In the second of a series of two posts Dr Haja Wurie (ReBUILD Consortium and College of Medicine and Allied Health Sciences, Sierra Leone) discusses the socio-economic impacts of Ebola and provides some recommendations on ways forward.
The post-conflict economy was a challenge for many people in Sierra Leone. But this outbreak has disrupted many people’s everyday lives. As the virus continues to spread, freedom of movement is curtailed by quarantining measures and people’s reasonable mistrust of public transport. Education, employment and trade have suffered, with schools and universities closed indefinitely for now. Ebola-stigma is having an injurious effect on social relations and effecting people’s security and livelihoods. Most people see Ebola as an invisible killer and something that is even worse than the war. During the war, you could, at least, hear the rebels coming and have the option to hide or try to negotiate for your life. In the case for Ebola, being positive is seen as a death sentence.
Employment, education and investment
Poverty in the post-conflict period meant for many that seeking an education was not a priority. This resulted in low levels of literacy which in turn translated into slow uptake of the sensitisation information about the virus in the early stage of the outbreak, in conjunction with the initial denial.
Ebola has had a negative socio-economic impact with loss of trade, fewer investments, and reduced farming. The majority of those dying of Ebola are in their most productive economic years which further adds to the negative socio economic impact on society. Productivity in the labour market has been compromised as working hours have been cut short voluntarily with some people not going into work altogether to minimise contact with others.
Sierra Leone heavily depends on food importation and with restricted movements across the borders and import vessels halted due to the outbreak; the prices of food and imported goods already in country have skyrocketed. As the outbreak progresses, all indications point to continued increase in food and commodity prices. This will continue to have a negative impact on low earners in society as they will struggle to afford buying food. The risk of starvation in the hard hit areas is also an ongoing challenge and provision of food to quarantined areas is needed.
In addition a number of low paid workers especially ‘house help’ workers have been sent home by their employees indefinitely due to fear of the continued spread of the virus. The outbreak of the Ebola virus has caused an enormous unemployment in especially the affected quarantine (Kenema and Kailahun districts) areas, the epicentres of the outbreak in the early phase of the outbreak. In recent weeks, more districts (Port Loko, Bombali and Moyamba districts) have been quarantined as the virus continues to spread. Most inhabitants living in those areas were principally self-employed in the mining and agricultural sector. These sectors have been closed and people in those districts are no longer working. Those who were employed by foreigners who had fled those areas are also hugely affected as they now stay home without working and not paid salaries. In the same vein, the Ebola outbreak has caused a reduction in goods exported out. Most companies have ceased to operate because of the outburst of this deadly disease. This has adversely affected the revenue base from this sector. The emergence of Ebola has also affected the tourism industry negatively. International air travel is becoming a challenge with a number of airline suspending or cancelling services altogether. The impact of this is a huge loss of revenue to the state from the tourism sector.
Survivor stigma and social life
People who survive Ebola are stigmatized in society; families are being wiped out with children, most coming from poor households, being made orphans. Health workers in the quarantined districts are faced with the additional burden of landlords no longer wanting them as tenants due to fear of the disease. Eviction notices have been issued and health workers are likely to be stranded because potential landlords will fear to accommodate them as they are perceived to be carriers of the virus. Thus health workers are becoming victims due to their choice of profession.
Social life is non-existent as people are afraid of congregating in large numbers. Its football season now but the cinemas are empty compared to before the outbreak. This will cause a loss of revenue to the owners of those cinemas and absence of social discussions which are normally done on these platforms.
The health care delivery sector was under performing even before the war in Sierra Leone with high levels of out of pocket spending, which probably influenced the health seeking behaviour of the service users. Thus service users become more accustomed to seeking health care services from traditional healers and drug peddlers, even before the war due to the high costs associated with health services at health facilities and the lack of efficient and effective service delivery. This was further fuelled during the war and in the post conflict phase as the health system was completely destroyed during the conflict and years after the end of the conflict it is still weak and fragile, and political backing for its strengthening is still weak. Health systems research is needed in Sierra Leone to address the issues underlying the historical fragile state of the health care delivery sector, to guide the way forward. Currently evidence based health systems research is internationally led, meaning national ownership is weak. This needs to change to ensure sustainability in terms of strengthening the health sector. Lessons were not learnt from the 2012 cholera outbreak wherein over 300 people lost their lives, implying a degree of complacency in address the issues that facilitate a rapid health response to a disease outbreak. Ebola provides an opportunity to take stock of what needs to change in the health system in Sierra Leone:
- Evidence based health systems research and strengthening should be an utmost priority using lessons learnt from this outbreak and with involvement from the local population
- Health workers should be fully empowered, equipped and motivated to work effectively and efficiently
- Health care services should be accessible to all (the government should find a way of incorporating traditional healers in this process and deter service users from seeking health services from them)
- Health facilities should be fully equipped (drugs, equipment and logistics, ambulances, etc.)
- Training should be provided to produce more, qualified health professionals to build up the health workforce
- Health education and promotion should be a priority both at central and district level
- An emergency response plan should be put in place for outbreaks of this nature
- The decentralisation process should be critically reviewed with no room for bureaucracies especially the procuring of drugs, equipment etc. in the health sector. The delayed response to the outbreak can be attributed in part to central government pulling the strings. A delayed response at central government translated to a delayed response at the district level.
Will we learn from this? I have my doubts, but the optimistic side of me is hopeful.
Photo courtesy of European Commission DG ECHO https://www.flickr.com/photos/69583224@N05/14700430098