USAID’s Response to the Ebola Virus Disease Outbreak in the Democratic Republic of the Congo

The Office of the Inspector General (OIG) has been monitoring USAID's response to the outbreak, which has been deemed a public health emergency of international concern (PHEIC) by the World Health Organization (WHO). As of August 4, 2019, WHO estimated 2,763 confirmed and probable EVD cases in DRC, including 1,849 deaths. USAID has obligated $127.8 million for responding to the DRC outbreak and $8.6 million for preparedness activities in neighboring countries. However, several key recommendations made by OIG in January 2018 remain open, including the need for USAID to develop a policy framework to respond to EVD outbreaks. This framework would address challenges related to intra- and inter-agency coordination, initial leadership support, and staffing capacity. The WHO assessment of the EVD outbreak cited several factors contributing to the high risk of further spread, including deteriorating security in EVD hotspots, community mistrust of and resistance to EVD response activities, and delays in EVD detection and infected individuals accessing EVD treatment and transit centers. These factors, combined with high population mobility and porous country borders, increase the risk of geographical spread and complicate a coordinated response. USAID has made some progress in closing the coordination gap in responding to international public health crises since the 2014-16 EVD outbreak in West Africa. However, challenges and barriers to controlling the outbreak remain, including the need for effectively coordinating a range of skill sets and functions. Developing policies for rapid data sharing and identifying and testing U.S. agency roles and responsibilities would further strengthen the response to the evolving EVD outbreak in DRC. Specifically, the following open recommendations exacerbate coordination challenges and require attention: developing policies for rapid data and information sharing among U.S. Government agencies and with WHO and host governments. Such policies would help fulfill the U.S. Government's December 2018 DRC EVD response strategy to "support mechanisms for timely and systematic sharing of surveillance information." According to the U.S. strategy, data sharing is improving, but data sharing challenges with WHO and the DRC government have impeded analyses. The U.S. Government developed an operational plan to coordinate the implementation of its strategy for supporting response efforts and mitigating further spread of the disease through improved preparedness and operational readiness in surrounding areas of DRC and neighboring countries. However, a delegation of senior U.S. officials who assessed the response to the outbreak in May 2019 concluded that there was underuse of community groups and that the outbreak was worsening in part due to poor coordination. In line with this assessment, OIG's audit of USAID's past response to the EVD outbreak in West Africa reported that coordination challenges internally and with key stakeholders hampered operational effectiveness. USAID has made some progress in closing the coordination gap in responding to international public health crises since that time. However, the need for effectively coordinating a range of skill sets and functions remains, and developing policies for rapid data sharing and identifying and testing U.S. agency roles and responsibilities would further strengthen the response to the evolving EVD outbreak in DRC.