This research investigates community-led interventions in Liberia and Sierra Leone. The objective is to examine the parallels and differences in the response and outcomes of the 2014 Ebola epidemic. Many challenges made aid less effective such as misinformation, rumors, stigma, and logistical difficulties that lowered the demand for aid resources. These market inefficiencies were the demand-side barriers that were prolonging the disease spread.
A qualitative methodology was employed to answer the research question. Sixty-seven semi-structured interviews were conducted from January to July 2017; 33 of these interviews were in Sierra Leone and 34 interviews in Liberia. Informants included health workers, chiefs, chiefs’ advisors, a secret society leader, NGO representatives, a government worker, and volunteers during the outbreak. Thematic analysis and the data were supported by NVIVO. The key themes are: ‘Government’s Response and Community Reaction,’ ‘Local Institutional Intervention,’ and ‘Governing the Outbreak.’ Informants were chosen through purposeful sampling methods in three provinces in each country.
The findings demonstrate that traditional leaders in Sierra Leone immediately responded through rulemaking and enforcement after the first Ebola case was officially announced. Specifically, rulemaking helped to create behavior changes to increase demand for aid resources, such as mandatory referrals to the health centers. These laws and door-to-door contact tracing were scaled up to a national emergency strategy, relying on traditional leaders to monitor and enforce them. In Liberia, community and traditional leaders organized in many areas to correct some of these demand-side barriers too. In both cases, the response from community-level leaders happened before the international community scaled up aid resources in August 2014, with some donors and humanitarians arriving as late as December 2014.
However, Liberia’s local strategies were not scaled up and coordinated nationally, as it was in Sierra Leone. Thus, the interventions implemented were not universal. According to figures by the World Health Organization, Sierra Leone had 25% more Ebola cases than Liberia but had 18% fewer Ebola deaths. This is interpreted as contact tracing and institutional changes having more impact in Sierra Leone to refer Ebola patients into early treatment and reduce deaths.