Table 8 Information extracted and results from the Expert interviews
Name | Date + duration | Affiliation | Communication + Location | Objective | Health System building blocks mentioned | Opinion |
|---|---|---|---|---|---|---|
1. Gillian McKay | 04/08/2015 25 mins 48 s | GOAL International – Behaviour change advisor | Face to face – LSHTM | Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak | Health financing | For the most part, the lack of investment in training of healthcare workers, in infrastructure, supply chain management (drugs, PPE, water and electricity), working with the community to increasing their valuing in the health care system is the biggest problem. In SL for example they have the least amount of government funding. Lack of supply chain and training in IPC and general epidemic management would be the most important things. |
Health workforce | They were not well trained and so they were not able to deal with Ebola and lots of them died. | |||||
Information and research | When Ebola came, it wasn’t recognised early and this lead to lots of casualties. This also fits into information and research where it was important to recognise the virus early and allow for contact tracing. | |||||
Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone | Health workforce | Health workforce! A big problem is the number of healthcare workers who die in Ebola compared to other viral haemorrhagic. | ||||
Service delivery | The shut of schools has led to an increase in teenage pregnancy which added burden to the health systems of the countries. People still do not trust the health systems of these countries. The number of women giving birth decreased in hospitals, increasing maternal mortality. Immunization rates are down and there is potential for other epidemics as a result. HCW decreases as they don’t feel safe to do so. | |||||
2. Jimmy Whitworth | 30/07/2015 24 mins 23 s | London School of Hygiene and Tropical Medicine - Professor | Face to face – LSHTM | Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak | The six blocks (GENERAL) | Simply insufficient money that goes into health systems and that means that they don’t have the staff, finances needed to provide services needed, medical products are only available intermittently, technologies only found in that capital cities, the leadership and governance isn’t very strong. Mostly service delivery isn’t that great. Perhaps in SL it might be better than the others. So it has not been a priority for others. |
Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone | Service delivery | All general services were not offered adequately as vaccinations, mother and child services. The number of people who died from Malaria are at least as many as those who died from Ebola. Babies who died from diarrhoea were high in numbers as well as from pneumonia. We started seeing epidemics of Measles as these countries were not able to avoid and deal with continuing vaccination programmes | ||||
3. Christina Atchison | 07/08/2015 27 mins 54 s | NHS England, Imperial College London, Department of Primary Care and Public Health - Clinical Lecturer in Public Health Medicine | Face to face – Imperial College London, Charing Cross Hospital, Department of Primary Care and Public Health | Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak | Leadership and governance | Leadership and governance closely linked to planning and financing. Leadership is the overarching. Lack of leadership at the national government level and the organisational leadership in the governmental level and ministries of health |
4. Erin Polich | 12/08/2015 45 mins 40 s | GOAL International – Emergency and transition coordinator | Skype – London to Freetown, Sierra Leone | Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak | Leadership and Governance | Ebola wasn’t mentioned publicly by the president until July of last year and there was a great amount of distrust in SL and they were very fearful of this disease that it was lethal. They were not even sure of it existed and if it did, it wasn’t brought up by the government. There was a lack of understanding by the government and on how communities operate. One of the reasons the outbreak has become so bad and so widespread is that there has been not enough emphasis on the understanding of the distrust of the communities in the health systems and their own governments as well |
Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone | Service delivery | People were afraid to go the health facilities because people were afraid of being infected if the doctors and nurses are infected and they can’t help themselves. People didn’t want to be transferred to wards as they knew that people walk in as Ebola negative and they walk out being positive. There weren’t enough beds and people were sharing beds and there was lots of contact with vomits, diarrhoea and so on | ||||
Health workforce | These countries are already low in human resources and we have lost hundreds of HCW that we can’t afford to lose. These people have put their heart and soul in defending the lives of other people more than you can imagine. People lost their lives because they were able to be there to care for the Ebola patients. We have lost a huge resource there that would take years and years to build back. One of the really sad things, in SL some of the prominent doctors like Dr. Khan are heroes before Ebola came and were looked up at. | |||||
Health financing | Incredible influx of donor funding in rate that SL has not seen in years which is now available to try to strengthen the government facilities. We see projects that started as IPC projects in hospitals and were now expanded to wider Ebola responses and beyond to build facilities for longer term | |||||
Medical products and technologies | There is now a national IPC unit that exists in the MOH in SL that didn’t exist before to make sure that this doesn’t happen again in the future. There is also the disaster preparedness unit that will be established. If this is funded and coordinated properly, this would be a great resource and we could see a really good thing happening for future outbreaks. | |||||
5. David Heymann | 24/08/2015 6 mins 22 s | London School of Hygiene and Tropical Medicine/Public Health England/Chatham House - Professor | Phone call – London to Geneva | Effects the health systems in Guinea, Liberia and Sierra Leone had on the management of the Ebola outbreak | Health workforce | These countries are recovering from war and many healthcare workers left these countries leaving the workforce in shortage. |
Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone | Service delivery | The outbreak has affected the countries negatively by shutting down health facilities in some areas and people without signs and symptoms of Ebola had difficulties to get care; some died from other diseases as diarrhoea or malaria, and in some areas of these countries immunisation programmes broke down and there were outbreaks of measles. | ||||
6. Chris Lewis | 28/08/2015 20 mins 36 s | Department for International Development – Health advisor | Phone call – London to London | Impacts the Ebola outbreak brought about on the existing health systems in Guinea, Liberia and Sierra Leone | Health Workforce | Ebola is a crisis that primarily affects healthcare workers and therefore there is a particularly negative impact with the number of healthcare workers that died, those who were sick as well as the psychological impact on healthcare workers. |
Service delivery | There is also the secondary impact on other diseases. It was incredibly difficult to have effective interventions for other health problems when Ebola has affected health facilities |