Strengthening Cross-Sectoral Leadership, Management, and Governance for Epidemic Preparedness and Response in Côte d’Ivoire: A One Health Approach

November 06, 2017

Strengthening Cross-Sectoral Leadership, Management, and Governance for Epidemic Preparedness and Response in Côte d’Ivoire: A One Health Approach

by Antoine Ndiaye and Emily Goldsmith

In 2014, an Ebola outbreak that started in Guinea and quickly spread to Liberia and Sierra Leone threatened health systems across West Africa. During the crisis, the Côte d’Ivoire National Institute of Public Health (INSP) mobilized a One Health cross-sectoral collaboration in the country’s western regions bordering the Ebola-affected countries and established committees to address the epidemic.

Thanks to emergency funds made available by USAID, the Leadership, Management and Governance (LMG) project, led by MSH, quickly focused on supporting the committees to form and run more efficiently.  A six-year, global project that strengthened health systems to deliver more responsive services to more people—LMG also placed technical advisors at the regional health offices to support integrated supportive supervision visits, data validation workshops, planning, coordination, and communication.

Beyond the committee level, the LMG project trained committee members from across different sectors in a One Health approach—including regional and district health offices, hospitals, health centers, and the water, sanitation, agriculture, animal, and fishery sectors—to change the way they related and communicated on an individual and interpersonal level. These diverse groups were not accustomed to working with each other, and it was through the LMG project-led Leadership Development Program Plus (LDP+) that cross-sectoral collaboration was fostered to strengthen epidemic surveillance systems. LDP+ is an experiential learning and performance improvement process that empowers people at all levels of an organization to learn leadership, management, and governing practices; face challenges; and achieve measurable results. As a result of their participation in LDP+, teams developed detailed epidemic prevention and response plans. Community leaders, members, and traditional healers now are also actively reporting suspected cases of disease to the local health authorities and referring people to health clinics.  

The LMG project experience in Côte d’Ivoire showcased the importance of inter-sectoral coordination when facing an epidemic like Ebola. Stakeholders learned that addressing a disease outbreak cannot be the purview of the health sector alone. Adequately preparing for, combatting, and eradicating epidemics involves the cooperation of other sectors, such as agriculture, the environment, security, and education.

This new cross-sectoral partnership was put into action when there was a suspected case of Ebola detected in the border region. The Prefet, the highest political authority in the region and chair of the multisectoral coordination committee, was in Abidjan. The Regional Health Director reached out to him by phone, and local authorities and leaders from both health and non-health sectors who had learned to work together as a team through the LDP+, quickly networked and were able to identify the suspected case, run a test, determine a negative result, and quell the rumors and panic that were building in the local community. Responsibility for addressing the suspected case was viewed as shared, rather than siloed, and the case was addressed quickly.

Project partners recognized that cross-sectoral communication needed to be institutionalized; they did not need to wait for an epidemic to prioritize this type of relationship building. In addition, they learned that cross-sectoral collaboration is valuable not just in the fight against epidemics, but in the fight against any disease. In Côte d’Ivoire, regional health directors are starting to understand the importance of these relationships. For example, a successful malaria bed net distribution campaign depends on the contribution of individuals from non-health sectors like the environment, education, community level, religious leaders, and others. This growing understanding of cross-sectoral importance is being applied through continued leadership, management, and governance work funded by the Global Fund to Combat AIDS, Tuberculosis,  and Malaria.

Whether addressing epidemic diseases like Ebola or other pervasive diseases like tuberculosis and malaria, cross-sectoral collaboration is crucial. This sentiment was expressed by Mamadou Tia, Regional Health Director and an LMG project partner. “In my mind, it was necessary to have sustained vigilance to strengthen epidemiological surveillance,” Tia said. “In the spirit of LMG, it was necessary to organize a strong team around me and to work in a team taking into account the multi-sectoral nature of the situation. To support this, we started to instill this vision in the district management teams through coordination meetings, supportive supervision, and organization of review meetings.”