East versus West in the Fight against Ebola

By Edward K. Chapnick

On October 3, 2014, the Council of Councils, an initiative of the Council on Foreign Relations, released a very insightful brief that analyzed the difference in the response between the eastern approach and western approach to a crisis like Ebola. The observations and analysis are important to discuss if the global community want to successfully beat the Ebola epidemic. Here are some highlights of the brief to consider:

  • Vertical response: The western approach to healthcare in Africa is primarily vertical, which means that it’s focused mainly on concentrating attention on the disease itself, stopping the spread of the disease or providing services to curtail the effects of the disease, as mandated in the UNMEER mission objectives.

    Vertical systems have been successful in eradicating smallpox and reducing death and morbidity from vaccine-preventable diseases, but they have limited integration with general healthcare, which has led to inefficient healthcare delivery and fragmented health systems. In fact, the vertical systems model of healthcare has been identified as one of the root causes of the failure to eradicate malaria.

    Vertical systems also potentially divert human and financial resources from resource-constrained health systems, but attract donors and political bodies because results are quick and the systems are easier to manage than horizontal programs.

    Horizontal systems are cost effective and sustainable in the long term, can deliver preventive services to poorer people who can’t afford private healthcare, and are preferential for policymakers, because of the appeal of long-term sustainability. In addition, if financed by government revenue and a broader, sustainable health plan, horizontal healthcare systems can be integrated into the public sector.

    However, these systems only work effectively in stable environments, which most developing states lack due to poor infrastructure and limited resources. And more often than not, the countries that need it most can’t afford to implement integrated programs into public healthcare systems.

  • Horizontal and integrated response: China’s approach to healthcare in Africa has traditionally been a strictly horizontal and integrated system method, which focuses instead on the development of access to medicines, hospitals, and infrastructure.

    Horizontal approaches are delivered through publicly financed healthcare systems, also referred to as comprehensive primary care. Horizontal approaches focus on prevention and care for prevailing health problems.

    The brief goes on to say that China’s approach can help build up the infrastructure needed to maintain a horizontal healthcare system, which can in turn increase developing states’ ability to fight disease outbreaks initially. In the case of Ebola, it would have been instrumental in stemming the spread of the disease.

The brief suggests that an ideal healthcare response could be to combine vertical and horizontal health systems, particularly in countries with weakened post-war economies such as Liberia, Sierra Leone, and Guinea. Such an approach would also seek to distribute health assistance funding to improve the conditions necessary for long-term sustainable healthcare solutions to be instituted. The World Health Organization has called for coordination between both horizontal and vertical health approaches to strengthen existing health systems and ensure successful communicable disease response programs.