In 2017, a Dengue Fever outbreak in Burkina Faso resulted in 12,087 cases and 24 deaths mostly in the central region. Such outbreaks have historically placed a major strain on Burkina Faso’s public health system and recently led to a call for a more coordinated emergency response mechanism. To this end, the Government of Burkina Faso commissioned the creation of a Public Health Emergency Operations Center (EOC) in 2018, to bolster national capacity to detect, prevent and respond to public health emergencies. EOCs lie at the heart of an effective emergency response system, convening actors and centralizing coordination, preparation, operations, data collection, and communication.
An EOC can play a major role in preventing a crisis from turning into a full-blown disaster. The 2014-2016 West Africa Ebola outbreak is a good example. The outbreak resulted in over 11,000 deaths primarily in Guinea, Liberia and Sierra Leone and in GDP losses of over $2.2 billion in 2015. This was in addition to several other socioeconomic losses e.g. Liberia lost 8% of its doctors, nurses, and midwives to Ebola while Sierra Leone lost 7% of its healthcare workers. Contrast this with the situation in Nigeria where an EOC was established utilizing systems and public health resources from its polio eradication campaign and staff from partner organizations. The Rapid Response Teams (RRTs) quickly identified and tested thousands of potential contacts resulting in a relatively low casualty rate of eight deaths. While there were other factors that prevented Ebola from spreading throughout Nigeria, the presence of a functional and coordinated system certainly was a contributing factor.
Less than two weeks after Burkina Faso’s EOC, the Operational Center for the Response to Health Emergencies – Centre Opérationnel de réponse aux urgences sanitaires (CORUS) – had been inaugurated on 18 December 2018, it was put to test. On New Year’s Eve, a group of terrorists arrived on motorbikes in the village of Yirgou, Barsalogho Commune in the Northern part of Burkina Faso. Having killed the chief and five other people in the community, they hastily retreated from the area. While the national and regional security bodies were working on securing the area and bringing peace to the region, a lesser known crisis was at the risk of developing in the background – the spread of meningitis in affected areas that could lead to a widespread health crisis.
With the mass displacement of close to 15,000 people in conflict-affected areas and camps for the internally displaced people (IDPs), Burkina Faso was experiencing increasing cases of meningitis infections and other public health threats due to the populations’ displacement. Given the high risk of a meningitis outbreak, the Ministry of Health gave signed orders for the activation of CORUS on 14 January 2019. CORUS’ key tasks included (i) determining the needs for drugs, technical medical equipment, vaccines, nutritional inputs and mosquito nets; (ii) establishing an epidemiological surveillance system; (iii) running a vaccination campaign against measles and meningitis; (iv) providing medical and psychosocial care; (v) screening for malnutrition; (vi) providing Vitamin A supplements; and (vi) deworming.
According to Dr. Brice Bicaba, the Director of CORUS, “within a few hours of the mandate being given, we were able to have a meeting in which we reviewed information on the growing meningitis crisis that had been collected by relevant partners on the ground. Everyone understood the chain of command and our role.” In daily crisis meetings with Ministry of Health officials and weekly meetings with other partners on the ground—such as UNFPA and Médecins Sans Frontières — CORUS constantly assessed the evolving situation, mobilizing the required resources and personnel as needed. This included sending RRTs wherever needed, deploying more staff to vaccinate people, and strengthening community-based surveillance and contact tracing.
In the absence of CORUS, Dr. Bicaba estimates that it would typically take 5-7 days for initial meetings to be organized – time which is vital in stopping the spread of an epidemic. Dr. Bicaba also credits the immediate access to emergency funds from the Bill & Melinda Gates Foundation as being a critical aid in responding to the situation in a timely manner, allowing CORUS to immediately deploy a team to the region.
According to Dr. Herve Hien, the Director of the National Institute of Public Health (INSP) – which houses CORUS – the immediate support from the Ministry of Health was also a key factor in the success in curbing the health crisis: “The Minister of Health gave us immediate access to officials of the relevant departments (nutrition, epidemiological surveillance, noncommunicable diseases, drug supply, vaccination) that we would need for our work. This was in addition to mobilizing the relevant local and regional healthcare workers.”
Despite CORUS’ success in curbing the crisis, it wasn’t all smooth sailing. Leadership transitions in the government before and after the inauguration of CORUS brought with them a certain level of uncertainty. Fortunately, there were no adverse effects to how CORUS operated even during these transitions. It shows that the EOC is carried by an entire system and not a single person. Working as part of the national system was a key success factor for CORUS. Additionally, there were practical challenges on the ground. According to Omar Taparga, the Head of Communication at CORUS, it was difficult to get people to adhere to certain behavioral changes that would limit the spread of the epidemic. Many were wary of being vaccinated and the flux in the population as people moved around was an added challenge. It was also difficult to keep healthcare workers motivated given the intense work schedule during the height of the crisis and the obvious fear of insecurity even if the region had been secured for the most part.
CORUS’ experience in handling the situation in Yirgou is unique in that having only been inaugurated in December 2018, it was now being called upon to act in a health-related emergency that was taking place against the backdrop of a security crisis. CORUS was activated for a total of 45 days and was effectively able to pull out at the end of February 2019 declaring the health crisis in the area as having been effectively contained. The fact that the team was able to intervene early on in Yirgou was a key factor in quickly curbing the spread of the meningitis epidemic.
The recent experience of CORUS can hopefully highlight the importance of having EOCs in other African countries. It shows how they can effectively limit damages whether in the context of a public health crisis in isolation (e.g. the West Africa Ebola outbreak), a natural disaster (e.g. Cyclone Idai in Mozambique, Zimbabwe and Malawi) or man-made crisis such as the recent events in Yirgou, Burkina Faso. Finding the right model for a national emergency response system requires careful strategic thinking to address questions around anchoring, mandate, organization, processes and sustainability. To ensure this, time must be taken right at the design stage, working with the chain of actors across the system to understand their current and future roles. The system needs to be resilient in the face of a real emergency. The Government of Burkina Faso took the time to establish an emergency response system, which was extremely instrumental in ensuring all the different actors were able to act to effectively tackle the crisis.
Since the 2014-2016 Ebola crisis in West Africa, the Bill and Melinda Gates Foundation (BMGF) and Dalberg Advisors (www.dalberg.com), a strategy consulting firm specialized in building solutions to address development challenges, have jointly supported several West African governments to create or strengthen their EOCs. This includes CORUS in Burkina Faso.