems. Data were collected employing a mixed methods systematic review carried out in March 2022 and an online survey conducted in April 2022. RESULTS: The 70 reports included in the evidence synthesis were about the 2014-2016 Ebola virus disease (EVD), Measles, Lassa Fever, COVID-19, 2021 EVD and Marburg virus disease. The main lessons were from 2014 to 2016 EVD and included: early community engagement in the response, social mobilisation, prioritising investment in health personnel, early involvement of anthropologists, developing health infrastructure and equipment and ensuring crisis communication. They were learnt through information (research and experts' opinions), action/practice and double-loop and were progressively incorporated in the response to future outbreaks through deliberation, single-loop, double-loop and triple-loop learning. However, advanced learning aspects (learning through action, double-loop and triple-loop) were limited within the health system. Nevertheless, the health system successfully controlled COVID-19, the 2021 EVD and Marburg virus disease. Survey respondents' commonly reported that enablers were the creation of the national agency for health security and support from development partners. Barriers included cultural and political issues and lack of funding. Common recommendations included establishing a knowledge management unit within the Ministry of Health with representatives at regional and district levels, investing in human capacities and improving the governance and management system. CONCLUSION: Our study highlights the importance of learning. The health system performed well and achieved encouraging and better outbreak response outcomes over time with learning that occurred.

The PA profession in Liberia: A case study in pioneering innovation and resiliency.

ABSTRACT: In Liberia, the physician assistant (PA) profession began in the mid-1960s. PAs have had a major role in providing access to healthcare for patients, many of whom live in poverty and reside in remote areas where access to physicians may be severely limited. In 1964, representatives from UNICEF selected Agnes N. Dagbe, MS, RN, to be the first director of a new PA program to be developed at the Tubman National Institute of Medical Arts. Dagbe was sent to Russia to learn about their feldsher profession, which served as a significant source of inspiration for the newly emerging PA profession in Liberia. To date, Liberia has faced extreme shortages of physicians, the ravages of two brutal civil wars over a 14-year period (1989-2003), as well as outbreaks of the Ebola and COVID-19 viruses. Now, more than 54 years since the first class graduated, PAs are vital for the delivery of essential healthcare services for the citizens of Liberia.

Lessons learnt from the applying the Centers for Disease Control and Prevention (CDC) evaluation framework to the measles incident management system response, USA, 2020-2021.

The functionality and performance of public health programmes at all levels of government play a critical role in preventing, detecting, mitigating and responding to public health threats, including infectious disease outbreaks. Multiple and concurrent outbreaks in recent years, such as COVID-19, Ebola and Zika, have highlighted the importance of documenting lessons learnt from public health responses of national and global agencies. In February 2020, the US Centers for Disease Control and Prevention (CDC) Center for Global Health (CGH) activated the Measles Incident Management System (MIMS) to accelerate the ability to detect, mitigate and respond to measles outbreaks globally and advance progress towards regional measles elimination goals. The activation was triggered by a global resurgence in reported measles cases during 2018-2019 and supported emergency response activities conducted by partner organisations and countries. MIMS leadership decided early in the response to form an evaluation team to design and implement an evaluation approach for producing real-time data to document progress of response activities and inform timely decision-making. In this manuscript, we describe how establishing an evaluation unit within MIMS, and engaging MIMS leadership and subject matter experts in the evaluation activities, was critical to monitor progress and document lessons learnt to inform decision making. We also explain the CDC's Framework for Evaluation in Public Health Practice applied to evaluate the dynamic events throughout the MIMS response. Evaluators supporting emergency response should use a flexible framework that can be adaptable in dynamic contexts and document response activities in real-time.

Advancing detection and response capacities for emerging and re-emerging pathogens in Africa.

Recurrent disease outbreaks caused by a range of emerging and resurging pathogens over the past decade reveal major gaps in public health preparedness, detection, and response systems in Africa. Underlying causes of recurrent disease outbreaks include inadequacies in the detection of new infectious disease outbreaks in the community, in rapid pathogen identification, and in proactive surveillance systems. In sub-Saharan Africa, where 70% of zoonotic outbreaks occur, there remains the perennial risk of outbreaks of new or re-emerging pathogens for which no vaccines or treatments are available. As the Ebola virus disease, COVID-19, and mpox (formerly known as monkeypox) outbreaks highlight, a major paradigm shift is required to establish an effective infrastructure and common frameworks for preparedness and to prompt national and regional public health responses to mitigate the effects of future pandemics in Africa.

Sustainable strategies for Ebola virus disease outbreak preparedness in Africa: a case study on lessons learnt in countries neighbouring the Democratic Republic of the Congo.

BACKGROUND: From May 2018 to September 2022, the Democratic Republic of Congo (DRC) experienced seven Ebola virus disease (EVD) outbreaks within its borders. During the 10th EVD outbreak (2018-2020), the largest experienced in the DRC and the second largest and most prolonged EVD outbreak recorded globally, a WHO risk assessment identified nine countries bordering the DRC as moderate to high risk from cross border importation. These countries implemented varying levels of Ebola virus disease preparedness interventions. This case study highlights the gains and shortfalls with the Ebola virus disease preparedness interventions within the various contexts of these countries against the background of a renewed and growing commitment for global epidemic preparedness highlighted during recent World Health Assembly events. MAIN TEXT: Several positive impacts from preparedness support to countries bordering the affected provinces in the DRC were identified, including development of sustained capacities which were leveraged upon to respond to the subsequent coronavirus disease 2019 (COVID-19) pandemic. Shortfalls such as lost opportunities for operationalizing cross-border regional preparedness collaboration and better integration of multidisciplinary perspectives, vertical approaches to response pillars such as surveillance, over dependence on external support and duplication of efforts especially in areas of capacity building were also identified. A recurrent theme that emerged from this case study is the propensity towards implementing short-term interventions during active Ebola virus disease outbreaks for preparedness rather than sustainable investment into strengthening systems for improved health security in alignment with IHR obligations, the Sustainable Development Goals and advocating global policy for addressing the larger structural determinants underscoring these outbreaks. CONCLUSIONS: Despite several international frameworks established at the global level for emergency preparedness, a shortfall exists between global policy and practice in countries at high risk of cross border transmission from persistent Ebola virus disease outbreaks in the Democratic Republic of Congo. With renewed global health commitment for country emergency preparedness resulting from the COVID-19 pandemic and cumulating in a resolution for a pandemic preparedness treaty, the time to review and address these gaps and provide recommendations for more sustainable and integrative approaches to emergency preparedness towards achieving global health security is now.

Continuity of essential health services in the context of COVID-19: the Eastern and Southern Africa Regional continuity of essential services sub-working group.

COVID-19 cases have continued to increase globally putting intense pressure on health systems, including in the East and Southern African (ESA) region, which bears the brunt of the continent´s cases, and where many health systems are already weak or overstretched. Evidence from the West Africa Ebola disease outbreak and early estimates for COVID-19 show that indirect impacts due to disruptions in access to essential health services can result in even higher mortality than that directly related to the outbreak. In March 2020, World Health Organisation (WHO) established a coordination mechanism to support ESA countries to enhance their response to COVID-19. Technical working groups were established, including a subgroup addressing continuity of essential health services. In this article, the development, activities and achievements of the subgroup over the past six months are reviewed and presented as a model for collaborative action for optimal service delivery in the context of COVID-19 and potentially, during other infectious disease outbreak responses.

The Evolution of the National Special Pathogen System of Care.

Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach. This network, spearheaded by the National Emerging Special Pathogens Training and Education Center, developed a conceptual framework and plan for the evolution of the RETN into the National Special Pathogen System of Care (NSPS). Building the NSPS strategy involved reviewing the literature and the initial framework used in forming the RETN and conducting an extensive stakeholder engagement process to identify gaps and develop solutions. From this, the NSPS strategy and implementation plan were formed. The resulting NSPS strategy is an ambitious but critical effort that will have impacts on the mitigation efforts of special pathogen threats for years to come.