Post-Ebola Strengthening of Primary Health Care in Sierra Leone

Community Readiness and Systemic Gaps

Abstract

Background: The 2014–2016 Ebola epidemic in West Africa exposed critical weaknesses in the primary health care (PHC) systems of affected countries, including Sierra Leone. In the aftermath, efforts have been made to rebuild and strengthen PHC structures. This study aimed to assess the level of community readiness and identify systemic gaps in PHC delivery across selected districts in Sierra Leone. Methods: A cross-sectional survey design was employed, collecting data from 380 community members across five districts using a structured questionnaire. Descriptive statistics, correlation analysis, and multiple regression were conducted to evaluate levels of community awareness, trust, participation, and systemic health service factors such as workforce availability and drug supply. Results: Findings revealed a high level of community awareness (M = 4.18, SD = 0.76) and moderate trust in local health authorities (M = 3.68, SD = 0.91), indicating improved public engagement with PHC systems post-Ebola. However, community involvement in decision-making and feedback mechanisms remained limited. Significant systemic challenges were identified, including inadequate trained personnel (M = 3.22), inconsistent drug supply (M = 2.91), and underdeveloped referral and medical equipment systems. Regression analysis showed that availability of trained health personnel (β = 0.241, p = 0.001) and consistent drug supply (β = 0.198, p = 0.012) significantly predicted community readiness. Conclusion: While community engagement in Sierra Leone's PHC system has improved, significant systemic barriers continue to undermine its effectiveness. The interdependence between community readiness and institutional capacity underscores the need for a dual strategy: enhancing health system infrastructure and fostering participatory governance. Targeted investments in workforce development, supply chains, and inclusive health planning are essential to achieving resilient, people-centered PHC. These findings offer valuable insights for policymakers and stakeholders committed to advancing universal health coverage in post-crisis contexts.