“Once you’ve poured the water out of the bucket it’s hard to get it back again” (Chinese proverb)
Neither the WHO, DANIDA or any other international donors have an excuse for the uncontrollable behaviour of the Ebola epidemic. There is tons of knowledge and donors have had time to pick it up, just as they have had time to act on it.There are five things donors have ignored, overlooked and misinterpreted.
One is that there is extensive evidence that the quality of care in many public hospitals in West Africa has maintained the same unacceptable level for decades.
The second is that the management of global epidemics requires that there is one strong, competent and financially prepared authority and a functioning global network of researchers, laboratories and epidemiologists as well as the necessary political contacts which could force necessary solutions through. WHO should have been be the global health agency, but has been constrained by the larger countries that would rather give money to health programs they have established themselves. Private actors such as the Gates Foundation have with the world’s acceptance taken over many of the tasks that the WHO previously was in charge of.
Thirdly, WHO has restricted its own opportunity to be able to act quickly with its inappropriate career system that rewards anything but skills and WHO has given too much autonomy to the regional WHO offices resulting in low competencies in some offices.
The fourth factor donors have overlooked is that epidemics move with people and if they change behavior so will the epidemic change behavior – with subsequent unpredictable risk environments.
Finally, WHO and the rest of the world overlooked the fact that while Ebola epidemics previously were known as small Ebola epidemics started by game hunters and farmers in relatively isolated rural areas, it could apparently spread seamlessly in slums or post war zones and defenseless fragile health care systems.