Lack of education is a bigger problem and cause of lack of trust in the control of Ebola virus disease.
Of course, care at home / hospital at home as suggested by some members would be best, if it is based on evidence to be better than facility based care, and who wouldn't implement it, including governments given the scarcity of resources both human and material.
Patients and families would embrace the choice too because who likes to be in a hospital setting if they can be treated as out patient.
But the current advice for facility based care, I believe comes from studying every previous episode of this deadly disease: its epidemiology, mode of transmission, behavior if latent and overt infected patients and impact on the contacts, the effect of sound traditions and cultures including methods of burial of the dead in a community and how the body and body fluids and effluents are handled, etc. Basically what worked and what did not work? Practice from lessons learnt!
Also important is the strength of the health system where an epidemic occurs, including the efficacy of the referral and followed-up systems.
This last point is very important: how strong are the health systems in these countries? Why do the health policy makers and providers have to wait for the next epidemic before they get into action by which time the population have forgotten basic infection prevention and control practices (IPC) and / or even the providers themselves? What has happened to best practice of continuing public health education and every day practice of IPC, not only in facilities but in the community as well.
'˜Coercion' per se (even though I prefer to say 'admission') would not be a problem if the population is Educated and re-educated and continually educated and reminded of the behavior and characteristics of Ebola, its consequences and mode of spread, (or any other disease for that matter), that informs the processes and processes necessary for its management and control. The current advice on facility-based care in the acute stages has saved millions of lives during any epidemic episode. A good example is the Ebola case in Nigeria in 2014: one wonders what catastrophe would have followed if the index case was allowed to leave the hospital where he was managed to take a flight from Lagos to Calabar where he wanted to attend an international conference of several hundreds of participants (Nigeria has a population of about 200 million, the largest in Africa)!
If the population is informed and kept informed, even between epidemics, they would comply with evidence informed management plans, even when it is not really convenient. No one wants to die, if they can avoid it. They just need to know the facts of how to stay healthy and alive, always and not only when the system is in panic mode. They become suspicious and read negative meanings to instructions given by panicky policy makers and providers, no matter how well intended.
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: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group: http://www.hifa.org/people/steering-group jneana AT yahoo.co.uk