Preparation Is Paramount

• Author: Agnes Binagwaho
• Position: Health Minister of Rwanda, Senior Lecturer at Harvard Medical School, and Clinical Professor of Pediatrics at Dartmouth University’s Geisel School of Medicine.

Commentary

One of the greatest challenges to progress in global health is the narrow view that investing solely in health systems is a panacea for managing health threats.Â

Rather, it is necessary to strengthen all the sectors that affect social determinants of health and governance—including finance, transportation, security, and communication—to ensure a collaborative and effective response to such threats.Â

As an example, look at how my country, Rwanda, is managing efforts to prevent the spread of the Ebola virus, which has devastated many countries in west Africa.Â

While it seeks to prevent Ebola from occurring in Rwanda, the health care system should not be distracted from its persistent fight against premature deaths due to maternal and childhood ailments, HIV/AIDS, tuberculosis, malaria, and others. It is critical that it adapt and adjust across all sectors to mitigate such an acute and unanticipated threat.Â

Ability to govern

The threat tests not only the responsiveness of the health care system, but also the country’s ability to govern. Rwanda’s response has required mechanisms for multisectoral and collaborative policymaking, as well as a shared mind-set of making the most of every available resource.Â

For instance, funds are needed to manage the prevention of an outbreak of Ebola—such as to quickly outfit all public hospitals with isolation units and to train health care professionals who can be on the front lines if needed—and the Ministry of Health needs the financial sector to support its decisions. Also, given the potential transmission of the virus from people entering the country, we have had to rely on the transportation sector and the immigration office to implement our foreign travel policies. Furthermore, the security sector has had to enforce emergency procedures—such as 24-hour countrywide readiness to contain any potential Ebola case.Â

To harmonize these decisions and to keep all stakeholders—especially the general population—informed, it has also been critical to involve the communications sector.Â

This multisectoral approach was not patched together in the face of this particular crisis. Rather, it was created carefully and collaboratively over time.Â

For example, leaders of Rwanda are accustomed to meeting in policy “clusters,” including the Social Cluster, which is cochaired by the Ministries of Health and Education. Rather than operating in silos with narrow vantage points, we...