John Campbell

Africa in Transition

Campbell tracks political and security developments across sub-Saharan Africa.

Print Print Cite Cite
Style: MLA APA Chicago Close


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

by Guest Blogger for John Campbell
August 28, 2012

A cholera patient lies in a treatment centre run by Medecins Sans Frontieres on Macauley Street in Sierra Leone's capital Freetown, August 23, 2012. (Stringer/Courtesy Reuters)


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.

Post a Comment 6 Comments

  • Posted by Chike Chukudebelu

    Cholera can be very easily cured using the oral re-hydration therapy.

    If Sierra Leone is waiting for “foreign donors” to help out, then they aren’t serious – like most modern African nations.

  • Posted by Sahr Pessima

    The above views appear very salient and worth taking note. I am a development practitioner and all what development is about freedom and capabilities. The government of Sierra Leone has the ultimate responsibilities of providing capabilities for its citizenry to fully maximise their freedoms. The issue of war will always be the easy excuse and a way out to international donors. Let’s be sincere to our poor and innocent people

    The major problem of Sierra Leone is poor governance and institutions. Thr so called politicians need to learn from local successful govern menus in the region to wake up. Look at simple initiatives in The Gambia. Although a chronic poor nation,there appears to be institutions especially in the health sector to respond to common health problems.

    Sierra Leoneans must first learn about their freedoms and demand it. No government I’d bigger than the people. Let’s first decide on who to be in the government and the rest is commoning. There will be shared interests,justice,and the bottom to top approach to development.

    I hope the international communities can rescue us this time around. How long are we going to rely on others who are also not self sufficient. We need a pragmatic solution. Sierra Leoneans must demand their freedoms peacefully. If that fails then the alternative will be justified.
    My recommendations are:
    1.lets practice good hygiene to prevent the epidemic at households education/ primary health at local levels for the right people to lead us. The current and past are criminals and perverts.

  • Posted by Amy Marie Herrick

    This article is spot on and effectively describes the situation here on the ground; however, the title should read: “Lack of foresight, planning and coordination lead to continuation of Cholera outbreak”.

    The problem is not a lack of resources or “Public Health Investment” (there are more NGOs and international funding flowing through here than in many neighboring countries) but rather a lack of coordination, political will and advanced planning that could have prevented the problem (or decreased its spread).

    As the article accurately describes, a lack of a garbage system, proper sanitary disposal in the main urban areas where many people live in “pan-bodi” homes ( lean-to shacks with corrugated roofs) in densely populated areas, a lack of clean water and sanitation facilities have caused a major outbreak. These are not new problems but rather part of the basic infrastructure problems that plague the country and have yet to be addressed.

    In addition, lack of public sensitization campaigns and a lack of access to clean water, soap, simple anti-biotics and oral re-hydration salts for the poor provide a breeding ground for the disease.

    Tackling the problem is arduous because, as if often the case in Sierra Leone, the solutions are deceptively simple (pick up the trash- start a public sensitization campaign with posters describing hand washing and other preventative measures along with treatment centers ) but coordination, especially through the appropriate ministries (MOHS and Ministry of Infectious Diseases) is difficult to say the least due to numerous inefficiencies, and a general country-wide inability to get anything done in a timely manner. A simple campaign with posters can take weeks if not a month to approve, design and coordinate through multiple agencies before it reaches the general population.

    Those in the NGO and international community are just as upset at the current condition as they try to slowly work with the government to set up programs. A lack of basic infrastructure and in country capacity has made this outbreak difficult to contain.

    It’s not dire though, as Monday I did receive a text message on my phone from the MOHS concerning sanitation (“Always wash hands with soap and water after using the toilet”), so some headway has been made.

    Amy-Marie Herrick is an American who currently works for an investment group in Freetown, Sierra Leone

  • Posted by Ahmid Thoronka

    As i spent time reading the comments of some authors above, i see more of politicizing social issues. Apart from the fact that outbreaks of diseases are in most cases natural, beyond the control of poor governments like ours in SL, the other fact here is peoples’ unhygenic habits or unfriendly attitudes towards the environment- especially in most parts of the city Freetown. Could you imagine that there are people in FT who are in the habit of defecating in black polythen bags and throwing the content randomly into the neighborhood, depositing also there domestic refuse into the public gutters or drainage? What a crude behavior, people sell food to the public in an unsanitary atmosphere and that is not also well prepared. If any reasonable govt. decides to enforce the law to the letter, the same authors blaming the govt will be the ones critisizing that govt, talking about human rights, bla! bla!. People should know that upgrading a country like SL requires more time, more investments in the public health sector, more positive change of attitudes. So as we always blame the cat for eating the fish we should also talk to the fish not to smell to attract the cat. Yes the we can blame the govt for their lapses, on the other side we should also inculcate the habits that support positve change. Lontha!

  • Posted by Chike Chukudebelu


    In pre-colonial African societies, basic hygiene was observed. Sierra Leone isn’t so poor it cannot afford to implement basic hygiene.

    Cholera is a disease resulting from the lack of basic hygiene.

    I think I’ve said enough.

  • Posted by lululemon

    There’s certainly a great deal to know about this topic. I love all of the points you have made.

Post a Comment

CFR seeks to foster civil and informed discussion of foreign policy issues. Opinions expressed on CFR blogs are solely those of the author or commenter, not of CFR, which takes no institutional positions. All comments must abide by CFR's guidelines and will be moderated prior to posting.

* Required