from Africa in Transition

Guest Post: Sierra Leone: Cholera Outbreak Underscores Need for Public Health Investment

August 28, 2012

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Sub-Saharan Africa

Sierra Leone


This is a guest post by Mohamed Jallow, a former interdepartmental associate at the Council on Foreign Relations, and now a program development specialist at IntraHealth International. Mohamed is originally from Sierra Leone.

Sierra Leone is in a state of “health emergency” after a cholera outbreak inundated the country’s ill-equipped health system. According to the WHO, since the beginning of the year, Sierra Leone has recorded over 11, 653 cases of cholera, and 216 deaths.

To many Sierra Leoneans though, this latest cholera outbreak is not unexpected. But the speed and scope of its spread within such a short period is a clear sign of the country’s precarious health care situation. According to the WHO, only about 30.5 percent of households in Sierra Leone have access to proper sanitary disposal (PDF), and only a small proportion of wastewater receives any kind of treatment prior to its discharge.

A more worrisome fact is that as this outbreak has proven, the country does not have a clear emergency response system to tackle a crisis of this scale. The civil war wrecked the country’s health system, which will take years to recover. But there are steps the authorities could have taken to avert this outbreak, or at the very least have in place an efficient plan to mobilize the population against the spread of the disease. Instead, there was a mixture of confusion, uncertainty, and panic in many areas of the country. The disease surveillance and monitoring system proved to be ineffective. Critical communication lines were hampered by lackluster bureaucratic hurdles and inefficiency. The instinct of the authorities was not to take the initiative when incidences of the outbreak first occurred, but to plead for help from the international community.

No one is expecting a country like Sierra Leone, given its recent past, to have the best healthcare and emergency response mechanisms in place, or to tackle the age-old problem of unchecked population growth in major urban areas. However, a little more earnest ground work designing and implementing preventive measures, and a little more investment in community health programs, especially in prioritizing  training and resources for frontline health workers who usually  have direct access to high-density population centers would have gone a long way in preventing  disease outbreaks of this scale.