Guinea, Liberia, and
Sierra Leone are among the poorest countries in the world, with recent history
of civil war and unrest that left basic health infrastructures severely damaged
or destroyed and created a number of young citizens with little or no
education. Basic infrastructures including road systems, transportation
services, and telecommunications are weak especially in rural area of these
countries. These problems greatly delayed the transportation of patients to health
centres and of sample analysis to laboratories, the communication of alerts,
reports, and calls for help, and public information campaigns.

Inadequate
infrastructure in health systems, severe shortages of trained health workers,
shortages of basic medicines and very weak health information and disease
surveillance 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 centre
respectively, compared to 10 320 people per health centre in nearby Ghana. In
addition, instead of the recommended one trained health care worker for every
439 people, there was one health worker for 3 472, 5 319 and 1597people
respectively for these three countries. The insignificant number of workforce
was further diminished by the unprecedented number of health care workers infected
during the outbreaks. Nearly 700 were infected by year end of 2014 and more
than half of them died. Though the number of infected health care workers was
high at the early state of the outbreaks, but diminished as proper safety
measure was put in place. In Liberia however, as cases began to decline and the
risk was perceived to be lower, stringent measures for personal protection
lapsed. Protective measures in the community, such as frequent hand hygiene and
keeping a safe distance from others, visibly declined. While in Sierra Leone,
exhaustion among staff causes an increase in loss of health workers.

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