Background: The Ebola epidemic in West Africa claimed over 4,800 lives in Liberia. The outbreak paralyzed the healthcare system with all government hospitals closed or operating at limited capacity at the height of the epidemic. Little is known about where patients were seeking care when healthcare facilities were closed and what impact this had on health. Objective: To determine the impact the Ebola outbreak had on access to basic health care in Liberia. Methods: Healthcare access and Ebola knowledge surveys were administered in interview format to a cluster randomized sample within 1 hours drive in the catchment area around Liberia's 21 government hospitals. Data was managed in a mobile data application on smart phones and analyzed using SPSS. Results: A total of 543 heads of household were interviewed. The average age of respondents was 42 years with equal male to female and rural to urban ratios. An average of 48% of respondents reported on a graduated scale that it was "very difficult" to obtain basic healthcare, and that it was more difficult in rural areas (55%). Reasons for not accessing healthcare included fear of exposure to Ebola in hospitals (33%), closure of hospitals (22%), and healthcare workers refusal to see patients presenting for care (20%). There was an overall decline in facility use by 30% with obstetric care, prenatal care and pediatric care down by 45%, 40% and 30% respectively. There was a slight increase in healthcare seeking at pharmacies for pediatric care and in use of traditional birth attendants and midwives for obstetric care. Interpretation: Access to basic healthcare was severely affected during the Ebola outbreak in Liberia. Although hospital closures/ limited functioning were a large factor in inability to provide care, other factors such as fear of exposure to Ebola within healthcare facilities played a role in reduced access. Obstetric, prenatal and pediatric care were especially difficult to access during this time. Strategies to preserve healthcare system function and public impression of these facilities will be critical, should future outbreaks occur.
McQuilkin, P., Udhayashankar, K., & Niescierenko, M. (2016). Health care access during the Ebola epidemic in Liberia. Annals of Global Health, 82(3), 541. https://doi.org/10.1016/j.aogh.2016.04.461