Evaluating Ebola: Liberian health care four years after the crisis

Evaluating Ebola: Liberian health care four years after the crisis

Nearly four years have passed since the beginning of the deadly outbreak of Ebola virus in Africa in 2014. Concentrated in Sierra Leone, Guinea and Liberia, the epidemic resulted in over 11,000 deaths and nearly 30,000 reported cases of Ebola over two years. Until now, it was unknown how such an intense outbreak affected access to primary health care in the region during and after the crisis. A new study by Bradley H. Wagenaar and colleagues, published in PLOS Medicine this week, attempted to understand the long-term effects of the epidemic on health care systems.

The researchers analyzed seven years of routine health information system data from public health care providers across Liberia, using indicators of primary care such as vaccines, clinic visits, pre- and post-natal care, and malaria treatments, to determine how the outbreak affected access to health care for people without Ebola. They found that by September 2014, these health services had decreased by as much as 67 percent compared to the month preceding the outbreak. The researchers found that the crisis accounted for 776,110 missed clinic visits and nearly 100,000 missed malaria treatments. Though the primary health care system had recovered to pre-outbreak levels by November 2016, it is still unknown how the disruption in services due to the virus will affect health outcomes for years to come.

The new study sheds light on the indirect repercussions of the Ebola virus outbreak that ravaged western Africa. Not only does it highlight the ways in which investment in public-sector health care is needed in Ebola-affected countries to account for the gaps in primary coverage during those years, it also provides lessons on how to better prepare health care systems for epidemics of a similar magnitude.


Research Article: Wagenaar BH, Augusto O, Beste J, Toomay SJ, Wickett E, Dunbar N, et al. (2018) The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016. PLoS Med 15(2): e1002508. https://doi.org/10.1371/journal.pmed.1002508

Image Credit: U.S. Army Corps of Engineers, Savannah District


Erin is a Publications Assistant and the press representative for PLOS Medicine. Since joining PLOS in 2017, she has been fortunate to read and report on new and important studies published by PLOS Medicine each week.

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