Keynote address by WHO Regional Director for Africa, Dr Matshidiso Moeti
Representative of the Honourable Minister of Health of the Democratic Republic of the Congo,
Honorable ministers of health of the countries neighbouring the Democratic Republic of the Congo,
African Union Commissioner for Social Affairs, Amira Elfadil Mohammed Elfadil,
Senor immigration officials,
Regional and national technical and development partners,
Distinguished delegates, colleagues, ladies and gentlemen,
I am pleased to join you for this high-level ministerial meeting on cross-border collaboration to prepare for and respond to the ongoing Ebola virus disease outbreak.
Cross-border collaboration is an increasingly vital component in our collective action to prepare for and respond to health emergencies – with international trade in goods and services, and mobile populations – we have seen time and again that diseases can quickly spread from one country to another – it is clear that diseases do not respect borders.
In recent times, Ebola has been in the spotlight, from the epidemic in West Africa to the current outbreak. However, other diseases also pose significant threats. For example, we have seen recurrent outbreaks of cholera spreading across multiple countries, and we are seeing cases of circulating vaccine-derived poliovirus type 2 crossing borders in the Lake Chad Basin. In 2016, we also saw the spread of yellow fever from Angola to the DRC.
These events emphasize the immense importance of cross-border collaboration, to harmonize resources, to increase coordination, and to improve information sharing to quickly contain outbreaks and stop diseases crossing borders.
As you are aware, all countries are state parties to the International Health Regulations, which is an international legally binding framework.
Under Articles 21 and 57 of the IHR, countries with common borders should consider entering into bilateral and multilateral agreements to prevent and control international disease transmission – this is a key objective of our meeting today.
You will recall that Dr Tedros, the WHO Director-General, on the advice of the IHR Emergency Committee, declared the current Ebola outbreak a public health emergency of international concern on 17 July 2019 – over three months ago.
This declaration called upon Member States to improve preparedness and collaboration between the DRC Government and its nine neighbours.
I would like to thank the countries present here for the tremendous efforts undertaken in this regard. Under your collective leadership, we have been able to mobilize resources to respond to the outbreak as well as building preparedness capacities and minimizing the spread of Ebola to other countries.
Together, you are demonstrating some best practices with respect to cross border collaboration. For example, following a meeting between the Ministers of Health in Uganda and the DRC, several actions have been initiated:
- the Ministers are using WhatsApp as a platform for sharing information at the political level on contacts and suspected cases who cross borders;
- joint surveillance is happening in selected zones of border districts between the two countries; and
- both countries are sharing resources and expertise – when imported cases were reported in Uganda, the DRC shared an initial supply of 100 doses of the Ebola vaccine and sent experienced vaccinators to support Uganda to initiate vaccination
These are excellent practices from which other countries can learn.
The Ministers of health of Rwanda and the DRC also met in Rubavu, signed a memorandum of understanding and agreed on a road map for cross border collaboration. Rwanda will be sending 25 emergency responders to the DRC as part of cross-border and cross-country learning from each other.
Such best practices need to be replicated in other Member States.
In addition, preparedness is a central component of our collective work on emergencies. Together, we have been conducting independent joint external evaluations of IHR capacities of Member States. I am pleased to report that 44 of 47 countries in the African Region have now completed the JEE process, out of 105 countries that have completed these assessments globally.
Many countries have developed national action plans to address the gaps identified in the JEEs. However, we need to ensure that these plans are funded through domestic and international investments.
Indeed, these national and sub-national plans should be the avenue for us to sustainably implement the priority actions that we will agree on today. Cross-border collaboration interventions should be costed in national and district plans, including delivery of cross-border health services.
Our partners also play important roles in preparing for and responding to emergencies and we greatly appreciate the work of the Africa CDC in setting-up sub-regional collaborating centres. These centres will be of huge importance in building capacities in preparedness and response across the continent.
We should also work with the regional economic communities. The East African Community has a framework for cross-border integrated disease surveillance and response and the Southern African Development Community has a protocol for cross-border communicable disease control. All these efforts and initiatives should be considered for us to holistically address the issue of cross-border collaboration.
At WHO we are investing in surveillance, setting-up data networks and emergency operations centres, and using real-time reporting through innovative technologies such as geographic information systems (GIS). In the ongoing outbreak, GIS has been deployed in Uganda, for example, as part of assessing Ebola preparedness by mapping available capacities in health centres in border areas. The DRC has also used GIS to identify infection prevention and control gaps in both private and public facilities thus enabling development and implementation of IPC improvement plans.
Further, and that is why we deemed it necessary to have our WHO representatives at this meeting, we need to plan in “peace time” to prepare for emergencies. Cross-border collaboration should be well articulated in the WHO country cooperation strategies, country support plans and business continuity plans.
Since 2004, we have convened at least six ministerial meetings on cross-border health issues resulting in the signing of protocols of collaboration, communiques and memoranda of understanding. These outcomes provide a sound basis for our joint work together.
In August 2019, technical officials of priority 1 countries neighbouring the DRC met here in Goma to agree on ways to improve collaboration and information sharing, and two weeks ago a meeting with priority 2 and other countries in Nairobi discussed emergency preparedness, operational readiness, and cross-border collaboration.
The recommendations from these meetings included that each neighbouring country should establish bilateral collaboration with the DRC, as well as instituting joint cross-border surveillance and quarterly meetings, standardizing case definitions across countries, and improving both formal and informal information sharing.
These recommendations should shape our deliberations and guide us on the way forward.
In containing the current outbreak, we face some persistent challenges: insecurity in the affected provinces with pockets of community resistance is continuing to negatively impact the ability of staff in the field to identify and track contacts. Contacts are also moving between countries, creating risks for continued transmission – these challenges require a multisectoral response.
Inadequate information sharing between countries also continues to be an issue, and we should work together to improve this by stepping-up Ebola preparedness in high-risk border districts.
I appeal to all Member States and partners to ensure continuous reporting of alerts and suspected cases in compliance with the International Health Regulations.
We need countries to openly share information, expertise and other resources to save lives and prevent the spread of infectious diseases – even more so in relation to Ebola. We have learnt from the Western Africa epidemic that when countries come together, Ebola can easily be controlled, and capacities to prevent and contain future outbreaks can also be developed.
WHO remains committed to working with you to protect communities from emergencies, including taking forward the recommendations and outcomes of this important meeting.