This post is part of a series that highlights the value of effective bottleneck analysis with 7-1-7 and brings to the front solutions to the top barriers to outbreak detection, reporting and response.
In a previous post, we examined data from 148 outbreaks across 18 partner countries in Africa, Southeast Asia and the Americas and the trends in bottlenecks that it reveals. In this post, we dive deeper into one of the top bottlenecks we identified – the lack of available resources to initiate outbreak investigation – and look at possible solutions.
The challenge: Why rapid resource mobilization is key to response initiation
Above: Across 148 outbreaks, the most frequent bottleneck was inadequate resource availability for early response, identified in 30% of outbreaks – see the full bottleneck synthesis graphic in our previous post
Stopping an outbreak – and meeting the 7-1-7 target – means that countries have to take action quickly. But when flexible funds are not immediately available to cover early response actions, responses stall and countries lose valuable time.
- Rapidly deployable outbreak funds don’t exist or aren’t fast enough.
- Countries might lack a budget line for rapid outbreak financing in advance of an outbreak.
- Rapidly deployable funds may not be included in annual budgets.
- Partner-led rapid financing mechanisms might be limited because of accounting requirements and a lack of clear sustainability plans for financing.
- Even when countries have available funds, response teams may have problems accessing them quickly.
- Bureaucratic bottlenecks impede the release of funds for immediate activities or resources.
- There are delays in the approval process for the distribution of funds.
- Response teams, particularly at the sub-national level, may lack authority to directly access funding.
Delays in funding ultimately lead to inadequate support for logistics, operations, supplies, and human resources needed to contain an outbreak – and slower response times.
What solutions exist
Set up rapid outbreak financing
Rapid outbreak financing ensure flexible resources are available at the first sign of an outbreak. The funding specifically supports outbreak investigation and the other early response actions. The establishment of rapid outbreak financing allows countries to balance the speed needed to control an outbreak and creates accountability for this funding, otherwise, bureaucratic processes can slow the process. This small amount of rapidly available funding, with accountability, saves lives
The 7-1-7 Alliance and Resolve to Save Lives (RTSL) have partnered with government entities and non-governmental partners in Uganda, Nigeria, the Democratic Republic of Congo, and South Sudan, bolstering 7-1-7 timeliness metrics. We have found that as little as 5,000 USD at the first sign of an outbreak can eliminate the need to spend tens or hundreds of thousands to control an epidemic later.
Partnerships for fast, flexible funding
In some instances, such as in Nigeria, rapid outbreak financing is designed as a pooled and rapidly accessible funding mechanism for qualifying outbreaks and used by multiple partners. Pooled funding or partnerships with global health organizations and multilateral development banks can make fast, flexible seed funding available during early response, balancing speed and accountability.
Resolve to Save Lives, AFENET, and PATH are examples of organizations that have supported these rapid funding initiatives in collaboration with relevant government entities and have improved response timeliness metrics, ultimately controlling outbreaks before broad social and economic impacts. In Nigeria, the median time for outbreak verification was reduced from six days before establishing the fund, to just two days after the fund’s implementation.
Regardless of the mechanism, partner-led, pooled, or fully domestic funding, rapid outbreak financing has proven to accelerate the speed of early response, ensuring that timeliness targets are met and reducing the severity and impact of outbreaks.
How 7-1-7 can help make the case
Setting up rapid outbreak financing requires advocacy and planning, and that’s where 7-1-7 can help. Public health authorities can use the 7-1-7 synthesis report template, designed to consolidate 7-1-7 findings for work planning, to make the case for the financing mechanism during annual operational planning sessions.
How South Sudan used rapid outbreak investigation funds to respond to cholera
The South Sudan Ministry of Health officially adopted the 7-1-7 target in March 2023 and used it for performance improvement in multiple outbreaks, including yellow fever, anthrax, and cholera. In late 2024, the ministry established a rapid outbreak financing mechanism with support from Resolve to Save Lives to ensure rapid response funding and resource mobilization to control outbreaks and achieve the 7-1-7 target.
It took only a short time before the financing mechanism was activated. In late 2024, South Sudan public health officials were on high alert. Due to an ongoing cholera outbreak in neighboring Sudan, the influx of returnees and refugees to South Sudan, and widespread flooding affecting large parts of South Sudan, the Ministry of Health was actively preparing for the potential spread of the disease across South Sudan.
On December 10, 2024, the Ministry of Health received a report of a person with cholera symptoms in Jonglei State who had been referred to Bor Hospital. The person had experienced symptoms since December 9 and had traveled from Renk, a town with ongoing Cholera transmission that borders Sudan.
On December 11, the One Health national rapid response team (NRRT) convened an emergency response meeting and recommended an urgent deployment to investigate. The Ministry of Health was able to immediately access rapid outbreak financing established through a partnership with to deploy the NRRT on the first available flight.
Above: South Sudanese health authorities responding to cholera in Bor. Thanks to rapid outbreak financing, it was the fastest the country had ever been able to deploy a team. Photo credit: Dr. Angelo Goup Thon Kouch
This immediate financing allowed the NNRT to arrive on site by December 15, to initiate the response, starting with investigation and sample collection. Samples collected were shipped to the National Public Health Laboratory in Juba on December 15, and rapid testing was conducted the same day.
On December 16, the team began its investigations. By tracing contacts of the infected woman, who was still in isolation, the team identified five additional cases – all from the woman’s own family. Thanks to the swift response, they were all admitted to the hospital where they received immediate treatment, including oral and intravenous rehydration. The team isolated the additional cases and worked with local health workers to identify potential new cases. No further infections were detected, and the outbreak in Bor was stopped at six cases with no recorded deaths. The team concluded its investigations and early response actions by December 21.
Dr. Angelo Goup Thon Kouch, director of health security at South Sudan’s Ministry of Health, called the response a breakthrough. “This is the fastest we’ve ever been able to deploy a team,” he said. “That is a direct result of rapid outbreak financing. This outbreak was contained because we could act quickly. You can see cholera outbreaks in other parts of South Sudan have many more cases when there are no funds available to act quickly.”
Ultimately, the team narrowly missed the 7-1-7 target. Despite detecting and reporting the case in one day, the team completed early response actions in 11 days, which included a four-day lag caused by limited flight options into Bor. Despite this, the team’s actions led to a successful outcome.
This case study is featured in Resolve to Save Lives’ Epidemics That Didn’t Happen.
