Executive Summary
This paper is a policy brief that explains the urgency of evaluating public health interventions introduced during the 2012 cholera outbreak in Sierra Leone. The problem statement stems from the failure of health agencies and public health stakeholders to follow up on the progress of past health interventions meant to improve community response to cholera. This study has an evaluative nature because it strives to understand the strengths and weaknesses (performance) of past health interventions meant to manage cholera in Sierra Leone. Its scope only covers emergency health responses introduced during the 2012 cholera outbreak in the West African country. Some of the recommendations highlighted in this brief include undertaking observational studies to assess the performance of existing health interventions.
Similarly, this document highlights the need for undertaking randomized control trials to address the public health problem. Collectively, this policy brief highlights the need for health agencies in Sierra Leone to improve their future response to cholera outbreaks by offering them a learning lesson to improve their response to the disease. Through an elaborate evaluative criterion, the health workers would understand the weaknesses of their health programs and correct them. Similarly, they would understand the strengths of ongoing health programs and capitalize on them.
Audience
The audience for this report includes health agencies and their workers. This audience would find the information presented in this paper useful to their work because it would help them make informed decisions about managing future cholera outbreaks. For example, by knowing the most effective public health interventions for managing the disease, they would know where to invest most of their resources in preparing communities for future disasters.
Public Health Issue and Problem Statement
Public Health Issue
Cholera is a public health issue in many developing countries. This is why, in 2012, it caused widespread human deaths and the suffering of thousands of people in Sierra Leone (World Health Organization, 2012). The disease manifests as an infection of the small intestine through infection of the bacteria, Vibrio Cholerae (World Health Organization, 2012). Contamination often occurs when people consume contaminated food or drinking water. Maintaining proper hygiene is at the center of the disease management efforts.
Therefore, when there was an outbreak in Sierra Leone, in 2012, health agencies rushed to introduce health interventions centered on promoting proper hygiene to prevent the further spread of the disease (World Health Organization, 2012). While most of these interventions were emergency responses to the epidemic, some of them strived to provide a long-term solution to the problem.
Problem Statement
The problem statement in the proposed study stems from the failure of health agencies and public health workers to follow up on the progress of health interventions introduced during the 2012 cholera outbreak in Sierra Leone. Sierra Leone has suffered from unpredictable outbreaks of the disease. Its long-term management depends on learning valuable lessons about past interventions designed to manage the disease. Thus, if health agencies fail to follow up on the progress of their interventions, they would not know if their interventions worked, or not (World Health Organization, 2012). This failure would undermine their effectiveness in managing future outbreaks.
Justification of the Public Health Issue
Cholera management is a public health issue because it could cause widespread deaths within a short time. Furthermore, it spreads quickly. The main stakeholders affected by this public health issue include key decision-makers in the public health sector. In this policy brief, I have singled out health agencies because they are the main points of contact between communities and health policies. Furthermore, they always look for new information to improve their practice. In fact, an article by Mandelblatt, Fryback, Weinstein, Russell, and Gold (1997) shows that most health agencies are always looking for new information to improve their responses to health disasters. Alternatively, an article by the Medical Research Council (2012) shows that, evaluating existing public health interventions is important in developing and implementing complex interventions in public health. It affirms this view through the advancement of the “2000 MRC Framework for the Development and Evaluation of RCTs of Complex Interventions to Improve Health” (Medical Research Council, 2012, p. 4).
At-Risk Populations
The populations affected by the failure of health agencies to review the efficacy of their health programs include low-income populations in Sierra Leone. They are victims of cholera because they suffer from health problems caused by poor and neglected health infrastructure, poor sanitation services, and inadequate access to health services. Similarly, people who live in peri-urban slums are at risk of contracting the disease because their environment lacks basic infrastructure that could prevent the occurrence of cholera outbreaks. Comprehensively, people who lack access to clean water and proper sanitation services are at risk of contracting the disease (World Health Organization, 2012).
Multidisciplinary Impacts
Law and Policies
Understanding the efficacy of cholera management interventions in Sierra Leone has implications for the country’s health law and policies because formulating useful policies could prevent the occurrence of another outbreak, or lead to a rapid response to prevent the further spread of the disease (Bhattacharya, 2013).
Therefore, the information obtained from the proposed study would provide sufficient data to help policymakers make effective laws and policies to protect communities from another outbreak. Similarly, by formulating effective health laws and policies, Sierra Leone would improve its institutional capacity to respond to cholera and similar future outbreaks.
Epidemiology and Medicine
Understanding the epidemiology of a disease is a critical part of understanding how to treat or manage it (Fowkes, Dobson, Hensley, & Leeder, 1984). The proposed study would provide information that explains the epidemiology of cholera in Sierra Leone by exploring why some interventions work, or not. This way, health agencies in Sierra Leone would have a better prognosis of how cholera affects certain populations in Sierra Leone and why. This information would help them to plan and evaluate future interventions. Similarly, health agencies would be better equipped to manage the health of cholera patients through the study’s contribution in understanding medicinal interventions that worked or failed to work, in 2012.
Economics
Public health economics focuses on optimizing scarce resources for purpose of improving community health outcomes. The proposed study would have an impact on this field by highlighting public health interventions that work. By doing so, health agencies would know how best to allocate their scarce resources. This way, they would divert their resources to support interventions that have positive results and decrease resource outflows to health interventions that have little or no impact. By failing to know successful and unsuccessful interventions, the health agencies would not have the right information to make such decisions. In such a case, they would suffer from resource inefficiencies and, possibly, poor public health economics (Fowkes et al., 1984).
Politics
Many modern-day researchers have studied the effects of politics on public health (Grogan, 2012). They have established that politics play a significant role in shaping public health outcomes (Fowkes et al., 1984). The interest of community health groups, advocacy groups, and governments on public health underscore the need for understanding the effects of politics on public health outcomes (Tarantola, 2012). The proposed public health study would have a similar effect on this field by expounding on the relationship between politics and cholera incidents in Sierra Leone. For example, it would explain how decades of civil war and government neglect of public health services have contributed to Sierra Leone’s vulnerability to cholera. Similarly, the findings of the study could explain the relationship between influxes of refugees in Sierra Leone and Sierra Leone’s vulnerability to cholera. Overall, by exposing the relationship between politics and health outcomes, the proposed study could redirect political discussions towards improving Sierra Leone’s preparedness to manage another cholera crisis.
Ethics
The mandate of improving community health outcomes stems from a moral obligation to improve human welfare (Thomas, Sage, Dillenberg, & Guillory, 2002). The need to exercise power over human populations and to avoid human rights abuse is at the center of our understanding of how public health workers should care for communities. The impact of the proposed study in this field of analysis stems from its quest to improve the professional competency of public health workers. Indeed, by knowing their mistakes and successes in managing cholera, public health workers in Sierra Leone would be better informed about their actions and improve accordingly. This contribution stems from one ethical principle of public health, outlined by Thomas et al. (2002), which shows that “Public health institutions should ensure the professional competence of their employees” (p. 1).
Analysis and Recommendations
Current Policy to Address the Public Health Intervention
In this policy brief, I have shown that cholera is a public health issue in Sierra Leone. I have also shown that, in 2012, many health agencies introduced new interventions to manage the outbreak, but few of them bothered to know whether these interventions attained their objectives, or not. Consequently, public health workers stand a huge risk of repeating the same mistakes they could have made in 2012 if another outbreak occurs. There are many interventions to manage this public health issue. For example, Rychetnik, Frommer, Hawe, and Shiell (2002) say systematically reviewing randomized control trials is one way of knowing the performance of current health interventions. This intervention analyzes the levels of evidence provided by each intervention to know whether they have succeeded, or not.
The Medical Research Council (2012) also proposes an alternative intervention for addressing the public health issue. It proposes that researchers should use observational studies to understand the performance of existing health interventions (Medical Research Council, 2012). Although some researchers say the efficacy of this intervention could match the level of efficacy demonstrated by RCT trials, many of them agree that it is essential to add new evidence from observation trials for this outcome to be true.
Merits of Current Interventions
The above section of this policy brief shows that systematically reviewing randomized control trials is one strategy of evaluating existing health interventions to improve health responses to cholera in Sierra Leone. Some researchers prefer this strategy because its systematic nature helps it to cover all health issues about existing interventions (Medical Research Council, 2012).
This brief has also highlighted observational studies as another strategy for addressing the health issue. Since it involves a lot of observation, researchers can independently describe implementation problems associated with existing interventions. Furthermore, its observational nature minimizes the possibility of bias when analyzing the health interventions. This way, health agencies can get reliable and valid information about ongoing health interventions. Collectively, these findings show the merits associated with current interventions that could address the health issue.
Alternative Intervention
Promoting accountability of health interventions is an alternative strategy to address the health issue. By doing so, health agencies would be keen on making sure that their work represents the interest of all concerned persons (Mandelblatt, Fryback, Weinstein, Russell, & Gold, 1997). Furthermore, they would make sure that their health programs achieve their goals. Stakeholders may demand accountability in different ways. For example, they may demand that concerned health agencies show how their 2012 cholera interventions reduced morbidity and mortality numbers associated with the disease. Similarly, they may demand to know how the health agencies have used their resources and whether these resources have supported tasks that strive to meet program goals. Through the formulation of such rigorous accountability standards, health agencies would be more inclined to understand effective health interventions and support them.
Similarly, they would know which health interventions have a poor performance and discontinue them. By extrapolating the contribution of the proposed intervention to the context of the proposed study, it would be easy to know which health programs, introduced during the 2012 cholera outbreak, in Sierra Leone, have achieved their goals, and which ones have not. Those that have achieved their goals of improving community response to cholera and minimizing the possibility of suffering another outbreak are likely to receive support. They are also candidates for replication in other health sectors. However, those that have not shown a success record are possible candidates for discontinuation.
Limitations to Recommendations
This policy brief has recommended the adoption of different strategies for evaluating health programs introduced during the 2012 Sierra Leone cholera outbreak. Conducting a systemic randomized trial of the public health issue and undertaking observational studies of existing health interventions are possible strategies for addressing the health issue. Similarly, advocating for accountability during the implementation of health programs is an alternative strategy for managing the health problem. These strategies are limited to the willingness of all concerned stakeholders to make them work. Stated differently, the unwillingness of some stakeholders to support these strategies could frustrate their implementation.
The success of the recommendations outlined in this brief is also limited to the availability of information surrounding existing health interventions to manage cholera. Therefore, the lack of information about cholera could undermine some of the interventions highlighted here. For example, the lack of information would undermine the use of randomized control trials to investigate the performance of health interventions.
Conclusion
Need for the Audience to Address the Public Health Problem
Policymakers are always looking for new ways to improve their decision-making processes. They do so to improve the efficacy of their public health programs. The proposed study provides an avenue for health workers to improve the effectiveness of their health programs by providing them with sufficient information regarding the performance of existing public health interventions. Public health organizations need to understand the efficacy of their programs because they need to be prepared to manage (or possibly prevent) a similar outbreak. They cannot do so without knowing the effectiveness of earlier interventions.
Actions that the Audience should take
The main goal of undertaking the proposed study is to offer a learning lesson for public health workers in Sierra Leone to improve their response to cholera. Through an effective evaluative criterion, the health workers would understand the weaknesses of their health programs and correct them. Similarly, they would understand the strengths of ongoing health programs and capitalize on them.
References
Bhattacharya, D. (2013). Public health policy: Issues, theories, and advocacy. San Francisco, CA: Jossey-Bass.
Fowkes, F., Dobson, A., Hensley, M., & Leeder, S. (1984). The role of clinical epidemiology in medical practice. Eff Health Care, 1(5), 259-65.
Grogan, C. M. (2012). Editor’s note: The hidden strength of prevention politics. Journal of Health Politics, Policy, and Law, 37(2), 177–180. Web.
Mandelblatt, J., Fryback, D., Weinstein, M., Russell, L., & Gold, M. (1997). Assessing the Effectiveness of Health Interventions for Cost-Effectiveness Analysis. J Gen Intern Med, 12(9), 551–558.
Medical Research Council. (2012). Developing and evaluating complex interventions: new guidance. Web.
Rychetnik, L., Frommer, M., Hawe, P., & Shiell, A. (2002).Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health, 56(1), 119-127.
Tarantola, D. (2012). Foreword: Public health, public policy, politics and policing. Harm Reduction Journal, 9(1), 22–23. Web.
Thomas, J., Sage, M., Dillenberg, J., & Guillory, J. (2002). A Code of Ethics for Public Health. Am J Public Health, 92(7), 1057–1059.
World Health Organization. (2012). Cholera in Sierra Leone: the case study of an outbreak. Web.