In the lead-up to a major fund-raising conference for Ebola recovery, the World Health Organization (WHO) called the rebuilding of the national health systems in West Africa a critical priority. While the countries are still working to get to zero Ebola cases, staying at zero is inconceivable unless rebuilding of the health systems begins now.
“Guinea, Liberia, and Sierra Leone entered the Ebola epidemic with severely underfunded health systems,” says Dr. Matshidiso Moeti, WHO regional director for Africa. “After a year of handling far too many severely ill patients, the surviving staff need support, better protection, compensation, and reinforcements. The existing facilities need a complete overhaul, and many new structures need to be built. If another outbreak strikes, the toll would be far worse.”
“Outbreaks of contagious diseases can flare up anywhere,” says Marie-Paule Kieny, WHO assistant director-general for health systems and innovation. “But the size of the Ebola outbreak in West Africa is directly related to the lack of resilience of the national health systems. In West Africa, the governments did not have the tools or resources to identify the initial cases or control the outbreak that resulted.”
“National pride will not stop a viral outbreak on its own,” says Dr. Philip Ireland, an emergency medicine physician at John F. Kennedy Hospital in Monrovia, Liberia. “But it provides a strong foundation for building a new health system; the one we had collapsed under the weight of Ebola. The hiring of well-trained doctors and technicians, nurses and physician assistants should be our nation’s number one priority.”
According to a WHO report released in May, Ebola took an exceptional toll on health workers. They were 20 to 30 times more likely to contract the disease than the general public, given the number of patients they saw and treated. More than 800 contracted Ebola, and more than 400 died—with the outcome of almost one quarter of the cases unknown.
The health systems of all three countries need an exceptional infusion of funding and other resources, the focus of the United Nations Secretary-General’s International Ebola Recovery Conference (July 9-10, 2015). To rebuild their health systems and provide services through the end of December 2017:
To rebuild their health systems and provide services from now through the end of December, 2017:
•Guinea has budgeted $1.176 billion and still needs to raise $386.5 million;
•Liberia has budgeted $550 million and still needs to raise $169.7 million; and
•Sierra Leone budgeted $361 million and still needs to raise an estimated amount of $140 million.
A sizable investment in the health systems would be a profound change of course for the region. As with other low-income countries, the governments of all three countries have not spent enough money on healthcare to provide basic services, and the life expectancy of the populations has suffered greatly as a result. In 2013:
•Guinea spent $7 per person on health services and the life expectancy was 52 years;
•Liberia spent $14 per person and the life expectancy was 56 years;
•Sierra Leone spent $11 and the life expectancy was 49 years; and
•In contrast, Norway spent $7160 per person and the life expectancy was 81 years.
“In this interconnected world of international travel and porous borders,” adds Kieny, “no one is immune from disease outbreaks. This is the lesson the West African Ebola outbreak has taught us. We need to ensure health systems everywhere can detect and treat emerging diseases and still keep their routine healthcare services up and running.”
“When people think global health security they think disease surveillance,” says Moeti. “Nobody wants to see the Ebola outbreak start in West Africa and spread around the world. But disease surveillance cannot happen in a vacuum. Emerging diseases cannot be detected and controlled if there are no laboratories, hospitals and health personnel.”