The loss of health workers due to the Ebola epidemic in West Africa may result in an additional 4,022 deaths of women each year across Guinea, Liberia and Sierra Leone as a result of complications in pregnancy and childbirth.
According to the new World Bank report Healthcare Worker Mortality and the Legacy of the Ebola Epidemic published in The Lancet Global Health today, the recent outbreak of Ebola in West Africa could leave a legacy significantly beyond the deaths and disability caused directly by the disease itself.
"The loss of health workers to Ebola could increase maternal deaths up to rates last seen in these countries 15-20 years ago," says Markus Goldstein, Lead Economist at the World Bank Group and a co-author of the report who heads the World Bank's Africa Gender Innovation Lab.
The paper estimates how the loss of health workers to Ebola will likely affect non-Ebola mortality even after the countries are declared Ebola-free. Maternal mortality could increase by 38% in Guinea, 74% in Sierra Leone, and 111% in Liberia.
Since the Ebola epidemic hit Guinea, Liberia and Sierra Leone, health workers have died at a higher rate than any other population group, exacerbating skill shortages in countries that had very few trained health personnel to begin with. Even once the countries reach zero Ebola cases, this will negatively affect the health of their populations.
As of May 2015, 0.11% of Liberia's entire general population had died due to Ebola, as compared with 8.07% of its health workers, defined in the study as doctors, nurses and midwives. In Sierra Leone, the loss was 0.06% of the general population compared with 6.85% of the health workers, while 0.02% of Guinea's overall population had died compared with 1.45% of all health workers.
According to the report this translates into a 10% reduction in doctors in Liberia (which only had about 50 to start) and an 8% reduction in nurses and midwives. In Sierra Leone, it means a 5% reduction in doctors and a 7% reduction in nurses and midwives. In Guinea, the reduction is smaller, 2% for doctors and 1% for nurses. At the outset of the epidemic, the World Health Organization ranked Liberia, Sierra Leone, and Guinea as 2nd, 5th and 28th from the bottom, respectively, among 193 countries in terms of doctors per 1,000 people.
"Ebola has weakened already very fragile health systems in these countries," says David Evans, Senior Economist at the World Bank Group and co-author of the report. "Ebola's devastating impact should be the catalyst to strengthen the health systems far beyond their pre-Ebola levels."
The report suggests that to save these lives, 240 doctors, nurses and midwives would need to be hired immediately across the three countries. This is a small fraction of the 43,565 doctors, nurses and midwives that would need to be deployed in Guinea, Liberia and Sierra Leone to achieve sufficient access to essential health services as implied by the Millennium Development Goals.
"These countries require urgent investment in health systems starting with a substantial increase in the number of trained health workers," says Dr. Tim Evans, Senior Director of Health, Nutrition and Population at the World Bank Group. "This is to ensure that Guinea, Liberia and Sierra Leone are not only equipped to deal with future deadly epidemics but that every day, mothers have access to the quality health care they need that will save their lives and prepare them for a more promising future."
About the World Bank Group and Ebola
The World Bank Group's response to the Ebola crisis is to help stop the spread of infections, improve public health systems throughout West Africa, and assist countries in coping with the social and economic impact of Ebola-including by enabling trade, investment and employment in the countries. As of May 2015, the World Bank Group has mobilized US$1.62 billion in financing for Ebola response and recovery efforts to support the countries hardest hit by Ebola.