MSF: Five lessons learned during the latest Ebola outbreak in DRC, Likati

Four people died in the most recent Ebola outbreak that occurred in a remote, forested area of the Democratic Republic of Congo (DRC). This small outbreak (five laboratory-confirmed and three probable cases) was quickly curtailed. The international humanitarian organisation Doctors Without Borders (MSF) shares lessons learned from this first occurrence of the deadly virus since the end of the large-scale Ebola outbreak that devastated West Africa in 2014-2015.

1. Train frontline health teams

The scale of this outbreak was minimised, thanks in no small part to a nurse named Dieumerci. With a name that literally translates to ‘Thank God’ in French, Dieumerci works at a Ministry of Health centre in northeast DRC, where the first Ebola cases started emerging.

He detected the risk of Ebola in a seriously ill man at the hospital, and rang the alarm. This man turned out to be the second confirmed case during the recent outbreak. Unlike in West Africa prior to the last major outbreak, Ebola is known in the DRC: the Ebola River, where the virus was first discovered, runs 100 kilometres away from where Dieumerci works.

That doesn’t mean that it is common disease in the area, but still, Dieumerci recognised the symptoms. His quick actions should not be taken for granted. Healthcare workers play a crucial role not only for patients, but also for general epidemiological surveillance. However, in many developing countries human resources within the health sector remain starkly inadequate.

On that fateful day where the Ebola patient came to the health centre, Dieumerci could have easily been on a sick leave, or visiting family somewhere else in the country. One cannot rely on a single individual to play the crucial role of on-the-ground surveillance.

What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the time of the epidemic. So all in all: thank you Dieumerci. We should all hope that during the next outbreak – be it Ebola or any other infectious disease – there will be another Dieumerci to ring the alarm bell for everyone’s sake.

2. Finally, a forgotten disease is taken seriously

The word “Ebola” doesn’t ring the same after 2014-2015’s devastating epidemic. At least 11,300 people were killed, and over 28,000 were infected. As a result, Dieumerci’s alarm bell sent shock waves across the world. Congolese authorities immediately activated their outbreak response team and had strong support from WHO and other organisations.

Henry Gray, MSF’s project coordinator during this recent outbreak, has worked on seven hemorrhagic fever interventions in DRC, Uganda and West Africa, to name a few. “The pressure we felt was very different from previous comparable outbreaks: it was clearly at the top of the agenda,” he says. “When it comes to Ebola, we have all learned that it’s better to be safe than sorry in order not to repeat the disaster of 2014-2015.

“However, it is sad to still see that other outbreaks in countries do not trigger the same mobilisation, even in regards to the main killer diseases like cholera or measles.

“Once the Ebola outbreak was over, we were able to re-assign some of the MSF staff towards a serious cholera outbreak on the other side of the country. Our teams went on to treat 1,100 cholera patients. “Considering the dire health needs in many parts of the country, additional support is always welcome”.

3. Old tricks are timeless – back to basics

The promise of new drugs or vaccines should not overshadow the necessity of putting in place the basic pillars of outbreak control.

It all starts with good surveillance, followed by the five pillars of outbreak control:

  1. Safely isolating and treating the sick.
  2. Actively looking for potential new cases and surveilling those who have been in contact with them.
  3. Burying the dead safely.
  4. Engaging and mobilising the affected communities.
  5. Offering psychological support.

In West Africa, the havoc wrecked by Ebola on the entire health system created more indirect than direct victims of the virus: children became prone to infectious diseases because they weren’t vaccinated; Childbirth complications led to the deaths of mothers and/or children because there were no healthcare workers to care for them; untreated cases of malaria became fatal…

International health actors need to do more to support local health facilities that often have much smaller means and equipment: training staff, ensuring there is basic protection equipment available, and that their pharmacies are stocked with first aid supplies and basic medicines. Our experience in DRC has shown that training frontline workers, even when done ad-hoc, can bring sustained effects to improve their performance in surveillance.

4. Location, location, location

Like the majority of haemorrhagic fever outbreaks prior to West Africa, the recent one occurred in a very remote, forested area.

Here, the virus was already known to exist within an animal reservoir (assumed to be fruit bats) that is occasionally transmitted to apes, monkeys or men. Some people are very mobile in the region, but can only go as far and as fast as their available transportation; which is pretty much nothing beyond walking and the occasional motorbike.

Dieumerci’s village is 45 kilometers from Likati, the closest town. It is home to 18,000 people, with a majestic cathedral and large, but under equipped, hospital serving as remnants of a time when a railroad was still linking plantations across the country. Today that railroad has been eaten by the encroaching jungle. By contrast, in Guéckédou, Guinea – where the West Africa outbreak started – people can jump on a motorbike and be in the heart of the capital Conakry and its 2.5 million people within two days.

These contrasting examples show how isolation from major cities can keep the spread of deadly disease under control.

5. Medical innovations are not the magic bullet

At the time of the latest outbreak, MSF was willing to use Ebola treatments which were still in development. However this window closed as the outbreak stopped before the process to allow the use of the experimental treatments was complete. However, this event acted as a ‘booster’ – speeding up the process of preparing medical protocols so that new drugs (still in the experimental phase) can be used in ways that are as safe and ethical as possible.

The rVsV-ZEBOV vaccine (the most advanced investigational vaccine candidate for an Ebola outbreak today) is in development, and needs to be implemented through a study protocol. This, and a vaccine strategy – including informed consent under good clinical practice – were mandatory requirements needed from us to access them.

Soon enough, a study protocol was developed and approved by the MSF Ethics Review Board a few months ago. It was ready for implementation should an outbreak occur. Additionally, a dedicated MSF research team was ready to be deployed. Unfortunately, our negotiations at the DRC Ministry of Health level only took place when the outbreak had already been declared.

It took some time for us to explain what we were planning to do, and how this would differ from a vaccination campaign. But, we managed to obtain authorisation from all the regulatory bodies to start activities in case of a future outbreak.

It is likely that the next outbreak (and trust us, there will be a next outbreak) will happen in a similar setting. We can continue to learn how to best tackle it, and ensure that the West Africa Ebola outbreak remains an isolated tragedy.

Since 1990 MSF has responded to over a dozen outbreaks in sub-Saharan Africa. During the devastating Ebola outbreak that struck mainly Liberia, Guinea, and Sierra Leone in 2014-2015, MSF launched one of the largest emergency operations in its 44-year history. MSF admitted 10,310 patients to its Ebola management centers of which 5,201 were confirmed Ebola cases, representing one-third of all WHO-confirmed cases. During the first five months of the epidemic, MSF handled more than 85 percent of all hospitalized cases in the affected countries. At the peak of the epidemic, MSF employed nearly 4,300 staff—most of whom were from the affected countries—who ran Ebola management centers, conducted surveillance, contact tracing, and health promotion, and provided psychological support.

[1] MSF analysis on the new Health Workforce Action plan currently under discussion at international level

[2] MSF book “The politics of fear”, chapter 5.

[3] MSF medical publication “Sparks creating light? Strengthening peripheral disease surveillance in the Democratic Republic of Congo” www.ncbi.nlm.nih.gov/pmc/articles/PMC4913685.

Distributed by APO on behalf of Médecins sans frontières (MSF).

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Egypt : river banks natural filtration technology

Egypt adopts river banks natural filtration technology to deliver drinking water at low cost

As Egypt continues to make every effort to improve the living conditions of its inhabitants and in line with the National vision of Egyptian development 2030, under the auspices of the Ministry of Housing, Utilities and Urban Development and the Ministry of Local Development,

Dr. Mostafa Medbouli – Minister of Housing, Utilities and Urban communities, and Dr. Hisham Al-Sherif -Minister of Local Development will inaugurate the national conference “River Bank Filtration (RBF) for Drinking Water Supply in Egypt”, organized by the United Nations Human Settlements Program in cooperation with the Holding Company for Drinking Water and Sanitation, and with the attendance of Eng. Mamdouh Raslan, Chairman – Holding Company for Water and Wastewater, and Mrs. Rania Hedeya, Programme manager of the United Nations Office of Human Settlements Egypt office.

Five UN organizations (UN-Habitat, UNIDO, UN-Women, ILO and IOM) have collaborated with the support and cooperation of the Ministry of Local Development and Minya Governorate to develop an example of integrated local development based on the combined protection and empowerment approach for local communities and administrations, through “Hayat project for local development”, funded by the United Nations Trust Fund and Swiss Development Cooperation.

As part of the project’s objectives of supporting and developing the infrastructure, the project was able to provide clean drinking water with innovative technology to 150,000 residents of Al Adwah and Maghagha centers in Minia governorate in less than 6 months and at a cost of less than 5% of the cost of water delivery using traditional technology.

The conference aims to develop a strategic vision for the scale up and replication of the implementation of this technology at the national level, which will save about 2.5 billion Egyptian pounds of the state budget and enable delivery of clean drinking water to more than 3 million people prioritizing vulnerable communities.

The conference calls on donors, international development and research communities to support this project to develop an executive plan that includes the stages of feasibility study for the implementation areas and the transfer of international expertise for planning and implementing these units through a clear system of management, operation and maintenance. This shall ensure sustainability and effectiveness of interventions to enable Egypt to comply with the latest international technologies that ensure economic and environmental efficiency, supporting Egypt’s progress towards development goals in line with the global vision of sustainable development and the envisioned enabling of Egypt’s human rights commitments and achieve prosperity for all its citizens throughout the country.

Distributed by APO on behalf of UN Information Centre in Cairo.

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Burkina Faso : IMF 7th Review July 2017

IMF Executive Board Completes Seventh and Final Review Under the Extended Credit Facility Arrangement for Burkina Faso and Approves US$6.2 Million Disbursement

  • The economic outlook is positive, owing to a significant increase of public investment as well as positive prospects for the mining and agricultural sectors.
  • To maximize the benefits of the planned increase in public investment, it will be important to pursue fiscal structural reforms that strengthen the budget and investment processes.
  • Reforms should prioritize increasing fiscal space by enhancing revenue mobilization, containing the wage bill, and limiting the buildup of contingent liabilities from the energy sector.

On July 14, 2017, the Executive Board of the International Monetary Fund (IMF) completed the seventh and final review of Burkina Faso’s program supported by the Extended Credit Facility (ECF). The decision was taken without a Board meeting[1] and enables the disbursement of SDR 4.47 million (about US$6.2 million), bringing total disbursements under the ECF arrangement that was approved in 2013 to SDR 55.64 million (approximately US$77.4 million).

Burkina Faso’s program implementation remained satisfactory under the ECF arrangement. After averaging 4 percent over 2014-2015, real GDP growth accelerated to 5.9 percent in 2016. The current account deficit narrowed slightly to just below 7 percent of GDP as increased cotton and gold exports were offset by higher domestic demand for consumer goods and public investment related imports. Despite an increase in revenue collection, the fiscal deficit widened in 2016 to 3.1 percent of GDP on a commitment basis, marginally above the WAEMU convergence criteria. The increase in the deficit largely resulted from higher current expenditures, particularly the wage bill following adoption of a new salary grid for public servants. This was partially offset by a decline in domestically-financed public investment to 4.8 percent of GDP, a reduction of 0.5 percent of GDP compared to the previous year.

The outlook for Burkina Faso is generally positive, owing to a significant increase of public investment as well as positive prospects for the mining and agricultural sectors. IMF staff projects real GDP growth of about 6.5 percent over the medium term, with risks tilted to the downside. Principal among these are security risks, volatility in international commodity prices (gold, cotton, oil), negative environmental shocks to agriculture, and socio-political tensions.

The government’s fiscal framework is appropriately anchored toward reaching a deficit of no more than 3 percent of GDP in 2019, consistent with the West African Economic and Monetary Union (WAEMU) convergence criteria. It is also geared toward achieving the economic and social development goals of the National Economic and Social Development Plan (PNDES), which entails significant investment in physical and human capital over the medium term. The authorities’ intention to revise the original 2017 budget is welcome, as it would make for a more realistic framework that accounts for developments in the first half of 2017. The authorities’ medium-term framework continues to retain some optimistic elements. Consequently, careful monitoring of budget execution and its financing is important, together with a readiness to adjust spending, if necessary.

To maximize the benefits of the planned increase in public investment, it will be important to pursue fiscal structural reforms that strengthen the budget and investment processes. Reforms should prioritize increasing fiscal space by enhancing revenue mobilization, containing the wage bill, and limiting the buildup of contingent liabilities from the energy sector. Strengthening investment efficiency through improved prioritization and selection of projects and institutional reforms to increase absorptive and implementation capacity are also priorities.

[1] The Executive Board takes decisions under its lapse-of-time procedure when the Board agrees that a proposal can be considered without convening formal discussions.

Distributed by APO on behalf of International Monetary Fund (IMF).

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Libya : UNICEF Child Friendly Municipality Award

In partnership with the Ministry of Local Government and support from the Delegation of the European Union to Libya, UNICEF launches the “Child Friendly Municipality Award” during a ceremony held in the Libyan capital Tripoli.

In addition to the recognition of the positive contribution and dedication of the municipality in promoting child rights and well-being of children, the award will create a positive competition among different municipalities to deliver for the children in Libya.

“The Child Friendly Municipality Award aims to promote municipalities to implement the Convention on the Rights of the Child which has been ratified by Libya in 1993,” said Dr Ghassan Khalil, UNICEF Special Representative in Libya. “I would like today from Tripoli to invite the municipalities to announce their self-nomination for the 2018 award,” he added.

“I welcome the engagement of the Ministry of Local Government in this initiative. Young generations are the most precious resource of the country, investing in children means investing in Libya’s future,” said Ms. Maria do Valle Ribeiro, United Nations Deputy SRSG, Resident and Humanitarian Coordinator for Libya.

In her speech during the event, H. E. Ms Bettina Muscheidt Head of the Delegation of the European Union to Libya affirmed that “there is a long standing commitment from the EU in supporting child development in Libya and that the EU has been helping thousands of boys and girls in accessing education, recreational and psychosocial services.”

H.E. Mr. Badad Abdel Jalil, Minister of Local Government declared that “the selection of the winning municipality will be done through an independent selection committee which will include prominent Libyan civil society representatives and child rights, youth development, and education Libyan experts.”

Distributed by APO on behalf of United Nations Support Mission in Libya (UNSMIL).

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