Health-care worker mortality and the legacy of the Ebola epidemic.

Abstract

The recent outbreak of Ebola in West Africa will leave a legacy significantly deeper than the morbidity and mortality caused directly by the disease. Ebola deaths have been disproportionately concentrated among health personnel. The fact that health-care workers are at greater risk of contracting Ebola will exacerbate existing skill shortages in countries that had few health personnel to begin with. The authors modelled how the loss of healthcare workers - defined here as doctors, nurses, and midwives - to Ebola may affect maternal, infant, and under-five mortality in Guinea, Liberia, and Sierra Leone, with the aim of characterizing the order of magnitude of likely effects, not providing specific pre dictions. The model’s use of cross country mortality coefficients assumes that the effect of health-care worker supply on maternal, infant, and under-five mortality in Guinea, Liberia, and Sierra Leone is similar to the cross-country average and has not changed since those coefficients were estimated. This work further assumes that unmeasured elements of health systems (such an overall measure of quality), associated with both health-care worker density and mortality, are not driving the result. The estimates suggest that substantial investment in health systems - and specifically in the health workforce - is urgently required not only to improve future epidemic preparedness and meet basic needs, but also to limit the secondary health effects of the current epidemic owing to the depletion of the health workforce.