{"id":8045,"date":"2015-06-30T09:14:45","date_gmt":"2015-06-30T09:14:45","guid":{"rendered":"https:\/\/africaresearchinstitute.org\/wordpress\/?p=8045"},"modified":"2016-03-01T16:10:14","modified_gmt":"2016-03-01T16:10:14","slug":"beyond-ebola-a-time-for-action-in-sierra-leone","status":"publish","type":"post","link":"https:\/\/africaresearchinstitute.org\/wordpress\/beyond-ebola-a-time-for-action-in-sierra-leone\/","title":{"rendered":"Beyond Ebola: \u201ca time for action\u201d in Sierra Leone"},"content":{"rendered":"<p><em>\u201cI am tired of hearing the government talk about \u2018post-Ebola\u2019. It is already too late, things are happening now and we can\u2019t wait for things to improve to change. It is time for action\u201d.<\/em><\/p>\n<p>Dr Bintu Mansaray (Connaught Hospital, Freetown) to ARI, June 2015<\/p>\n<div id=\"attachment_8046\" style=\"width: 704px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/wp-content\/uploads\/2015\/07\/nurses-ebola-instruction-sierra-leone.jpg\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-8046\" class=\" wp-image-8046\" src=\"https:\/\/africaresearchinstitute.org\/wordpress\/wp-content\/uploads\/2015\/07\/nurses-ebola-instruction-sierra-leone.jpg\" alt=\"Nurses listen intently during a panel discussion at the United Methodist Church's Mercy Hospital in Bo, Sierra Leone to help prepare health care workers for a possible outbreak of the Ebola virus.\" width=\"694\" height=\"486\" srcset=\"https:\/\/africaresearchinstitute.org\/wordpress\/wp-content\/uploads\/2015\/07\/nurses-ebola-instruction-sierra-leone.jpg 4064w, https:\/\/africaresearchinstitute.org\/wordpress\/wp-content\/uploads\/2015\/07\/nurses-ebola-instruction-sierra-leone-300x210.jpg 300w, https:\/\/africaresearchinstitute.org\/wordpress\/wp-content\/uploads\/2015\/07\/nurses-ebola-instruction-sierra-leone-1024x717.jpg 1024w\" sizes=\"auto, (max-width: 694px) 100vw, 694px\" \/><\/a><p id=\"caption-attachment-8046\" class=\"wp-caption-text\">Photo by Mike DuBose, UMNS.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>While Ebola has killed <a href=\"http:\/\/www.cdc.gov\/vhf\/ebola\/outbreaks\/2014-west-africa\/case-counts.html\" target=\"_blank\">3,933 Sierra Leoneans<\/a>, \u201c<a href=\"http:\/\/www.theguardian.com\/world\/2015\/apr\/28\/too-many-dying-sierra-leone-response-ebola-report\" target=\"_blank\">huge numbers of people are dying from avoidable causes<\/a>\u201d says Dr James Elston, author of a recent report by <a href=\"http:\/\/doctorsoftheworld.org.uk\/blog\/entry\/theres-a-health-crisis-in-west-africa-and-its-not-ebola\" target=\"_blank\">M\u00e9dicos do Mundo<\/a>.<\/p>\n<p>The report sheds light on the dire impact Ebola has had on <a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-health-care\/\" target=\"_blank\">tackling preventable diseases<\/a>. It cites drastic drops in attendance at health facilities, poor availability of supplies and growing mistrust between the health care system and the communities it is supposed to serve as the causes of rising death rates.<\/p>\n<p>Belatedly, the question of post-Ebola reconstruction of the health system is now <a href=\"http:\/\/uk.reuters.com\/article\/2015\/05\/21\/us-health-ebola-who-idUKKBN0O61SU20150521\" target=\"_blank\">being debated<\/a>. Despite the substantial investments made by international donors such as the UK\u2019s Department for International Development (DFID) between 2002 and 2014, and the vast quantities of emergency funding received during the Ebola epidemic, the health system in Sierra Leone remains wholly unfit for purpose.<\/p>\n<p>The majority of Ebola treatment centres are expected to be dismantled once \u2018zero cases\u2019 has been achieved. This is because of stigma, their lack of connection to basic infrastructure such as roads, water and electricity and, because there are simply not enough staff to operate them. This underscores the importance of creating a sustainable, \u2018context specific\u2019 health system in Sierra Leone.<\/p>\n<p>What stands in the way of this being achieved?<\/p>\n<p>There are arguably three main obstacles:<\/p>\n<ul>\n<li><strong>A lack of trust in government<\/strong>, an issue that extends beyond the provision of basic health services. In particular, the failure to deliver on the promises of the 2010 <a href=\"http:\/\/www.mamaye.org.sl\/en\/evidence\/free-health-care-services-pregnant-and-lactating-women-and-young-children-sierra-leone\" target=\"_blank\">Free Healthcare for All Initiative<\/a>, which has been undermined <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/25908714\" target=\"_blank\">by petty corruption<\/a>. The absence of trust was discernible right at the outset of the epidemic, for example when residents of Kailahun district proved distinctly unreceptive to advice <a href=\"http:\/\/www.economist.com\/news\/middle-east-and-africa\/21610250-many-sierra-leoneans-refuse-take-advice-medical-experts-ebola-death\" target=\"_blank\">issued by the government<\/a> and its international partners about preventative measures.<\/li>\n<li><strong>Recruiting and retaining health care workers<\/strong>. Salaries and incentives need to be offered that enable staff to advance their skills and improve retention. About half of the medical staff trained in Sierra Leone <a href=\"http:\/\/www.theguardian.com\/global-development\/poverty-matters\/2011\/jun\/24\/sierra-leone-free-heatlh-care-one-year-on-missing-drugs\" target=\"_blank\">leave<\/a> for Ghana, the UK and elsewhere.<\/li>\n<li><strong>Poor basic infrastructure<\/strong>. Poor access to water was a major hindrance at Ebola treatment centres. Electricity supply is sporadic, at best, and limited in reach. Generators often lie idle as hospitals and other health facilities have no money for fuel. Ambulances capable of navigating roads in rural communities are in short supply. The centralised dispensation of drugs is not done with sufficient district level input, meaning that local health facilities often lack one or two key drugs that would improve treatment of leading afflictions in rural communities.<\/li>\n<\/ul>\n<p><strong>A strategy built on local expertise <\/strong><\/p>\n<p>Local health experts must be the bedrock for improvement of health care. Here are some recently-voices opinions from three of them:<\/p>\n<ul>\n<li>Dr Bintu Mansaray told ARI that conditions for health care workers must be improved. \u201cWe need the supplies, training and incentives; currently we don\u2019t even have risk allowances or health insurance\u201d. At the moment, patients see hospitals as a \u201cplace you go to die, not to be cured\u201d.<\/li>\n<li><a href=\"http:\/\/healthsystemsglobal.org\/blog\/14\/Ebola-s-collision-with-the-Sierra-Leone-post-conflicthealth-system.html\">Dr Haja Wurie <\/a>(College of Medicine and Allied Health Sciences) stresses the need for services to be accessible to all. \u201cThe government should find a way to incorporate <a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/publications\/modern-african-remedies\/\">traditional healers in this process<\/a>, while emphasising the primacy of health facilities\u201d.<\/li>\n<li>Felix Conteh, who worked with the World Bank on decentralisation in the health sector, told ARI that a long-term approach is needed. Crucial to its success will be \u201censuring that conducive conditions are created for health workers, as well as establishing mutual accountability mechanisms between them and the government, whether at the centre or the local level\u201d.<\/li>\n<\/ul>\n<p>Ebola did not decimate the infrastructure of a functioning, adequate health system \u2013 there was no such thing. However, it ravaged skilled human resources. The government needs to acknowledge the contribution of health professionals who have died and ensure that employment conditions and facilities in future will enable their successors to build a functional health system.\u00a0 This would be a crucial first step on a long road to rebuilding trust in the government\u2019s seriousness about providing basic health care for the people.<\/p>\n<p><small><em><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/jamie-hitchen-policy-researcher\/\" target=\"_blank\"><br \/>\nJamie Hitchen<\/a> is a Policy Researcher at the Africa Research Institute.<\/em><\/small><\/p>\n<p style=\"text-align: left;\">\n<div class=\"message-box-wrapper not ugly\">\n<div class=\"message-box-title\">ARI Series: Ebola in Sierra Leone<\/div>\n<div class=\"message-box-content\">\n<div class=\"shortcode-list \"><\/p>\n<ul>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-health-care\/\" target=\"_blank\">Health care at breaking point<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-sierra-leone-economics\/\" target=\"_blank\">The Cost of Living on the Margins<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-stigma\/\" target=\"_blank\">Stigmatisation<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-sierra-leone-politics\/\" target=\"_blank\">Political leadership for a crisis?<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/ebola-sierra-leone-pujehun\/\" target=\"_blank\">Getting to Zero: Learning from Pujehun<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/mismanagement-ebola-spending\/\" target=\"_blank\">Mismanagement of Sierra Leone&#8217;s Ebola spending<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/behind-closed-doors-schools-teenage-girls-and-ebola-in-sierra-leone\/\" target=\"_blank\">Behind Closed Doors: Schools, Teenage girls and Ebola in Sierra Leone<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/part-1-a-year-with-ebola-the-grievous-experience-of-health-care-workers-in-sierra-leone\/\" target=\"_blank\">A Year With Ebola: The Grievous Experience of Health Care Workers in Sierra Leone<\/a><\/li>\n<li><a href=\"https:\/\/africaresearchinstitute.org\/wordpress\/blog\/beyond-ebola-a-time-for-action-in-sierra-leone\/\" target=\"_blank\">Beyond Ebola: &#8220;a time for action&#8221; in Sierra Leone<\/a><\/li>\n<\/ul>\n<p><\/div><\/p><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Jamie Hitchen looks ahead to when Sierra Leone is declared Ebola free and asks how the country can build an adequate health care system that offers sufficient support and protection to patients and staff.<\/p>\n","protected":false},"author":7,"featured_media":8046,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"_uf_show_specific_survey":0,"_uf_disable_surveys":false,"footnotes":""},"categories":[17],"tags":[1690,64,221,578,1689,1861,352,198,1928,1852,1931,742,1933,1930,835,1552,1859,1492,832,1934,743,77,1561,1854,1562,1935,833,1857,1929,1858,1932,36,162],"class_list":["post-8045","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","tag-beyondebola","tag-africa","tag-africa-research-institute","tag-ari","tag-beyond-ebola","tag-connaught-hospital","tag-department-for-international-development","tag-dfid","tag-doctor","tag-doctors","tag-dr-bintu-mansaray","tag-ebola","tag-ebola-epidemic","tag-ebola-in-sierra-leone","tag-ebola-outbreak","tag-ebola-series","tag-ebola-virus","tag-electricity","tag-epidemic","tag-epidemiology","tag-freetown","tag-health","tag-health-care","tag-health-care-workers","tag-healthcare","tag-healthcare-workers","tag-jamie-hitchen","tag-nurse","tag-nurses","tag-nursing-in-africa","tag-preventable-disease","tag-sierra-leone","tag-west-africa"],"aioseo_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - 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