Marburg is a highly contagious virus characterized by high fever, muscle pain, headaches, and vomiting. It can lead to severe health complications, including death. In Rwanda, 15 Marburg-related deaths have been reported since an outbreak was recorded in late September. Though cases have eased in Rwanda following immunizations of the most vulnerable people, including health workers, other countries remain on high alert.
Mozambique is one such country. Although no cases of Marburg have been reported, the country has taken proactive steps to prepare for potential outbreaks.
The Mozambique Ministry of Health (MISAU), in collaboration with VillageReach and other partners, conducted a tabletop simulation exercise from October 17 to 18, focusing on preparedness, readiness and response to a potential Marburg outbreak.
The workshop brought together chief medical officers, managers and technical staff from a variety of fields, including the Expanded Program of Immunization, Surveillance, Environmental Health, Communication and Community Engagement. The exercise is part of strengthening the Public Health Emergency Operation Center (PHEOC).
Participants Better Equipped for Emergency Response
Following the training, participants felt more prepared to effectively respond to Marburg cases. Facilitators also observed an increased capacity at the provincial and national level for preparedness and response to public health threats.
Dr. Carlos Trindade Caomba, the Head of Community Engagement at the Provincial Health Directorate in Niassa province, described the exercise as highly beneficial. Prior to this training, he felt unprepared to effectively respond to Marburg cases.
“We learned about the different phases of implementation in case there are rumors or reports of cases in a neighboring country. We now know what actions to take to protect our communities,” he shared.
After the training, Dr. Caomba emphasized the importance of convening meetings with all key stakeholders to ensure that information is effectively communicated at all levels if a case is detected.
Dr. Carlos Trindade Caomba, Head of Community Engagement, Niassa Provincial Health Directorate. Photo Credit: Arsenio Manhice
Improving Response Capacity
Participants also highlighted the need to enhance provincial response capacity and advance planning.
Dr. Elsa Malango, the head of Health Surveillance in Manica province, noted that the training highlighted the need to enhance her institution’s response capacity. She stressed the importance of creating conditions for patient management and isolation, such as identifying health units where patients can be isolated. “We can set up tents or designate isolated areas for patient care, and all these aspects must be planned in advance,” she emphasized.
Dr. Malango also pointed out the key lessons learned from teamwork and the complementarity of each group’s functions. “We need guiding instruments, updated flowcharts and all necessary information displayed in health units and other locations.”
Dr. Elsa Malango, Head of Health Surveillance, Manica Province. Photo Credit: Arsenio Manhice
Replicating and Integrating with Other Institutions
Some participants hope to replicate the success of the training in their own institutions and teams to better respond to not just a potential Marburg outbreak but other public health emergencies, building towards a resilient and adaptable health system.
Dr. Vanda Zitha, Chief Medical Officer of the Maputo City Health Service, stated that replicating the training in her own institution will improve knowledge and enhance the ability to respond to potential cases. She noted that the exercise revealed that many emergencies occur when health care staff are not fully prepared, leading to insecurity and rumors.
“It is essential to conduct simulation exercises for all health sectors,” she said. “Many cases which could be handled locally are often referred to provincial or central hospitals.”
Dr. Zitha also highlighted the need to train airport and migration teams to assist in detecting cases and notifying health authorities. “We need robust response plans at all levels,” she added. “The establishment of a provincial emergency fund is essential to ensure an immediate response while waiting for support from partners. Additionally, it is crucial to have a communication and alert system between neighboring countries to ensure effective passenger control.”
Dr. Vanda Zitha, Chief Medical Officer, Maputo City Health Service. Photo Credit: Arsenio Manhice
Invaluable Learnings to Prepare and Prevent at Maputo Central Hospital
This advanced preparation for potential public health emergencies can also alleviate the burden placed on health care workers and hospitals.
Dr. António Luis Assis da Costa, Clinical Director of Maputo Central Hospital (HCM), emphasized that HCM is often overwhelmed by patients who could be more quickly and effectively treated at district health units. For him, the simulation exercise was invaluable.
He explained that HCM conducts weekly epidemiological assessments to evaluate the types of cases that enter the hospital. “It is more expensive to control a severe health crisis than to prevent one. Therefore, we must all see prevention as the best investment,” he said.
“As a first step, we will ensure that key staff who handle patients are knowledgeable and prepared to identify and respond to cases,” he added.
Dr. António Luis Assis da Costa, Clinical Director, Maputo Central Hospital (HCM). Photo Credit: Arsenio Manhice
Coordinating and Collaborating for a Responsive and Resilient Future
Addressing current and future public health emergencies requires a strong and coordinated response from MISAU and its partners. VillageReach will continue to support and assist MISAU through PHEOC learnings and capacity building as they continue operationalizing the PHEOC network for better control and coordination of public health emergency preparedness and response.
Lorna Gujral, project manager at VillageReach, was a facilitator in this exercise.
“At VillageReach, we are proud to collaborate with different teams committed to identifying and responding to Marburg and other diseases. Additionally, we understand that teams need to be fully aware of their roles and responsibilities, empower others and remain vigilant to potential outbreaks,” she said.
Lorna Gujral, Project Manager, VillageReach. Photo Credit: Arsenio Manhice
Implementing preparedness exercises and training builds towards our goal of responsive health systems in Mozambique that can adapt to changes in demand and remain functional during public health emergencies. Participants left October’s Marburg exercise feeling more prepared to effectively respond to outbreaks and more confident that we can build a more resilient health future for Mozambique.