Background: The devastating 2014-2015 Ebola outbreak in Sierra Leone could erode the gains of the health system including the Community Health Worker (CHW) programme. We conducted a study to ascertain if the positive trend in reporting cases of malaria, pneumonia and diarrhoea treated by CHWs in the post-Ebola period has been sustained 18 months post-Ebola. Methods: We conducted a retrospective cross-sectional study using aggregated CHW programme data (2013-2017) from all Primary Health Units in Kenema district. Data was extracted from the District Health Information System and analysed using STATA. Data in the pre- (June 2013-April 2014), during- (June 2014-April 2015) and post-Ebola recovery (June 2016-April 2017) periods was compared and analysed for reporting completeness; Rapid Diagnostic Tests (RDTs) performed and cases of malaria, diarrhoea and pneumonia treated per month. Differences across periods were tested using two-sample t-test with significance set at 0.05. Results: CHW reporting increased from pre-Ebola by 8% (p-value=0.29) intra-Ebola and 19% (p-value=0.012) post-Ebola. Compared to the pre-Ebola period, in the post-Ebola recovery period, there was a significant increase in the mean monthly reported RDTs of 35% (p-value=0.020); malaria treatments 66% (p-value<0.001); and pneumonia treatments increased by 80% (p-value=0.004). Conversely, the mean monthly diarrhoea cases treated decreased by 20% (p-value=0.16) in the post-Ebola period. Conclusion: The resiliency demonstrated by the CHW programme during and immediately after the Ebola outbreak has been sustained in the post-Ebola recovery period. Continued programme investments in supportive supervision and financial incentives for CHWs will be critical to ensure uninterrupted contribution towards Sustainable Development Goal 3.
Ebola and community health worker services in Kenema District, Sierra Leone: please mind the gap!
