The Not-Flashy, Essential Part of Outbreak Preparedness and Response

Staff at Bwera General Hospital in Uganda take part in a weekly Ebola preparedness drill in December 2018. (Isaac Kasamani/AFP/Getty Images)
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Staff from Bwera General Hospital in Uganda take part in a weekly Ebola preparedness drill in December 2018. (Isaac Kasamani/AFP/Getty Images)

When an outbreak hits, how do we immediately get a Ministry of Health representative, an animal health specialist, a communications expert and a laboratory sample transporter on the same page? 

The answer isn’t flashy or particularly exciting, but it is crucial: program management. 

In epidemic preparedness, we dive deep into the core components of outbreak detection and response like laboratory strengthening and response planning. But when an outbreak occurs, it’s the strength of the system working as whole—not the individual pieces in isolation—that determines whether it will be contained quickly or spiral out of control. 

Last year, when I was back home in Australia, I caught up with an old friend who is an engineer. As we talked about work over beers and barbecue, I explained the daunting task of improving epidemic preparedness. There are 19 focus areas in the Joint External Evaluation, the gold standard we’re using to gauge a country’s preparedness. And there are hundreds of action items within those areas. Sometimes it feels truly overwhelming to address all the gaps and make progress. He could relate. He’s in charge of quality control in manufacturing processes that could include as many as 150 different issues. His take is that it’s too expensive and time consuming to fix all 150 so he takes a different tack. He reckoned that by changing one key thing, several of the other issues organically resolve themselves over time. These ‘leverage spots’ deliver the most impact and cause ripple effects across other parts of the process. 

As we at Resolve to Save Lives worked with countries to identify neglected leverage points in pandemic epidemic preparedness, we learned that they had some technical support for lab capacity building and surveillance systems but lacked program management support. Coordinating multiple partners across many technical areas with limited budgets requires careful planning, budget control, stakeholder engagement and change management. To make the most of resources from domestic and international partners, we needed to support the planning and implementing skills of key staff. While it’s tempting to support countries with the more exciting parts of preparedness and response like a new lab or emergency operations center, what we’ve found is that it’s often the glue between the blocks that’s most needed. Without skilled program managers, these complex multisectoral efforts are doomed for failure. 

This is why, we created the Program Management for Epidemic Preparedness (PMEP) program to train mid-level health security managers. We’re only a few months in, but we’ve already seen a positive impact on preparedness and growing demand for us to bring the program to new countries. 

While we are proud of this initiative, it’s not enough to bring about sustainable management capacity to the field of health security. Dr. Chikwe Ihekweazu, Director General of the Nigeria Centre for Disease Control, spoke to this at the World Health Assembly last month in Geneva: “Program Management training is vital for strengthening the NCDC team, but it must be sustainable and coordinated. One-off opportunities for one or two of my staff on management of specific technical areas are not enough.”

Program management and leadership have long been recognized as key ingredients for success in public health. If we are to make progress in global health security, we need to come together as a sector to prioritize sustainable and coordinated approaches to program management capacity building. While it may not be the flashiest thing to work on, how else can we bring the laboratory technician, the epidemiologist and the community organizer together to prevent or find and stop the next epidemic? 

In public health, there seems to be a strong understanding that capacity for management is a must-have, not a nice-to-have. It’s time for that conviction to spread to the health security field so that all pieces of the preparedness to response “assembly line” run smoothly.


Amanda McClelland is senior vice president for Prevent Epidemics at Resolve to Save Lives, an Initiative of Vital Strategies.

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