MINING companies which profit from natural resources in one of the world’s poorest countries should pay more tax to invest in health services that could avert the preventable loss of huge numbers of lives.

This alert comes today in a new report from a British charity working in Ebola-hit Sierra Leone, published as the House of Lords debates the disease. It warns that many thousands will still fall victim to avoidable deaths because of the weak health system in Sierra Leone, which could be better funded by steps such as cutting revenue exemptions to the extractives industry.

Estimates suggest that Sierra Leone has lost £127 million a year in recent times due to tax incentives, over three times its 2015 health budget.

But, according to the report, launched by Health Poverty Action, reducing incentives could bring £60m revenue in the next few years. The figures are based on the five largest mining companies operating in Sierra Leone last year. These were Sierra Rutile, Octea Mining, Sierra Minerals Holding Limited, African Minerals and London Mining, though the latter two are now owned by Shandong Iron and Steel, amid a decline in the iron ore market.In the absence of strong health systems in Sierra Leone, the current emergence of Ebola has become an epidemic.

Almost 4,000 people have died from the recent outbreak in the country, which has the worst rates of maternal mortality and life expectancy and among the highest rates of infant deaths. Many others are dying of unrelated conditions and diseases, such as malaria, as public health work grinds to a halt and weak health systems teeter on the brink of collapse, incapable of meeting the needs of the population. The lack of adequate, sustainable funding for the health system means the people of Sierra Leone are dying needlessly.

Mistrust in the poorly functioning health system is increasing the spread of Ebola. Over 40 years of underinvestment in health and high user fees — charges levied on individuals in order to access health services — have forced people to resort to alternative methods to manage illness. 

Responding to Ebola is not just about controlling infections. An effective response, and prevention of future crises, requires a strong and efficient health system, accessible to and trusted by the people.Despite Sierra Leone’s scheme that grants mothers and young children free healthcare, other citizens must still pay upfront fees, which make provision a luxury beyond their reach, or force them into poverty. 

At the same time, the Free Healthcare Initiative for mothers and infants is dependent on donor funding, when far more sustainable sources could include higher tax revenues from mining companies.

Besides shrinking current tax breaks, the charity believes donor countries that benefit from health workers’ migration should pay compensation. It reveals that present Sierra Leone subsidies to British health services may total as much as £22.4m. The sum represents the cost Britain would have faced to train the doctors and nurses from the west African state who are now in Britain.

Despite Sierra Leone having only 136 doctors in 2010, another 27 trained in the country are now in Britain. And though Sierra Leone had just 1,017 nurses in 2010, the profession’s British body lists 103 trained earlier there. The report cites a World Health Organisation threshold of 230 doctors, nurses and midwives per 10,000 people as the minimal level for essential maternal and child health services. Yet Sierra Leone has faced the recent Ebola crisis with just one doctor for every 45,625 people.

The charity urges Sierra Leone’s donors to continue aid for a stronger health system, to help build its tax and finance capacity and to provide financial compensation where they have benefited from health worker migration.

Health Poverty Action also highlights the fact that, in addition to the money lost through tax breaks, illicit capital flight — unrecorded financial outflows, some from revenue evasion and avoidance — has cost the state about £45m a year over the past decade. This requires the international community to address the issue. Britain, and all participants in next month’s Financing for Development Conference, must take firm action to stop the draining of resources from countries such as Sierra Leone.

The current Ebola crisis has thrust Sierra Leone firmly back into the humanitarian spotlight. There are fears this will fade once the epidemic is under control, only to return with the next crisis. Yet there is an alternative to this pattern. Sierra Leone’s emergence from this crisis will provide a critical opportunity to channel the renewed energy and resources into sustainable solutions for the country. With the necessary national and international political will, a strong health system can emerge from this tragedy — a system that will provide a barrier to health crises and protect the health of its people.

• Natalie Sharples is Health Poverty Action senior policy adviser.