Ebola in the DRC: The Perverse Effects of a Parallel Health System

On August 1, 2018, the tenth epidemic of Ebola in the DRC was declared. While the country’s nine previous epidemics were relatively small in scale, managing Congo’s tenth Ebola epidemic, the world’s second largest to date, was especially challenging. The normal difficulties of containing an infectious disease in urban areas with limited running water, a mobile population, and a weak healthcare system were exacerbated by conflict dynamics that have affected the region since 2013.

Despite significant international investment, the epidemic took nearly two years to contain and cost over 2,200 Congolese lives.

This report, the first of three to be published by the Congo Research Group on the epidemic, examines the public health aspects of this international response. We argue that this epidemic emerged at the intersection of two histories—the perception of Ebola as a global health security threat and the privatization and decline of the Congolese health system. Both trends led the donor community to create structures parallel to the existing health system and led largely by outsiders. Viewed with suspicion––many thought these outsiders had come to profit from the disease––this parallel system struggled to be accepted, leading to a lack of collaboration with local communities and even violent attacks, feeding into a cycle of militarization.

Immense scientific and clinical advances during this epidemic have revolutionized the care of Ebola and transformed Ebola into a vaccine-preventable and treatable disease. Yet the fact that the response remained external to the health structures familiar to the community significantly compromised its efficacy, potentially prolonging the epidemic and contributing to violence.

This approach is not unique. In recent decades, donors have responded to the dilapidation of the Congolese health system by designing interventions that target specific diseases, often through parallel structures. While these are short-term fixes, they end up compromising the existing health system in the long term and fail to effectively contain disease. If future epidemics are to be prevented or contained effectively, the Congolese health system must be rebuilt, which would allow international epidemic responses to be reduced to a support role or eliminated altogether.