Universal health coverage (UHC) is defined as ensuring health for all and a great aspiration for humankind. Sadly, this is constantly being undermined by the threat of infectious diseases. Global health security and universal health coverage are two sides of the same coin. Hence, it is impossible to achieve one without the other. This is why lessons from the last Ebola outbreak in Uganda are imperative if we must achieve health for all.
Uganda was declared Ebola-free on January 11, 2023. This event followed 42 consecutive days of unconfirmed new cases of Ebola. The global health community heaved a sigh of relief after battling a serious epidemic within the COVID-19 pandemic. Without a doubt, it was a global partnership led by Uganda’s Ministry of Health. However, while most of the world has moved on, Ebola survivors are left to deal with physical, psychological and medical complications.
WHO describes UHC as a spectrum of care including health promotion, prevention, treatment, rehabilitation and palliation. The care that Ebola survivors need fall within this spectrum. Lessons from previous Ebola outbreaks show that long-term care and support of Ebola survivors should be a critical part of the response to an Ebola outbreak. We must learn from these to prevent the next outbreak. Liberia’s experience shows that any program to care for Ebola survivors should have two overarching goals: stopping human transmission to prevent the next outbreak and providing survivors with the right support.
Provide comprehensive medical care to Ebola survivors
In the DRC, the ministry of health and partners ensured that all survivors enrolled into a comprehensive program of follow-up care. Each survivor received follow-up visits every month over a period of six months and then every three months for a year. These clinics were established at all hotspots. Sexual transmission of the Ebola virus is a concern although uncommon. The Ebola virus can be detected in the semen more than 180 days post-recovery. Uganda must incorporate a screening plan for men that includes semen testing, counselling on lowering sexual risk, and the distribution of free condoms to prevent flare-ups that could result in outbreaks. A similar intervention prevented flare-ups in Liberia as the semen screening by the disease surveillance programme detected cases on time.
Reintegrate Ebola survivors back to their communities
The goal of disease control during epidemics is to stop the spread of infection. This should include mental and psychological effects on survivors. Sadly, these usually receive less attention. Challenges faced by survivors include stigma, discrimination, grief, survivor’s guilt, unemployment, and the loss of personal possessions. Here, the term “stigma” refers to negative attitudes, convictions, and behaviour held towards those who have the illness and those who are thought to have previously been infected. It is common for Ebola survivors to struggle as they attempt to reintegrate into their communities. Although the risk of catching Ebola from a survivor is low, poor communication and rumours portray survivors as high risk and they are often banished from their communities.
The survivor programme should foster healing and community reintegration, a sense of shared responsibility, and extend care beyond the initial emergency. The commitment to safeguard their human rights and ensure that they have access to critical medical and social assistance is crucial to Ebola survivors. The ability to unlock fresh potential and maintain their dignity depends on survivors’ involvement in the healing process. There should be facilitated information-sharing events to counter these myths about survivors and share the real risks around Ebola. Organisations, alongside national initiatives, should send teams out into affected communities to spread health messages and to help reduce stigma and discrimination. In Guinea, for example, MSF reached 18,300 people through group and individual sessions. Local leaders were urged to continue engaging and raising awareness among community members, monitoring affected individuals and households, and supporting Ebola survivors to avoid stigmatisation.
Political will is necessary to finance health security
International partners often depart after an outbreak is over, leaving the country to figure out a path to recovery on its own. Uganda must prepare adequately either through local funding or sustaining partnerships with international organisations which was the case in Liberia. Uganda is already on the right path with an articulated post-Ebola recovery plan, which is a joint effort with partners that can be called on to support financially and/or technically. Organisations that were working in Uganda with those affected by Ebola must also plan how they can remain working with communities after the outbreak.
Ultimately, the government of Uganda must work towards providing universal health coverage for all Ugandans. This would ensure improved detection, prevention, and response to infectious disease outbreaks, including Ebola.
About the Authors: Dr. Ifeanyi M. Nsofor, a global health equity advocate, is a Senior New Voices Fellow at the Aspen Institute, Global Atlantic Fellow for Health Equity at George Washington University and an Innovation Fellow at PandemicTech. You can follow him on Twitter @ekemma
Ezinne V.C Onwuekwe, a Pharmacist is a Project Manager, and Data Analyst at Africa Centres for Disease Control and Prevention. She is a member of International Federation of Pharmacist Technology Advisory Board and #1MillionGirlsinStem Ambassador. You can follow her on LinkedIn and Twitter @EzinneOnwuekwe
Competing interests: None
Handling Editor: Neha Faruqui