Opinion

opinion | Larry Ronan and Craig Vanderwagen

The right aid in Ebola crisis

Volunteers in a relay line in Sri Lanka help move incoming relief material after the massive 2004 tsunami struck.

AFP/Getty Images

Volunteers in a relay line in Sri Lanka help move incoming relief material after the massive 2004 tsunami struck.

The Ebola crisis in West Africa brings to mind earlier global disaster responses in Haiti and Indonesia. There are key lessons learned from those two disasters that will help us with Ebola going forward.

Haiti taught us how a nation dealing with catastrophe can become dependent upon donor states and programs. The influx of international donor assistance after the earthquake in 2010 was massive and appropriate considering the scale of the even. However, despite tremendous resources from donor nations and the nongovernmental communities, little attention was paid to the recovery phase and its potential for empowering a stronger local and national capability to handle disasters.

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The response did not build local capabilities, and indeed less than 10 percent of funding was provided to the local and national governments. The dependency relationship on international funding of basic services that existed before the earthquake has persisted and perhaps worsened to this day.

By contrast, the Indonesian tsunami crisis of 2004-05 illustrates where local capacity-building — using an emergency management framework — facilitated the recovery of local and national authority in ways that preserved and strengthened the independent functioning of the affected communities and economy.

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Daily operational planning sessions were held at the local health authority, and those efforts were guided by Indonesian officials. Mental health interventions were developed with the local schools and universities and religious leadership in the lead and supported by international responders, rather than the other way around. Medical facilities were swiftly rebuilt and indeed enhanced with locally controlled programs such as an improved tuberculosis control program funded by international donors. By 2009 over 94 percent of reconstruction had been completed including homes, schools, and infrastructure.

The response to the disaster was successful because it was built on empowering local recovery and leadership. Developing this host nation capacity was planned as part of the response, not grafted on as an afterthought. Because of this, and unlike in Haiti, there is little ongoing international involvement in the public health and medical activities in Indonesia in the post-tsunami period as these efforts are under the guidance of the national and local health authorities.

Let’s emulate the Indonesian rather than Haitian experience for West Africa. To do so will require local capacity building that starts with the training of West African country leadership in a standardized set of emergency management practices and principles. And it will require assisting the host nations in implementing these important lessons. Fundamentally, it means putting the West African nations, appropriately trained and assisted, in control of their own emergency response.

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Emergency management establishes timely and measurable objectives to develop plans that guide response efforts. Through identification of gaps and unmet needs, holes in the response efforts can be addressed quickly.

The emergency management framework deals with all the areas in the country that are affected by a disaster; it anticipates problems associated with the economic, education, social services, and infrastructure components of an affected nation. The framework compliments the coordinating activities on the ground organized by the World Health Organization.

This approach breaks down silos of information by collecting, analyzing, and communicating key information with all stakeholders in a way that is consistent and current. Resource management is another basic tenet of this framework. Matching scarce resources, both human and material, to identified needs maximizes the effectiveness of those resources, in a form of resource triage that gets the right stuff to the right place for the right reasons.

It means building functional operations centers and developing a cadre of emergency managers. By bringing the functioning of these units into a standardized set of practices and procedures, the innate capabilities of these health authorities will be intellectually, technically, as well as operationally advanced.

The ability of the West African governments to anticipate, detect, and respond to events is a critical element in governmental credibility and stability. By building the skills and knowledge systematically during this event, we will leave not only a legacy of survival, but an ongoing ability to independently meet the needs of their people.

An emergency management framework is not a revolutionary concept. But implementing these principles in the Ebola crisis may be revolutionary. The tendency to rush in and take action for a population in crisis often sidelines the need to empower and build capability. Now is the time for WHO to train local leadership and implement a system of West African-run regional emergency management to support and coordinate the Ebola response.

Dr. Larry Ronan is director of the Thomas S. Durant Fellowship in Refugee Medicine at Massachusetts General Hospital. Dr. Craig Vanderwagen is a senior partner at Martin-Blank and Associates. He is former assistant secretary for preparedness and response at the US Department of Health and Human Services and a retired admiral in the US Public Health Service.
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