The West African Ebola outbreak in 2014 captured the attention of the world. It also saw unprecedented cooperation between global health experts, country leaders, and communities working together to bring the outbreak to an end. Lessons were learned, and new tools were created to prepare for the next Ebola outbreak. In early 2018, we all celebrated the enormous success of the Ebola vaccine and the quick response of the government of the Democratic Republic of the Congo (DRC) in ending an outbreak in Equateur Province.
Unfortunately, one week after the Equateur outbreak was declared over, new cases began to emerge in the eastern part of the country. Ebola was back in the DRC.
Making the right decision, fast.
Deciding how, when, and where to respond to an outbreak is critical. And the faster, the better. In the DRC, these decisions are made at the Emergency Operations Center (EOC)—the national-level strategic command center of disease response in the country. Here, the Minister of Health and the National Ebola Surveillance Commission gather physically and virtually to guide the response. In Kinshasa, the national EOC is staffed by Ministry of Health (MOH) personnel with the support of PATH, the World Health Organization (WHO), and others, tracking and monitoring disease outbreaks across the country. A temporary EOC was also established in Beni, at the frontline of the current Ebola outbreak, by the MOH, WHO, and MONUSCO (the United Nations peacekeeping force). Together, these two EOCs serve as the communication and information backbone of the response effort—where data are collected and analyzed, and decisions are made.
PATH has partnered with the MOH to streamline the collection of high-quality data, understand what the data are telling us, and make quick, data-led decisions. Using the existing National Health Information System based on District Health Information System 2, PATH created a dashboard for monitoring Ebola cases. Updated daily, this dashboard provides real-time information on important indicators like the epidemic curve, case data, contact-tracing, treatment, and timelines. The Minister of Health and his team use this dashboard to stay informed at all times.
Monitors mounted on the walls cycle through maps, graphs, and charts displaying different aspects of the outbreak. These maps—the collective work of a consortium of partners, including the United States Centers for Disease Control and Prevention (CDC), WHO, the DRC’s Expanded Program on Immunization, the DRC’s National Health Information System team, the United Nations Children’s Fund, Médecins Sans Frontières, the University of California, Los Angeles, OpenStreetMap, and the Center for International Earth Science Information Network—show where new cases are appearing. Other charts and graphs show information on demographics and progress of the different response efforts. All day, the data are a constant reminder of what has been accomplished and what still needs to be done.
Getting the experts in the room.
Each morning, these same monitors host a web conference between the EOCs in Kinshasa and Beni. The data are reviewed piece by piece along with any activities planned for the day. These video conferences create a unique sense of intimacy and solidarity between national-level decision-makers and those working on the frontlines. It’s an approach that bolsters the sense of teamwork and helps keep everyone on the same page.
Having strong communication links at the EOCs also provides the opportunity to bring in experts from around the world. Ebola experts in Kinshasa, West Africa, and Atlanta can have direct access to the data, and more importantly, to the people at the center of the outbreak. Advice, decisions, and problem-solving can happen in real time, with everyone on the line together.
“ It was a perfect example of getting the right people, the right data, and the right technology together to address a pressing public health emergency. ”— Trad Hatton, PATH DRC Country Director
A biweekly video conference has been established between the two EOCs and CDC headquarters in Atlanta. CDC Director Dr. Robert Redfield, Minister of Health Dr. Oly Ilunga, and a host of others join these calls to help shape the future of the response. As Trad Hatton, PATH’s DRC Country Director, reflected, “Seeing Dr. Redfield speaking directly with Minister Ilunga in Kinshasa and the frontline team in Beni for the first time has been one of the most satisfying moments in my public health career. It was a perfect example of getting the right people, the right data, and the right technology together to address a pressing public health emergency.”
The same approaches, better.
Partners continue to build off of the strategies that proved effective during the outbreak in Equateur Province, using digital technologies to increase the speed and efficiency of these approaches. Mobile phones are helping health workers report and monitor individuals who have come in contact with an Ebola-infected person to catch signs of the virus early. Digital tools support the supply chains and information systems that ensure vaccines are available where they are most needed. All of this information passes through the Kinshasa and Beni EOCs, creating a dynamic repository for data and knowledge about the outbreak.
PATH and its partners are constantly looking for ways to improve the speed and reliability of data collection and communication in this outbreak. Simple messaging applications like WhatsApp are being used to communicate with everyone from health workers to Ministry staff. Because the application can operate on low bandwidth, it works in most areas, and is widely preferred by teams for real-time response coordination. It provides a 24/7 channel of communication between decision-makers, experts, and the EOCs. Mobile money applications are also being assessed as a potential tool in this response, as they would allow for funds to be transferred via mobile phone. Currently, health workers in eastern DRC struggle to receive payment for their lifesaving work, as it can be difficult, dangerous, and sometimes impossible to deliver cash to their towns. Using mobile money could ensure that local health workers are paid on time and in full, so they have the resources they need to provide care to patients and reports to the EOC.
New challenges to overcome.
The Ebola response is supported and guided by the CDC’s Global Health Security Agenda. This agenda identifies the DRC as one of 31 focus countries requiring specialized guidelines to prevent, detect, and respond to outbreaks. The lessons we are learning from this outbreak will continue to strengthen the DRC’s response to outbreaks in the future—not only of Ebola, but also of other diseases—and provide best practices that can be implemented around the world.
We are still in the midst of responding to and containing the Ebola outbreak—our work is far from done. But we have forged strong partnerships with a dedicated Ministry of Health and experts around the world. Our response is fortified with new tools like the Ebola vaccine, better systems for gathering data, and communication channels at all levels. There is no place better equipped to address this outbreak than the EOCs in Kinshasa and Beni. Together, we’ll see this through to the end.