The problems and challenges
EVD has devastated the health systems and the economies of Guinea, Liberia, and Sierra Leone. When the outbreak started, existing public health services – which were already quite limited – were diverted to Ebola. In addition, many health workers became ill and died from the virus. The net result is that people have encountered significant barriers in accessing needed care, whether for Ebola or for other, more typical health conditions.
A precipitating factor concerned communities’ widespread lack of information/misunderstandings about EVD; and a more generalized lack of trust of health workers especially foreign medical teams.
This fuelled the spread of the virus and hampered contact tracing.The World Bank estimates that in 2015, the three affected countries will forego USD two billion due to the virus. Major sources of employment have been hit hard; the impact on poverty is large and growing. The health, economic and social gains of the past decade are now at risk for the three countries, and indeed for the entire subregion.
Ebola became epidemic in Guinea, Liberia, and Sierra Leone in large part because of their weak health systems. Particular structural weaknesses included (a) insufficient numbers and maldistribution of qualified health workers, and (b) inadequate surveillance and information systems. Other weaknesses include absent or weak rapid response systems, few laboratories mainly located in cities, unreliable supply and procurement systems for PPEs and other supplies, lack of electricity and running water in some health facilities, few ambulances.
When the crisis struck, the countries had no reserve capacity to mount an effective and timely response, particularly without compromising essential health services for other conditions. In this sense, their health systems lacked resilience.
Despite the acknowledged health systems challenges pre-existing in the affected countries, their pre-EVD performance on many indicators mirrors many other countries in the subregion and this raises the both the opportunity and the need for a broader cross-country and regional approaches to building robust and resilient health systems.