Washington: The Ebola outbreak in West Africa has exposed major gaps in development aid, prompting a rethink of the balance between building health systems and tackling specific diseases like AIDS, malaria and tuberculosis.
For more than a decade richly-endowed global campaigns funded by governments, philanthropists and celebrities have poured billions of dollars into preventing and treating individual diseases that long plagued Africa.
This investment led to a steady decline in diseases in Africa and saved countless lives, but much less attention went to building clinics and training doctors and nurses, experts say.
As a result the weak health systems of Liberia, Guinea and Sierra Leone, battered by war and neglect, were ill equipped when the deadliest outbreak on record of Ebola struck in March. Donors were left scrambling to reallocate resources to respond.
"The Ebola epidemic shows how decades of health services neglect can bring fragile countries to their knees," World Health Organization Director General Margaret Chan told a recent health conference in South Africa.
Aid for healthcare underwent a major shift in the last decade, from government-to-government handouts to a bigger role of the private sector, including multibillion dollar foundations.
Total foreign aid for health-related projects more than doubled to $18.8 billion between 2000 and 2011, the latest year for which full data is available, according to AidData, a development finance research center.
New funding for HIV/AIDS, malaria, polio and tuberculosis projects received 44.5 percent of the total healthcare dollars in 2011, while primary healthcare systems received 25 percent, the figures analyzed by the Thomson Reuters Foundation show.
EBOLA LESSONS LEARNED
Donald Kaberuka, president of the African Development Bank, said there were obvious advantages for the funds to focus on specific diseases. "It was like the sweet spot, easy to sell and the results are there," Kaberuka said.
Experts are now debating whether the funding balance needs to be adjusted to concentrate more on building general health systems in poor countries so they can withstand health crises like Ebola, which has claimed more than 4,000 lives.
"This is going to have to be a deep, deep analysis of what went wrong and why, because a lot of things went wrong at the same time," said World Bank President and physician Jim Yong Kim.
"We now have to go back and say given what we`ve seen with Ebola we really have to be much more committed to building integrated models that are flexible and able to deliver across different priorities," he said.
Kim cited the case of Rwanda, which used donor money to create a universal healthcare system after its 1994 genocide.
"If (the Ebola outbreak) had happened in Rwanda my own sense is that because they built district hospitals and community hospitals and have community health workers connected to the whole system, that we would have gotten this thing under control very quickly," said Kim.
Chris Elias, president of the global development program at the Bill and Melinda Gates Foundation, said countries should learn from practices that have worked, including where disease programs also strengthened systems.
A Gates Foundation-funded polio and HIV clinic in Lagos, for example, was quickly turned into an emergency center for Ebola when the virus hit Nigeria. The center already had trained dozens of doctors, who were reassigned to deal with Ebola.
Efforts to contain the Ebola outbreaks in Nigeria and Senegal appear to have succeeded, even as the virus continues to spread in the hardest-hit West African countries.