CRISIS RESPONSE: TA TO AFRICAN UNION TO SUPPORT COUNTRIES MOST AFFECTED WITH EBOLA EPIDEMIC
- Reference: P-Z1-KF0-044
- Approval date: 26/01/2015
- Start date: 29/09/2015
- Appraisal Date: 31/08/2014
- Status: OngoingOnGo
- Implementing Agency: African Union Commission (AUC)
- Location: AFRICAN UNION COMMISSION - ADDIS ABABA
Deployment of external medical personnel: The UA1.5 million (USD2.3 million) supplementary financing will specifically support the following costs related to deployment:
(i) screening and selection,
(ii) logistical/transport costs of medical personnel;
(iii) insurance cover of medical personnel;
(iv) pre-deployment training costs; and
(v) deployment of medical personnel. The project expected output is deployment of 150 external medical professionals that include medical doctors, nurses, pharmacists, clinical officers, social workers, hygienists, public health workers, and Lab technicians. These will be deployed to the affected countries for a period of 4 months.
The specific objective is to help address a critical gap in the medical human resource capacity to better respond to the Ebola outbreak at the country level while strengthening monitoring and evaluation at the regional level, including in countries that are marginally or could potentially be affected
STRATEGIC THRUST & RATIONALE 1.1 Fragility Context
1.1.1 Liberia, Sierra Leone and Guinea experienced several decades of fragility, instability and conflict between the late 1980s and 2000. Since the early 2000's the three countries have made tremendous progress in consolidating peace and rebuilding state institutions. Despite recent gains, the period of conflict and instability left a legacy of weak governance systems and institutions, as well as poor and inadequate infrastructure. The region suffers from low human capacity, and has one of the lowest doctor to patient ratios in the world, and a dilapidated physical infrastructure without sufficient roads, schools, and hospitals. In short, the three countries are a classic case of what fragility entails.
1.1.2 The prevailing peace and stability and recent growth had raised optimism in the region, with all countries on a recovery trajectory. But, the Ebola outbreak has quite dramatically exposed these weaknesses of state capacity and social resilience. It is also interrupting the trajectory of steady recovery in the region, inflicting significant economic costs and negatively restructuring social relations. The difficulties and challenges faced by the three countries in responding effectively to the outbreak have their basis in the institutional and human capacity breakdown arising from a long term fragility.
1.1.3 Addressing the drivers and effects of fragility is one of the areas of special emphasis for the Bank within the context of its Ten-Year Strategy. For Liberia, Sierra Leone and Guinea, meeting the institutional and human capacity gaps in the health is vital in putting an end to the current crisis now, but also halting economic and social decline.
1.2. Project linkages with regional/country strategy and objectives
1.2.1 The proposed operation is aligned with the Bank Group's Ten-Year Strategy 2013 - 2022, the strategy for Addressing Fragility and Building Resilience in Africa (2014 - 2019), and the West Africa Regional Integration Strategy Paper (RISP; 2011 - 2015). All the strategies consider fragility as a major constraint to the realization of the development potential of many countries in the continent. More importantly, fragility is one of the three areas of special emphasis in the Bank's long-term strategy, with the other two being agriculture and food security, and gender. It also notes that fragility is episodic and calls for tailored responses. In the context of Ebola, or any other crisis for that matter, timely responses to the complex challenges presented is critical to limiting the contagion effect. Besides, the Ebola epidemic has exposed the institutional and capacity weaknesses of the affected countries, issues that were identified in the West Africa RISP. 1.2.2 More importantly, in approving the Bank Strategy for Addressing Fragility and Building Resilience in Africa, the Board called for innovation and thinking out of the box in its implementation. Acknowledging that there is no toolkit in addressing fragility, this proposal seeks to build on the aspirations for Africans to assist each other when faced with shocks. This proposed support to the affected countries, therefore, is in sync with the aspirations of the African Union as expressed in the African Solidarity Initiative. Other African countries such as Uganda have had Ebola infections in the past and have valuable experiences and capacity in managing similar cases hence the transfer skills necessary to address the challenges of the current epidemic. Additionally, the human capacities of African countries differ. Opening a window of opportunity to enable African health professionals to assist in these efforts would also help in building a response system that could be used in similar situations of emergency.
1.3. Rationale for Bank's involvement
1.3.1 The proposed project builds upon the Bank's interventions through the provision of resources for technical assistance, particularly in Liberia and Sierra Leone. It also augments the resources made available through the recently approved Bank contribution (USD 60 million) to the short-term response (July-December 2014) under the WHO's led EVD Outbreak Response Plan of West Africa and USD 3.1 million under emergency response, the USD 150 million Ebola Sector Budget Support that is concurrently being designed. Through these responses, the Bank has contributed to the long-term multinational response program of approximately USD220 million that seeks to address some of the fragility drivers through building the human resource capacity and systems for epidemic preparedness and response, developing infrastructure to boost active surveillance and control in frontline services and health services as well as strengthening governance and regional institutions 1.3.2 This project responds to the unique situations facing the Ebola affected countries. It seeks to contribute to reducing the length of the current Ebola episode through scaling-up treatment and response capacity in the affected countries through the procurement of health workers and incentivizing the local staff. The project supports the prevention capacity of the affected countries. As part of building sustainable health system, this project also supports scaling up of community health workers in these countries in order to raise awareness at individual and household levels. These health workers will be trained for one year on a curriculum designed to address preventive, promotive and basic treatment aspect of Ebola and other epidemic diseases. Negotiations will be conducted with MOFs to ensure that these health workers will be hired on full time basis to strengthen health systems in the affected countries in a sustainable manner. Through this project, the Bank is also demonstrating the collaborative nature of its different departments, working seamlessly in responding to the evolving situations related to the Ebola crisis in its member countries. All three countries endured a long period of conflict and instability from the late 1980s to as recently as 2004. While violent conflict has abated, long period of unrest and conflict depleted and destroyed human capacity, leading to one of the lowest doctor to patient ratios in the world. The conflict also led to the destruction and the dilapidation of physical infrastructure such as roads, schools, and hospitals. The effects have been a degradation of infrastructural, human and institutional capacity which is currently being reflected in the region's difficulties in responding to the recent outbreak of Ebola. 1.3.3 The outbreak has claimed lives of communities, health workers in these three most affected countries. In one of the worst cases at Redemption Hospital in Liberia 23 out of 25 nurses that contracted the virus died. Ignorance among some communities also pose a risk to health workers, with the recent incident of eight (8) health workers trying to raise awareness being hacked to death in Nzerekore in Guinea by villagers using machetes and clubs. Besides the health related impacts, the Bank recognizes that the current Ebola outbreak has also affected social and economic activities due to isolation procedures and through death of breadwinners (Appendix I). The extractive and service industries, including transport, hotels and restaurants and trade have suffered the most. The agriculture sector has also lost its workforce as workers deserted affected rural areas. Emerging evidence indicates the risk of fiscal imbalances, as governments allocate more resources to fight the scourge. Estimates of unbudgeted expenditures in Liberia, the worst affected country, amount to USD 126 million (22% of current budget); USD 66 million in Sierra Leone (12% of budget) and USD 110 million (2.9% of budget) in Guinea. These estimates could be optimistic as the slowdown in economic activities will negatively affect revenue collections. Guinea, Liberia and Sierra Leone are now projected to shed-off between 2.4 % to 3% of their economic growth in 2014. This will result in lower revenue inflows, impacting the fiscal balances in the countries concerned. Food security is also of concern, there is a high risk of nutrition- related ailments especially for infants, owing to the reduction of farming and harvesting activities. It is in this context, the Bank is preparing a USD 150 million budget support program in order to secure recent gains and reduce the risks of reversal. 1.3.4 The Bank and other development partners are currently developing responses to the medium- to long-term challenges. Addressing some of the immediate challenges in the response is however, critical. Such an approach acknowledges the existing fragility of the affected countries, the strain on health delivery systems, risks to regional security and development imperatives. The Ebola epidemic has also accentuated gender imbalances, with women bearing the greatest burden of caring for the sick.
The project expected output is deployment of 150 external medical professionals that include medical doctors, nurses, pharmacists, clinical officers, social workers, hygienists, public health workers, and Lab technicians
MKANDAWIRE Timothy Blackwell Kausipa - RDGW4