WASHINGTON, D.C. -- Before the recent Ebola outbreak, people in the West African countries most affected by the epidemic were already among the most dissatisfied in the world with the availability of quality healthcare in their areas. Dissatisfaction reached 78% in Guinea, while residents of Sierra Leone (74%) and Liberia (73%) were also among the world's 10 most dissatisfied out of the 137 countries and areas Gallup surveyed in 2013.
Because the three countries that Ebola has hit hardest are also among the world's poorest and least equipped to handle a large-scale epidemic, the virus has proven difficult to contain. Healthcare systems in Guinea, Liberia, and Sierra Leone that ordinarily struggle to provide even basic health services to their residents lack the hospital beds, ambulances, and healthcare workers needed to effectively combat the outbreak.
Further underscoring West Africa's poor healthcare capacity, slightly more than one in three West Africans (36%) expressed satisfaction with the availability of quality healthcare, significantly fewer than in Southern Africa (62%) and Eastern Africa (47%). Still, as a sub-region, Central Africa does the worst, with only one in four residents (25%) saying they are satisfied with the availability of quality healthcare. Recently, 35 deaths have been blamed on a separate strain of Ebola in the Democratic Republic of Congo, a Central African country whose residents are among the world's most dissatisfied with access to quality healthcare at 76%.
In Guinea, where the West African Ebola outbreak began last December, concerns about healthcare are among residents' top priorities. In a 2012 national Gallup survey, 21% of Guineans cited healthcare as the government's top priority alongside the 24% who mentioned improved agriculture and 26% who mentioned job creation. At that time, roughly four in five Guineans also mentioned that there had been times in the last year when they were unable to pay for medicine (82%) or medical expenses (77%) that they or their families needed.
Misinformation about health issues poses a serious challenge in sub-Saharan Africa, where fake medicine and superstition complicate efforts to combat public health problems. In Guinea, where only 2% of homes have Internet access, grassroots awareness campaigns are key to stopping the outbreak's spread amid reports of attacks on treatment centers and the belief among some that the epidemic is a hoax. In 2012, radio (42%) was the primary source through which Guineans say they obtain health information, followed by word of mouth/friends and family (29% together).
Implications
Rather than showing signs of dissipating, the worst Ebola outbreak in history appears to be only spiraling further out of control. Though it took nearly five months for the World Health Organization to declare the outbreak a public health emergency, there are signs that the international community is awakening to the seriousness of the outbreak. Citing the potential for profound political, economic, and security implications, President Barack Obama dramatically upped the U.S. commitment to battle Ebola this week.
While the international community acts now to shore up response efforts in affected countries, the failure to address the poor state of healthcare infrastructure and training in Guinea, Liberia, and Sierra Leone will continue to leave these countries vulnerable to future outbreaks and public health emergencies in the future. Though all three countries already rely on international donors for large parts of their national budgets, greater focus on long-term healthcare programs and public health awareness in these and neighboring countries with similar ratings will leave West Africa better prepared for future epidemics.
For complete data sets or custom research from the more than 150 countries Gallup continually surveys, please contact us.
Survey Methods
Results are based on telephone and face-to-face interviews with 1,000 adults, aged 15 and older, conducted in 137 countries in 2013. For results based on the total sample of national adults, one can say that the margin of sampling error ranged from a low of ±2.1 percentage points to a high of ±5.6 percentage points at the 95% confidence level. The margin of error reflects the influence of data weighting. In addition to sampling error, question wording and practical difficulties in conducting surveys can introduce error or bias into the findings of public opinion polls.
The regions in this analysis include the following countries:
West Africa: Benin, Burkina Faso, Ivory Coast, Ghana, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone
East Africa: Ethiopia, Kenya, Madagascar, Malawi, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe
Central Africa: Angola, Cameroon, Chad, Congo (Kinshasa), Congo (Brazzaville), Gabon
Southern Africa: Botswana and South Africa
For more complete methodology and specific survey dates, please review Gallup's Country Data Set details.
