The World Bank yesterday reported that 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, 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 rates even after the countries are declared Ebola-free. Maternal mortality could increase by 38 per cent in Guinea, 74 per cent in Sierra Leone, and 111 per cent 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 per cent of Liberia’s entire general population had died due to Ebola, as compared with 8.07 per cent of its health workers, defined in the study as doctors, nurses and midwives. In Sierra Leone, the loss was 0.06 per cent of the general population compared with 6.85 per cent of the health workers, while 0.02 per cent of Guinea’s overall population had died compared with 1.45 per cent of all health workers.

According to the report this translates into a 10 per cent reduction in, doctors in Liberia (which only had about 50 to start) and an 8 per cent reduction in nurses and midwives. In Sierra Leone, it means a 5 per cent reduction in doctors and a 7 per cent reduction in nurses and midwives. In Guinea, the reduction is smaller-2 per cent for doctors and 1 per cent for nurses. At the outset of the epidemic, the World Health Organisation 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. Ebola’s devastating impact should be the catalyst to strengthen the health systems far beyond their pre-Ebola levels,” says David Evans, senior Economist at the World Bank Group and co-author of the report.

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.

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