The World Bank’s support for countries facing deadly Ebola outbreaks contain some pertinent lessons for the current fight against COVID-19—and responses to future disease outbreaks.

Collateral benefit

Building incident management system capacity in countries for one disease benefited responses to other risks. For example, an established polio incident management system in Nigeria made it possible to effectively control an Ebola outbreak in that country in July 2014.

The efforts against Ebola from 2014 to 2019 ranged from collaboratively planning the World Bank’s response across countries, to support for addressing mental health and nutrition issues at the start of the response and improving school hygiene to ensure the safe return of children after the crisis was over.

The World Bank Group’s Independent Evaluation Group extracted the Findings for COVID-19 from the World Bank’s Support to Address Ebola Outbreaks from a rapid review of the institution’s support for addressing Ebola outbreaks in Liberia, Guinea, Sierra Leone (2014–16), and the Democratic Republic of Congo (2017–19).

Local and national coordination

The World Bank helped set up joint monitoring with the government and other partners of the outbreaks and response, with monitors in the communities using smartphones for real-time data tracking and for patient feedback. The World Bank also strengthened information sharing from the response at the local level, both across countries and within countries. These were useful ways to improve the coordination of emergency operations efforts at all levels.

Another component was emergency budget support to governments, to ensure that they could carry out their Ebola response plans. For instance, in Guinea, at a time when tax revenues were reduced because of Ebola and a decline in mining revenues, a World Bank project contributed to national Ebola-related spending to finance treatment centers, training of health workers, and national sensitization campaigns.

Financial incentives for frontline workers also were critical in scaling up the response to the West Africa outbreaks. The World Bank supported training of more than 30,000 health workers, who along with volunteers, took on tasks ranging from early case detection to safe burials. At the height of the epidemic, approximately 40,000 community health workers and other volunteers received a graduated rate of compensation, depending on the risk category assigned to their role. Emergency workers, frontline health works and others, also benefited from a formal hazard payment system. These payments depended on a transparent and accountable financial incentives system, which included a list of beneficiaries, a reliable cash transfer system, and routine monitoring and reporting.

The World Bank supported improved contact tracing, under which more than 37,000 community health workers and other volunteers were deployed for door-to-door communication and case identification in Guinea, Liberia, and Sierra Leone. This surveillance required support at the community level, from stakeholders including traditional and religious leaders, women, and youth. Also critical was a comprehensive database of contacts, to track the number of cases and provide analyses of trends in the outbreak.

Laboratory and treatment response

Access to laboratory testing at community level—such as local facilities with equipment and trained technicians to conduct timely testing—was crucial to identify Ebola cases. This access to local testing in “hot spot” areas of the outbreak allowed quick collection of samples, to avoid the risk of further transmission. The World Bank supported improvements in laboratory capacities in Guinea, Liberia, and Sierra Leone. Furthermore, cross-border collaboration and networking among laboratories in this subregion helped improve their weak diagnostic capacities. However, during COVID-19, these countries often requested funds for the same supports as during Ebola: improvements to surveillance, laboratory capacities, and health workforce recruitment and training. Thus, investments in these response systems should be preserved and built on between outbreaks.

In late 2014, more than 50 Ebola treatment centers were needed and only 16 were operational. Therefore, Ebola patients tended to remain at home, which led to further transmission among families. The World Bank supported the establishment of community treatment centers, where infected patients could be isolated and receive basic care. The organization also provided drugs, protective gear, and other medical supplies and helped set up logistic hubs, jointly used by all partners to stock supplies. Initially, procurement of supplies through United Nations agencies was not fast enough. Therefore, direct contracting of local medical supply providers should be used in emergency situations.

Related health and nutrition issues

The Ebola crisis absorbed funds originally allocated for maternal and child health. World Bank measures to ensure the continued use of essential health services during the outbreak included providing free medical supplies for non-Ebola illnesses, reimbursing travel costs or offering transport to health facilities, providing psychosocial support and food and nutrition assistance, and improving water and sanitation in health facilities. These helped overcome the population’s fear of using health services. Also, efforts in Sierra Leone supported by the World Bank to encourage closer links between traditional and modern health system providers, and to train health care workers in cultural sensitivity, improved access to health care.

World Bank mental health interventions were designed to reduce depression, decrease stigma, and increase levels of trust at the community level. The institution supported services ranging from treatment at mental health facilities to community healing dialogues for more than 20,000 people in Liberia, and psychological services provided by more than 1,000 trained community volunteers in Guinea.

Nutrition challenges arose because quarantines, travel restrictions, and fear of infection complicated efforts to organize farming teams, prepare fields for planting, maintain a steady supply of seed, and market produce. As a result, hungry farming families resorted to eating seed intended for the next cropping cycle. World Bank measures included food support: people in quarantined areas and affected households received food, and children in Guinea were fed at school. However, there was no protection for the planting season. Support to assure access to food and prevent undernutrition of children must be part of emergency planning at the onset of a pandemic.

Lessons from Rebuilding after Ebola

  • Support for teacher training and improvements in school classrooms and sanitation expedited the safe return of students.
  • Flexible grants and cash transfers helped support vulnerable households and geographic areas affected by Ebola. This included funds for safety nets, orphanages, female-headed households, reopening of schools, and seed and fertilizer for farmers.
  • Short-term employment helped vulnerable groups recover their assets and reengage in services.
  • Continued support to improve surveillance, laboratory capacities, and health workforce training for preparedness between epidemics.
  • Support to recover essential health services and strengthen the continued delivery of services in the re-emergence of the epidemic, such as in areas of immunization, and improving reproductive, maternal, neonatal, child, and adolescent health services.
  • Continued support for public financial management reform opportunities that emerge from the pandemic.
  • Support to restore the agriculture planting seasons and child nutrition to prevent the deepening of undernutrition in communities.

Pictured above: 16 January 2019 - Beni, Democratic Republic of Congo. Health workers put their gloves on before checking patients at the hospital. Photo credit: World Bank / Vincent Tremeau

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