Weak health systems and Ebola

The response to the Ebola crisis in west Africa is shining light on the weak health systems in these countries, which have been crippled by years of underinvestment. 1 Sierra Leone, one of the three countries at the epicentre of the Ebola outbreak, is a small country with a population of 6 million and an average income of US$513. As of Dec 13, 2014, Sierra Leone had recorded 6638 confi rmed cases of Ebola and 2033 deaths. The weak health infrastructure is generally explained in the media as resulting from the civil war which ended in 2002. However other factors, including those that precipitated the civil war, need to be considered, such as structural adjustment which caused the collapse of the education system. The combination of jobless youths and income from diamonds provided fertile ground for the formation of the Revolutionary United Front, a group that claimed to be on the side of the population against the government. 2 To pay for health systems, governments need to raise revenue. The most predictable and sustainable way to do this is through taxes, and both the UN and west African heads of state have agreed that governments need to raise 20% of their gross domestic product (GDP) in tax to meet their development needs. 3 However, although the economy has been growing at 6% per year, Sierra Leone currently only raises 11% of its GDP in taxes. 4 The three main categories of tax are customs duty, goods and services tax, and corporate income tax. Waivers and special deals are given to foreign mining and agribusiness companies to attract foreign investment into the country, despite little evidence to suggest that such incentives attract investment or promote economic growth. 5 When several countries provide widespread tax incentives at the same time, there may be a race to the bottom, with multinational companies being the benefi ciaries and the population being the losers, in the form of lost potential revenues that could fund public services. Individualised tax arrangements reached between a small number of government offi cials and companies, with lack of transparency , also increases the likelihood of corruption. Looking at just fi ve mining companies in Sierra Leone, one recent study 6 found that the country will lose $44 million per year simply from corporate income tax exemptions, nearly all from two UK companies. Losses from exemptions on customs duties and taxes …