Building stronger health systems could help prevent the next epidemic in Madagascar

The peak epidemic season for plague in Madagascar is fast approaching and the severity of these outbreaks could be significantly reduced with improvements to their public health system, argues Matthew Bonds from Harvard Medical School and the nongovernmental health care organization, PIVOT, in a new Viewpoint publishing January 4, 2018 in PLOS Neglected Tropical Diseases.

Bonds uses November 2017's epidemic of bubonic and pneumonic plague as a recent example to pinpoint areas of improvement in Madagascar's public health system. While the treatments for this epidemic were seemingly simple, the methods to deliver them got tangled up within an under resourced health system. The combination of delayed detection and treatment resulted in 2,200 confirmed infections, and 200 citizens dead.

Bonds and team argue for a three-pronged solution to strengthen Madagascar's health systems and control outbreaks of plague: 1) horizontal improvements of system "readiness" i.e., staffing, infrastructure, and supply chain, 2) vertical integration of clinical programs, and 3) integrating high-quality surveillance data within local health systems.

If the numerous independent multilateral and nongovernmental partners within Madagascar cooperated with its Ministry of Health, and coordinated their efforts within Madagascar's diverse communities, Bonds suggests that they could efficiently implement the existing policies to ultimately curb plague outbreaks.

Paul Farmer, the senior author of the paper, argues that, "in the district of Ifanadiana, where PIVOT has been strengthening the health system, 29 out 30 plague patients survived. This proves that when government, nongovernmental, and academic partners fully cooperate in accordance with the Ministry of Health agenda and make long-term commitments to its implementation, scourges like plague can be overcome." Once the non- and governmental partners collaborate, Madagascar has the potential to reduce the number of plague outbreaks and become an example within the global community for health system transformation, providing lessons that could prevent the world's next health crisis.