How APC Caused the Spread of the Deadly Ebola Virus Disease!
By: Jacob Jusu Saffa, Guest Editor (10/01/18)
Fingers are now pointing directly at the corridors of the APC governement for the careless spreading of the Ebola virus in Sierra Leone.
In December 1989, armed forces of the National Patriotic Front of Liberia (NPFL) under the leadership of Charles Ghankay Taylor launched an attack on Liberia through a northern town in Nimba, bordering Ivory Coast. Quickly, the NPFL overran major towns and approached the capital city, Monrovia. Acute humanitarian crisis loomed the country with splinter fighting groups everywhere. ECOWAS responded by quickly establishing ECOMOG to help control the situation and create safe corridors for humanitarian support.
Under the watchful eyes of ECOMOG, Samuel K Doe (then Head of State) was assassinated in a brutal manner by Prince Johnson's mad INPFL rebels, unprecedented in the history of Africa. The then APC government received credible intelligence that Sierra Leone would be the next target. Even Charles Taylor on a BBC broadcast informed the world that Sierra Leone would taste the bitterness of war. He truly followed that statement with action. He supported the mobilisation of disgruntled Sierra Leoneans in Liberia to form the Revolutionary United Front (RUF) led by Foday Sabannah Sankoh.
On March 23, 1991, the RUF launched an attack on Bomaru, Upper Bambara, Kailahun district, eastern Sierra Leone. Within a year, the RUF had taken over many towns and villages in the East and South of the country. The excuse by the then reckless Momoh regime was that they were not prepared for war and did not have experience in guerilla warfare. That war was ended by the SLPP led Government of Ahmad Tejan Kabbah after 11 years of brutal onslaught on the people of Sierra Leone.
President Ernest Koroma in 2007 promised to run Sierra Leone like his predecessors, Joseph Momoh and Siaka Stevens. He has indeed done what he promised. He and his cronies kept saying, EVD was new and they had no experience in managing it. This was an indictment and nothing could have been more reckless than that. It was an utter bunkum and Sierra Leoneans should dismiss it. Any responsible government should be prepared to manage disaster. If it cannot, then it has no place in governance.
The first EVD outbreak in the Mano River Union (MRU) was in Guinea in March 2014 followed by Liberia a month later. In Sierra Leone, our first outbreak was on May 25, 2014. Between March and end May, 2014 our government led by the then Minister of Health and Sanitation, Miatta Kargbo and Minister of Information and Communications, Alpha Kanu were busy telling the public that government was prepared for any outbreak and assured the nation that a government had the wherewithal to tackle any outbreak.
In particular, Alpha Kanu was busy demonising Dr. Sylvia Blyden who was very honest in her reports on the spread and management of the disease. She was forthright to raise the alarm and warned the government about our ill preparedness to manage the scourge. Yet, nobody listened. Between June and July, the Ebola had spread in many towns and villages in Kailahun and Kenema District and by August, we had our first outbreak in the Western Area.
Affirmatively, I can establish that the management of the EVD was poor in the first three months and the APC was responsible for the spread of virus to many more communities in the country for the undermentioned reasons.
First, the APC government was indecisive and failed to effectively man or close our borders throughout the EVD period. Few months ago, the Minister of Internal Affairs, J B Dauda (Late), publicly accepted the fact that our borders are poorly manned and by extension we are vulnerable to attack and disease outbreak. The Government of the Gambia like many other serious governments even banned persons travelling from Sierra Leone to the Gambia.
The Gambian government was responsible enough to realise that such outbreak would not only cause loss of lives, but a slowdown in economic activities as well as damage to our international reputation. Sierra Leoneans were denied entry Visas to some countries and for two years now, we did not participate in the yearly pilgrimage in Mecca. Our spurious defence as a nation remains to be the porousness of our borders and the fact that border closure has serious implications. What could have been more eccentric like this?
Second, this government was busy collecting money and establishing bogus structures instead of strengthening existing state institutions. A friend of mine once shared with me at a community joint as follows “Borbor, you watch TV yesterday, de Pa en mammy dae collect Ebola money (meaning both President Koroma and Wife, Sia Koroma were receiving donations). An unwieldy Presidential Task Force was established with very ambiguous focus. Months later, an operational body referred to as Emergency Operational Centre (EOC) with conflicting roles with the Task Force and Ministry of Health. Already, we had state institutions like the Ministry of Health, Local Councils, Office of National Security (ONS) that houses the Disaster Management Unit and NGOs working in the health sector.
After 7 years in office, the APC failed to strengthen capacities for managing disease outbreak despite all the loud talk about commitment to national health care. Our capacity for disease surveillance continues to be weak, our laboratories are still nothing but mere structures with poor capacity for basic diagnosis and only a few districts had functional ambulances despite the huge resources provided in previous years.
Third, the initial commitment of the APC government to fighting the scourge was tepid in every respect, largely because it has no compassion for where the disease started. Instead, they were busy blaming the Kailahun district MPs for spreading false rumours about the disease. No budgetary resources were made available to the then affected local councils and chiefdoms for social mobilisation. Instead, the councils were instructed to vie money from funds disbursed to them earlier and were already committed for other activities. It was much later; government disbursed funds for constituency development and instructed that such funds be used for social mobilisation.
Fourth, it was nearly 3 months when this hopeless and corrupt APC government succumbed to pressure from the Civil Society, particularly the fourth estate to institute a State of Public Emergency. In fact, President Koroma wanted to travel to the US for UN General Assembly but the pressure from the Civil Society led by Lamarana Bah and Umaru Fofanah. He eventually cancelled it in shame when his counterpart, President Ellen Sirleaf of Liberia did so.
Fifth, president Koroma only visited the eastern regional towns of Kenema and Kailahun two months after the outbreak. His earlier visit would have indicated his commitment to fighting the disease, motivated the frontline workers, heard from affected communities the true story and given him a better sense of what to do. Sure, that would not have been the case if the first outbreak started in Bombali. The bogus argument by the government’s spokesman after the public outcry was that, “during war commanders do not go to the front”. If Alpha Khan was a scout during his school days, he would never have said so. I am not military man but I know serious commanders lead in battles.
Sixth, the management of Ebola funds was reckless. The Audit report on management of EVD confirmed this. There was no system for approving of activities, no monitoring of the use of such funds and no report. Some activities were approved by the Task Force, the Minister of Health, the EOC and sometimes by the President using his ‘Supreme Executive Authority’. It was a messy situation. To date, nobody knows what this government received in cash and kind and how it was spent. The argument is that it was an emergency context. This is hogwash at best. We have adequate provisions for procurement and financial management in emergency situation. All guidelines were ignored because the operating context provided them the opportunity to embezzle state resources.
Seventh, between March 2014 when the EVD started in Guinea to end May 2014 when we had the first outbreak, this government failed to assess our human capacity to handle the disease. We had sufficient time to have sent a delegation to DRC and Uganda to gain first-hand experience of how to manage such deadly disease. We cannot say we lacked the resources to do so. If we can spend huge amounts on Presidential delegations why not do so for the well-being of our people. Such study tour would have enhanced our capacities to detect an outbreak, manage the spread of the disease and care for infected persons. The mediocrity in this government and its naive outlook of serious issues could not allow them to think about that.
Eighth, unlike what the governments of Cote d’Ivoire and Mali did, this government failed to establish holding centers in border towns and even treatment centre in readiness for possible outbreak. The Ivorian and Malian Government established holding centres and treatment centres to curtail the spread of any outbreak. This explains why Mali was quick to stop the spread of initial outbreak. Additionally, basic things like PPEs were not available and our frontline workers never benefitted from local training within the first three months of the outbreak.
Ninth, by the time of the outbreak, as a consequence of its record of corruption as revealed by the MCC report card, the APC government has lost donor confidence. It was not initially capable of mobilizing international support. President was crying all over the place for donor neglect and call for assistance. It was only when US had the outbreak and the fear of further spread that the WHO through the influence of the US, the EVD was declared an international health emergency. It was only then donor started supporting the country to fight the disease. Thus, the international support provided was effortless and was so to prevent the spread to other countries and a global crisis. This government had no credible system to track donor inflows. In fact, it does not serve the interest of this Government to have one since such messy situation creates a perfect platform to duplicate spending.
Tenth, the EVD sensitization messages were inadequate and incorrect. Initially, we were told there is no cure and any infected person will die. We could not distinguish between symptoms of cholera and EVD. The wrong message scared away people from reporting to health facilities for immediate care which at any rate never existed. It was months later we were told to report to health facilities when we fall ill and that infected persons can be provided palliative care and has chances of survival if they report earlier for treatment.
As if the poor management of the fight against the disease is not enough, even the design of the Ebola Recovery Strategy was faulty. It is highly centralised and not participatory. No serious consultations were done with the chiefdoms and district councils. I am not sure of any national data collected to guide the design. It was quickly put together to meet the requirements of donors meeting. A strategy was first presented to the EU in Brussels, later to the World Bank and IMF at the spring meeting and recently at the UN. The question is who was driving the process? How different are the various presentations? Why was this government not smart to prevent Sierra Leone been used as a battle ground for donors? Why did we not insist on traditional resource mobilisation platforms or a single resource mobilisation platform? How much new money is raised in each of this forum?
The implementation like the designs was even more challenging. We have the National Commission for Social Action (NaCSA), a state institution with credible record of managing resettlement, recovery and post-war reconstruction. This hopeless government neglected this institution and established a centralised structure at State House in the office of the Chief of Staff which has no district office, no system in place for managing recovery, no fiduciary or monitoring system in place and is busy with more strategic issues. A preferred option for managing recovery is use the local councils and MDAs to implement, NaCSA coordinate and monitor with an inter-ministerial committee to oversee.
Recovery had no place at State House except for the purpose of control, chopping of funds and basing resource allocation on political considerations. Strengthening the health system could have be better done through MOHs directly with reports provided to the coordinating structure; education support can naturally be channeled through the local councils and MEST while social protection can be done through local organisations or local councils using a social fund mechanism. NaCSA could have coordinated, provided implementation support (where necessary) and monitored.
This would have prevented huge spending on staffing and laid the foundation for sustainability of the interventions. The current chief of staff knows that. He was in NACSA for many years during the SLPP regime, served as Commissioner NaCSA under the APC and would have surely objected it if he was the Commissioner. Unfortunately, this nar salone, all minister wan project.
This is a general assessment of how the APC government managed the Ebola Virus Disease and how it could have done things differently to prevent the spread to all districts. Rigorous assessment should cover the planning process, social mobilisation, contact tracing, treatment and care of infected persons.
Courtesy: By Jacob Jusu Saffa, Development Economist/Evaluation Specialist