Treatment Seeking and Ebola Community Care Centers in Sierra Leone: A Qualitative Study

Abstract

Ebola Treatment Units were able to provide only 60% of necessary treatment beds in Sierra Leone. As a result, the Government of Sierra Leone decided to construct Community Care Centers. These were intended to increase treatment-seeking behavior and reduce the community-level spread of Ebola by facilitating access to care closer to communities. Through qualitative data collection in 3 districts, this study seeks to understand the perceived impact that proximity to such Centers had on treatment-seeking behavior. Feedback from community members and Community Health Volunteers indicates that proximity to treatment reduced fears, especially those arising from the use of ambulances, lack of familiarity with medical Centers, and loss of contact with family members taken for treatment. Participants report that having a Center close to their home enables them to walk to treatment and witness survivors being discharged. Living close to Centers also enables communities to be involved in their design and daily operation, helping to build trust in them as acceptable treatment facilities. Further research is required to understand the appropriate design, operation, and epidemiological impact of Centers. Further investigation should incorporate the effect of an outbreak’s severity and the stage (duration) of the outbreak on potential acceptance of Centers.

Acknowledgments

This study was conducted with the great support of Oxfam International’s Sierra Leone country team. Our staff worked in extreme conditions during this response, and for this we are grateful. It is with appreciation and respect that we thank the participants of this study, who gave their time, perceptions, and stories to help us better understand their communities and their needs.

Notes

¹ For example, in November 2014, Medicin Sans Frontiers stated, “The way [CCCs are] operating, the way they’re putting responsibilities on the community, and the way they’re designed is not something [Medicin Sans Frontiers] is behind at this point” (Gulland, 2014).

² Community outreach was part of the National Social Mobilization Pillar. Its aim was to contribute to the government’s national strategy to end the transmission of EVD through evidence-based social mobilization, public education, and behavior change.

³ A study conducted on community preferences in Ebola interventions in Uganda also found that proximity and familiarity were key barriers to treatment seeking. The study reported that communities did not like being unable to view the areas surrounding the treatment Centers and isolation wards (Raabe et al., 2010).

⁴ This was also found by the WHO during interviews in Kono district: Community members told them that they had to walk further for regular medical care after the outbreak (WHO, 2015).