The year 2014 saw 2 parallel outbreaks of Ebola virus disease in Africa. The West African outbreak – which began in December 2013 and mainly affects Guinea, Liberia and Sierra Leone – continues to this day. A separate and unrelated outbreak in Boende, Equateur Province, in the Democratic Republic of the Congo (DRC) – first reported to WHO on 24 August – was officially declared at an end on 21 November, less than 3 months later.

How did the DRC end its outbreak so quickly?

“In DRC there was long experience with Ebola – this was the seventh outbreak of the disease here. The country had the knowledge and the people needed to stop an outbreak – plus strong technical assistance and support from WHO,” says Dr Joseph Waogodo Cabore, WHO Representative to DRC. “It is an impressive achievement, considering that overall, the country’s health system has serious weaknesses.”

Those weaknesses include a severe shortage of doctors, nurses and other health workers; and uneven coverage across the country for basic services like immunization and maternal care. “Preparedness for Ebola is another matter, however,” Dr Cabore says. “The well-coordinated response to the recent Ebola outbreak shows that when national authorities set priorities and stick to them, extraordinary things can happen within a health system.”

As soon as the Ebola outbreak was discovered in Boende in August, the country’s Minister of Health, Dr Félix Kabange Numbi Mukwampa, made a personal visit to the district with Dr Cabore to assess the situation and take leadership. The 2 visits he undertook within the first month of the outbreak were a great opportunity to motivate the personnel at the front, sensitize the population and advocate with local authorities.

Swift action to contain the outbreak

Health workers in the district, like those across the DRC, were aware that Ebola is always waiting in the wings and can emerge at any time. When the virus arrived on the scene, they knew they had to alert national authorities and swing into action. Then, virtually all the boxes in a to-do list for controlling an Ebola outbreak were ticked.

Blood samples from the first suspected Ebola infection were transported by aeroplane to Kinshasa, where there is a lab that does state-of-the art genetic testing and can deliver results within hours. Health services, which under ordinary circumstances require fees for service from patients, were delivered free of charge.

Contact tracing was initiated immediately and continued throughout the outbreak. Strict triage was observed – people with suspected Ebola infection were isolated from other patients in clinical settings. Communities and their traditional and religious leaders were mobilized from day one - which diluted fears about seeking care for people with symptoms of Ebola and strongly encouraged safe burial practices.

“We could not say the response was perfect – there were some problems, for example, with infection control in the facilities of Boende health district,” Dr Cabore says. Still the response proved highly effective.

WHO and partners' support essential

In addition to WHO, Médecins Sans Frontières, the US Centers for Disease Control and Prevention, UNICEF, Canadian National Microbiology Laboratory in Winnipeg and other partners supported the government with expertise for outbreak investigation, risk communications, social mobilization, mobile lab testing, safe burial, contact tracing and clinical care.

WHO has also been running district-level training programmes aimed at general health system strengthening. “In terms of keeping us ready to deal with an Ebola outbreak, WHO has played an especially important role in building management capacity,” says Dr Passy Bosombo, medical director of the Boende health district. In July – just weeks before the outbreak - WHO supported one of these courses for all relevant personnel in Boende. This was one of 17 districts in DRC that received this training in 2014.

Catching up on health services after Ebola

Now that the outbreak has come to an end, DRC’s system is striving to catch up on health issues that have been neglected in Boende, for want of resources, since August. For example, a vigorous integrated campaign for routine vaccination, polio immunization, administration of vitamin A, deworming and check-ups for women and children who may have missed out on care is under way, as is integrated surveillance strengthening.

Still, like military sentries, health staff in DRC are always on the alert for Ebola. They know it could return at any time and are ready to confront it. Their challenge now is how to encourage ramping up of government resources to the health system overall as a critical element of advancing their nation’s development.