BRUSSELS — When Liberian President Ellen Johnson Sirleaf prioritized West Africa's long-term post-Ebola needs at a high-level meeting convened by the European Union, health care unexpectedly took a back seat.
"The most important long-term response to Ebola," Sirleaf told the meeting's 800 delegates, "rests in plans and strategies for economic recovery."
Sirleaf outlined a regional plan first floated last month by the three countries most affected by the world's deadliest Ebola outbreak. The plan includes a hoped-for regional center for disease control and regional "emergency response capabilities."
Guinea, Sierra Leone, and Liberia have pledged to eliminate Ebola transmission by April 15; the Brussels meeting is the first in a series of three devoted to national and international priorities for post-Ebola reconstruction. Sirleaf said the specifics of the regional plan will be presented to donors at the next meeting, to be held at the World Bank in April.
On Tuesday Sirleaf focused most specifically on the economic demands of recovery from Ebola, in remarks that broadened the focus far beyond the health sector.
"There is no doubt that this will require significant resources, perhaps even a Marshall Plan, as suggested by World Bank President [Jim] Kim," Sirleaf told the delegates. She did not specify the cost.
Liberia's finance minister, Amara Konneh, listed Liberia's priorities at the meeting — covering, it would seem, every need the country faced before the disease. "We want to focus on health, the private sector, the security sector, the rule of law, education, agriculture, and social services," Konneh said.
Sirleaf later told BuzzFeed News that health care was the most important part of the future planning, with an emphasis on improving primary health care in rural areas.
"We never had the resources to bring properly trained people, or the equipment" to community level, Sirleaf said. "We want to see health care at that community level, not just at referral hospitals."
But in her public remarks, Sirleaf called for a "focus on private-sector led growth, expanding and attracting investment with the highest potential to create a large number of sustainable jobs."
She also called on private investors to behave more responsibly.
"Our investing partners must give back more in fair taxes, fair pricing, and fair high-level job opportunities," she said. "In turn we must do more to create a conducive environment by making it easier to do business and by better control of corruption."
More than 800 delegates joined the daylong meeting, including: the presidents of Guinea and Sierra Leone, the other two countries still battling the epidemic, and of the Republic of Congo, which fought off four outbreaks, at a much smaller scale, between 2000 and 2005; representatives from the United States, Australia, and China, as well as Cuba, which sent more than 150 doctors to Sierra Leone at the height of the crisis; and representatives of the philanthropic and private sectors, including the Gates Foundation and Johnson & Johnson, which is working on an Ebola vaccine.
Much of the daylong meeting focused instead on "taking stock" of the current situation, including an overview of what worked well to drive the outbreak down from more than 300 new cases a week at its highest point last fall to roughly 30 new cases a week in the region now.
Sirleaf told BuzzFeed News that the case drop was due primarily to "the ownership in the communities, of the community workers. We empowered them." Sirleaf referenced in particular the incident management teams that help identify and respond to new Ebola cases. "We gave them proper training, and we put them in control," she told BuzzFeed News.
But international efforts didn't follow suit, according to David Miliband, president of the International Rescue Committee. Miliband told BuzzFeed News that international funding has focused disproportionately on facilities and equipment and "inverted the cart and the horse" by prioritizing international interventions for treatment, rather than local efforts at prevention.
"In the West we love to think there is a medical solution to every illness," he said, "but actually in the case of an epidemic, you cannot treat your way out of an epidemic."
Miliband told delegates that Ebola was "a stunning wake-up call for all of us who had spent the previous decade working to build up health systems in Sierra Leone and Liberia." He said plans to rebuild national health sectors include not just training health workers but paying them "a living wage, every month, on time."
Disputes over hazard pay, late paychecks, and concerns about overly restrictive contracts led to health worker strikes in Liberia and Sierra Leone, but Sirleaf acknowledged in a press conference that health worker grievances in Liberia predate — and likely will postdate — Ebola.
"There were problems with health workers before Ebola," Sirleaf said. "The issue will still face us even when Ebola goes."