More support needed for local health workers responding to Ebola, advocates say

A healthcare worker dons in protective gear before entering an Ebola treatment center in the west of Freetown, Sierra Leone. (AP Photo/Michael Duff)

Guinea, Liberia and Sierra Leone shared a big problem before Ebola struck. The three countries had fewer than three doctors, nurses or midwives for every 10,000 people. It was a far cry from the World Health Organization’s minimum recommended ratio of 22.8 per 10,000 people.

The emergence of Ebola in early 2014 and the rapid spread has killed more than 8,000 and infected more than 1,300, according to the U.S. Centers for Disease Control and Prevention. Many problems coalesced to make a usually controllable outbreak a crisis. One of those pieces is the lack of health-care workers who can respond to emerging health problems in all of the countries.

“The biggest gap in what is going on now is there has been quite a bit of attention paid to the needs of foreign health workers and volunteers. There needs to be a lot more focus on what is happening in the local health work force,” said Vince Blaser, deputy director at the Frontline Health Workers Coalition, in an interview with Humanosphere.

The Ebola health workers got notice recently, thanks to TIME naming them collectively as the publication’s 2014 Person of the Year, but they need support and more resources. Blaser wants to see more done to support the health workers who are responding to the current crisis. He and the members of the Frontline Health Workers Coalition are also encouraging the global community to step up their financial commitments so that more workers can be trained to meet the demand for the estimated 5,000 additional health workers needed to respond to the outbreak. A lot can be done with a little money.

“The annual salary of a Liberian nurse is about $2,000, which is about the price of an airline ticket,” added Julia Bluestone, senior technical adviser for Jhpiego. “We believe more of the focus needs to be on how to leverage the local health work force. That includes meeting some of the needs of local workers, like making sure they get paid and access to food.”

The lack of support was behind a health workers strike in Sierra Leone in November. A promise for $100 in weekly hazard pay was not being met by the government, they said. Some 60 patients in Bandajuma were left unattended, according to Doctors Without Borders. Then there are the more than 300 health workers who have died responding to Ebola.

“Each time we lose a health worker, we lose the ability of the country to respond not only to this epidemic, but the next one,” said Joan Holloway, formerly of PEPFAR and interim director of the Frontline Health Workers Coalition. “What is really needed is a broader approach to not only say we are doing it in this part of Liberia, but to expand services across the country and across all three countries so there is a much larger response and a much broader response.”

While promising progress is happening in Liberia, there are still troubles in Sierra Leone. Holloway draws lessons from the AIDS epidemic in the early 1980s, saying that education is paramount to helping defeat something like Ebola. Other recommendations from the coalition include improving supply chain, eliminating stigma faced by Ebola survivors and health workers, and making long-term investments.

All center around the importance of taking the important steps to stop the current outbreak and ensure that all three countries do not run into the same problem again.

“The Ebola epidemic has shown how a lack of health workers and systems can exacerbate a situation,” said Holloway.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]

  • Garth Luke

    Tom, these very low levels of health staff reflect the small amounts of health funding provided by each of these countries and the international donor community.

    WHO figures show that Liberia has met the Abuja target of 15% of general government expenditure to health and Sierra Leone has come close, although Guinea still lags at only 6.8% of the budget going to health in 2012. However because of the low per capita income in
    these countries total health expenditure is still very small at US$32 per person in Guinea, $65 per person in Liberia and $96 per person in Sierra Leone.

    OECD donors have done little to improve this situation, the official donor community has provided an average of just US$14.50 per person across these three countries in official development assistance for health each year in recent years, and less in previous years. (Source: OECD DAC Creditor Reporting System)

    With these meagre resources and the assistance of non-government organisations these countries have been able to slash child and maternal mortality rates in recent years but are in a very weak position to handle major additional threats such as Ebola.

    It is way past time that all African countries met their 2001 commitment to lift health funding to 15% of government expenditure. Donor countries also need to drastically lift their levels of health funding from the current low base – the best estimates are that a doubling or tripling of global health aid is required to ensure that basic health services are accessible to all.

    • Thanks for the really insightful and informative comment, Garth.