BMJ: Ebola in Sierra Leone and DRC (4)

29 August, 2019

The ongoing epidemic in DRCongo that is spreading outside that country should make the world thing out of the box for fresh ideas on how to achieve total mobilisation of the populations. It is an opportunity to escalate tried and tested approaches that bring out the population to support health interventions especially in emergency times like now in DRCongo. There are National Immunisation Days in Nigeria (NID Days) that bring out parents and carers and guardians to bring their children for immunisation to event that are very high profile. High profile because it attended by Government, (like Governor/Deputy Governor/Commissioner for Health, etc), Traditional Rulers (like Emirs, Obas, Obongs, Igwes, other Chiefs and High Chiefs, etc) VIP dignatories, Development Partners and Civil Society Organisations, Sports men and Actors/Actresses, etc. Incentives and motivation that bring out the parents and children includes that after immunisation they are given a variety of items including: cash (conditional cash transfer scheme, wrappers and other clothings, bags of rice and other food items, etc etc). The turnout is often even over subscribed. I have seen reports that say that over 100% rates of registered children in a particular community is achieved on NID Days. Its usually total mobilisation and total attendance and participation.

(I must recall that sometime ago some of us called for as much resources as is pumped into the periodic NID Days, and the energy, to be devoted also to Routine Immunisation, because we noticed that parents were only bringing their children out for immunisation on such ad hoc high profile events, at the expense of avoiding Routine regular immunisation).

Importantly, Nigeria only last week, announced 'three years on no Wild Polio Virus' milestone, and we believe that the NID Days played a key part in achieving the result.

Therefore for such health crisis like the world is witnessing in DRCONGO at this time, over the Ebola epidemic, it would be a wise move to try / apply the NID Days approach described above. Is it sustainable, probably not, in the long term, but we suggest that there should be a plan to follow the successful implementation of such an approach without interruption after its done its job of eliminating this present epidemic, so that there is no lag time or complacency, with intensive mobilisation of all the VIPs to promote Routine immunisation and sanitation and healthy living. Furthermore, if this epidemic is eliminated, the world needs to intensify efforts to strengthen the whole health system of DRCongo which has been ravaged by repeated recurrent attack of Ebola virus disease since it was first discovered in the 1970s.

It is not easy but not to have all hands on deck with intensive action and increased resources is not an option that the world has. To allow Ebola to spread further outside DRCongo will be too catastrophic for the world. The tragic West Africa experience in 2014 was a call for action.

Joseph Ana.

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT