The three West African countries at the center of the Ebola outbreak have at least one thing in common – weak healthcare systems. Experts say that prevented Guinea, Liberia and Sierra Leone from responding quickly and effectively to the epidemic.

Dan Nelson, the organization’s expert on fragile states, describes what’s often lacking in countries with weak health care systems.

“They tended not to have sufficient qualified personnel. They tend not to have routine data collection systems that are reliable. So it’s difficult to get good planning. Poor facilities. Lack of equipment. Lack of supplies. Lack of essential medicines.”

He said there’s a reason many developing countries have not invested in their health systems.

“Many are financially strapped to begin with, especially those in conflict or post-conflict. During times of conflict, generally resources would be syphoned off for the war effort or for general security. Also, these tend to be poorer countries. So if you look at basic economic indicators you’re going to find that most of the fragile states are indeed quite poor to begin with and have a hard time funding even in the best of times for health facilities,” he said.

What’s more, Nelson said, these countries often lack infrastructure for educating and training health personnel.

Also many health workers come under attack, not only in conflict situations, but in the Ebola-affected countries. Many have been threatened by residents of towns and villages when they have attempted to deal with the Ebola outbreak. Much of that has been blamed on fear and stigma surrounding the disease.

There’s also a shortage of health workers in developing countries. Many leave for better jobs in richer nations.

In Guinea, Liberia and Sierra Leone, many health workers, themselves, have been infected by the Ebola virus.

Nelson said, “Generally, the healthcare workers are on the front line. Sometimes they’re insufficiently trained to deal with a situation like this and sometimes they have insufficient equipment. You see the WHO, CDC people coming in with these contamination suits in which they bare completely blocked from a threat of contamination. And even with those suits sometimes you still find some contamination. Sometimes it’s just bad luck. Despite having the suit you can still have a needle stick that would puncture the suit and you could still become infected.”

The Management Sciences for Health official said in building a strong health care system it’s very important to get women involved. Also, the system needs to be resilient -- strong enough to withstand shocks and trauma. The Ebola outbreak and natural disasters are two examples.

“Especially in Africa where most of my experience is you find that there’s [an] amazing amount of creativity in problem solving. They’re used to working in situations with very poor infrastructure and they’re used to being able to get things done. But they do need resources,” he said.

He added it’s important to work with the local population in building health systems. He says when bringing in outside medical personnel to help in a crisis, they should be made familiar with the local culture and customs.