After the recent Ebola outbreaks in West Africa unfolded, it is clear that something needs to change in the way disease is monitored and managed in Africa. International organizations such as the World Health Organization struggled to keep up in the face of the epidemic. In recent months, the African Union decided to create an African-based organization called Africa Centers for Disease Control and Prevention, or Africa CDC.
As Africa CDC is operationalizing its functions, organizations such as the CDC and the United States Agency for International Development will provide support in expertise and funding. Those organizations already have many resources on the ground in Africa—people, facilities, and vehicles.
There are many benefits to building capacity so local people can manage their own health systems with continued technical backup from the United States.
The formation of Africa CDC is an opportunity to apply many lessons learned through the decades when it comes to creating health systems within countries and internationally.
What Models Exist for Africa CDC’s Operations?
How can Africa CDC provide disease surveillance, prevention activities, and population monitoring across a continent as diverse as Africa?
In order for Africa CDC to be successful, it must create processes that generate buy-in and function across the borders of its 54 countries. The United States, with its 56 states and territories, can provide insights about how to integrate work across diverse and sovereign entities.
The Strategic National Stockpile (SNS) is an example of a health service in the United States that requires buy-in from national, state, and local entities. The SNS is our nation’s repository of antibiotics, vaccines, chemical antidotes, antitoxins, and other medical needs. It has been strategically designed to ensure that critical medical equipment and supplies can be transported to any part of the United States within a designated period of time, even if there has been a crisis that impacts many transportation and communications systems.
The Strategic National Stockpile is distributed but has to be coordinated as a national entity. There are pieces of the stockpile distributed at fire and police departments at more than 1,340 locations nationwide. Local people participate in training exercises to follow specific processes and communicate in ways that may not be part of other emergency plans.
From 1999–2012, LMI played a crucial role in the design and implementation of the Strategic National Stockpile. LMI calculated the optimal placement of these supplies, designed procurement and distribution plans and developed exercise plans to make sure the Stockpile functions as it was intended to.
LMI prepared the analysis to ensure a 12-hour response time to any place in the United States, while also having a reasonable number of storage facilities. The plan took into account what would happen if a hurricane or other disaster destroyed some storage facilities and transportation methods.
Developing this system required experience in many skill sets:
- Human capital,
- Organizational development,
- Procurement, logistics planning, and material distribution,
- Communication and coordination, and
- Exercise planning and conduct.
Creating Decentralized Health Systems Requires the Right Mindset
During the development of the Strategic National Stockpile, LMI learned that although this may be a national-level asset, no one at the federal level can tell states and localities how to do emergency preparation and response. Managing decentralized health systems is a balancing act which requires a mindset of humility. So much work goes into the development of these systems not only around logistics, but around managing the expectations of the parties involved. With the Strategic National Stockpile, this included federal, state, and local people. In the case of Africa CDC, there is an additional layer of international participation.
Health challenges in Africa are fundamentally different than in the United States. In sub-Saharan Africa, problems of nutrition, agriculture, and clean water are much more intertwined with health. Health systems in the United States can take for granted that those areas are mostly functional here. For example, if there is an issue related to agriculture, our health agencies can coordinate with the Department of Agriculture. That level of institutional support may not always be available to Africa CDC.
It is critical that Africa CDC designates sufficient resources around building buy-in in these early days of its existence. Hopefully, the creation of an African-based organization will expedite this process. Models such as the Strategic National Stockpile can assist in the development of critical operations in an expeditious fashion.