Operational research: did health systems in Sierra Leone recover after the 2014-15 Ebola outbreak?

Abstract

Findings from participants who attended the second post-Ebola SORT-IT course are reported in five short papers on the “legacy of Ebola on health Systems in Sierra-Leone”. After a decline of health service provision and utilisation during the Ebola outbreak, present findings show recovery over time in the post-Ebola period. However, important challenges remain, including an important health workforce gap.

The impact ofInfection Prevention and control (IPC) bundle implementationon IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: a before and after design

“…The EVD outbreak in 2014 in West Africa gave an opportunity to strengthen the health system and to set up (or reinforce) national IPC programmes in the affected countries 12. In Sierra Leone, findings showed recovery over time in the post-Ebola period and that some health indicators might even be better than before the outbreak 13 14…”

Indirect Effects of Ebola Virus Disease Epidemics on Health Systems in the Democratic Republic of the Congo, Guinea, Sierra Leone and Liberia: A Scoping Review Supplemented with Expert Interviews

“…Disruptions in the supply and use of essential health services (outpatient consultation, hospitalization of patients, delivery in the presence of qualified personnel, treatment of confirmed cases of malaria and vaccinations) during EVD epidemics were well documented [ 9 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. These disruptions were due to health workers’ fears of contracting EVD [ 39 ], community distrust of health workers and limited availability of health services in health care facilities [ 46 ] or the closure of some health facilities [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ...…”

“…Many other studies noted a significant decrease with sometimes dramatic consequences in the use and capacity of care for certain disease control programs (tuberculosis, malaria and HIV/AIDS) [ 9 , 20 , 22 , 23 , 25 , 26 , 27 , 28 , 29 , 38 , 41 , 42 , 50 , 51 , 52 , 53 , 54 , 55 , 60 , 63 , 68 , 69 , 70 , 71 ]. Indeed, tuberculosis caused approximately 11,900 deaths in Guinea, Liberia and Sierra Leone in 2014.…”

“…[ 20 ]. With regards to malaria, there was a decline in malaria consultations (e.g., a 60.5% decline in malaria cases diagnosed and treated in health facilities in Sierra Leone) during the EVD epidemics [ 9 , 20 , 22 , 23 , 25 , 27 , 28 , 29 , 38 , 41 , 42 , 50 , 60 , 63 , 69 ]. For HIV/AIDS, there were drug shortages that led to the deterioration in the quality of care, an increase of more than 40% of treatment dropouts in Guinea and Liberia [ 25 ] and a decrease in the use of HIV/AIDS services [ 22 , 23 , 25 , 36 , 38 , 52 , 69 ].…”

“…On the one hand, health workers were severely affected during the EVD epidemics. In particular, the reduction in and even absence of the workforce during these epidemics in the four studied countries was noted [ 9 , 20 , 24 , 26 , 27 , 29 , 30 , 32 , 33 , 35 , 37 , 42 , 49 , 51 , 65 , 73 , 77 , 78 , 79 , 80 , 81 ]. This was either due to health workers leaving health facilities because of the fear of contracting and dying of EVD while providing services [ 9 , 24 , 32 , 35 , 37 , 64 , 65 , 77 , 79 ].…”