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D+C  e-Paper  August 2016 25 Anne Jung is a health-care adviser with medico international, an aid and human-rights organisation that has been cooperating with partners in Sierra Leone since the end of the civil war in 2002. [email protected] Awareness raising in Freetown, Sierra Leone. wounded – especially those who had been savagely mutilated – were accommodated in separate camps. Redistributing resources for health care Where will the money for development come from? To generate more government revenue, it is important to diversify the economy, promote small-scale farming and establish manufacturing industries. At present, not a single one of the three Ebola-affected countries can possibly fund a proper health-care system on its own. External donor funding is essential, and it must be monitored independently. The recently published Panama Papers give an idea of the kind of money that could be made availa- ble to post-Ebola countries. Closing tax havens would significantly boost government revenues and – even more important perhaps – restore confidence in gov- ernment capacities. The lack of such confidence made fighting Ebola much harder. The call for financial support for health care is based on more than only the Ebola crisis however. An international financing mechanism should com- pel all sufficiently prosperous countries to contrib- ute to poorer countries’ welfare-state social budgets. The principle of solidarity has long been practised at national levels, and it must be extended to the global context. Humanity does not lack the resources to pro- vide full-fledged health care to all people in all coun- tries. The truth is that the rich countries are refusing to share existing resources in a fair and equitable manner. Preventing medical migration Sierra Leone has about 7 million people and employs fewer than 300 doctors. Around three times that num- ber work at Frankfurt’s University Hospital alone. In the wake of the Ebola epidemic, health-care provision contracted even more. The number of malaria deaths doubled, maternal mortality began to rise again, and measles spread. Similar developments were observed in the neighbouring countries too. Patients almost always have to pay personally for treatment at a health centre or hospital, even though mother and child health-care programmes are offi- cially free of charge. It was the lack of public health- care infrastructure that allowed the Ebola outbreak to become an epidemic. Unless an effective health- care infrastructure is built and well-trained profes- sionals are made available, there can be no effective disease control in the future, warns Albrecht Jahn of Heidelberg University. The problem is that only 10 % of the doctors trained in Sierra Leone stay in the country after graduation. The vast majority emi- grate in search of acceptable salaries, and many are poached by health institutions based in prosperous nations. One of the first steps for effective preventive action should therefore be a reduction of the brain drain in the health-care sector. It could be achieved by intro- ducing a binding international code of conduct for the recruitment of health-care professionals. Moreover, according to Shecku Mansery of the aid organisation SLADEA, which organised Ebola aid for the churches, “the government finally needs to meet its responsi- bility by raising salaries in health and education to a level that encourages professionals to stay in the country.” Key factors in stemming the epidemic included involvement of local communities, reliance on their specific expertise and development of the necessary empathy. Strengthened by that experience, commu- nities now expect the health-care system to improve fundamentally. Moreover, participants in the first post-Ebola conference in Freetown earlier this year called for healthier living and working conditions. The next step in a policy aimed at meeting peo- ple’s needs would be to reform the constitution. Such changes are demanded by non-governmental organi- sations such as the Civil Society Forum in Sierra Leone. They want to see the right to education and the right to health enshrined in the constitution. Experience in South Africa, for example, shows that it makes a difference when the government can be sued for breaching the constitution. “Access to quality edu- cation and health care is the prime requirement for curbing the power and despotism of the state,” says Abu Brima, director of the NMJD. AP Photo/picture-alliance