Healthcare Delivery during Crises: Experimental Evidence from Sierra Leone's Ebola Outbreak

Abstract

The 2014-2015 Ebola outbreak in West Africa is the largest ever recorded. Post-mortems on the crisis assert that engaged and accountable health personnel slowed transmission by encouraging early isolation and treatment — a major challenge given fears about sub-standard care and stigma. We take advantage of a unique opportunity to experimentally test this ``lesson learned”: roughly a year before the outbreak in Sierra Leone, two interventions were randomly assigned to government-run health clinics, one focused on community monitoring of clinics and the other on status awards for nurses. We find that these programs substantially increased the reported number of Ebola cases in the sections where they were implemented. We explore three possible explanations: the programs (1) unintentionally increased incidence; (2) improved surveillance efforts; and/or (3) increased the likelihood that patients sought care. We only find evidence consistent with the last. By improving the perceived quality of healthcare, the programs may have encouraged patients to report and receive treatment.

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