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Justice For Sambo Abdullahi, Victory For Whistleblowers In Nigeria By Chido Onumah and Godwin Onyeacholem

Whistleblowers are the first line of defence against corruption, crime and cover-ups, according to a 2019 paper by the All–Party Parliamentary Group (APPG) on whistleblowing in the UK.

For Sambo Abdullahi, head of internal audit at the Nigerian Bulk Electricity Trading (NBET) Plc, it has been one long tortuous journey. Over the past two years, he has been at the receiving end of the retaliation whistleblowers around the world, including in Nigeria, face for shining the light on malfeasance around them: denial of wages, job losses, expensive court cases, abuse, psychological trauma, blacklisting across their sector, and sometimes death.

Abdullahi has been denied his salary and other allowances since December 2017, threatened, blacklisted, arrested and sued. All of this for acting professionally and responding patriotically to the call of the Nigerian government asking citizens to join the fight against corruption by blowing the whistle on corrupt practices and other forms of wrongdoing in the country.

In two separate courts, in Ifo, Ogun State, and Okitipupa, Ondo State, where in a most brazen abuse of judicial process, Abdullahi was summoned to answer charges of defamation levelled against him by his boss, Dr. Marilyn Amobi, Managing Director of NBET, he easily walked through the doorway of victory. Both cases were struck out on account of Dr. Amobi’s lack of seriousness in prosecuting.

The crisis of corruption in NBET has been going on for almost three years and the government appears not to have any solution. The appointment of Dr Amobi as the second substantive MD/CEO of NBET signified doom not only for Abdullahi as head of internal audit but also for the entire staff of the company. The MD withheld Abdullahi’s salary and other emoluments just because he exercised the right to decline participation in her fraudulent activities and rejected an unwarranted deployment to a new department unilaterally created by the MD to continue to perpetrate fraud.

Abdullahi, a Fellow of the Institute of Chartered Accountants of Nigeria (ICAN), graduated in Accounting from a reputable university and has over two decades of experience. He acquired experiences from both the private and public sectors before joining NBET. He was the pioneer Head of Internal Audit of NBET in 2012; a position he held till 2016 when Dr Amobi joined the company.

Within one month of Dr. Amobi’s assumption of office, Abdullahi discovered the illegal over-payment of N2 billion to two generating plants, Omotosho Power Plc and Olorunsogo Power Plc, both of which have no Gas Supply Agreement (GSA) and Gas Transportation Agreement (GTA) as required by industry agreement. The implication of this fraudulent transaction is that electricity consumers on a monthly basis pay N2billion in excess of what they ought to have paid if this fraud is averted. It is on record that the very first month the fraud was detected, Dr Amobi assumed the role of internal auditor by signing off the payment vouchers.

Her defence for this unlawful violation was that the mandatory GSA and GTA had been waived. The questions for her are, who approved the waiver? Why was the waiver not extended to other thermal plants? And why did the waiver idea come only after the head of internal audit had uncovered the fraud?

Other transactions that made Abdullahi to incur the wrath of Dr. Amobi was his refusal to endorse other payment vouchers for illegal procurement of alcohol using taxpayers’ money, proposed monthly payment of N2.5million to one Engr. Achinaya (an ex-staff of both NEPA and PHCN) without procurement process, procurement of legal advisory services of Azinge & Azinge and Aelex law firms in gross violation of the Procurement Act, and payment for return flight ticket from London for Dr Amobi to resume work in NBET in violation of the NBET Board-approved benefit compensation packages just to mention a few.

As a retaliation against Abdullahi for doing his job professionally, which to Dr Amobi connotes standing in her way, she colluded with the Office of the Accountant General of the Federation to get rid of Abdullahi and his colleague Waziri Bintube. Both were removed from their duly appointed and NBET Board- approved functions as head of internal audit and Chief Finance Officer respectively. While Abdullahi’s salary was stopped, Bintube was sacked.

In response, the duo wrote a petition to the Ministry of Power in 2017. The ministerial committee report was released in March 2018 and vindicated them, while indicting Dr. Amobi. But despite the minister’s (Babatunde Fashola) directives that Abdullahi’s salary should be restored and Bintube reinstated immediately, and in fact that both workers should enjoy the rights of NBET staff, Dr. Amobi refused to comply with the directives.

Till date, she denies Abdullahi his salaries and Bintube has not been called back. Dr. Amobi heads a government agency supervised by a Ministry, but her insolent defiance of a Ministerial order is unprecedented in the history of public sector administration in Nigeria. And it is strange that this is happening under a government that claims to prioritize due process and accountability in the public sector.

As if the stoppage of salaries and sacking were not enough, Dr Amobi got Abdullahi and Bintube detained in the facility of the State Security Services (SSS) for more than twenty-four hours. Several directives by Babatunde Fashola, then Minister of Power, were rebuffed by Dr Amobi who insisted that as an appointee of President Muhammadu Buhari she would only take directives from the president.

While the issue of salary suspension remained unresolved in spite of interventions from the Ministry of Power, Office of the Secretary to the Government of the Federation and the office of the Vice President, among others, Abdullahi approached the National Industrial Court in December 2018, twelve months after the unlawful stoppage of his salaries, with Nigerian Bulk Electricity Trading Plc, Dr Marilyn Amobi (MD/CEO), Hon Minister of Power and the Ministry of Power as defendants.

On March 11, 2020, Abdullahi (the claimant) once again walked the path of victory with the court delivering judgement in his favour. According to Hon Justice O. O. Oyewumi, the act of the suspension of the claimant’s salaries from December 2017 till date was wrongful; the denial of the claimant’s 2017 and 2018 leave was wrongful; the 1st and 2nd defendants, contrary to its terms and conditions of service, withheld the claimant’s salary and other emoluments wrongfully. The judge ordered the payment of Abdullahi’s salaries and other allowances, noting, “All sums awarded in the judgement is to be paid within 30days of the judgement, failure upon which it attracts 21% interest thereon per annum.”

While the case lasted in court, the Economic and Financial Crimes Commission (EFCC), Independent Corrupt Practices and Other Related Offences Commission (ICPC), Auditor General of the Federation and the Bureau of Public Procurement all issued reports indicting Dr Amobi while recommending her immediate prosecution. Sadly, some higher powers are preventing this from happening.

Governance problems are commonly found in federal government agencies due to either lack of a Board or total collapse of the governance structure. The Director General of the Bureau of Public Enterprises, Alex Akoh, noted in a letter to the Minister of Finance, Budget and National Planning, Zainab Ahmed, dated January 7, 2020, that “for the past 14 months, no Board meeting of the company (NBET) was held, a situation which has serious consequences on the corporate governance of the company”. Truth is, no Board meeting of NBET has held since August 2018 when Professor Yemi Osinbajo, then Acting President, ratified the reconstitution of the NBET Board of Directors recommended by Kemi Adeosun, the immediate past Minister of Finance.

The governance collapse in NBET has entrusted the fate of about 80 million electricity consumers in Nigeria in the hands of Dr Amobi who sees herself as not only untouchable, but also a sort of “Alfa and Omega.” She formulates and executes policies at will, such as changing the company organogram whenever she sees any staff as standing in her way. The entire senior management has passed a vote of no confidence in Dr Amobi but despite this and other fraudulent activities traceable to her, no action was taken by the government to ameliorate the problem in the power sector and curb the continuous fraud being perpetrated in NBET.

The Minister of Power of Power Engr. Sale Mamman, in December 2019, made a daring move to respond to the situation by suspending Dr. Amobi from office indefinitely. But curiously, he was overruled by President Muhammadu Buhari in less than two weeks and Dr. Amobi was returned to office.

This forced the Minister to fire a letter dated January 8, 2020, to Boss Mustapha, Secretary to the Government of the Federation, detailing investigations by the ICPC, EFCC and the reports of the Auditor General of the Federation which implicated the NBET boss “for breach of due process in the award of contracts and several financial wrongdoings.” In that letter copied to President Buhari, the Minister reminded the SGF of “the additional baggage which the suspended MD carries in the light of the anti-corruption stance of the Federal Government.”

If this government wants to be seen as genuinely fighting corruption, the NBET case is a golden opportunity to faithfully demonstrate that conviction. Dr. Amobi has been indicted for corruption by government anti-corruption agencies. The place for her, therefore, is the courtroom, not a cushioned seat of a government agency.

Meanwhile, before Dr. Amobi’s prosecution, government should direct her to obey without delay the judgment of a court of competent jurisdiction in the suit filed by a whistleblower, Sambo Abdullahi, the head of internal audit of NBET.

In addition, government should realize that all whistleblowers deserve full and effective protection from all kinds of retaliation, without which its whistleblowing policy will not succeed as an instrument for reducing corruption in the country.

Onumah and Onyeacholem are with the African Centre for Media & Information Literacy (AFRICMIL)

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Chido Onumah and Godwin Onyeacholem

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March 26, 2020
Private hospitals urged to provide more assistance to govt hospitals

PETALING JAYA: Private hospitals are asked to put profits aside for now and in the name of service, support the Health Ministry in combating the Covid-19 pandemic.

Federation of Malaysian Consumers Association (Fomca) CEO Datuk Dr Paul Selvaraj said in this time of crisis, private hospitals, especially those run by government-linked companies, should give their utmost to assist the government given that public hospitals are called to treat the rising number of Covid-19 patients.

“Put service as priority and put aside profits for now,“ he told theSun today.

Suaram adviser Kua Kia Soong suggested that private hospitals step forward to take some of the burden off the public sector by providing some sort of subsidised charges or no cost at all. They should also help with cases which are not related to the viral pandemic, fill the need for special wards, offer intensive care unit space and equipment such as ventilators and oxygen supply.

“In the best of times, private hospitals reap the benefits of the much touted Malaysian product known as ‘medical tourism’ and attract the best medical talents from the public sector.

“Now that we are in the worst of times, private hospitals don’t seem to be doing too badly either.

“According to the Affin Hwang Capital Research, the coronavirus pandemic is likely to have only a muted impact on private hospital operators as they are required to report such cases to public hospitals and the national infection centre,“ Kua said in a statement today.

Meanwhile, in response to the many questions broached of late, president of the Association of Private Hospitals Malaysia (APHM) Datuk Dr Kuljit Singh said they (private hospitals) have made available 51 ventilators to the Health Ministry.

“We will be accepting non Covid-19 cases from the Health Ministry hospitals too. Discussions on taking on cases are in the final stages,“ he said in a statement on Tuesday.

He also said the APHM and its member hospitals see this as an opportunity for the private hospitals to work with the Health Ministry and the government in facing this national crisis.

“We have the support of all private hospitals in cancelling electives and reducing non urgent consultation while some private hospitals have even started Covid-19 screening for walk-ins and drive-ins,“ he added.

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March 25, 2020
Edo Government Restricts Gatherings To 20 Persons

In a bid to curb the spread of Coronavirus in Edo State, the state government has reduced the number of persons allowed in any public gathering from 50 to 20.

Other measures taken by the state government in the face of continuous spread of the virus in the country include the closure of markets with only sellers of food items, medicines and other vital commodities allowed to operate.

Governor Godwin Obaseki disclosed the new measures during the inauguration of the Edo State COVID-19 Response Committee at Government House, Benin City, the state capital.

He said, “We are reducing the number of persons allowed to gather in public places from 50 to 20 persons.

“Also, only markets where essential commodities like foodstuffs are sold should remain open for now.

“The state government is working with the Irrua Specialist Teaching Hospital for mass production of hand sanitisers in drums that would be distributed to local government areas, palaces, markets and other government agencies for use in public places.”

He directed transport unions to intensify sensitisation among members on the need to implement social distancing by reducing the number of passengers on their vehicles.

The governor while tasking security agencies in the state on the enforcement of the new measures, disclosed that the state government would partner with Nigeria Medical Association to intensify public health services.

PUBLIC HEALTH

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March 25, 2020
Govt to bear RM662m electricity bill discount

KUALA LUMPUR: The government will bear the cost of an electricity discount for selected sectors amounting to RM662 million, of which RM122.5 million is for Sarawak and RM37.2 million for Sabah, this year, Energy and Natural Resources Minister Datuk Dr Shamsul Anuar Nasarah said.

He said the cost would be borne through the Kumpulan Wang Industri Elektrik’s (KWIE) fund for Peninsular Malaysia, and by the federal government for Sabah and Sarawak, he said in a statement today.

The electricity discount of 2% and 15% for six months beginning April was specified under the Economic Stimulus Package 2020, which was aimed at reducing the cash flow problem faced by tourism-related businesses, as well as commercial, industrial and agriculture users affected by Covid-19.

A discount of 15% is given to six selected business sectors under the Trade Tariff category and is expected to result in a reduction of electricity bills for the period amounting to RM40 million in the Peninsula, RM20 million in Sabah and RM8.5 million in Sarawak.

Shamsul Anuar said the 15% discount would involve 10,000 accounts in the six sectors, namely hotel operators, travel and tourism agencies, shopping complexes, convention centres, theme parks, and local airlines offices.

On the other hand, commercial, industrial and agriculture users would get 2.0% discount.

“This would benefit about 1.6 million Tenaga Nasional Berhad (TNB) account holders with electricity bill savings estimated at RM370 million for the six-month period,” he said.

For Sabah, it would benefit 99,322 account owners with an estimated cost of RM11.5 million, while for Sarawak, it involves an estimated cost of RM107.2 million for 100,000 account owners.

Shamsul Anuar said domestic or residential category users would enjoy electricity bill savings through a 2% discount on the electricity consumption for the April 1-Sept 30, 2020 period.

“This means that the people will enjoy a 2% discount during the period, in addition to the 6% discount already enjoyed by domestic consumers for the Jan 1-June 30, 2020 period,” he said.

This is expected to provide estimated electricity bill savings of RM92 million to about 7.5 million TNB account holders for the six-month period.

“For Sabah, it will benefit 520,378 domestic consumers at an estimated cost of RM5.7 million, while for Sarawak, it will benefit 585,637 domestic consumers at an estimated cost of RM6.8 million,” Shamsul Anuar said. – Bernama

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March 19, 2020
Do not bring family to buy essential goods: NSC

PUTRAJAYA: There is no restriction on individuals going out to buy essential goods when the Movement Control Order comes into effect from March 18 to 31 throughout the country, but they are not allowed to bring their family members along.

National Security Council (NSC) Maritime Sovereignty Division director Roselin Rajab said the order was aimed at reducing the movement of people in public places in the effort to curb the spread of the Covid-19 infection.

“There is no problem if you want to buy daily necessities but do not bring the entire family and children for the chore. Just go out alone,” he told reporters after a special Covid-19 meeting between Communications and Multimedia Minister Datuk Saifuddin Abdullah and media editors, here today.

In terms of surveillance, Roselin said the authorities would be monitoring to ensure there is no assembly or gathering at public places.

“If we come across people meeting in a place, they will be told to return home,” he said.

On transit flights at the country’s airports, Roselin said these passengers would not be allowed to come out of the terminal.

“As they are on transit, the passengers would not be allowed come out of the terminal. This is because, they have not entered the country so long as they do not pass the Immigration checkpoint,” he said.

The Movement Control Order was announced by Prime Minister Tan Sri Muhyiddin Yassin on Monday to prevent the virus from infecting more people. – Bernama

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March 17, 2020
ICC-WHO Joint Statement: An unprecedented private sector call to action to tackle COVID-19
In a coordinated effort to combat the coronavirus COVID-19 pandemic, the International Chamber of Commerce (ICC) and the World Health Organization (WHO) have agreed to work closely to ensure the latest and most reliable information and tailored guidance reaches the global business community.

The COVID-19 pandemic is a global health and societal emergency that requires effective immediate action by governments, individuals and businesses. All businesses have a key role to play in minimising the likelihood of transmission and impact on society. Early, bold and effective action will reduce short- term risks to employees and long-term costs to businesses and the economy.

To aid this collective effort, ICC will regularly send updated advice to its network of over 45 million businesses so that businesses everywhere can take informed and effective action to protect their workers, customers and local communities and contribute to the production and distribution of essential supplies.

ICC will also contribute to enhancing information flows on the coronavirus outbreak by surveying its global private sector network to map the global business response. This will both encourage businesses to adopt appropriate precautionary approaches and generate new data and insights to support national and international government efforts.

As an immediate priority, businesses should be developing or updating, readying or implementing business continuity plans. Business continuity plans should aim to reduce transmission, including by: promoting understanding of the disease, its symptoms and appropriate behavior among employees; setting up a reporting system for any cases and contacts; preparing essentials; limiting travel and physical connectivity; and planning for measures such as teleworking when necessary.

Calls to Action
- ICC strongly endorses WHO’s call on national governments everywhere to adopt a whole-of- government and whole-of-society approach in responding to the COVID-19 pandemic. Reducing the further spread of COVID-19 and mitigating its impact should be a top priority for Heads of State and Government. Political action should be coordinated with actors in the private sector and civil society to maximize reach of messaging and effectiveness.
- Governments should commit to making available all necessary resources to combat COVID-19 with the minimum of delay and to ensure that cross-border medical and other essential goods supply chains are able to function effectively and efficiently
- ICC and the WHO encourage national chambers of commerce to work closely with UN country teams, including WHO country offices where they exist, and to designate mutual focal points to coordinate this collaboration.
- ICC encourages its members to support their country’s national response efforts and to contribute to the global response efforts coordinated by the WHO through www.covid19responsefund.org.
As the pandemic evolves, ICC Secretary General John W.H Denton AO and WHO Director General Dr Tedros Adhanom Ghebreyesus will continue to coordinate their efforts.

Essential information on the COVID-19 pandemic can be found on the WHO’s dedicated site.

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March 17, 2020
Europe airlines chart path through coronavirus crisis

European airlines are reducing flights to Italy due to coronavirus as part of drastic cost-cutting in an industry rocked by fallout from the deadly outbreak.

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February 28, 2020
WHO Global Initiative for Childhood Cancer: progress on all fronts

Peru shows the way forward and the courage of Ander Martinez

“When Ander was diagnosed, I didn´t have the possibility to cover the cost of the treatment. It was very expensive, and I had nothing,” says Rosalina Tocto, 29 years mother of Ander Martínez Tocto. Ander had just been diagnosed with acute leukemia at the young age of 6 years. From the beginning, the odds were stacked against him. He and his family lived in a rural town, six hours from the nearest city. His parents did not have a formal job, placing the family under financial strain.

Ander and his family were not alone in this situation. “In Peru, nearly 1800 children and adolescents are diagnosed with cancer every year; however, up to 70% will have a late stage, often metastatic due to delays in diagnosis,” says Dr. Juan García, medical chief of the Pediatric Department of in the National Institute of Neoplastic Diseases (INEN) in Lima, Peru. “Most of our patients come from outside Lima and the majority of parents do not have formal employment and therefore do not have any type of insurance.”

Fortunately, Peru has made a strong commitment to Universal Health Coverage. In 2009, a law was passed to improve access to care by introducing a mandatory health insurance system and registering everyone living in extreme poverty under Seguro Integral de Salud (SIS), regardless of age or circumstance.

Dr. Reina Bustamante, Executive Director of the Division of Prevention and Control of Cancer of the MINSA says “UHC is an important step in public health particularly for those who lack public or private insurance like Ander. In this context, we are trying to follow WHO guidance to achieve UHC and ensure all individuals and communities receive the health services they need without suffering financial hardship.”

In 2019, Peru was selected as a focus country for the WHO Global Initiative for Childhood Cancer as the first focus country in the Region. The Global Initiative aims to improve survival for all children with cancer to at least 60% by 2030 while reducing suffering, altogether with the potential to save an additional one million lives.

Four main goals were formulated for the national pediatric cancer plan: (1) improve early diagnosis of childhood cancer, (2) decrease treatment abandonment, (3) implement a national pediatric cancer registry and (4) improve the quality of services in pediatric oncology units.

Dr. Liliana Vasquez, pediatric oncologist who works as an external consultant for the Division of Prevention and Control of Cancer of MINSA said, “Ten working groups have been established to achieve the goals.”

Dr. Vivian Perez, advisor of the Non-Communicable Diseases Office in PAHO-Peru added “the initial focus for the Initiative will be on six cancers selected as tracers for monitoring progress across the health system, alongside engagement of at least six focus countries with a record of strong political commitment and foundational efforts supporting children with cancer.”

For Ander, his health care team, the commitments from the government of Peru and partners and Global Initiative have made it possible to be successfully treated and will now allow him to dream of a healthy future though better access to surveillance monitoring and psycho-oncological support aimed at childhood cancer survivors.

Peru is showing what is possible for all countries. By concerted action and promoting universal health coverage, every child in the world can have access to high-quality care with the greatest likelihood of survival, and every family should be protected from financial hardship. We can do more together.

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February 27, 2020
Ministers to agree new global road safety agenda to 2030

Government ministers and senior officials from over 100 countries will meet in Stockholm, Sweden from 19-20 February to discuss new steps to halve road traffic deaths and injuries by 2030, in line with global targets agreed in the United Nations Sustainable Development Goals (SDGs).

“The fact that an estimated 1.35 million lives are lost every year due to road traffic collisions is an outrage. It is an unacceptable price to pay for mobility,” said Dr Tedros Adhanom Ghebreyesus, Director-General at the World Health Organization (WHO).

Road traffic injuries are now the leading cause of death for children and young adults aged 5 to 29 years, according to WHO’s most recent Global status report on road safety.

More than half of all road traffic deaths occur among pedestrians, cyclists and motorcyclists. The risk of a road traffic death remains three times higher in low-income countries than in high-income countries. Moreover, as many as 50 million people experience non-fatal road injuries, which impose human suffering and major economic losses.

“Most road traffic deaths and injuries can be prevented, using tried and tested strategies,” added Dr Tedros. “This conference is an opportunity for the world to embrace a new agenda to radically reduce the number of lives lost on our roads and re-think how we can provide access to safe, affordable, accessible and sustainable transport systems for all.”

Progress in road safety

Many countries have already made progress through effective road safety management and focusing on better legislation and enforcement around key risks such as speeding; drinking and driving, and failing to use seatbelts. They have also improved infrastructure through measures such as safer sidewalks and dedicated lanes for cyclists; implemented vehicle standards such as those that mandate advanced braking and electronic stability control; and enhanced post-crash care.

Improvements have occurred when a number of sectors have been involved – including transport, health, urban planning and law enforcement, among others. Success has also depended mainly on strong leadership and political will at the highest level of government and in close collaboration with civil society and the private sector.

The Stockholm Declaration

Hosted by the Government of Sweden in collaboration with WHO, the 3^rd Global Ministerial Conference on Road Safety offers delegates an opportunity to share successes and lessons learned, chart future strategic directions for global road safety, and define ways to fast-track progress around proven strategies to save lives.

The Stockholm Declaration will be presented as the final outcome document of the Ministerial Conference calling for strong political will and international cooperation as well as partnerships across many sectors of society. The Declaration will lay out key recommendations for accelerated action to drive progress towards halving global road traffic deaths and injuries by 2030.

Beyond preventing human suffering and major economic losses, addressing road traffic deaths and injuries has positive impact across all aspects of society and development ─ including those linked to environment, climate change, education, employment, energy, poverty, human rights and equality ─ as outlined in the SDG targets.

Note to editors:

Road safety is reflected in the SDGs agreed in 2015, with two dedicated targets: (a) 3.6 aimed at preventing road traffic deaths and injuries and (b) 11.2 providing access to safe, affordable, accessible and sustainable transport systems for all.

Achieving these targets would lead to increases in walking, cycling and using public transport, in other words, those modes of transport which impact most favorably on noncommunicable diseases like heart and lung diseases, cancer and diabetes. It would also contribute to reducing environmental risks, such as air and noise pollution, and steering sustainable urbanization, with less congestion and universal access to safe, inclusive and green public spaces.

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February 27, 2020
Pregnancy and breastfeeding during an Ebola virus outbreak

Women who are pregnant or breastfeeding in an Ebola outbreak face similar challenges as other population groups, but they have specific health needs which must be met.

As the second largest Ebola outbreak in history continues in the Democratic Republic of Congo, WHO has released new clinical guidelines for healthcare providers supporting pregnant or breastfeeding women in the context of Ebola virus disease.

Improving clinical care and reducing mortality

Clear and coherent guidance is needed to meet the combined needs of women requiring Ebola treatment, pregnancy care and management of complications.

Information on how to protect breastfeeding children and other members in the community from transmission of the disease is also critical.

Limited scientific evidence on how to best manage these needs has previously been a challenge for affected countries. In addition, misconceptions that pregnant women have a higher mortality rate than other populations with Ebola may in some contexts have put pregnant women at risk of not receiving standard care.

WHO’s Guideline on the management of pregnant and breastfeeding women in the context of Ebola virus reviews existing evidence and provides a single set of recommendations on the care continuum for women exposed to, diagnosed with, or recovered from Ebola.

This will enable healthcare providers, emergency response teams and health policy-makers to improve prevention and treatment measures in an Ebola outbreak.

Obstetric care at an Ebola Treatment Centre

Optimal supportive care should be offered to all pregnant women with Ebola. Likewise, they should be offered experimental treatment and vaccination under the same conditions as non-pregnant populations.

Ebola virus disease does increase the risk of miscarriage and early labour, requiring close clinical management at Ebola treatment centres. It is important to engage both obstetric providers and those trained in Ebola response.

This dual expertise is also important because early Ebola and pregnancy-related symptoms can overlap. Pregnant women should be prioritised for testing to confirm an Ebola infection.

Ebola virus can persist in pregnancy related fluids as well as breastmilk. If healthcare providers are not clear on how to manage Ebola infection risk, they may be less willing to provide care. This stigma can be life-threatening for women who experience complications during delivery.

The new WHO guidelines advise healthcare workers on how to protect themselves while caring for pregnant women with Ebola virus disease. This includes induced labour or surgical procedures, which carry greater risk of transmission in cases of acute infection. Any invasive treatments should be carried out in full personal protective equipment.

Breastfeeding recommendations in an Ebola outbreak

WHO recommends that women with suspected or confirmed Ebola immediately stop breastfeeding and are prioritised for diagnostic testing. Any child exposed to Ebola through breast milk should be placed into safe care, closely monitored for symptoms over a 21-day period and fed with an appropriate breast milk substitute.

The guidelines strongly recommend that breastfeeding is only restarted following two consecutive negative tests of breast milk, separated by 24 hours.

A breast milk substitute should be used even if infection is confirmed for both the mother and her child. Exceptions can be made for infants under 6 months of age who are already infected, if breast milk substitutes are not feasible, affordable, sustainable or safe and separation cannot be implemented safely.

Women’s health and rights in a disease outbreak

A disease outbreak does not change women’s and adolescent girls’ fundamental human right to sexual and reproductive healthcare, including evidence-based care during pregnancy and childbirth.

Women need support to make informed reproductive health care choices for themselves and their children. Women living in an Ebola outbreak should have access to all relevant reproductive options, regardless of economic, cultural, racial or religious status, including contraception and safe abortion to the full extent of the law.

Pregnant and breastfeeding women across affected communities need equitable and respectful care that considers the risks they face and supports the choices they make.

Accessing the guidelines and further research

These guidelines are now available online and may be freely downloaded. The executive summary will be available in French.

WHO will closely monitor new data as it emerges, as there is still a pressing need to prioritise ongoing research related to Ebola virus transmission.

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February 27, 2020