Guinea, Liberia, andSierra Leone are among the poorest countries in the world, with recent historyof civil war and unrest that left basic health infrastructures severely damagedor destroyed and created a number of young citizens with little or noeducation. Basic infrastructures including road systems, transportationservices, and telecommunications are weak especially in rural area of thesecountries. These problems greatly delayed the transportation of patients to healthcentres and of sample analysis to laboratories, the communication of alerts,reports, and calls for help, and public information campaigns.
Inadequateinfrastructure in health systems, severe shortages of trained health workers,shortages of basic medicines and very weak health information and diseasesurveillance systems are peculiar challenges in the affected region (Dubois et al., 2015). Before 2014, Liberia,Sierra Leone and Guinea have 88 496, 79 365 and 24 096 people per health centrerespectively, compared to 10 320 people per health centre in nearby Ghana. Inaddition, instead of the recommended one trained health care worker for every439 people, there was one health worker for 3 472, 5 319 and 1597peoplerespectively for these three countries. The insignificant number of workforcewas further diminished by the unprecedented number of health care workers infectedduring the outbreaks.
Nearly 700 were infected by year end of 2014 and morethan half of them died. Though the number of infected health care workers washigh at the early state of the outbreaks, but diminished as proper safetymeasure was put in place. In Liberia however, as cases began to decline and therisk was perceived to be lower, stringent measures for personal protectionlapsed.
Protective measures in the community, such as frequent hand hygiene andkeeping a safe distance from others, visibly declined. While in Sierra Leone,exhaustion among staff causes an increase in loss of health workers.