Global Health Security Partnership

Learning across borders

Senegal’s brush with the Ebola virus made its health system grow stronger, and created an opportunity to share valuable lessons

PATH staff from Senegal and DRC spent a week sharing lessons learned from past outbreaks, and planning for a more secure future. Pictured here: PATH staff from Senegal and DRC, the DRC Ministry of Health, and Institut Pasteur de Dakar. PATH/Lynn Heinisch

In the midst of the 2014 Ebola outbreak in West Africa, Senegal’s infectious disease service ensured that the country’s first case was also its last.

That case was a 21-year-old man from Guinea who had traveled to Senegal, bringing the virus with him. When he presented at the Infectious Disease Service at Fann University Hospital, the presence of the virus was confirmed through diagnostic testing. Following their training, hospital staff followed biosafety protocol to prevent further spread of the illness. They also tracked individuals who had been in contact with the patient and enacted quarantine and monitoring measures. As a result of this swift and controlled action, Ebola did not spread further into Senegal, and the patient—who survived—was the country’s only confirmed case during the outbreak.

Despite this victory, Senegal is not resting on this success. Instead, health officials have used the experience to identify weaknesses in the health system that could be improved as part of the Global Health Security Agenda (GHSA). Over the past two years, PATH has supported the Senegalese Ministry of Health to strengthen its ability to prevent, detect, and respond to infectious disease threats by building better systems for epidemiological surveillance and laboratory testing.

Visiting laboratory facilities at the Institut Pasteur de Dakar. PATH/L. Heinisch

“To me, the Ebola crisis had a positive impact for Senegal,” said Dr. Abdoulaye Bousso, who leads the country’s emergency operations center (EOC), Le Centre des Opérations d’Urgence Sanitaire (COUS), which was created in December 2014. “This one case showed us the gaps in the health system, and the big gap was with coordination. We have the structures, and we have all the human resources, but during a big crisis, people don’t have the habit to work together.”

Now, Senegal is sharing its learnings with other countries in the region as they work to strengthen their ability to prevent, detect, and respond to outbreaks.

The Democratic Republic of Congo (DRC), with technical support from PATH and CDC, is working to establish the country’s first EOC. In November 2016, a delegation from DRC, including PATH staff and Dr. Benoit Kebela, director of the DRC Department of Disease Control at the Ministry of Public Health, visited Senegal to learn from that country’s experience in establishing the COUS. Over four days, the teams met with the Senegalese Ministry of Health, COUS staff, the emergency medical assistance service, the CDC, and the Institut Pasteur de Dakar.

The DRC delegation learned about budgeting and cost, institutional architecture, establishing standard procedures, staffing, and other operational decisions from COUS staff. As the DRC visitors considered the Senegal model, they debated whether a similar approach would work in their country, which has a different government structure and specific challenges. DRC is 12 times larger than Senegal, with six times as many people and numerous borders. DRC lacks strong infrastructure, bears the toll of years of conflict, and has half the per capita income of Senegal.

“Your road will be different,” acknowledged Aminata Lenormand, lab strengthening officer in Senegal. “Your reality is very different than here.”

As the teams discussed their respective experiences, Dr. Bousso urged the DRC delegation to move quickly on setting up its EOC. He noted that countries like Senegal, which experienced the strain of the 2014 Ebola outbreak, may feel a greater sense of urgency to put something in place than countries that did not face that crisis.

“Ebola passed, now we have Zika and it will pass,” Dr. Bousso said. “It’s important to get going because something else is coming. We are learning by doing.”

(L to R) Dr. K.A. Daye, who led the medical team at the SMIT (Infectious Disease Service) during the 2014 Ebola outbreak; Dr. Aissatou Ndaye Lakhe, current assistant chief of service at SMIT; and nurse Marie Louise Ndour, standing at the site where Senegal’s new emergency operations center is being built, behind the Fann University Hospital where the SMIT is housed. PATH/Lynn Heinisch

Leon Kapenga, deputy director for PATH in DRC, cited the country’s yellow fever outbreak that spread from Angola in December 2015, officially announced by the Minister of Health of DRC in June 2016. DRC launched a mass yellow fever campaign along the border with Angola and in the capital of Kinshasa. It was one of Africa’s largest vaccination campaigns–nearly 8 million people in Kinshasa were vaccinated in just ten days.

“We broke the epidemic,” Kapenga said. “That’s a really big achievement with minimal doses of yellow fever vaccine and a city of 11 million inhabitants was protected. But this epidemic threatened us all and still it took time [to respond]. That is why we are here to discuss the global security work, because it took six months to react, when we could have had a catastrophe.”

Participants from both countries said the exchange was valuable not only for global health security but for tackling long-standing health challenges. They noted that epidemics can “paralyze” the health system, jeopardizing lives as efforts are diverted from other vital health services. Improving a country’s ability to prevent, detect, and respond to emergencies by strengthening surveillance, labs, data quality and other core elements of a health system will yield far-reaching benefits.

“This was a great opportunity for DRC to learn from Senegal, but also Senegal learning from DRC, and I certainly hope that this is the first step for a much longer and deeper collaboration for our two countries,” said Philippe Guinot, PATH country manager in Senegal. “We share a lot of the health challenges in the region…GHSA is one opportunity [for PATH to serve] as a catalyst for change and sharing information.”

Dr. Abdoulaye Bousso, who leads Senegal’s EOC, presents a welcome gift to mark the occasion of the DRC delegation visit to Senegal’s EOC to Dr. Benoit Kebela, director of the DRC Department of Disease Control at the Ministry of Public Health. Dr. Kebela was on the frontlines of the 2014 Ebola crisis in Guinea. PATH/L. Heinisch

 

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