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Principal Investigators: Lara Ho, IRC & Ruwan Ratnayake


This study used a participatory mixed methods approach to evaluate the processes that health workers take in adhering to standard precautions, after being trained and supplied with materials, in order to ensure the strict adherence that is necessary to prevent Ebola infection.

The aim was to develop strategies to improve adherence to standard precautions through the assessment of knowledge, risk perception, self-efficacy, and barriers and enablers for standard precautions in primary health facilities. It also enabled better understanding of the perspectives of health facility staff and health committees on the use of personal protective equipment.

Lara Ho


It was important to understand the experience of front line health workers with IPC in the context of Ebola and to see how we could improve practices. Our approach was participatory: the health workers would identify the problems and issues, and we would work with them to come up with solutions depending on what the baseline results showed— for example, a solution might be to increase health worker engagement with community members or it might be to rearrange layout of the health centre.

Lara Ho


Many of these front line health workers had no knowledge of Ebola before the epidemic, but they remained dedicated to continuing to provide health services despite huge challenges—including facing stigma from many people in their communities. The IPC training provided by the MoHSW and the Ebola Response Consortium was crucial in that it gave them confidence, knowledge, and supplies that they didn’t have before to carry out their work in the most difficult of situations.


The research has helped understanding of the levels of knowledge, risk perceptions, barriers, and enablers of adherence to standard precautions for health care workers who were provided with basic equipment and training on IPC for Ebola control in Kenema District, Sierra Leone. The publications produced as a result of the study also outline what strategies health facility staff can use to improve adherence to standard precautions

Healthcare workers’ (HCW) level of knowledge about Ebola and IPC evolved dramatically over the course of the Ebola epidemic. HCW felt at greater risk than the general population because of their work at health facilities where Ebola patients might present, although the eventual provision of IPC supplies and training greatly increased their confidence and sense of being protected.

One main finding was a widespread, acute feeling of stigmatisation and isolation among primary health care workers. They were stigmatised and ostracised at work and at home, by friends, family members, fellow health professionals, and the broader community. As a result, health care workers described experiencing a profound sense of loss, loneliness, anxiety, isolation, and sadness, along with the disruption of their lives at work, in communities and at home. The workers interviewed during the research expressed continued commitment to their work despite these challenges.

Key Findings

During recovery from this epidemic and in future ones, the research recommended responders and donors to:

  • Recognise and address the mental health and psychosocial needs of frontline primary health care workers subjected to intense and protracted fear and stigmatisation by the communities in which they live and work.
  • Devise community engagement strategies that address not only knowledge on disease transmission, but also mental health and psychosocial needs Explicitly promote non-discrimination and nonstigmatisation toward all health workers.
  • Give health workers guidance on psychological first aid.
  • Support Ministries of Health in the development and implementation of national plans to integrate mental health services into primary health.

Key Outputs

  • 3 peer review articles published (See below ‘Publications’ section for details).
  • Health policy and planning brief published.
  • A workshop presentation in Freetown by two co-investigators in June 2015 to key stakeholders from the national Ebola Response Consortium (ERC), UNICEF, CDC and others.
  • An oral presentation at the American Society for Tropical Medicine and Hygiene’s annual conference, October 2015.
  • Abstract accepted at the Global Symposium on Health Systems Research in November 2016.
  • Project was presented at the Sierra Leone Health and Biomedical Research Group (HBIOMED-SL)’s Research Symposium held in March 2016.


Peer Reviewed Ebola

A mixed-methods investigation to understand and improve the scaled-up infection prevention and control in primary care health facilities during the Ebola virus disease epidemic in Sierra Leone

Peer Reviewed Ebola

We and the nurses are now working with one voice: How community leaders and health committee members describe their role in Sierra Leone’s Ebola response

Article, Peer Reviewed

Improving Ebola infection prevention and control in primary healthcare facilities in Sierra Leone: a single-group pretest post-test, mixed-methods study

Peer Reviewed

Health care providers on the frontlines: A qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic

Briefing Note Ebola

Ebola’s psychosocial toll on frontline health workers – Research Brief

Latest Updates

Stopping Ebola at the Frontlines: Infection Prevention and Control in Sierra Leone

May 2016

Stopping Ebola at the Frontlines: Infection Prevention and Control in Sierra Leone


Briefing sheet

Jan 2015

Participatory behavioural change to reinforce infection prevention and control for Ebola virus disease in Sierra Leone


Related Projects

R2HC Funding for Ebola Projects.  A Rapid Response

 In August 2014, the Ebola Outbreak in West Africa was declared an International Health Emergency by WHO and within a couple of weeks ELRHA launched a rapid-response call for research to combat the crisis.  The UK Department for International Development (DFID), the Wellcome Trust and ELRHA opened a special funding window through the Research for Health in Humanitarian Crises (R2HC) programme.

 The aim of this emergency call was both to produce robust research findings that could contribute to the effectiveness of the response to the current outbreak and help to draw lessons for future outbreaks of Ebola and other communicable diseases. The projects funded will strengthen the evidence base for the Ebola response in topics ranging from diagnostics to anthropology, surveillance and disease control.

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