The democratically elected government since 2006 has

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The democratically elected government since 2006 has sought to re-establish stability in the context of rapid development and access to humanitarian assistance (UNDP, 2014a). Despite various programmes undertaken to address Liberia’s severe developmental challenges, most families cannot afford a single meal a day or fees for basic health services. Liberia remains a very poor country. Sierra Leone suffered a devastating civil war from 1991 to 2002, which left 50,000 dead, an average income of around 38 cents a day, and 2 million displaced persons, or almost a third of the total population. The health system was almost completely destroyed. The restoration of peace and democratic rule since 2002 encouraged very rapid growth. GDP rose by 9.5 percent per year in real terms from 2002-2013, and per capita income in current dollars quintupled. The share of the population living on less than a dollar a day declined only marginally, however, from 59 percent in 2003 to 57 percent in 2012 (UNDP, 2014b). A large proportion of Sierra Leoneans are still too poor to afford basic necessities of life including health services. The health systems in Guinea, Liberia and Sierra Leone were unprepared for Ebola at the outset. They lacked sufficient amounts of all that is required to contain the epidemic: drugs, ambulances, facilities, trained health personnel, and many other items. This is not surprising since these countries had few resources and suffered from many serious health issues that generated competing demands for resources, even prior to the onset of Ebola. Tragically, the shortage of protective equipment resulted in multiple infections and deaths among medical personnel and further spread the disease. Also, rumours led people to avoid treatment for fear of being infected. Table 2 provides an overview of how the deficiencies in the health system hindered EVD containment in West Africa, focusing on human resources, governance and leadership, funding, commodities and supply chain networkers, service delivery and information. SOCIO-ECONOMIC IMPACT OF EBOLA VIRUS DISEASE IN WEST AFRICAN COUNTRIES
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17 Moreover, impoverished rural areas have more limited access to services than relatively well-off urban areas. This inequitable distribution of human and financial resources has hampered the response to the epidemic, which originated in, and continues to heavily affect, many rural areas. Human resources are inequitably distributed. Conakry, which is home to just 15 percent of the population, has 75 percent of the health workers. By contrast, Guinée Forestière, which has been hardest hit by the Ebola epidemic and is home to 22 percent of the Guinean population, has 9 percent of healthcare workers (UNDP-RBA, 2014a). This shows that the affected countries’ health systems were not ready for the outbreak because they were not equipped to cope with the epidemic. Indeed, before the EVD epidemic, Liberia had only 2.8 healthcare workers per 10,000 people and 51 medical doctors serving its population of 4.29 million (UNDP, 2014a; Lewnard et al., 2014). The situation is the same in Sierra Leone and very similar in Guinea. Table 3
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