Sub-Regional Health Governance And Management Of Ebola Epidemic In Nigeria And Sierra Leone 2014- 2016

ABSTRACT

The year 2014 was a defining year in terms of infectious disease outbreak in West Africa and the world. The Ebola Virus Disease (EVD) 2014 outbreak that began in Guinea became a regional epidemic spreading across the sub-region and beyond. Despite the global awareness and attention that trailed the 2014 EVD outbreak, the effect and impact were felt predominantly at the level. This has prompted this study to evaluate the state of the sub-regional response to the outbreak amidst global response. This inquiry is necessary because of the peculiarity of the sub-region, which houses several countries with the worse Human Development Index (HDI), complemented with weak health systems, significantly porous and poorly governed borders amongst other sub-regional traits. These are key amongst the factors that made the EVD epidemic to thrive in the sub-region. Theoretical justifications also exist for a sub-regional level of analysis of the outbreak, based on the theoretical assumption of the New sub-regionalism theories/Approach. One of which is the Sub-regional Security Complex Theory (RCST) adopted in this study. The theorists postulate that proximity is a factor in the spread of risk factors and that security risks travel faster within short distances than longer ones. To achieve the objectives, the study adopted an ex post facto research design. It included a systematic review of documentary sources and reports as well as a series of in-depth interviews in both Sierra Leone and Nigeria. Furthermore, a framework analysis based on the World Health Organisation (WHO) health system strengthening framework and Social Network Analysis (SNA) was also conducted to demonstrate actor ties, roles, and collaborations. The results revealed that there was a deluge of actors who were involved in the EVD response with varying degrees of collaborations. The prominent sub-regional organisations and partnerships include the African Union Support to Ebola Outbreak in West Africa (ASEOWA) and the West African Health Organisation (WAHO). They have hitherto been charged with the responsibility to coordinate and collaborate in response to health issues did not play significant roles. The ASEOWA, which was the preeminent institution of sub-regional partnership, scored 0 out of 38 possible connections in the outdegree statistics conducted in Nigeria and just 3 out of 31 possible connections in Sierra Leone. The findings indicate that the level and nature of sub-regional governance during the EVD outbreak was significantly low and inadequate. The quality of the response was tilted more towards dependency than cooperation. It is recommended that the sub-regional platforms be strengthened to build more effective and efficient capacities for early warning and response at the sub-regional level.

Keywords: Disease Control, Ebola Virus Disease, Health Governance, Nigeria, Sierra Leone, Sub-regionalism