It has been over two months since the World Health Organisation (WHO) has declared Sierra Leone Ebola free. But the hard work is not over. If anything, it has just begun.
The Ebola outbreak revealed some vast, global discrepancies between health systems in the West, namely Europe and the USA, and West Africa. For example, Sierra Leone possessed an almost non-existent public health system when Ebola struck and it was quickly overwhelmed by the outbreak. This fuelled the outbreak’s unprecedented spread, as there were few adequate facilities or resources to treat highly infectious individuals who therefore remained in their communities infecting others.
Consequently, much of the post-Ebola dialogue has focussed on strengthening Sierra Leone’s public health system in order to enable it to quickly overcome future disease outbreaks and also to provide basic healthcare for the whole population.
Emphasis has been placed on disease surveillance to ensure Ebola does not go under the radar, resuming the mission to provide free healthcare for children and mothers, and feeding all these healthcare systems into the Ministry of Health and Sanitation (MoHS).
The latter is arguably the most essential pillar of the post-Ebola recovery phase, as Sierra Leone’s largely NGO-led, project-based health facilities has prevented the country from building a central health system that can offer widespread basic care or that can deal with widespread outbreaks of disease.
It has also meant that the Government of Sierra Leone (GoSL) is mainly reliant on the whims of foreign aid. For example, after the civil war that ravaged intermittently from 1991-2002, there was an abundance of NGOs providing public services, such as healthcare and education. These programs often circumvented the powers of government, and consequently, when NGOs began to leave after peace returned the Sierra Leonean government was unable to sustain their social services.
The ephemeral nature of many NGO programs also prevented NGOs from dealing with issues that sustain widespread, poverty, inequality and corruption in Sierra Leone, an attitude to development that is in danger of being repeated post-Ebola.
So far, the global health governance community is working to ensure development projects in Sierra Leone are more sustainable, are coordinated with the GoSL, and ultimately, that the GoSL is strengthened enough to take control of these programs. However, only time will tell if this is achieved, as NGOs are obviously reliant on having development projects. Therefore, if they become government led this will nullify their role in Sierra Leone.
Moreover, the complex causes of Sierra Leone’s ingrained social, political and economic issues are not easy to overcome and are sustained by much larger global systems. For example, many of Sierra Leone’s financial decisions are controlled by international financial organisations such as the International Monetary Fund (IMF) and the World Bank.
For instance, after the civil war the IMF and the World Bank supplied Sierra Leone with large loans to recover from the conflict. However, accepting these loans also required Sierra Leone to accept the IMF and World Bank’s policies, in this case the IMF and the World Bank’s Poverty Reduction and Growth Facility (PRGF). The PRGF focussed on macroeconomic stability and reduced spending, for example on the government wage bill (IMF/World Bank, 2002: 29, 36 in Hanlon, 2007; 463) and healthcare. Accordingly, although prior to Ebola GDP was increasing, in 2011 only 16.3% of Sierra Leone’s budget was spent on healthcare.
So far, it is clear that Sierra Leone’s systematic issues are far from over. Already there is anger amongst Sierra Leoneans over promises of improved healthcare and most importantly free healthcare for Ebola survivors. Despite the government promoting Ebola survivors as ‘heroes’ in attempt to reduce the stigma that the survivors face in their communities, the government has failed to deliver on its promise of free healthcare for survivors. The GoSL has admitted that medicines are not available to treat the many ailments, such as loss of sight and aching joints, that plague those who have overcome Ebola.
Freetown, the capital of Sierra Leone, has also recently gone weeks without water. A major water company claims that years of unpaid bills, deforestation and housing development projects near water catchment areas is the cause of the drought. The GoSL has attempted to supply enough water tanks to control the crisis but has been unable to prevent communities from queueing for hours and young children from searching through the night to find water supplies.
Thus, many of the systems that contributed to the Ebola outbreak are not easy for the GoSL or NGOs to control. These issues are something that only larger powers, such as those that lead Global Health Governance, namely the WHO and the major countries that fund and lead its polices, can grapple with.
But in spite of the country’s problems and the chaos caused by Ebola, the atmosphere in Sierra Leone is overwhelmingly positive. Despite the images of poverty and suffering fuelled by the civil war and Ebola, Sierra Leone is one of the liveliest and fun loving places you will ever experience. Post-Ebola Sierra Leone has seen endless street parties and festivals to celebrate its freedom from the virus. Locals also report that Sierra Leone is buzzing with new business, new projects and general opportunities.
Systematically, the country has a long way to go and some powerful institutions to deal with. However, what will never change is the positivity, energy and resilience of Sierra Leoneans that makes Sierra Leone so much more than a country ravaged by disease and war. It shouldn’t have to, but Sierra Leone’s attitude to life will overcome much more than Ebola and questionable international policy.