Individual behavior plays a central role in the disease burden faced by society (Kessler/Zhang, 2014). Seldom has this impact of health behavior on society and also on economy been so strongly evident as at the current Ebola crises in West Africa. The BBC Africa Debate in Ghana discussed the role of the weak health system in West Africa and its challenges to cope with Ebola. The discussion included inter alia representative of the Ghana and Liberian governments, of the WHO and of Medicine sans Frontières, as well as the audience, representing the voices of (educated) common people but mostly doctors and nurses, faced by the problem.
Two central problems haven been clear due to the discussion. First, the weak health system in some West African countries is mainly not a problem of lack of equipment or capacity constraints but one of unhealthy public behavior. In West Africa, population strongly deviates from rational health behavior, causing negative externalities. Second, in this setting of a weak health system, the intervention of government is highly necessary. However, not only did the government action fail to stabilize the health system, but rather caused an atmosphere of mistrust.
In countries mostly hidden by Ebola, Guinea, Liberia, Sierra Leone, the population is not taking the standard requirement to protect against the spread of the disease. Families want to take care of Ebola infected or passed family members themselves instead of visiting the hospitals or sterilisation centers. They do not consider, that while washing or burying their beloved they could get infected. Prevention care like washing hands or not eating from stand sides are considered time costly, so people are not seeing the benefits and are therefore not engaging in this behavior. How important preventative care is shows in Nigeria which claims, after six week of no cases, to be free of Ebola. In Nigeria, the population is aware of the severity of the disease and behaves in accordance by e.g. not shaking hands with each other. This behaviour causes positive externalities to the whole society and resulted in the defeat of the epidemic.
What responsibility does the government have in this scenario? A question asked to each countries representative in the discussion, mutually answered with “none”. No wonder why not only the lack of a public communication system causes irrational behavior, but also the mistrust in governmental information’s and actions. In Liberia, the government reacted to the irrational behavior of the population with a temporary legal punishment for every unreported Ebola case which caused no impact to cope with Ebola. In Sierra Leone a recent three day lockdown of the population has been used to hand out bars of soap, to inform on how to prevent infection and to survey household to discover new cases. 130 unreported cases of Ebola have been found, showing the lack of trust the general population has for government actions in hospitals and sterilisation centers.
In conclusion, the BBC Africa Debate resulted in:
It was a very hard task for West African government to defeat Ebola from the beginning, because the epidemic was unknown and needed a long time to be discovered. However, the weak health system in Guinea, Liberia and Sierra Leone, resulted in further difficulties to cope with it. The central problem is thereby the irrational behavior of individuals caused by uninformed decisions and mistrust in government actions. This behavior results in negative externalities, making it impossible to handle the spread of the virus.
Recommended to listen: BBC Africa Debate in Ghana