Analysis & Opinions - The Guardian
How Nigeria Defeated Ebola
Global Development Professionals Network
Key to Nigeria's successful containment is the strength of the public sector: state governments, universities, and hospitals
In a moment of welcome relief about the Ebola outbreak in West Africa, the World Health Organisation (WHO) has declared Nigeria free of the virus. This news comes at a time of competing pledges from the international community to fight the outbreak.
A brief look at the news suggests African countries aren't stepping up their support to the affected countries. This view, however, ignores three important lessons from Africa's response to the outbreak.
The first is the capacity of the state to act in a timely and aggressive manner. Recently, WHO Nigerian representative Rui Gama Vaz said: "The virus is gone for now. The outbreak in Nigeria has been defeated.
"This is a spectacular success story that shows to the world Ebola can be contained, but we must be clear that we have only won a battle. The war will only end when West Africa is declared free of Ebola."
Behind this success story lies competent public leaders and institutions that pursued their mission with vigour. After the diagnosis was made, Nigeria implemented a co-ordinated approach that involved making 18,000 visits to about 898 people to check their temperatures. This was possible because Nigeria had the state capacity to undertake such a massive effort in a timely manner.
The 898 people were linked to one initial infected patient. These included 351 primary and secondary contacts as well as 547 tertiary contacts. One nurse who had cared for the patient had traveled over 500km to Enugu where she potentially infected at least 21 people.
This aggressive tracing, that included having access to phone records, was possible because Nigeria had the state capacity to undertake such a massive effort in a timely manner.
One of the most decisive aspects of the campaign was the role of the Lagos state government under the competent leadership of Governor Babatunde Fashola. The state was able to draw relevant lessons from previous campaigns against polio. Equally important was the biomedical capacity in the teaching hospital of University of Lagos, which completed tests in 24 hours.
First, a key lesson from Nigeria is the importance of the capacity of the state in protecting its citizens through a diversity of options. Those who believe the private sector can only function by shrinking the capacity of the public sector may be giving up their ability to protect citizens against public emergencies.
The second lesson is the importance of human capacity. Pledging funds is only a small part of the solution. What is critical are medical boots on the ground. The most resounding rebuke of this old-school pledging competition came from Médecins Sans Frontières (MSF). In rejecting an offer of cash, MSF said: "Even a dozen trained staff who could oversee local teams to manage an isolation centre, help case finding and outbreak control measures would save thousands of lives today."
Nigeria is sending trained healthcare workers to affected countries, yet its efforts hardly receive attention in the international media. Uganda has sent doctors to the region, some of whom have perished in the fight. East Africa and the Democratic Republic of Congo (DRC) are sending 600 and 1,000 healthcare workers to the affected countries respectively.
The third lesson is reforming the governance system in light of lessons learned from the outbreak. Dr Stella Ameyo Adadevoh, who helped to stop the spread of Ebola in Nigeria and lost her life in the process, symbolises Nigeria's heroic battle. Her legacy now includes a decision by Governor Fashola to appoint Dr Adekemi Oluwayemisi Sekoni of Lagos University's teaching hospital as chief scientific adviser (CSA). Her primary role will be to continue the fight against Ebola.
By appointing a medical practitioner to serve as his CSA, governor Fashola has demonstrated the power of leading by learning.The recognition of the key role advisers play demonstrates how cities in Africa can leverage scientific and technical knowledge to inform their decision-making
Ebola is rolling back years of economic effort in Liberia, Sierra Leone, and Guinea. It is also exposing the limitations of development models that ignore the importance of building state capacity. A major lesson from the outbreak is that there is no substitute for effective public institutions in protecting the public interest.
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