A key reason why the World Health Organisation and leading health groups have warned that the epidemic will take months to bring under control and may effect up to 2000 people is that no health crisis can be swiftly and sustainably resolved with weak health systems. Health workers are the core of every health system, but most African countries have only between 5% and 40% of numbers and required mix of health workers. In addition current levels of health financing are a fraction of required investment.
Ebola, and the ongoing challenges of HIV, Malaria, TB, Neglected Tropical Diseases, Non-Communicable Diseases, Reproductive, Maternal or Child Health will not be sustainably resolved without the necessary long term population based planning, multisectoral coordination and investment across the Education, Labour, Human development, Finance, Economic development and Health sectors.
The historical underinvestment in especially the Education sectors - including poor population based and development needs planning in many African countries - has resulted in many having just a fraction of human resources required across multiple sectors for long term sustainable development.
Health Worker Shortages Have Undermined Fight Against Ebola
Liberia with about 4 million people has only about 50 doctors compared to over 12,000 doctors for roughly the same population in Croatia. Sierra Leone with almost 6 million people has 136 doctors compared to over 18,000 in Denmark for roughly same population. Guinea with about 11 million people has just over 900 doctors compared to over 76,000 doctors in Cuba for about same population, and Nigeria has just under 59,000 doctors compared to 295,000 doctors in Japan which has 40 million people less than Nigeria. It is not a coincidence that Ebola has devastated Liberia and Sierra Leone which are 2 of the 5 countries globally with the lowest numbers of doctors. (See Factsheet for comparison tables on doctors, nurses & midwives and pharmacists in Ebola affected countries. See Scorecard for Africa Rankings).
Poor Health Financing
The poor investment in overall education and human resources development; combined with poor actual per capita investment in the health sector - translates into huge differences in life expectancy between African and other countries. Liberia invests only $18 per capita in health compared to Croatia's $818; Guinea $7 compared to Cuba's $573; Sierra Leone $13 compared to $5,563 in Denmark; and Nigeria $29 compared to Japans $3,824. Consequently and in tandem with other related factors - the difference in life expectancy between Liberia and Croatia is 16 years; between Guinea and Cuba 21 years; between Sierra Leone and Denmark 34 years; and between Nigeria and Japan 30 years.
Disruption to Society and Economy
With experts estimating that a one year improvement in life expectancy can result in an increase in GDP of up to 4%, the reasons for persistent economic under development become much clearer. Ebola has with higher visibly - than other long standing but equally serious health challenges - disrupted education, farming, food production and supplies, banking, mining, manufacturing, airlines, tourism, retail markets and supply chains, with predictions for heavy economic losses in affected countries.
Emergency funding and donations are only useful for a short term response. Ebola demonstrates again like HIV before it that health is not just a responsibility of the health sector – and the long term response must involve Finance, Planning, Human, Social and Economic Development Sectors.
Women Account for Up To 75% of Cases and 60% of Mortality
The Ebola response must take account of the special situation of women and girls, and take necessary measures to protect them. Disaggregation of case’s and mortality indicates that women tend to be disproportionately affected. Women account for 55 to 60 percent of the deceased in the current epidemic in Liberia, Guinea and Sierra Leone, according to UNICEF. Women also constitute a large section of the health workers and are on the frontlines of response.
Liberia’s task force on Ebola has reported that 75 percent of those who were infected or died from Ebola were women, because they are often the primary care-givers, nurses and traders within their communities. Women are also the traditional birth attendants, nurses and the cleaners and laundry workers in hospitals – and often have to work in less than ideal conditions.
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