The Politics of Poverty

Ideas and analysis from Oxfam America's policy experts

Ebola: It’s not just a health problem

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A NADEL community outreach worker oversees children washing their hands using a tippy tap at the Cuntabane border post in Guinea-Bissau. Ebola has not reached the West African nation of Guinea-Bissau but the country’s location (next to Guinea) its porous land and maritime borders and its poor health system and roads are just some of the factors that have made it extremely vulnerable to the outbreak and spread of the disease. Oxfam partner NADEL - the National Association for Local Development – has helped prepare the country to identify cases at the borders and to contain the disease if it crosses over. (Photo: Jane Hahn / Oxfam America)

The recent Ebola outbreak in DRC serves as a reminder for the need to have integrated development, so every nation can prevent, detect, and respond to the threat of infectious diseases.

On Friday, news broke that an Ebola outbreak was declared after three deaths and 6 additional suspected cases were detected in the Democratic Republic of Congo.  Currently there is nothing to indicate that the outbreak will become an international pandemic, especially since DRC has experienced several Ebola outbreaks in recent decades and has a history on containing them.  As suspected Ebola case numbers tick up it suggests the initial case wasn’t contained, highlighting the need for overall development and a world where every country is able to prevent, detect, and contain infectious diseases so global pandemics are less and less of a threat.

To achieve this dream though there is a lot of work to be done.  Tons of other people have talked about the need to improve health systems (here, here, here, and here) which is obviously a critical piece of the puzzle, but I want to focus on other less talked about pieces.  The non-health system development that is critical to ensuring the health system works, basic things many people take for granted like primary and secondary education systems, functioning roads that still exist when it rains, telecommunications, access to electricity, and trust in institutions.

When I worked in rural South Sudan doing disease eradication work, two of the largest challenges we faced were the lack of communication and ability to access remote communities. Typically, I would receive information on suspected cases from in these inaccessible areas from colleagues’ handwritten notes or by word of mouth from colleagues and community members. Getting to the area to investigate could then require hours to days of walking because it was impossible for vehicles to access the area, especially during rainy season. Conversely, if people were sick and wanted to go to a health facility they would often have to walk for days to get themselves there. For diseases like Ebola and measles that spread through human contact, this lack of access and rapid communication can mean an inability to contain the spread of the disease.

In Liberia, one of the countries that was devastated by the 2014 Ebola outbreak that terrified the world, there are only 1.4 doctors per 100,000 people (the US has 255.4 per 100,000 people), so even if there were functioning roads and communication systems there may not be enough health care workers to help, making it hard to contain a disease outbreak.  This is where having a function education system is critical in addition to a functioning healthcare system.  If more people have access to education in Liberia there would be a bigger pool to feed into beefing up the health workforce – not to mention other critical sectors – and with a literacy rate less than 50 percent there is a lot of room for improvement.

Lack of trust in governments and institutions is another factor that can contribute to the spread of disease as it did in the West Africa outbreak.  Since people saw governments and institutions as corrupt or untrustworthy there was a belief that Ebola wasn’t real, but instead a way for the government to make money from Western aid or for outsiders to harm people.  To combat this distrust, institutions need to be strengthened so they are more effective, transparent and accountable to the people they represent and serve – not only in emergencies, but all the time.

Pandemics from emerging diseases like Ebola are a real threat to the US. Diseases don’t need visas to enter and can’t be prevented simply through stronger border security.  Addressing this threat , and living up to our humanitarian values, will only happen through targeted investments in helping countries create the systems – health, education, governance, and more – that will allow them to prevent outbreaks and detect, contain and treat outbreaks when they occur. To work toward this goal, Congress must reject President Trump’s proposed budget and fully fund International Affairs programs; and the administration must ensure that US foreign assistance is focused on reducing poverty and creating strong institutions that can prevent and address challenges little by little rather than throwing billions of dollars at a crises. We cannot wash our hands of the problem and cross our fingers it doesn’t show up at our border again.

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