The Ebola outbreak in West Africa is not over, but it appears to be winding down. Liberia announced today the discharge of its last Ebola patient. No new infections were reported in the past week, signaling the end of the outbreak is near for the country.
Health advocates used this week’s EU High Level Conference on Ebola to look beyond Ebola and encourage donors and countries to take steps that will ensure similar health catastrophes do not happen again anywhere by learning from the mistakes that were made.
Some 28 countries have health systems that are worse off than the three Ebola-endemic countries and many others are not much better, according to Save the Children.
The group released an index ahead of the Ebola conference ranking countries on their overall health-care systems. It determined that India is in a worse position than both Liberia and Sierra Leone. Bangladesh, Ethiopia and Nigeria also rank towards the bottom of a list of 72 countries. In fact, only Chad and Somalia perform worse than Nigeria, the largest economy on the continent.
“It should not be left to chance whether people can afford health care. The world needs to see it as a global responsibility,” said Simon Wright, head of child survival for Save the Children U.K., in an interview with Humanosphere. “This is about building the movement for the right of access to health care.”
Save the Children is one of many groups that have pointed to the absence of health systems as the reason for the spread of Ebola in West Africa. The report estimates that filling a $1.58 billion spending gap in 2012 for the three countries would have significantly improved health access. That is roughly one-third the $4.3 billion spent by donors to respond to the crisis. Spending money now can prevent costly disasters in the future. It should serve as a “wake-up call” for the world.
A report by the International Rescue Committee echoes many of the same sentiments. The group argues that more support is necessary for local responders.
“Responders must acknowledge and support the leading role of communities. We must make every effort to build trust,” concludes the report. “And we must ensure that workers in public institutions have the support and the tools to keep themselves, and the public, safe. We ignore these lessons at great peril.”
One way to do that is to increase the number of health workers in countries. In Sierra Leone, there are fewer than 2 doctors, nurses and midwives per 10,000 people. Liberia has an average of 2.9 and Guinea has 6.1. All pale in comparison to top country Brazil where it has nearly 95 health workers for every 10,000 people. That is about 2 health workers for every 210 people. The health work force in Sierra Leone has to support 50 times more people than in Brazil.
The three West African countries, and many others in the world, need to take steps increase their number of health workers. The Frontline Health Workers Coalition estimates that it will cost $575 million over the next five years to double the number of health workers in the countries. Compared to the amount spent responding to Ebola, it is a bargain. Like Save the Children, the coalition’s report was timed to ensure that the EU meetings think beyond the current crisis.
“We want to ensure world leaders turn their words on post-Ebola recovery into action,” said Erin Hohlfelder, global health policy director for ONE, in a news release. “Leaders must commit the targeted investments needed to strengthen health workforces and systems to build a strong foundation for broader recovery.”
At minimum, the ratio has to be 22.8 per 10,000, according to the World Health Organization (WHO). Meeting the coalition’s financing goals would still leave Liberia, Sierra Leone and Guinea significantly behind the bottom line set by the WHO. And it is still only one part of improving overall health care for the countries and others. Save the Children’s index shows that neonatal mortality, a rate that they say is closely tied to health services and access, is not necessarily lower in countries with more health workers. India exceeds the WHO health worker minimum, but its 29.2 neonatal deaths per 1,000 live births is worse than neighboring Bangladesh, where there are only 5.7 health workers per 10,000 people.
“The global debate needs to be more about having comprehensive health systems. Universal health coverage is entirely about that,” said Wright.
Save the Children says that the countries at the bottom of its index “furthest away from universal health coverage.” Achieving the goal means donors must work with governments to invest in health systems. Wright pointed out that a key part of the equation is the level of spending by countries themselves. He attributes the gains made in Rwanda to the spending by the government. The fact that it spends more than Sierra Leone explains why it performs better in the index despite spending less overall.
Wright and others are hopeful that the lessons learned from West Africa will spur on investment in improving access to health care around the world. Not only do donors need to increase their support, they need to make sure their approach is in line with what countries need and are trying to accomplish.
“We have to be careful about the role of aid. It needs to be aligned to support the development of health systems,” he said. “We think the vast majority of the money going towards building universal health coverage need to come from the countries.”
“We have a real opportunity with universal health coverage that is quite extraordinary.”