On the 7th October 2015 it was reported that no new cases of Ebola had been reported across the three countries with widespread and intense transmission (Liberia, Guinea and Sierra Leone).
Since then, 3 new cases in Guinea have meant the countdown clock to zero cases has been reset. In Sierra Leone the countdown to zero cases began on August 25th and ends on November 7th. The fragile health systems of all three countries were ill equipped to deal with not just the epidemic but also its’ consequences on routine healthcare. Maternal and newborn health in particular has been badly affected.
With the advent of Ebola the gains that were made in reducing maternal and newborn mortality were in danger of being lost. The UNFPA feared that of the 800,000 women due to give birth across the three worse affected countries in the 12 months from October 2014 approximately 120,000 could die of complications of pregnancy and child birth. The feared increase in maternal and newborn deaths was confirmed in a study conducted by CMNH and VSO in June and July 2014. The study showed a decrease in the numbers attending antenatal care of 18% and in post-natal care a decrease of 11% Deliveries at healthcare facilities also dropped by 22%. This was despite the health care facilities still being able to provide services, women were just too afraid of getting Ebola at the health facility to go for care. Consequently the number of maternal deaths has increased by 30% and stillbirths by 24%. Similar studies in Guinea and Liberia have also shown the negative impact of Ebola on maternal and newborn health care.
The common themes in all of the studies is that women stayed away from healthcare facilities because they mistrusted health care workers and were afraid of catching Ebola. Women and children were dying not because the services were lacking but because they were too afraid to use them.
The Centre for Maternal and Newborn Health (CMNH) at Liverpool School of Tropical Medicine has been working in Sierra Leone since 2009 on improving health outcomes for pregnant women and newborns. This is done through increasing the capacity if health care workers to provide emergency obstetric. Over 2500 health care workers and facilitators have been trained and were continuing to provide care during the epidemic There are lessons to learn from this Ebola epidemic not just for planning against future epidemics but also in rebuilding public confidence in maternal and newborn health services. Communities need to engage with health care services not just as patients but as real stakeholders who can have a say on what is being provided for them. Too often communities are passive recipients of care rather than active partners. Sensitisation to health care issues should not wait until it is too late as with the Ebola epidemic but be part of every countries ongoing health care strategy.
This week CMNH has been in Freetown talking with the Ministry of Health and Sanitation and others about the future of emergency obstetric care, training of health care workers and providing an enabling working environment. The focus now is on training in a continuum of maternal and newborn health care across all levels of education (pre-service, in-service, post graduate) and at all levels of health. There is also a need for high quality research that informs current and future practice. Because of its expertise in programmes of education, training and research the Centre for Maternal and Newborn Health is in a unique position to help in the fight to improve maternal and newborn health and will continue to work in partnership to do this.
About the Author:
Susan Jones is a Senior Research Associate at the Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine. Sue has worked in Sierra Leone since 2011 and currently the country lead for CMNH in Sierra Leone working on the implementation of the Making it Happen programme including support to programmes of pre and in service education programmes.