Guinea-Bissau - National Institute of Public Health (INASA)

Transform the national public health system by creating a new NPHI

With a plan in hand and against all odds, war-torn Guinea Bissau – which has not traditionally been the focus of donors – has been able to attract resources and virtually transform its ability to respond to health threats within a few short years. Guinea-Bissau celebrated the official opening of its new national public health institute, INASA, in February 2011, marking the country’s remarkable journey to rebuild its dessimated public health system.  Today INASA's new headquarters building houses the INASA administrative staff as well as state-of-the-art meeting and training space available nowhere else in the bomb-damaged capital city of Bissau.
Guineabissau NPHI
The new institute links and unites the formerly fragmented components of Guinea-Bissau’s national public health system and is already promoting evidence-based decision making that is improving lives in Guinea-Bissau. With its own and leveraged funds from IANPHI and other partners, and guidance from colleagues in Brazil and Portugal, Guinea-Bissau has rebuilt its lab and galvanized disease monitoring and reporting. The national school of public health is now part of INASA and is training public health staff, nurses, midwives, and lab technicians to replace those who fled during the civil war. A surveillance program equipped with laptops and cell phones has reduced response time to outbreaks from weeks to days.

The journey from dream to reality was impeded by a sad recent history of coups and coup attempts, political crises, and civil war and destruction – but was ultimately achieved through the determination and perseverance of the country’s public health leadership. Born from a vision by Guinea-Bissau’s Secretary General for Health Augusto Paulo Silva more than 15 years ago, the project to create the new institute was ultimately started with IANPHI seed funding in 2009. Since then, that initial investment has been leveraged many times and every day brings more partners and more progress toward development of a fully functional NPHI.

Located in a small corner of West Africa, Guinea-Bissau is one of the world’s poorest countries. The conflict and bombings that ravaged Guinea-Bissau in the late 1990s disrupted economic growth, impoverished the country, and left the public health system weak and fragmented. Efforts to carry out core public health functions were constrained by disrupted programs, loss of human resources, precarious laboratory capacity, and lack of external aid during and after the crisis. The toll on public health was severe, and the country has since faced many serious disease outbreaks, including a devastating cholera epidemic in 2008-2009 that dramatized the grave condition of the national public health system and the urgency of efforts to strengthen infrastructure and capacity.

As optimism returns, the country’s leaders have championed efforts to rebuild the national public health system and improve their population’s health. Propelled by enthusiastic leadership within the Ministry of Health, a team of stakeholders in Guinea-Bissau worked with peers from Fiocruz, IANPHI’s member institute in Brazil, to develop an organizational strategic plan for combining much of their current capacity into an NPHI.

With IANPHI funding, the new institute  brought together and began strengthening the four components that previously conducted core public health functions: National Laboratory of Public Health Laboratory, Bandim Health Project, MOH Hygiene and Epidemiology Unit, and the National School of Public Health. This new entity is allowing the country to realize its vision for a well-organized, substantive, and sustainable public health system.

The four units now work in the newly renovated headquarters building on the campus of the National Laboratory. Improvements and capacity building within the lab —some as basic as securing dependable power supplies to keep the lights on and samples and reagents cold—are enabling scientists to continue the work disrupted by civil war and get on with the task of improving public health in their recovering nation. The new institute in Guinea-Bissau is strengthening core public health functions including laboratory science, data collection and analysis, disease outbreak monitoring, and training. 

As the first donor to the new institute, IANPHI has leveraged funds from other donors including the World Bank, WHO, UNICEF, GIZ, and the governments of Brazil, China, Portugal, and Spain, which have provided lab equipment, phones, computers, generator fuel, library materials, training, and technical assistance.

Examples abound: 
  • China is investing USD $10 million in building a INASA campus that will house the headquarters building, national public health school, faculty of medicine, and a guest residence.
  • INASA is working with the architecture firm CUH2a on a plan for construction of a new national public health laboratory on the same site.
  • Several countries and donors are helping INASA build capacity in molecular biology –  $328,000 from the Brazilian Agency for Cooperation for early infant HIV diagnosis, lab mentorship, and training, and support from the Global Fund, the West African Health Association,, and the Economic Community of West African States for PCR and other equipment critical to quicklly detecting and diagnosing infectious diseases. 
  • A partnership was established with the University of Oslo to strengthen the health information system. Spain is providing significant development support to this effort, supporting the INASA website.
  • Spain is also conducting a feasibility study of solar power. The World Bank is providing 12 solar generators for INASA and the regions.
  • Portugal is funding a TB reference lab and sentinel HIV surveillance in two sites per region. With support from IANPHI, a team from US CDC conducted a two-week INASA workshop on data management and analysis. INASA carried out the country’s first nationwide community prevalence survey on HIV, which was used to revise the strategic plan for funding from the Global Fund.
  • A consultant from Brazil is assisting INASA with organizational development and elaboration of an institutional development and fundraising plan, and INASA’s principal management officer received training at the University of Zambia in public health leadership and management and is implementing a project to train all division directors in financial management.

“The new institute represents hope for Guinea-Bissau’s public health future. By coordinating and providing leadership for core public health functions, the NPHI will transform our capacity to recognize and monitor health problems and respond with evidence-based policies and actions," says INASA President Amabelia Rodrigues. 

Notes from the Field

INASA President Amabelia Rodrigues (front, third from left), international partners, and local dignitaries attracted resources and transformed publlic health capacity in Guinea-Bissau in just a few years. The opening celebration of INASA attracted a crowd of well-wishers representing Guinea-Bissau’s prime minister, government ministries, and development partners; partners and collaborators from other African countries; WHO; and the governments of Brazil, Portugal, Spain, China, Angola, Cape Verde, Iceland, and Denmark. 

guineabissau public health