4 Legacy in Sierra Leone
10. The health system in Sierra Leone has been overwhelmed
by the Ebola epidemic. Given it is a post-conflict state in the
lowest reaches of the UN Human Development Index this is to some
extent not a surprise.[26]
The system has been particularly undermined by unprecedented levels
of infection among medical professionals at a late stage in the
outbreak.[27] However,
Sierra Leone was already woefully short of doctors and nurses
before the crisis began.[28]
This was partly a reflection of net outward migration flows of
health professionals to rich countries who had failed to train
sufficient staff for their own needs. In our report on Recovery
and Development in Sierra Leone and Liberia we expressed alarm
at the high proportion of health professionals trained in Sierra
Leone currently working in the UK.[29]
The ten Sierra Leonean doctors we were told work in the UK would
have been invaluable in a country that only had just over 100
doctors before the epidemic.[30]
11. DFID has committed £230 million to tackling
Ebola, a total that may well grow.[31]
This is already approximately equivalent to DFID's total planned
bilateral expenditure in Sierra Leone in the four years from 2010-11
to 2013-14 and ten times planned bilateral expenditure on health
in the 2014-15 financial year.[32]
12. Witnesses stressed that stopping the Ebola epidemic
as soon as possible was the most important short and long-term
priority for Sierra Leone.[33]
Aside from the devastating direct impact of the epidemic, it has
had indirect repercussions for local economies, food security,
education (including the closure of schools), tax receipts, institutional
stability and the wider health system, including access to maternity
care and basic health services.[34]
13. The Secretary of State told us that her Department
had begun to plan for longer-term reconstruction in Sierra Leone,
including how to re-establish and strengthen the health system.[35]
Our recent report on health system strengthening stressed the
importance of building up systems and emphasised that DFID needed
to ensure that the global health funds which it supports pay more
attention to this work. Echoing the conclusions of our report,
WHO told us that one of the lessons of the Ebola epidemic was
that "without fundamental public health infrastructures in
place, no country is stable, no society is secure, no resilience
exists to withstand the shocks that 21st century conditions are
delivering with ever-greater frequency and force".[36]
14. The health system in Sierra Leone has been
overwhelmed by Ebola. Given the post-conflict fragility of development
in the country and the severity of the epidemic, this was inevitable.
However, had more attention been paid over recent years to strengthening
the health system, and had more Sierra Leonean health professionals
been retained in the domestic system, the impact of Ebola would
have been less severe. So too would have been the cost of tackling
the outbreak. We reiterate the recommendations of our report
on Strengthening Health Systems in Developing Countries and recommend
that strengthening the health system be the centrepiece of DFID's
reconstruction plans for Sierra Leone. We further recommend that
DFID and the Department of Health undertake a review of the training
of health professionals in the UK and the impact on the developing
world.
15. DFID rightly identifies defeating Ebola as
quickly as possible as the most important step in giving Sierra
Leone the best chance of successful reconstruction and development
in the long term. It is also right to be planning for that long
term now. It is imperative that, once the immediate crisis is
over, the eyes of the world do not turn away from the region.
We recommend that DFID convene a global conference in early
2015 to agree a common plan for post-crisis reconstruction in
the region.
26 Q40 Back
27
WHO written evidence Back
28
Report ref, WHO written evidence Back
29
International Development Committee, Sixth Report of Session 2014-15,
Recovery and Development in Sierra Leone and Liberia, HC
247, para 72 Back
30
Oral evidence taken on 11 December 2014, Q143 [Kathryn Tyson] Back
31
Q52 Back
32
DFID, DFID Operational Plan 2011-15: Sierra Leone, June
2012, table 4 Back
33
Q16 Back
34
For example, The Guardian, We can no longer ignore Ebola's
wider impact - particularly on women, 14 October 2014 [Accessed
16 December 2014] Back
35
Q33 Back
36
WHO written evidence Back
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