A qualitative study examining the health system’s response to COVID-19 in Sierra Leone

Hana Stone, Emma Bailey, Haja Wurie, Andrew J M Leather, Justine I. Davies, Håkon A. Bolkan, Stephen Sevalie, Daniel Youkee, Divya Parmar*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

The paper examines the health system’s response to COVID-19 in Sierra Leone. It aims to explore how the pandemic affected service delivery, health workers, patient access to services, leadership, and governance. It also examines to what extent the legacy of the 2013–16 Ebola outbreak influenced the COVID-19 response and public perception. Using the WHO Health System Building Blocks Framework, we conducted a qualitative study in Sierra Leone where semi-structured interviews were conducted with health workers, policymakers, and patients between Oct-Dec 2020. We applied thematic analysis using both deductive and inductive approaches. Twelve themes emerged from the analysis: nine on the WHO building blocks, two on patients’ experiences, and one on Ebola. We found that routine services were impacted by enhanced infection prevention control measures. Health workers faced additional responsibilities and training needs. Communication and decision-making within facilities were reported to be coordinated and effective, although updates cascading from the national level to facilities were lacking. In contrast with previous health emergencies which were heavily influenced by international organisations, we found that the COVID-19 response was led by the national leadership. Experiences of Ebola resulted in less fear of COVID-19 and a greater understanding of public health measures. However, these measures also negatively affected patients’ livelihoods and their willingness to visit facilities. We conclude, it is important to address existing challenges in the health system such as resources that affect the capacity of health systems to respond to emergencies. Prioritising the well-being of health workers and the continued provision of essential routine health services is important. The socio-economic impact of public health measures on the population needs to be considered before measures are implemented.
Original languageEnglish
Article numbere0294391
Number of pages20
JournalPLoS ONE
Volume19
Issue number2
DOIs
Publication statusPublished - 2 Feb 2024

Bibliographical note

Funding:
This research was funded by the National Institute of Health Research (NIHR) Global Health Research Unit on Health System Strengthening in Sub-Saharan Africa (GHRU 16/136/54) using UK aid from the UK Government to support global health research. DP is funded by the GACD-MRC IMPACT Grant and DY by NIHR (GHR:17:63:66) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the funders or the UK government. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Keywords

  • covid-19
  • Sierra Leone
  • health systems
  • qualitative
  • Ebola

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