It is a cruel irony that many of the top doctors and nurses in Guinea, Liberia and Sierra Leone will not be around to help rebuild their health systems in the wake of Ebola, having succumbed themselves to the virus. For those that are, the biggest challenges are likely to be electricity, sanitation, and, most of all, water.
“How is it possible to build, or rebuild, as you may call it, a health institution or hospital without [access to] water, which serves as a major catalyst to run the facility?” asked Moses Tamba, a spokesperson for Liberia’s Ministry of Public Works. “It is not possible. You need water.”
With the head of one international aid organisation warning in recent days that if the Ebola epidemic was to flare up again, health authorities in West Africa would be no better off to deal with it than they were a year ago, it is time to focus urgently on what can be done.
Even before the outbreak began in December 2013, the three countries that were to become worst affected had some of the weakest health systems in the world. Frequent power cuts and water shortages afflicted even the most-developed clinics and hospitals in Guinea, Liberia and Sierra Leone on a near-daily basis.
During the Ebola outbreak, which has killed more than 11,150 people in the region and is still rife in Guinea and Sierra Leone, a lack of access to water both in private households and public health clinics meant that the virus, which is passed on through contact with infected individuals or soiled materials, continued to spread.
Many people were unaware or unable to properly disinfect their homes and belongings.
“You need water to boil to wash bedding, clothes, cooking utensils, equipment and so forth,” Tamba said. “You need water to drink, both for hospital staff and the patents. Electricity is also essential to operate our health facilities. This is serious and every health facility needs these [basic necessities].”
Worldwide, more than 2.5 billion people still don’t have access to proper sanitation facilities, including toilets, according to a 12 June joint report by the World Bank and World Health Organization.
In Guinea, a quarter of the population has no access to potable water, according to the international development organisation WaterAid. In Sierra Leone and Liberia, 40 percent and 25 percent of people, respectively, don’t have sustainable access to safe drinking water.
“If you really look at these figures, they can help to explain some issues around hygiene attitude and the context that has caused Ebola to spread,” head of WaterAid’s West Africa region Mariame Dem told IRIN. “If you have health centres where you can’t ensure proper hygiene practices, supported by the availability of toilets… and if you can’t ensure 24-hour access to safe water… it will really have a bad impact on [people’s] health and hygiene.”
All three countries, backed by their international partners, have pledged to improve their public health systems despite the fact that the Ebola outbreak has strained their already limited resources.
In Guinea, the government has allocated more than $200 million to modernise and equip Conakry’s Donka hospital with better access to water and sanitation facilities. Across the country, 3,000 hand pumps will be installed outside hospitals and health clinics so that “patients can stay clean,” Health Minister Remy Lamah told IRIN.
The Guinean government has also just completed a new dam that will supply hospitals and clinics in and around Conakry with “constant power.” The government says it is also in the process of installing generators in many of these facilities in case of power failures.
But, for many, it’s a question of too little too late.
“If the government had previously taken the initiative to improve the Guinean health care system… Ebola could have been detected and eradicated long ago,” said Mohamed Toure, an epidemiologist at Donka hospital, which now contains the country’s largest Ebola treatment centre.
In Sierra Leone, Jonathon Abass Kamara, a public liaison officer at the Ministry of Health, told IRIN that the government was, “working very hard to ensure that public health services are improved beyond what they used to be.”
He warned, however, that funding would be a problem.
Sierra Leone spends just 1.7 percent of GDP on public health expenditures, according to the World Bank.
But Dem warned that fixing the problem would require a lot more than just money.
“It’s obvious that funding, or rather, a lack of funding, is one of the reasons [why water and sanitation remain poor] in these countries,” she said. “But we also need to go beyond that because… the most important thing is political will – not only by the government of the country, but also at the global level.”
The world has already met the Millennium Development Goal of halving the number of people who don’t have sustainable access to safe drinking water by 2015, but Dem said even that wasn’t adequate for the fight against Ebola.
“We need to go beyond these commitments,” she said. “If you invest in water and sanitation systems, you will not only give better quality health services, but also lessen the burden, lessen the impact, in terms of financial cost and human cost, of Ebola and these other diseases, during times of crisis.”
(With contributions from Prince Collins in Liberia, Karim Kamara in Guinea and John Sahr in Sierra Leone)