Health
Five Lessons Learned During Latest Ebola Outbreak in DRC
By MSF
Four people died in the most recent Ebola outbreak that occurred in a remote, forested area of the Democratic Republic of Congo (DRC).
This small outbreak (five laboratory-confirmed and three probable cases) was quickly curtailed. The international humanitarian organisation Doctors Without Borders (MSF) shares lessons learned from this first occurrence of the deadly virus since the end of the large-scale Ebola outbreak that devastated West Africa in 2014-2015.
Train frontline health teams
The scale of this outbreak was minimised, thanks in no small part to a nurse named Dieumerci. With a name that literally translates to ‘Thank God’ in French, Dieumerci works at a Ministry of Health centre in northeast DRC, where the first Ebola cases started emerging.
He detected the risk of Ebola in a seriously ill man at the hospital, and rang the alarm. This man turned out to be the second confirmed case during the recent outbreak. Unlike in West Africa prior to the last major outbreak, Ebola is known in the DRC: the Ebola River, where the virus was first discovered, runs 100 kilometres away from where Dieumerci works.
That doesn’t mean that it is common disease in the area, but still, Dieumerci recognised the symptoms. His quick actions should not be taken for granted. Healthcare workers play a crucial role not only for patients, but also for general epidemiological surveillance. However, in many developing countries human resources within the health sector remain starkly inadequate.
On that fateful day where the Ebola patient came to the health centre, Dieumerci could have easily been on a sick leave, or visiting family somewhere else in the country. One cannot rely on a single individual to play the crucial role of on-the-ground surveillance.
What is needed are proper surveillance systems in resource-poor countries, which were clearly lacking in West Africa at the time of the epidemic. So all in all: thank you Dieumerci. We should all hope that during the next outbreak – be it Ebola or any other infectious disease – there will be another Dieumerci to ring the alarm bell for everyone’s sake.
Finally, a forgotten disease is taken seriously
The word “Ebola” doesn’t ring the same after 2014-2015’s devastating epidemic. At least 11,300 people were killed, and over 28,000 were infected. As a result, Dieumerci’s alarm bell sent shock waves across the world. Congolese authorities immediately activated their outbreak response team and had strong support from WHO and other organisations.
Henry Gray, MSF’s project coordinator during this recent outbreak, has worked on seven haemorrhagic fever interventions in DRC, Uganda and West Africa, to name a few. “The pressure we felt was very different from previous comparable outbreaks: it was clearly at the top of the agenda,” he says. “When it comes to Ebola, we have all learned that it’s better to be safe than sorry in order not to repeat the disaster of 2014-2015.
“However, it is sad to still see that other outbreaks in countries do not trigger the same mobilisation, even in regards to the main killer diseases like cholera or measles.
“Once the Ebola outbreak was over, we were able to re-assign some of the MSF staff towards a serious cholera outbreak on the other side of the country. Our teams went on to treat 1,100 cholera patients. “Considering the dire health needs in many parts of the country, additional support is always welcome”.
Old tricks are timeless – back to basics
The promise of new drugs or vaccines should not overshadow the necessity of putting in place the basic pillars of outbreak control.
It all starts with good surveillance, followed by the five pillars of outbreak control:
Safely isolating and treating the sick.
Actively looking for potential new cases and surveilling those who have been in contact with them.
Burying the dead safely.
Engaging and mobilising the affected communities.
Offering psychological support.
In West Africa, the havoc wrecked by Ebola on the entire health system created more indirect than direct victims of the virus: children became prone to infectious diseases because they weren’t vaccinated; Childbirth complications led to the deaths of mothers and/or children because there were no healthcare workers to care for them; untreated cases of malaria became fatal…
International health actors need to do more to support local health facilities that often have much smaller means and equipment: training staff, ensuring there is basic protection equipment available, and that their pharmacies are stocked with first aid supplies and basic medicines. Our experience in DRC has shown that training frontline workers, even when done ad-hoc, can bring sustained effects to improve their performance in surveillance.
Location, location, location
Like the majority of haemorrhagic fever outbreaks prior to West Africa, the recent one occurred in a very remote, forested area.
Here, the virus was already known to exist within an animal reservoir (assumed to be fruit bats) that is occasionally transmitted to apes, monkeys or men. Some people are very mobile in the region, but can only go as far and as fast as their available transportation; which is pretty much nothing beyond walking and the occasional motorbike.
Dieumerci’s village is 45 kilometres from Likati, the closest town. It is home to 18,000 people, with a majestic cathedral and large, but under equipped, hospital serving as remnants of a time when a railroad was still linking plantations across the country. Today that railroad has been eaten by the encroaching jungle. By contrast, in Guéckédou, Guinea – where the West Africa outbreak started – people can jump on a motorbike and be in the heart of the capital Conakry and its 2.5 million people within two days.
These contrasting examples show how isolation from major cities can keep the spread of deadly disease under control.
Medical innovations are not the magic bullet
At the time of the latest outbreak, MSF was willing to use Ebola treatments which were still in development. However this window closed as the outbreak stopped before the process to allow the use of the experimental treatments was complete. However, this event acted as a ‘booster’ – speeding up the process of preparing medical protocols so that new drugs (still in the experimental phase) can be used in ways that are as safe and ethical as possible.
The rVsV-ZEBOV vaccine (the most advanced investigational vaccine candidate for an Ebola outbreak today) is in development, and needs to be implemented through a study protocol. This, and a vaccine strategy – including informed consent under good clinical practice – were mandatory requirements needed from us to access them.
Soon enough, a study protocol was developed and approved by the MSF Ethics Review Board a few months ago. It was ready for implementation should an outbreak occur. Additionally, a dedicated MSF research team was ready to be deployed. Unfortunately, our negotiations at the DRC Ministry of Health level only took place when the outbreak had already been declared.
It took some time for us to explain what we were planning to do, and how this would differ from a vaccination campaign. But, we managed to obtain authorisation from all the regulatory bodies to start activities in case of a future outbreak.
It is likely that the next outbreak (and trust us, there will be a next outbreak) will happen in a similar setting. We can continue to learn how to best tackle it, and ensure that the West Africa Ebola outbreak remains an isolated tragedy.
Since 1990 MSF has responded to over a dozen outbreaks in sub-Saharan Africa. During the devastating Ebola outbreak that struck mainly Liberia, Guinea, and Sierra Leone in 2014-2015, MSF launched one of the largest emergency operations in its 44-year history.
MSF admitted 10,310 patients to its Ebola management centres of which 5,201 were confirmed Ebola cases, representing one-third of all WHO-confirmed cases. During the first five months of the epidemic, MSF handled more than 85 percent of all hospitalized cases in the affected countries.
At the peak of the epidemic, MSF employed nearly 4,300 staff—most of whom were from the affected countries—who ran Ebola management centres, conducted surveillance, contact tracing, and health promotion, and provided psychological support.
By Adedapo Adesanya
The National Health Insurance Authority (NHIA) says the number of Nigerians enrolled in health insurance has risen to more than 22 million.
The Director-General of NHIA, Mr Kelechi Ohiri, said this resulted from the implementation of the mandatory health insurance, which has gained momentum nationwide.
He said this on Wednesday at the Annual General Meeting of the Nigerian Association of Insurance and Pension Editors (NAIPE) in Lagos.
Mr Ohiri said enrolment had increased to 22.03 million, representing a 35 per cent year-on-year growth, attributing this to stronger collaboration with state social health insurance agencies, ministries, departments and agencies, organised labour, employers, the private sector, and the gradual implementation of the mandatory health insurance provisions of the NHIA Act.
He said that the country had moved beyond policy formulation to delivering measurable improvements in healthcare access, service quality and consumer protection in line with the federal government’s health sector reform agenda.
According to him, Nigeria already has the necessary policies and legislation to achieve Universal Health Coverage, positing that the key challenge was effective implementation.
“The decisive variable is now implementation- consistent, rigorous and accountable execution that converts political commitment into healthcare access for real Nigerians,” he said.
Mr Ohiri said that the transition from the former National Health Insurance Scheme to the NHIA had strengthened regulation, consumer protection, accountability and strategic purchasing, while providing the legal and operational framework for achieving Universal Health Coverage.
He added that improving the experience of enrollees remained central to the Authority’s reform agenda.
According to him, NHIA has strengthened its complaints management system, introduced faster resolution timelines, and intensified compliance monitoring of Health Maintenance Organisations (HMOs) and healthcare providers.
He further added that NHIA had sanctioned facilities that failed to meet the required standards, adding that his organisation had resolved 3,878 complaints, representing an 87 per cent resolution rate, while 95 per cent of the cases were concluded within prescribed timelines.
Mr Ohiri noted that more than N14.2 million had been refunded to enrollees, while non-compliant healthcare facilities had been sanctioned.
He said NHIA had also introduced service standards, including a one-hour treatment commencement target for enrollees requiring urgent care, to improve access to timely and quality healthcare services.
The NHIA boss further disclosed that capitation payments to healthcare providers had been increased by 93 per cent.
He said fee-for-service reimbursements rose by 378 per cent to enable providers to invest more in personnel, equipment and infrastructure.
According to him, 7,592 healthcare facilities have been assessed under the SafeCare quality framework as part of efforts to institutionalise continuous quality improvement across the country.
Mr Ohiri also highlighted interventions targeted at vulnerable groups, including support for more than 48,500 pregnant women, expanded maternal and newborn healthcare services, the Vulnerable Group Fund, and improved access to healthcare for pensioners and retirees.
He said Universal Health Coverage could only be achieved if every Nigerian, regardless of income or location, had access to quality healthcare services.
By Modupe Gbadeyanka
The new one-hour authorisation response time ultimatum policy introduced by the National Health Insurance Authority (NHIA) has received the full backing of SUNU Health Nigeria Limited.
This policy was introduced by the agency to ensure enrollees get prompt approval codes to access care.
Healthcare service providers have been urged to report any Health Maintenance Organisation (HMO) that violates this initiative through an email, with the HMO in copy and a timestamp attached as evidence of the request. They may proceed to offer services to enrollees thereafter.
Speaking at the company’s second-quarter Providers’ Forum for the Lagos-Ogun region in Lagos recently, the chief executive of SUNU Health, Dr Moyosore Olomola, expressed optimism that this policy would improve healthcare delivery in the country, especially for enrollees, who crave quality service.
At the event themed Improving Quality and Access to Care Through Stronger Provider Network, and held at the Nigerian Institute of Medical Research (NIMR) in Yaba, Lagos, Mr Olomola reaffirmed the HMO’s commitment to operating within legal and operational frameworks to guarantee adequate care for enrollees.
“Access to care and quality of care remain key priorities in our healthcare systems. We know quite well that deliberate collaboration, strategic partnerships, and a shared commitment to excellence are required to achieve these priorities.
“A strong provider network is doubtless the backbone of any effective healthcare system. It ensures that our mutual enrollees receive the right care, at the right time, in the right place, and at the right price,” Mr Olomola, represented at the programme by the organisation’s Chief Operating Officer (COO), Dr Faith Nwachi, stated.
He further assured that SUNU Health would strictly adhere to the one-hour authorisation limit, stressing that this aligns seamlessly with one of the organisation’s core values—promptness and its corporate slogan, Humanity is the centre of our initiatives.
In a bid to further improve access and quality of care, SUNU Health also demonstrated its new operational software and Mobile app, aptly named SUNU Legacy.
Also speaking at the event, the NHIA Lagos State Coordinator (Ikeja), Dr Bethuel-Kasimu Abraham, noted that the forum’s expected outcome is to significantly reduce delays in accessing medical care.
Other key expectations include ensuring continuity of care, improving patient outcomes, and strengthening accountability among HMOs.
Addressing specific pain points faced by enrollees, the NHIA Ogun State Coordinator, Mr Dare Adefeso, acknowledged that the agency had received complaints regarding out-of-stock drugs and the discrimination of enrollees by certain providers.
He affirmed that the NHIA is actively addressing these issues, stressing that moving forward, every facility must ensure enrollees are properly catered to regardless of their status, provided they have an active health insurance plan.
Corroborating the long-standing legacy of SUNU Health, the Ogun State Director of the National Orientation Agency (NOA), Mrs Aishat Tiamiyu, shared that her agency is responsible for public information dissemination and has been enrolled with SUNU Health for over 25 years.
Commending the HMO’s stellar service over two decades, she called for the immediate enrollment of new NOA staff into the scheme.
The Providers’ Forum remains one of the strategic channels employed by SUNU Health to consistently engage healthcare providers, understand their operational challenges, introduce new software updates, and solidify partnerships aimed at fostering premium healthcare delivery across Nigeria.
By Aduragbemi Omiyale
The National Agency for Food and Drug Administration and Control (NAFDAC) has announced the recall of a sexual enhancement product known as WAP Sensual Enhancement Capsules.
In a statement on Monday, the Nigerian agency disclosed that the recall is due to “undeclared pharmaceutical ingredients” in the product, whose country of origin is unknown, but is marketed and distributed online in the US through eBay.
It was emphasised that the recall is being “voluntarily” made by the manufacturer, Best Supplements Best Prices Company.
The detection of the undeclared pharmaceutical ingredients was made by the US Food and Drug Administration (FDA).
Laboratory analysis by the US FDA revealed that the product contained undeclared sildenafil, tadalafil, and flibanserin, which were not mentioned on the product label. Such substances may include phosphodiesterase type-5 (PDE-5) inhibitors or related compounds commonly used for the treatment of erectile dysfunction, the statement by NAFDAC stated.
Sildenafil and tadalafil are ingredients in FDA-approved prescription drugs used to treat erectile dysfunction.
It was noted that these undeclared ingredients may interact with nitrates found in some prescription drugs, such as nitroglycerin, and may lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates.
Flibanserin is the active ingredient in an FDA-approved prescription drug used to treat low sexual desire in women. Flibanserin can cause drowsiness, sedation, dangerously low blood pressure, and fainting, especially when combined with alcohol.
Consumers have been encouraged to report compromised products (medicines or medical devices) to the nearest NAFDAC office, call 0800-162-3322, or send an email to sf******@********ov.ng.
