I was pleased to be selected to go to Guinea during the recent Ebola outbreak to help my country in any way I could. We went in response to a request from USAID to do a rapid assessment of Ebola implications on reproductive health and maternal and child health service utilization and service delivery.
We collected data from public facilities for 15 months (October 2013 to December 2014) for 18 indicators around child health, maternal health and family planning services. We collected the data in reference hospitals and health centers around reference hospitals in 12 prefectures, and also from three districts health facilities in the capital, Conakry. In addition, we interviewed health providers and head of health facilities in both public and private clinics as appropriate. District officers were also interviewed to get a good sense of the effect of Ebola in changing service delivery practices, training of health staff on Ebola prevention and control, closure or suspension of facilities, infection of health staff and final outcomes of infected staff. Finally, we interviewed traditional healers around selected health facilities to learn about communities’ concerns about Ebola, health seeking behaviors, and changes in service delivery practices at the community levels whenever appropriate.
I was impressed that the data we were looking for existed, so we were successful in building a strong database. While we were doing the work in the field, we were also able to help build capacity at the district and regional levels by bringing representatives from the Ministry of Health for training purposes.
After data collection, we returned to the capital for a second data cleaning and verification, and were able to produce some preliminary results for the USAID mission. For example, we found a decrease in the use of child immunization services. It’s my view that this decrease occurred because parents avoided bringing their children to health facilities due to fears about the Ebola epidemic.
We also found a decrease in the recorded number of children with diarrheal disease. I suggested two explanations. The decrease in numbers could indicate that people avoided the health facilities. However, if the populace is getting the message about better handwashing, and were purchasing clean water to drink as preventive measures, then that would be another, positive, explanation for the decrease. Those were practices that were being promoted, and I did indeed see these practices being observed in many places.
In Guinea, there is a lack of trust of the government. The population had resisted applying preventive measures or to accept contact tracing due to this distrust, and as a result the epidemic was significantly worse than it might have been. In addition, about 30% of the interviewed staff did not benefit from infection prevention and control measures, which made them highly vulnerable to Ebola in cases of risky contact.
In hopes of improving government response throughout Africa, I shared my perspectives on priorities for fighting Ebola in this video, available in English and French and also available at EbolaWatch.net.