Lessons from Sierra Leone: trust in health care is essential for virus control
Public trust in government and health care is indispensable to control an outbreak of an infectious disease. At the beginning of the Ebola epidemic in 2014, the government and donor organisations set up large-scale clinics in Sierra Leone. This did not work, because a large part of the population did not trust the government and the health care system. Many inhabitants refused to be tested and sick people hid. Investing in good relations with the population is crucial, concluded development economists of Wageningen University & Research (WUR). The lessons from the Ebola epidemic are now helping to combat the COVID-19 pandemic.
The development economists from WUR, together with colleagues from universities in Sierra Leone, have been carrying out research in that country for more than ten years, for example on the impact of development programmes on the prosperity of inhabitants. The WUR development economists were also in Sierra Leone during the Ebola outbreak in 2014. They had to stop their work and leave the country. Back in Sierra Leone, they helped set up studies to combat the Ebola.
Several health clinics were already working on a better relationship with the community before the Ebola outbreak, thanks to a programme run by the Ministry of Health of Sierra Leone and various development organisations, and with funding from the World Bank. The health workers involved the villagers in their work and provided information on health and diseases. A study by WUR and American researchers shows that these clinics had more deliveries and vaccinations and lower infant mortality rates.
Researcher Maarten Voors of the Development Economics Group (DEC) and his colleagues saw the same positive effects in their research into the small-scale temporary care centres set up by the government during the Ebola epidemic, especially in rural areas. The employees of these so-called community care centres came from the surrounding area and invested in good relations with the villages. ‘During the Ebola epidemic about 60% more villagers were tested here than in other clinics. Infected patients could be isolated and treated’, explains Voors. ‘This prevented further spread and fewer people died’.
When the Corona pandemic emerged, the government of Sierra Leone reacted quickly. As a result of the earlier Ebola outbreak, the country has a great deal of experience in organising testing, contact tracing and isolation and protection measures.
Queen mothers and village chiefs
Maarten Voors is now investigating the impact of the Corona crisis on the economic situation for households and businesses with an international research team: ‘We call about 3500 people a month, a cross section of the population, with questions about their situation. For example, do they have enough to eat? On the basis of the results, we produce data letters and bulletins to give governments and donor organisations an insight into how best to help and support citizens and communities’.
‘Health care is not just about buildings and hardware. Invest in relationships with communities and in the trust of citizens by involving people in care and in their own health,’ Voors emphasises. ‘Local leaders, such as queen mothers and village chiefs, played a major role in the fight against Ebola because they have the confidence of their community’.
Lessons from Sierra Leone apply more widely, for example in the US. There, too, many citizens have little confidence in government and science.
Voors stresses the importance of making long-term commitments in research: ‘We can make an impact in Sierra Leone because we have been active in that country for ten years. Only then can you draw lessons that can be applied more widely - as is currently the case with corona and Ebola - and at the same time go into depth’.