JAMA: 'The Ebola Outbreak, Fragile Health Systems, and Quality as a Cure'
Posted on Oct 7, 2014
Staff. Stuff. Systems. In recent media appearances, lectures, and op-eds, PIH Co-founder Dr. Paul Farmer has been arguing that to contain the current Ebola outbreak in West Africa and take meaningful steps toward mitigating future outbreaks, we need trained medical staff, a steady supply of resources (or stuff), and a strategic approach that focuses on long-term development of health systems.
Today, Dr. Farmer, along with Dr. Andrew Boozary and Dr. Ashish Jha of the Harvard School of Public Health, published an article in The Journal of the American Medical Association elaborating on the need for quality care, and why the needs for staff, resources, and systems persist in low-resource settings.
In making the argument for staff, the authors write:
The scarcity of health care workers in western Africa poses a serious challenge. Even before the outbreak, Liberia’s 4.3 million people were served by just 51 physicians—fewer than many clinical units in a typical major U.S. teaching hospital. Many more physicians are needed, but focusing on physicians will not be enough. Successful integration of prevention and treatment efforts requires a comprehensive strategy, including community health workers, who can encourage sick patients to come to health care institutions, and nurses, who provide lifesaving supportive care, such as intravenous rehydration and electrolyte management, in an environment that is safe for both practitioners and patients.
In explaining the need for health care resources, the authors write:
While experimental therapeutics have garnered significant attention, vaccines or monoclonal antibodies that have yet to enter clinical trials are no panacea for the current outbreak. However, appropriate supportive care can help reduce many unnecessary deaths. Currently, the lack of basic health care resources—such as protective gloves and gowns, intravenous fluids, and straightforward protocols and guidelines—has limited front-line health workers who risk their lives to care for those affected with Ebola. The health systems of high- and middle-income countries are awash in basic health care materials and guidelines, and there is no good reason these fundamental health care resources cannot be provided to front-line workers in West Africa to save lives.
Lastly, in discussing the need to build and strengthen health systems, they write:
The problems of inadequate systems reach far beyond West Africa. Despite a recent global movement to expand access to health care, the Ebola outbreak is a cogent reminder to carefully consider 2 simple questions: What kind of care are people going to access? Is that care worth having, and can it be made better? A focus on accountability, especially for quality, is critical. Over the past decade, many countries have committed to spend more money on health care, but spending more is not enough. There has been little effort to understand the quality of care that such spending buys and how that care might be made better.
The authors conclude with a sobering sentiment. “The outcomes of the next several months will reveal the capacity to forge effective partnerships across borders and disciplines, and the extent of the commitment to value all human lives equally.”
