Impact of the Ebola outbreak on health systems and population health in Sierra Leone.

BACKGROUND: The current Ebola outbreak has proved devastating to vulnerable populations in West Africa. Health needs assessments were conducted in two districts of Sierra Leone to identify and quantify the impact of the outbreak on population health and health systems.

METHODS: Mixed qualitative and quantitative methods were employed including interviews, focus groups, and interrogation and analysis of data from health facilities, district health records and burial teams. T-tests were performed to compare periods before and during the outbreak.

RESULTS: A breakdown in relations between the health system and communities was demonstrated leading to marked and significant reductions in utilization of health facilities including: paediatric all-cause and malaria admissions, maternity admissions and attendance in the community. High avoidable all-cause mortality was identified (3.4 times higher than normally registered for the period, 42% deaths in children <5 years, 2% attributed to Ebola). Negative impacts on the health workforce, health system leadership and governance, and disruption of health programmes and systems were demonstrated. Reductions in vaccination coverage and a rise in teenage pregnancy were noted.

CONCLUSIONS: The findings indicate a public health emergency as a legacy of the Ebola outbreak. Sustained commitment of the international community is required to support health system re-building.