Resilient Health System As Conceptual Framework for Strengthening Public Health Disaster Risk Management: An African Viewpoint.

Abstract

Disasters whether natural or man-made, pose major challenge to human health and development in Africa; their impact on the health of individuals and communities are often severe and could hinder attainment of global, regional, and national development goals (1–3). Recent disasters in Africa aptly illustrate the complex interaction between health systems and disasters; a vicious cycle in which weak health systems provide fertile grounds for deterioration of public health and natural hazards into disasters while on the other hand, disasters further decimate already weak health systems (4). The sustained transmission of the 2014/15 Ebola virus disease outbreak in Guinea, Liberia, and Sierra Leone was consistently linked to the weak health systems in these countries (5, 6). The outbreak resulted in the death of several health workers (7), depletion of scarce financial resources, diversion of medical equipment. This in addition to overburdening of already weak health information and supply chain management systems resulted in disruption of health services delivery in these countries (8–10). Other disasters such as the Yellow Fever outbreaks in Angola, Democratic Republic of Congo and Uganda, and ongoing armed conflicts in South Sudan, Central Africa Republic, northeast Nigeria, and other African countries also had similar consequences (11–15). This pattern is not limited to Africa; the fragile pre-disaster health systems in the city of New Orleans in America and the Eastern Visayas Region of the Philippines contributed to the public health consequences of Hurricane Katrina and Haiyan (Yolanda) and constrained timely and effective post-disaster health system recovery efforts (16, 17). The pre-Katrina health system in the city of New Orleans was characterized by low coverage of health insurance and reduced access to health services by the largely poor population of the city (16). Similar challenges such as inadequate health-care infrastructure, staffing, and low coverage of health insurance, which reduced access to health services were also prevalent in the affected areas of the Philippines pre-Hurricane Haiyan (17). The Sendai Framework for Disaster Risk Reduction (SFDRR) and sustainable development goals (SDGs), both of which are landmark United Nations agreements adopted in 2015, recommend scaling up implementation of disaster risk reduction (DRR) strategies as means to improve resilience to disasters globally (18, 19). The SFDRR in contrast to its predecessor, the Hyogo Framework for Action, puts a lot of emphasis on health (20). It proposes resilient health systems as an opportunity for ensuring effective DRR in the health sector (20). The World Health Assembly, through resolution 64.10, urged countries to strengthen disaster risk management (DRM) programs by incorporating them into national health systems (21). The 2008 Ouagadougou declaration on Primary Health Care and the African Regional strategy for DRM in the health sector also advocated for the use of strong health systems as the basis for addressing the health vulnerabilities and inequalities, which are associated with disasters in Africa (22, 23). The foregoing and available literatures (2, 24) make a strong case for the use of resilient health systems as a conceptual framework for public health DRM in Africa. Calls for the use of resilient health system as the basis for public health DRM have intensified lately (25); however, there is paucity of practical guidance, requisite tools, and skills for integration of DRM into longer-term health system programs in public health settings in Africa (26). This often results in parallel implementation of health systems strengthening and public health DRM programs within Ministries of Health and between their Disaster Management counterparts with duplication of efforts and lack of synergy. This article reflects on the nexus between the health system framework and DRM and provides insights into how a resilient health system could be used as a framework to strengthen public health DRM in Africa.