“Rachel Glennerster is Executive Director of the Abdul Latif Jameel Poverty Action Lab (J-PAL). HerRachel - Credit Blu Nordgren research includes randomized evaluations of community-driven development, the adoption of new agricultural technologies, and improving the accountability of politicians in Sierra Leone; empowerment of adolescent girls in Bangladesh; and health, governance, education, and microfinance programs in India. She serves as Scientific Director for J-PAL Africa, Co-Chair of J-PAL’s Agriculture Program and is a board member of the Agricultural Technology Adoption Initiative (ATAI). She is the lead academic for Sierra Leone for the International Growth Center. Between 2007 and 2010 she served on the UK Department for International Development’s (DFID) Independent Advisory Committee on Development Impact. Rachel Glennerster helped establish Deworm the World, of which she is a board member, which has helped deworm 23 million children worldwide. Before joining J-PAL, she worked at the IMF and Her Majesty’s Treasury. She has a Ph.D. in economics from Birkbeck College, University of London. She is coauthor of Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases, and Running Randomized Evaluations.”

1. 'Looking Ahead' Post-Ebola
Strategy in West Africa
22 October 2014
1pm EST

2. Agenda Points
• Short term strategy: the facts, containment strategy &
humanitarian aid – Dennis Glover, Chief Operating
Office The African Youth Movement
• Long term strategy: improvement of (social) health
care & international assistance - Speaker Rachel
Glennerster, Executive Director of the Abdul Latif
Jameel Poverty Action Lab (J-PAL) and Researcher at
International Growth Center
• The importance of micro programmes: Engagement,
voicing the right people, AYM’s call for action - Speaker:
Zeinab Camara, Global Lead on Ebola at Africa2.0 and
Tutu Fellow

3. Ebola virus disease (EVD)
So far (data up till 17 October)
9216 confirmed, probable, and
suspected cases have been
reported in Guinea, Liberia,
*Nigeria, *Senegal, Sierra
Leone, Spain and the U.S.
More than 4,555 people have
died
(Nigeria and Senegal now clear of virus
transmission)
Spread
Best case scenario: 11,000-
27,000 cases through Jan. 20
Worst case scenario: 537,000-
1,367,000 cases through Jan.
20

4. Vaccinations
WHO has announced it hopes
to begin testing two
experimental Ebola vaccines in
west Africa by January and
may have a blood serum
treatment available for use in
Liberia within two weeks
Testing new vaccination on
20,000 frontline health care
workers and others in west
Africa
.

5. The personal experience in Sierra
Leone

6. Planning for Post Ebola in West Africa
Rachel Glennerster
Executive Director, Abdul Latif Jameel Poverty Action Lab, MIT
Lead Academic for Sierra Leone, International Growth Center
October 22, 2014

7. Planning under uncertainty
• Planning is challenging given enormous uncertainty
about:
– The final extent of the outbreak and timing of its conclusion
– The economic damage caused by the knock on effects of Ebola
– The status the health care system will be in by end of outbreak
• Reliable information has been a casualty of the
outbreak
– Health facilities are overwhelmed and travel is restricted
– Incentives are skewed for individuals, journalists, and agencies

8. Overview
• Some evidence on economic impacts and importance of
restoring confidence
• Challenges in rebuilding the post Ebola health care system
including coping with weaknesses in the pre Ebola system
• Caveat: I have worked on Sierra Leone for 10 years but I
don’t have data or experience in Liberia or Guinea

9. The economic cost of fear
• Most economic costs will be indirect: people putting off
purchases, investment, activity that involves meeting others
Number of Traders of Domestic Rice in 2012 and 2014
Source: Glennerster and Suri, 2014 www.theigc/country/sierra-leone

10. Restoring economic confidence is key
• Govt can support this by improving reliability and
transparency in government pronouncement and actions
• Macroeconomic stability, esp exchange rate stability,
essential to restoring confidence
• Government expenditures can help prime the pump
– Reduce payment delays for govt purchases relieves credit shortages
– Big announcements followed by delays undermines confidence
• Ebola has exposed the costs of low trust in government
– Medium term objective needs to be more transparent and
accountable government

11. Rebuilding health care

12. Challenges in rebuilding the health care system
• Immediate: restoring confidence in/utilization of health
system
– Getting children immunized, mothers delivering in clinics etc
• Short run: recruiting and training new health workers
• Medium: Limited budget means making difficult choices
– Investments that have most impact on health might not be those
that would have prevented Ebola
– There may be a short run influx of donor money for “rebuilding”
health systems but need to plan for a realistic medium term
• Medium to long run: Improving accountability

13. Immediate: Judicious use of nudge incentives
• Substantial evidence that small nudges (incentives) can have
big impact on behavior, including preventative health
• Small incentives linked to immunization in other contexts to
increase immunization rates dramatically
• More cost effective to have nurse at clinic with incentive
than have the nurse do outreach to remote communities
– Mothers willing to walk to get child immunized for small incentive
• This is particularly true when health workers are in short
supply, as is tragically the case in West Africa post Ebola

14. Recruiting and training health workers
• Need to experiment with new ways to recruit, train and
utilize health workers to fill a large gap rapidly
– What roles don’t need a fully qualified nurse?
– What can be done by someone carefully trained on a narrow set
of protocols?
• Recruitment is key
– Zambia experiment with different ways to recruit health workers
– Those attracted by potential for a career were better educated
and worked much harder
– Recruiting the right people had big impacts on the quality of
service delivered. (Ashraf, Bandiera and Lee, 2014)

15. Difficult tradeoffs
• In 2013 SL government spent $40million on health i.e $7 per capita per year. (WB
estimates $20 public, $80 private)
• Local public clinics are focused almost entirely on maternal and child health and
preventative health
– Most cost effective investments in health esp for a poor country
– But clinics not seen as place for men or nonchild bearing women
• Investments that would have helped reduce severity of outbreak (more diagnostic labs
and inpatient facilities) not the most cost effective in a nonEbola world
• Important not to fight the last war
• Only one RCT in South Asia not Africa
• Program conducted by NGO not government

16. Accountability
• Health care workers are experiencing the largest toll from
Ebola. They are working under enormous stress in difficult
conditions and are the heroes of this crisis
• However, part of the medium term challenge is improving
accountability in the health care system
– Although malaria treatment is meant to be free, 60% of people
who received malaria treatment at public clinic reported paying
– In 2008 survey, 18% of clinics were closed despite prior warning
– 44% of health workers on roster were absent
• Improved accountability is essential to improve trust and
ensure investment in rebuilding is used effectively

17. ZeroEbola-Ntondi
Africa 2.0 Global Response on EBOLA
Micro Level programs in Post-Ebola Strategy
African Youth Movement
Webinar
22 October 2014

18. OVERVIEW
• The 2014 outbreak of Ebola is the largest in history. As of today, more than 9000 cases with more than
4000 deaths ( half are women and the youth).
• The Center for Disease Control predicts s as many as 1.4 million case by January 2015, with 10 000
cases a week in the affected countries.
• Countries will lose 13 billions USD in revenue and feel the impact of Ebola for the next 10 years (UNDP)
• Multinational companies are reducing their footprint in affected countries, farmers are leaving their
farms to go to unaffected areas , creating more unemployment, and a revenue gap in the countries
GDPs, predicted food shortages and many more.
• The social-economic and political impact have been enormous. The notion of African unity has been
damaged by several African states closing their borders to the affected countries, isolation a large
number of the African Youth, women.
• The crisis, as we know, will last long after Ebola is contained, because the affected countries social and
economic fabric will be decimated. The Communities have been the most hit by the crisis
• All efforts are made to contain the disease, few reflection are been done to look ahead and define the
post-Ebola Strategy.
• Post-Ebola Healthcare Strategy- Community Based-approach- Strategic plan for more resilient
communities?

19. Guinea Country Response Strategy
• Inter-ministerial Committee to oversee all the crisis committee activities.
• Crisis Committee established by the Government of Guinea, with the UN agencies under the leadership of the
World Health Organisation, the EU, Embassies, Doctors without Borders, the Red Cross and other partners. A
country Strategy was developed with key components:
• In order to oversee all the partners efforts, a Presidential decree was published which established a National
Coordination Unit to oversee actions on the ground.
Communication
Sensibilisation
Media
Engagement
Follow
contacts
Monitoring &
Evaluation
Prevention Community
Involvement
Healthcare
Mgts
National
Coordination
Early prevention
Management of
corpses
Treatment centres
Logistic
mobilisation
Nutritional
assistance
Traditional leaders
Community healthcare
professionals
Inter-ministerial
Crisis
Committee
National
Coordination
Unit
CDC
GoG
Unicef
International
NGOs
MSF
Red Cross
CDC
UNFPA
WFP
Red Cross
Religious Leaders
Local authorities
Committee
National
Coordination
Unit
WHO
CDC
GoG
• Sierra Leone- Liberia: decisive measures taken cases are still increasing
• All the management structures in place- increase number of cases- Containment not prevention
• All agree that we should adopt Community- based approach to contain and prevent more cases
• Social mobilisation helped to contain cases in some areas: Success story Telimele

20. Guinea Healthcare System
1. State Led healthcare System (9% National Budget), health structure every 5 km (objective)
2. Decentralised system: University Hospital, Regional Hospitals, Community Hospitals, District Health centres,
local health clinics
3. Well distributed healthcare infrastructures in the country
Why not functional:
1. Failure of Communication channel
2. Resources (financial, human, equipment)
3. Governance
Ministry of Health
University Hospitals
Regional Hospitals
Community Hospitals
District Health centres
Local health centres
Doctors/ Professors
Regional Hospital Director
Community Hospital
Director
District Healthcare
Workers
Community Healthcare
Agents
Local
Health and
hygiene
Committee

21. Post-Ebola Strategy
• Re-enforce Healthcare system
• Capacity building of local structures
• More investment in Infrastructures in rural areas
• Decentralized healthcare system
• Good Governance
• Increase revenues for better healthcare services (minimise traditional healers)
• Country Brand restructuration
• Improve and Re-enforcement of existing Health Systems
• Education
• Decentralisation (more revenues to Local Structures)
• Increase investment in R&D
• Information Management System
M
A
C
R
O
M
I
C
R
O
Community Based
Approach
Regional
Govt
Capacity Building
Increase revenue
Good Governance
Improved Communication channel
Training and Education
Specialisation
Regulation
R&D

22. Conclusion- Resilient Communities
• Ebola could have been controlled by a more resilient Community
• Capacity Building needed for a resilient Community to be able to absorb shocks and pandemic
• Community based Approach for a better and improved Healthcare System
• More Investment in local healthcare structures
• Social structures empowered in the decision-making of their health and communities
Improved
Resources
More
confidence
in the
system
More
revenues to
reinvest in
the system
Better
healthcare
service
Better
health of
population

23. ZeroEbola N’TODI Campaign
• Africa2.0 positioning:
Local Civil Society Partner of Choice for the execution of the Social Mobilisation Strategy working with the
Government and Key Partners. Our approach will be based on 4 axes:
1. Prevention: distribution of preventive kits and equipment
2. Communication: Sensibilisation and awareness campaign
3. Logistics: facilitation and coordination of donations from the Diaspora
• The campaign will be conducted in: GUINEA, SIERRA LEONE, LIBERIA, CONGO DRC, ANGOLA, MOROCCO AND BENIN.
• Community Based Approach
Government
United Nations Agencies-
UNICEF/UNFPA/WFP
Orange
Diaspora
International NGOs
Communication &
Sensibilisation
Distribution & Logistics
Regional Awareness
Youth
Women
Community Healthcare
Professionals
Civil Society
Local Media
Women
Youth
Community healthcare
Professionals
Media
Execution-Community
based NGOs
Beneficiaries
Local Partner-
ZeroEbola Ntondi-
Af2.0
Partners
Schools
Orphanages
Local healthcare centres

24. Contact
Zeinab Camara- AF2.0 Global Lead on Ebola
camarazeinab@hotmail.com
www.africa2point0.org
www.wimguinee.org
Facebook: https://www.facebook.com/#!/pages/ZeroEbola-Ntodi/1566419193586979
Twitter: @zero_ebola
WE ARE THE ONES WE HAVE BEEN WAITING FOR!

25. African Youth Movement
AYM empowers and
mobilizes Africa’s youth
through employment in
technology, agriculture,
education, ecotourism,
entrepreneurship, and the
arts.

26. Q&A
Thank you for your time.
info@aym-inc.org
Hands at Work, Minds in Motion