The international development select committee says Britain’s reduced funding to the west African countries could have helped compromise their health systems, which have disintegrated in the face of the epidemic, exacting a heavy death toll on health workers as well as patients.
The report comes as world leaders and public health experts are gathering in London for a conference to raise awareness about the Ebola virus.
Philip Hammond, the UK foreign secretary, Justine Greening, the UK development secretary, and Ernest Bai Koroma, president of Sierra Leone, will be among those taking part at the Defeating Ebola event at Lancaster House in central London on Thursday.
Participating countries will discuss how the global community can provide an effective response to the crisis in west Africa. They are expected to announce pledges to support the international effort to defeat the disease, with both the UK and Sierra Leone urging them to contribute extra funding for hospital beds and staff.
“The scale of the Ebola crisis now unfolding in Sierra Leone and Liberia may well be connected to declining levels of international support for health system improvements in what remain two of the poorest and least developed countries in the world,” said the committee chair and Liberal Democrat MP Sir Malcolm Bruce.
“In the midst of this devastating epidemic, and at a time when the UK has reached its 0.7% target for overseas development assistance, it is wrong for the UK to cut its support to these two countries by nearly a fifth. The planned termination of further UK funding to the Liberian health sector is especially unwise.
“The UK can be proud of the work DfID [the Department for International Development] has done to help deliver many improvements in Sierra Leone and Liberia following the civil wars in both countries. We believe that this work should continue through bilateral aid programmes. It is also good that in the short time since our report was agreed DfID has provided extra support for Ebola and many NHS staff have volunteered to go to Sierra Leone.”
Healthcare in Sierra Leone and Liberia was inadequate even before the Ebola epidemic took hold. The committee’s report says one of the key issues is the shortage of healthcare workers – Liberia had just 57 doctors and 978 nurses and midwives in 2008, while Sierra Leone had 136 doctors in 2010 and 1,017 nurses. The equivalent of 10% of Sierra Leone’s nurses – 108 – are working in the UK.
Sierra Leone has one of the world’s highest rates of women dying in pregnancy or childbirth and one in five children die before they reach the age of five. Both countries have introduced some free healthcare – in Sierra Leone for pregnant women and small children and in Liberia for everyone. But DfID’s direct funding to support healthcare in Liberia ended in March and there is now talk of the reintroduction of user fees.
The Ebola outbreak, says the report, “has demonstrated how critical DfID and other donors’ support for strengthening and supporting health systems in Sierra Leone and Liberia is”. DfID has announced £5m to strengthen health systems in the two countries, but hospitals are breaking down under the strain.
“The problem Sierra Leone and Liberia are now facing is the collapse of their ability to treat people with non-Ebola-related diseases such as malaria and typhoid as well as complications from childbirth as hospitals and clinics are forced to close,” says the report.
“Immunisation programmes have also come to a halt. People are not going to the hospitals or clinics because they are frightened of catching Ebola; some hospitals have been totally taken over by Ebola patients. Other centres are without any staff due to their fear of turning up to work where protective clothing is in short supply.”
The report says inadequate healthcare systems are part of the reason for the spread of the disease. “The horrific Ebola outbreak has spread for many reasons, but the weakness of health systems has played a part. The outbreak indicates the continuing need for the governments of Sierra Leone and Liberia and for donors to give a high priority to health.
“Both countries are also going to need support from the international community on the long-term effects of the crisis in rebuilding the health systems and economies. We question whether the World Health Organisation is really on top of the epidemic and whether the international community are providing enough funds to manage the spread of the disease,” it says.
The committee also expresses serious concern about the use of funds from the EU intended to shore up health systems in Liberia and calls on UK ministers to work harder to ensure the money goes where it is intended. “When the committee visited Liberia recently it learned that barely more than 5% ($3.9m out of $60m) of EU health sector support given to Liberia was passed on by its ministry of finance over a two-year period,” said Bruce. “This failure placed many of the gains made by earlier DfID programmes at risk and left the Liberian health system struggling even before Ebola struck.
“The spread of Ebola has clearly demonstrated the importance that governments of developing countries need to attach to health system spending. We have to ask whether Liberia would have dealt better with the original outbreak and prevent its spread had $56m from the EU been spent as intended by the Liberian ministry of finance on its health system.
“DfID donates 16% of its total budget via the EU, so ministers must take a closer interest in where UK money is going and whether it is being spent as intended. Yet neither the EU itself nor DfID seem to be concerned about how much of the work they recently funded has been undone through this failure to distribute ongoing support.”
DfID responded to the report by pointing to its major response to the Ebola epidemic in Sierra Leone, where it is taking the lead internationally because of historic ties. “This report is out of date,” said a spokesman. “Britain remains the largest bilateral donor to Sierra Leone and we are leading the international response to this unprecedented outbreak through a £125m pledge to contain, control and defeat this disease.”
Original Article
Source: theguardian.com/
Author: Sarah Boseley
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