It's eight months since the World Health Organisation declared the Ebola outbreak as an emergency. During that time, the virus has claimed more than 5,000 lives and devastated communities across West Africa. Here Laura Searle looks at how a lack of trained healthcare professionals continues to make the region vulnerable to health crises like Ebola.
When the Ebola crisis begins to diminish, and the journalists and camera crews withdraw, public interest fades and political pressure on leaders subsides, the people of Sierra Leone, Liberia and Guinea will be left to rebuild their lives, their communities and their countries. Understanding the problems that led to the escalation of the Ebola crisis is essential in order for these countries to emerge safely from it and to prevent another crisis in the future.
People will be left to rebuild their lives, their communities and their countries.
A country's ability to contain an outbreak of an infectious disease like Ebola is largely dependent on the strength of its healthcare system and having enough staff to cope with the crisis. Clearly the healthcare systems in the affected countries were too weak to control the outbreak. For example, Sierra Leone had 119 doctors serving a population of nearly six million people. This meant that for every 50,000 people in Sierra Leone, there was one doctor (compared to a ratio of 100:1 in the UK). This falls well below the WHO's recommended minimum of at least 23 doctors, nurses and midwives per 10,000 of the population.
In Liberia and Guinea, the shortage of healthcare workers is even worse. In these countries, there is only one doctor for every 100,000 people. In addition this, there are also problems in terms of the number of health facilities accessible to citizens and insufficient medical supplies. For example, in Liberia, there are only 3,352 hospital beds for a population of nearly 4.5 million. Guinea has a similar number of beds (3,435) for a
population of nearly 11.5 million. It is hardly surprising then that these countries have struggled to contain the Ebola virus.
Inequality and the rich country drain on health workers
The health worker shortage in Africa is a stark example of global inequality. According to WHO research, Africa has the highest burden of disease of any continent, but has only 3% of the world's health workers, and less than 1% of the world's financial resources. While the continent continues to grapple with infectious diseases, such as HIV, malaria, cholera, tuberculosis and child pneumonia, as well as problems with maternal health, there has also been a rise in noncommunicable
diseases. But the number of health workers available to respond to these challenges remains remarkably few.
In Liberia and Guinea, there is only one doctor for every 100,000 people.
To address the unequal distribution of healthcare workers, we need to understand the labour market dynamics that affect the training, recruitment, deployment and performance of global and local health workforces. There is a global shortage of healthcare workers, affecting high-, middle-, and low-income countries, from the USA and Germany to India and Uganda. The difference between high-income countries and low- and middle-income countries lies in their ability to address these health workforce shortages,
and to invest in the recruitment and training of medical staff and managers.
Too often, richer countries simply recruit staff from poorer ones. It is estimated that 10% of Sierra Leone's trained nurses are working in the UK health system. There are many issues that lead health workers to seek employment outside their country of origin, including low salaries, inadequate health facilities and a lack of training and career development. Serious investment is needed to avoid the damage to local health services caused through the loss of healthcare workers. When
significant numbers of doctors and nurses leave the countries that financed their education, there is a huge loss of public investment making it more difficult to deliver services and to offer education and training to those who wish to enter the health profession in the future.
While workers should enjoy freedom of movement, mechanisms should be in place to support their retention, such as improving working conditions, remuneration and career development. In Zambia, for example, healthcare workers receive an extra 25% recruitment and retention allowance on top of their basic salary, which has been effective in decreasing the migration of nurses.
Ensuring countries have the human resources tackle health crises
Wealthier nations are more able to make these kinds of investments, both nationally and internationally (through providing aid and sharing expertise). A recent Global Forum on Human Resources for Health recommended that countries with severe healthcare personnel shortages should be supported to strengthen their health workforce, as part of a broader national health strategy. This should include a special focus on the most poor and marginalised sections of society, as well as strategies to train skilled
health workers to maximise their performance.
An estimated 10% of Sierra Leone's trained nurses are working in the UK health system.
The Ebola crisis has undermined the economic progress that Sierra Leone, Liberia and Guinea were making, thereby limiting the ability of these governments to make much-needed investments in their public services. It has, however, also succeeded in focusing attention on the shockingly unequal distribution of healthcare workers, which stands in the way of achieving key public health priorities, such as reducing child mortality, improving maternal health, increasing vaccine
coverage, and combating HIV/AIDS, malaria and other diseases.
The international community must invest in human resources for health for all. Health workers are the basis of a functioning healthcare system, which in turn helps to drive economic growth, save lives and improve the quality of life for millions of people around the world.
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