By Alex Whiting
LONDON (Thomson Reuters Foundation) - Traditional healers were blamed for worsening the spread of Ebola in Sierra Leone, but they need to be included in any plan to improve the country's healthcare and prevent such crises in future, researchers said on Thursday.
In parts of Sierra Leone, people trust their local healers more than health clinics, where overworked and underpaid staff can be rude, dismissive or charge for services that should be free under the national health system.
In other areas, people visit both the healer and the clinic when they fall ill - one for treatment to cure their body, the other for more spiritual healing, said Richard Mallett, co-author of "After Ebola: why and how capacity support to Sierra Leone's health sector needs to change".
"Traditional healers are considered incredibly important in local communities. You can disagree with them as much as you want, but if you don't work through them it's not surprising if you then see limited results," Mallett said in an interview.
Mallett is a research officer at the Overseas Development Institute (ODI), the London-based thinktank that published the report.
Ideally, health clinics should have good relationships with community leaders and traditional healers and birth attendants, Mallett said.
"It's tricky to say for sure, but the impression we got was the health clinics that seemed to be working relatively well were the ones that had much better relationships with the community they served," he said.
Ebola killed more than 3,900 people in Sierra Leone during the outbreak that hit western Africa earlier this year.
Some of the earliest cases were traced to a faith healer who claimed to have a cure for the disease. The healer died of Ebola and women who attended her funeral became infected, local medical officials said.
People who distrusted their local clinics were also more likely to question the information they gave about Ebola.
Sierra Leone has received some $350 million in aid for its health system since the end of its civil war in 2002. This has helped train medical staff, build new clinics, and support free healthcare for pregnant women and young children.
Aid agencies are appealing for more aid for the country's health system, but the ODI researchers said the way that aid is spent must focus on longer-term impact and be focused less on results.
"We're not saying that's been a complete waste of money, but we are saying it could probably have been used better ... More of the same won't cut it," Mallett said.
For example, training alone is not enough when health staff are working in a difficult place, often going without pay for months.
A better culture of care across the system is needed from the top down, giving staff greater support, supervision and incentives to provide quality care, researchers said.
"When you have ongoing peer support or some kind of ongoing monitoring you tend to get better ... quality health care provided."
ODI researchers spoke to many who had suffered at the hands of health staff, including one pregnant woman who had walked for more than three hours to her nearest clinic, only to be told to return the next day for an appointment, and refused a drink of water.
"If people are treated badly, they are unlikely to return," Mallett said.
Improved communication between different parts of the health service from local clinics to the health ministry is also vital, the report said.
At present, it is a bit like a slow system of Chinese whispers, and the information that finally reaches the top can be unreliable, Mallett said.