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Ebola response: Looking back on an unprecedented year

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Photo credit: Dominic Chavez/World Bank

Exactly one year ago, I received an unexpected call from my manager just as I was finishing a week of paternity leave following the birth of my daughter.   She asked me to lead an “absolutely urgent” project and said she was cutting her summer break short to return to the office.    That project was on Ebola response. We had monitored Ebola cases in Guinea, Liberia and Sierra Leone over the previous months with growing concern, but now the World Bank was mobilizing its first emergency funding commitment to help the three affected countries contain the disease’s spread and help communities cope with the economic fallout.

We’ve learned a lot in the last year. As the Bank’s financing commitment for Ebola response grew to the current level of $1.62 billion, Bank staff and our many partners faced unprecedented challenges and discovered solutions that have stretched the boundaries of what and how we can deliver services to countries in crisis. We had to get it right for all affected by this terrible disease, which has, to date, taken more than 11,000 lives and infected more than 27,000.
Two challenges in particular illustrate how close collaboration and creative thinking led to positive results.
Our first challenge was how to respond with speed and flexibility. As of August 2014, the Ebola outbreak   was escalating, and yet no one had been able to deliver a substantial amount of personal protective equipment (PPEs) and essential medicines to the three hardest hit countries. In order for the Bank to disburse fully our initial $123 million in 45 days, from scratch, and enable the countries to start full-fledged responses, we formed a 100-member team across seven different sectors (e.g., health, social protection, governance, IT, finance and markets); deployed our senior health specialists to Guinea, Liberia and Sierra Leone, as well as to WHO headquarters; and worked as a team with the governments, UN agencies, nongovernmental organizations, and bilateral partners.
We asked: “What needs to be done urgently, and who can do it fastest in the most efficient way?” We fully disbursed our initial funds to 15 implementers in the three countries, including the governments and UN agencies. We also took informed risks, together with the governments and partners.  UNICEF, for example, secured a large batch of PPEs and essential medicines and delivered it to Ebola treatment centers even before the Bank’s Ebola emergency response project had been approved by our Board of Directors, using our reimbursement mechanisms. As a result, Bank funds catalyzed the Ebola response in all three countries.
A second major challenge arose when we needed to make key decisions without sufficient information. Providing hazard pay to Ebola response workers in the three hard-hit countries, for example, was initially daunting. In Sierra Leone and Liberia, we started with a dearth of information on such workers:  many on the beneficiary list had no titles, no clear assurance that they actually worked, no identification, and no information to allow any automated payment.
It was professionally rewarding for me to see how different partners can work together efficiently, under the leadership of the government, to turn such situations around. In Sierra Leone, the government hired an accounting firm to strengthen fiduciary management.  Internal auditors and anti-corruption agencies, together with UNDP and an IT firm, provided oversight on  cash payments to workers, while verifying the work they do, collecting  payment information, and later issuing IDs and contracts to “formalize” workers.
A national hazard payment policy for Sierra Leone, outlining rates for different cadres, worker verification and a payment process, was literally written together with all front-line agencies and managers, pillar leads from the Ministry of Health, National Ebola Response Center staff, UNMEER and U.K. government coordinators, and UNDP, African Development Bank, and World Bank staff, by projecting the draft on a wall. The government, UNDP and an IT firm created an online database, and a consortium of telecom providers developed an e-payment system. Having tried, earlier in my career, to set up an e-payment system in Nigeria, I was skeptical that we could pay workers in rural areas of Sierra Leone through e-payment, but the system started covering most of the affected health workers within 1-2 months of its launch.  
These are just a few examples of how the Bank and our partners challenged ourselves to support Ebola-affected countries effectively. For sure, we experienced shortfalls and bitter lessons learned, too. The absolute sense of urgency and threat that the Ebola outbreak created, however, encouraged each stakeholder to focus on solutions and results, collaborate as a team openly under the government’s leadership, and be innovative in solving problems.
It is  good to see that this  “new tradition” of collaboration continues in each country as we now transition to recovery of essential health services and rebuilding of resilient health systems, with a sense of trust built through the joint Ebola response.
We should take it as a collective challenge to build on the assets of the Ebola response, as we refine development and partnership approaches in the post-2015 era. The Bank remains fully committed to provide rapid, flexible and effective support to help Guinea, Liberia and Sierra Leone get to and remain at zero Ebola cases. We will also continue to stretch ourselves, to improve our effectiveness as we work toward recovery and rebuilding of the health sector in the three countries.
Follow the World Bank health team on Twitter: @WBG_Health
World Bank Ebola Response
World Bank Ebola Response Fact Sheet
Pandemics Emergency Facility

Jim Yong Kim Op-Ed: Are we prepared for the next global epidemic? (Aug. 5, 2015)

World Bank Flickr: Ebola Crisis


Shunsuke Mabuchi

Senior Health Specialist

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