Many issues surrounding the preparedness of HCWs have been extensively discussed globally especially in the aftermath of the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) and the Middle East Respiratory Syndrome (MERS)-CoV epidemic. While it is on record that the recent EVD outbreak recorded very high mortality among HCWs, to the best of our knowledge, only few studies have addressed these issues in anticipation of an EVD outbreak particularly in countries not hit by the EVD epidemic and especially in sub Saharan Africa, such a study is almost non-existent. Our study therefore assessed how prepared HCWs are in the face of a possible EVD epidemic.

The results of this survey showed that more than half (54.46%) HCWs indicated that their facilities were not ready to handle EVD cases. Nearly 92% indicated they were not adequately trained to handle an EVD suspected case and it is not surprising that less than 50% indicated they would willingly attend to a suspected patient. Moreover, nearly a third of HCWs would also want insurance for themselves and their families in case they were infected with EVD.

These results are clearly indicative of how ill-prepared the HCWs surveyed are in the face a potentially life threatening epidemic prone diseases, such as EVD in Ghana. In this study, only 25.7% of HCWs said their facility was sufficiently equipped to handle an EVD outbreak. Such low ratings of the hospitals by majority of HCWs is a mark of lack of confidence in their facilities preparedness and this may actually indicate a real lack of preparedness and readiness of the hospitals to handle not only EVD cases but potentially other epidemic prone diseases. Alternatively, it could also mean that HCWs were probably unaware of preparatory work and retooling of their facilities to handle EVD outbreak situation.

Willingness to work during outbreaks and emergencies is deemed a sense of duty even in the face of risk. In this study, less than 50% of HCWs indicated their willingness to work in the event of an EVD outbreak. Additionally, over one third indicated various forms of compensation for themselves or families in case of death or while taking care of an EVD case. This implies that if HCWs are assured or guaranteed that they and or their families would be taken care of in case of death or while taking care of an EVD case, they will willingly work in the face of any emergency scenario. The assumption is that HCWs would willingly work in the face of an infectious diseases emergency and respond appropriately; however, there are evidences of HCWs avoiding this “sacred duty” in caring for patients and would leave patients vulnerable in times of crisis [11]. In order to prevent HCWs from being infected while obliged to work even in the face of personal risk as required by their codes of ethics and professionalism, it is imperative to ensure that appropriate conventional standards, guarantees and effective public health practices are met to enable HCWs respond to such outbreaks so that they are not infected and or affected despite the risks they might face and continue to face [12]. Thus, appropriate training of HCWs as indicated by those surveyed during the study, coupled with retooling of some health facilities preparation is very critical in ensuring that they are equipped with the needed knowledge and tools needed to work with in the face of any epidemic.

General knowledge of EVD is crucial to adequately respond to and care for patients. Nearly 17% of our study population could not identify that EVD as caused by a virus. Arguably, infection control measures would be difficult and problematic for such HCWs. Less than 10% could correctly identify 0.5% Sodium Hypochlorite as the best disinfectant out of the many options provided. This strongly contradicts a similar study in Conakry conducted during the peak of the epidemic where 68% of HCWs knew the correct concentration of disinfectant [5]. While not trying to compare these two scenarios, this information may be vital in the realization that knowledge of HCWs in infection prevention and control measures is critical in their line of duty.

This study showed that most HCWs first heard of EVD through the media especially radio. This establishes the crucial role media plays in informing the general populace in such disease outbreaks. In Ghana, there are over 350 media outlets (radio and television put together) and majority of households either own a radio, television or have access to internet. Notwithstanding the media pluralism, it is still incumbent upon health institutions and facilities to organize special training on any emerging infectious disease that occurs globally to update the knowledge of HCWs.

Isolation is a key public health measure to prevent the spread of infectious diseases. In this study, over 97% of HCW indicated their willingness to comply and accept to be isolated in case they became infected after attending to suspected EVD patient. However, a small proportion of HCWs surveyed stated that they would be very unhappy, and this could ultimately affect compliance. Isolation is one of the oldest methods of controlling communicable disease outbreaks for patients [13]. However, it is worthy of note that less that 50% said they would be willing to attend to an EVD suspected patient and we suspected that this could be related to fear of personal safety [14]. Emergency response from an epidemic prone disease from an exotic virulent virus or pathogen will naturally spark some level of fear and skepticism among any group of individuals especially when their knowledge about the dynamics of the disease outbreak is low. There are stories of HCWs who have avoided the responsibility of treating patients [15] and this was apparent in the HIV/AIDS and Severe Acute Respiratory Syndrome-Coronavirus (SARS-CoV) during the 1980s and 2003, respectively where the fear of contact with suspected and infected patients gripped some HCWs [16, 17]. In the long run, this fear would likely affect their confidence and commitment to professionalism.

The results of this study point to the fact that knowledge and the provision of tools such as personnel protective equipment (PPE) and other logistics alone is not good enough strategy. There might be the need to as well address issues related to myth, and culture as well as assurances of upkeep should one be infected. The general outlook one’s country’s devotion to their health staff might be a contributory factor in all of this and cannot be ignored. However, getting HCWs inspired and feel safe in caring for such highly infectious disease outbreaks is critical. During our study, HCWs indicated various forms of compensation to be paid to them should they be affected in the case of EVD attack.