Impact of the recent Ebola epidemic with pandemic potential on the economies of Guinea, Liberia and Sierra Leone and other West African countries.

West Africa experienced its first Ebola epidemic in 2014. Its magnitude in terms of morbidity and mortality was greater than any other epidemic. It has particularly affected Guinea, Liberia and Sierra Leone. Its impact, beyond the high mortality, is also economic. The Ebola virus disease spread to several other African countries with limited resources, causing a significant financial burden to their health systems but also impacting the entire economy of the countries. The objective of this essay is to reflect on the consequences of the Ebola virus epidemics on West African economies in the short term. Estimates of the economic burden of the epidemic range from $2.8 billion to $32.6 billion in lost gross domestic product. The sectors affected by the economic crisis are the most important of the contaminated countries, namely agriculture, mining and trade. There has been a halt in socio-economic activities in the most affected regions. The decrease in the number of workers affected by the virus, the exodus to the least affected areas, and the repatriation of government employees have contributed to the decrease in the income of individuals and states. The fear of contamination by foreign countries has reduced imports, but also all tourist activities, which in turn have had an impact on the restaurant and hotel sectors. All these financial and food disruptions have exposed the population of these countries to food insecurity. The analysis of the impact of the Ebola virus on West African economies in the short term was as devastating as the health impact. This impact has directly contributed to a decrease in economic growth not only for the affected countries but also for all West African countries that depend on these same resources. A loss of about US$32.6 billion over two years in the West African region has been estimated, which is equivalent to 3.3% of the regional gross domestic product (GDP) in the absence of Ebola in 2014.

Quality improvement of health systems in an epidemic context: A framework based on lessons from the Ebola virus disease outbreak in West Africa.

Quality improvement (QI) in health generally focuses on the provision of health services with the aim of improving service delivery. Yet QI can be applied not only to health services but also to health systems overall. This is of growing relevance considering that due to deficiencies in health systems, the main countries affected by Ebola virus disease (EVD) outbreak in West Africa (2014-2016) were insufficiently prepared for the epidemic, and according to the WHO, epidemics are increasingly becoming a threat to global health. Our objective is to analyze QI constraints in health systems during that EVD epidemic and to propose a practical framework for QI in health systems for epidemics in developing countries. We applied a framework analysis using experiences shared at the "Second International Quality Forum" organized by the University of Heidelberg and partners in July 2015 and information gathered from a systematic literature review. Empirical results revealed multiple deficiencies in the health systems. We systemized these shortfalls as well as the QI measures taken as a response during the epidemic. On the basis of these findings, we identified six specific "priority intervention areas," which ultimately resulted in the synthesis of a practical QI framework. We deem that this framework that integrates the priority intervention areas with the WHO building blocks is suitable to improve, monitor, and evaluate health system performance in epidemic contexts in developing countries.

A scoping analysis of the aspects of primary healthcare physician job satisfaction: facets relevant to the Indonesian system.

BACKGROUND: Although there is extensive literature on the different aspects of physician job satisfaction worldwide, existing questionnaires used to measure job satisfaction in developed countries (e.g., the Job Satisfaction Scale) do not capture the aspects specific to Indonesian primary healthcare physicians. This is especially true considering the 2014 healthcare system reform, which led to the implementation of a national social health insurance scheme in Indonesia that has significantly changed the working conditions of physicians. Therefore, the current study aimed to identify aspects of primary care physician job satisfaction featured in published literature and determine those most suitable for measuring physician job satisfaction in light of Indonesia's recent reforms. METHODS: A scoping literature review of full-text articles published in English between 2006 and 2015 was conducted using the PubMed, Psycinfo, and Web of Science databases. All aspects of primary care physician job satisfaction included in these studies were identified and classified. We then selected aspects mentioned in more than 5% of the reviewed papers and identified those most relevant to the post-reform Indonesian context. RESULTS: A total of 440 articles were reviewed, from which 23 aspects of physicians' job satisfaction were extracted. Sixteen aspects were deemed relevant to the current Indonesian system: physical working conditions, overall job satisfaction, patient care/treatment, referral systems, relationships with colleagues, financial aspects, workload, time of work, recognition for good work, autonomy, opportunity to use abilities, relationships with patients, their families, and community, primary healthcare facilities' organization and management style, medical education, healthcare systems, and communication with health insurers. CONCLUSION: Considering the recent reforms of the Indonesian healthcare system, existing tools for measuring job satisfaction among physicians must be revised. Future research should focus on the development and validation of new measures of physician job satisfaction based on the aspects identified in this study.