“If you want to go fast, go alone. If you want to go far, go together.”

This ubiquitous African proverb became the unofficial motto of the first ECOWAS Forum on Good Practices in Health, held July 29-31 in Ouagadougou, Burkina Faso. More than 300 health professionals, researchers, donors, implementing partners, and stakeholders gathered at the conference, hosted by the West African Health Organization (WAHO), a partner of Management Sciences for Health.

In his opening speech, USAID West Africa Regional Mission Director Alex Deprez reminded the assembly that most maternal and child health indicators in West Africa are “unflattering.” The average fertility rate remains the highest in the world at 5.7, while the contraceptive prevalence rate, at 10 percent, is the lowest. West Africa loses thousands of mothers and young children daily to preventable complications and diseases. More than 100 children in West Africa die per 1,000 live births, and there are between 438 and 888 maternal deaths per 100,000 live births.

This week, African Strategies for Health (ASH)—a USAID-funded, MSH-led project that identifies public health best practices in sub-Saharan Africa and advocates for their adoption—has been attending the International Conference on Urban Health from May 24 through 27 in Dhaka, Bangladesh. At the conference, ASH has been sharing A Corridor of Contrasts [9], a report compiling photographs and stories of the people living along the West African Abidjan to Lagos transport corridor, which crosses Côte d'Ivoire, Ghana, Togo, Benin and Nigeria.

In partnership with USAID’s Africa Bureau and Bureau of Global Health, ASH sent me and a photographer, Pinky Patel, to West Africa this past January to document life along the Abidjan to Lagos transport corridor. We traveled the majority of the road through Benin, Togo, Ghana, and Cote d’Ivoire, talking with and photographing people from all walks of life with the goal of learning how cities influence health. Our experience is documented in A Corridor of Contrasts.

The October/November issue [15] of the Global Health Impact Newsletter (subscribe [16]) focuses on the Ebola outbreak in West Africa and MSH's response, including what is needed to save lives, contain Ebola (or any similar outbreak), and maintain essential health services: stronger health systems.

A Note from Dr. Jonathan Quick

Dr. Jonathan D. Quick [17]The Ebola outbreak in West Africa is unprecedented. Already, over 13,000 people have been affected and over 5,000 lives lost. What’s more, this outbreak was preventable.

Tuesday, November 4, was my first day back at MSH headquarters since returning from Liberia nearly three weeks ago on October 21. I volunteered to go to Liberia—one of three West African countries at the center of the Ebola outbreak—because MSH has a wealth of experience to offer to help resolve one of the great public health challenges of our time. 

I started my career in smallpox eradication, and through the years have worked on other outbreaks: hemorrhagic fevers, SARS, avian and pandemic influenza, and multi-drug resistant tuberculosis (TB).  These diseases were—and are—highly infectious and carry significant mortality if proper infection control procedures are not followed.

Management Sciences for Health (MSH) hosted [22] an interactive, three-day, online seminar on the West African Ebola outbreak [23] on LeaderNet.org, October 28-30, 2014. Edited summaries from seminar facilitators (MSH Global Technical Lead on Malaria and Communicable Diseases, A. Frederick Hartman, MD, MPH, Days One-Three, and co-authored by Independent Pandemic Planning Advisor, Lisa Stone, Day Two), appear below. You can access seminar archives, including resources for preparedness and response, by joining LeaderNet.org [24].

Day One (Oct. 28): Mobilizing community-based care

Many thanks to the 240 individuals from more than 50 countries who have signed on to participate in the LeaderNet Ebola seminar [23] so far. I am very impressed with your interest and enthusiasm in discussing, and ultimately controlling, this massive Ebola outbreak.

The unprecedented outbreak and spread of the Ebola virus in three West African countries (Guinea, Liberia, and Sierra Leone) continues to wreak havoc on the lives, economy, and already-strained health systems of the region. The outbreak is particularly high in Liberia with 2,413 people [27] killed by the disease to date.

While the Government of Liberia and partners are mobilizizing all efforts to control Ebola [28], there is evidence that other diseases are being neglected as a result of health facilities closing down, fear of seeking treatment at health facilities, and the Ministry of Health’s policy to focus its resources and staff to manage Ebola, maternal and child health, and emergency services.

In its early stages, malaria [29] symptoms closely resemble those of Ebola infection: fever. The unrelenting influx of suspected Ebola cases to health centers raises serious issues of capacity, safety, and ability to identify Ebola cases in time for isolation and management.

My aunt, Dr. Ameyo Adadevoh, identified and contained the first case of Ebola in Nigeria.  She paid with her life because the health system was not ready to deal with Ebola.  The system has since caught up, and is today a model for other countries.  But the loss of such a gifted doctor and family anchor is incalculable.

Ebola arrived in Nigeria at a time when doctors at all federal government hospitals were on a labor strike (my aunt worked in a private hospital).  After ongoing negotiations with the government failed to meet their demands, the doctors – desperate to see significant changes in the health system and seeking improved salaries, positions, and titles – reached their breaking point.  So they went on an indefinite strike.

Patrick Sawyer – the index case – left quarantine in Liberia and collapsed at the airport in Lagos, Nigeria.  He was trying to travel to a meeting of the Economic Community of West African States (ECOWAS) in Calabar, Nigeria.

On this historic World Population Day --- the first with the world’s population at seven billion and growing --- we call your attention to a crucial summit in London happening today, and to the ongoing importance of supporting access to family planning and sexual and reproductive health.

The London Summit

Over one hundred high-level decision-makers are convening at The London Summit on Family Planning [36] in hopes of securing a better future for women and girls globally. Hosted by the UK government [37] and The Bill & Melinda Gates Foundation [38], with UNFPA [39] and others, the summit seeks to provide an additional 120 million women in resource-poor countries with lifesaving contraceptives, information and family planning services by 2020.

Apegnon Akpene is a 20-year-old mother of three children: four-year-old Joseph, two-year-old Romance, and one-month-old Akou Jacqeline. Since attending USAID's Action for West Africa Region, Phase II (AWARE II) [43]  community health worker training, she has become a client of family planning -- and a role model for family planning in her community.

Akpene is one of three community health workers in Diguegue, a small village of about 800 people in the hills of the southwestern forest separating Togo and Ghana. Distance and difficult terrain are major hindrances to accessing health care for the inhabitants of the village. Diguegue is 47 kilometers from the nearest health facility, a small clinic, in the Prefecture of Tchifama. The village is served by a 12-kilometer dirt road that winds through the thick forest.

Akpene attended school for eight years. When she became pregnant at age 16, she was forced to drop out. She gave birth to three children within four years.