The recent outbreak of the Ebola virus epidemic in Guinea, Liberia and Sierra Leone has exposed the underbelly of many of Africa's healthcare systems. They are often poorly funded, severely neglected and in some cases virtually nonexistent.
The disease's virulence has overwhelmed health systems that even before Ebola lacked basic equipment and facilities, medical staff and supporting infrastructure.
Ebola has shaken and awakened decision-makers in a way that malaria, tuberculosis and other epidemic diseases that claim millions of lives in Africa each year have failed to do, with the possible exception of HIV/AIDS.
As fate would have it, the epicenter of the virus is in countries that are among the world's poorest, although in 2013 Sierra Leone and Liberia ranked second and sixth among the top 10 countries with the highest economic growth rates in the world, according to The Brookings Institution, a US think tank.
As The New York Times reported: “The disintegration of the health care systems in the affected countries is already having a profound impact on the populations' health beyond Ebola, as clinics close or become overwhelmed or nonfunctional.”
To exacerbate the situation, these health systems, including the general infrastructure, were wrecked by internal conflicts and civil wars to the point where they now struggle to provide basic health care to citizens.
Although the years of conflicts in West Africa are still being felt, this does not solely explain the devastation brought by the Ebola virus. Graça Machel, the widow of former South African President Nelson Mandela, said the Ebola outbreak should be a wake-up call for African leaders.
“Ebola has exposed the extreme weaknesses of our institutions as governments, countries which are affected were found totally unprepared,” she told African business leaders in November 2014 at a meeting in South Africa.
The prognosis for the affected countries, which now include Mali, is even more dire.
In an editorial in The New England Journal of Medicine, Dr Jeremy Farrar of the Wellcome Trust, a charity that funds research in health, and Dr Peter Piot of the London School of Hygiene and Tropical Medicine, who helped discover the Ebola virus in 1976, wrote: “West Africa will see much more suffering and many more deaths during childbirth and from malaria, tuberculosis, HIV/AIDS, enteric and respiratory illnesses, diabetes, cancer, cardiovascular disease, and mental health during and after the Ebola epidemic.”
They warn of “a very real danger of a complete breakdown in civic society, as desperate communities understandably lose faith in the established systems,” adding that “without a more effective, all-out effort, Ebola could become endemic in West Africa, which could, in turn, become a reservoir for the virus’s spread to other parts of Africa and beyond.”
Back in 2001, African health ministers signed on to the Abuja Declaration pledging to allocate at least 15 per cent of their national budgets towards improving their health systems.
According to the World Health Organisation (WHO), a decade after the declaration was signed, 27 countries had increased the proportion of their total government expenditures allocated to health, but only Rwanda and South Africa had achieved the 15 per cent target.
More depressingly, seven countries had actually reduced their health budget over the same period, and 12 had not made any progress. A different scorecard developed by the Africa Health, Human and Social Development Information Services (Afri-Dev.Info), a research coalition, showed that by 2010, the top five countries who had met the target were Rwanda, Malawi, Zambia, Burkina Faso and Togo.
In 2013, Africa had an estimated deficit of 1.8 million health workers. Perhaps not surprising is the state of the health systems in the affected countries.
According to Afri-Dev.Info, in 2014, with a population of 4.2 million, Liberia had only 51 doctors, 269 pharmacists, 978 nurses and midwives, while Sierra Leone, with 6 million people, had 136 doctors, 114 pharmacists and 1,017 nurses and midwives.
Regrettably, Ebola struck at countries whose health systems were already on their knees. This has not stopped analysts from acknowledging that the response to the outbreak was indeed weak.
