Testing Resilience: An evaluation of the health system impact of COVID-19 in Post-Ebola Sierra Leone

In 2014, Sierra Leone was hit with an unprecedented Ebola outbreak with devastating consequences for those directly affected by the virus and through collateral damage across other health sectors. Post-Ebola recovery plans were put into place centered around strengthening systems-level resiliency to buffer against structural shocks like future pandemics. When COVID-19 hit the country in 2020, this post-Ebola health system strengthening was tested. Our team, a partnership between scientists Sierra Leone and Canada, proposes to examine the wider impacts of the COVID-19 pandemic on essential health services in Sierra Leone. First, we will measure the extent to which the COVID-19 epidemic changed the delivery/uptake of essential services and led to negative health outcomes in infectious diseases (HIV, tuberculosis, malaria), childhood vaccination, maternal health. We will compare this wider health impact against that of the Ebola epidemic. Second, we will examine how differences in public health measures and SARS-CoV-2 vaccine coverage over time and geography (districts) influenced service disruption, and the extent to which adaptive service reconfiguration (adaptations and enhancements) may have mitigated the wider health impacts of the COVID pandemic. Results will be used by stakeholders and service providers, including the National COVID-19 Emergency Operations Center and the Sierra Leone Ministry of Health and Sanitation, to inform ongoing program adaptation in the context of future waves of COVID in a region with limited SARS-CoV-2 vaccine supply to date.