Published on The Lancet Global Health.
The 2014–15 west African outbreak of Ebola virus disease is unprecedented in scale, especially in Sierra Leone, which as of May 15, 2015, had reported 8598 confirmed cases and 3538 confirmed Ebola-related deaths.1 Sierra Leone's response to this emergency has been compromised by a fragile health system with scant resources, limited infrastructure, and one of the world's severest shortages of health-care workers,2, 3 tragically compounded by the deaths of 221 health-care workers from Ebola virus disease since the outbreak began.4 Despite support from donors and partner organisations, Ebola treatment units were able to provide only 60% of necessary treatment beds as the outbreak neared its peak in November, 2014.5 Limited access to treatment centres forced individuals with suspected Ebola virus disease to remain in the community and for families to care for such individuals at home, putting caregivers and household members at high risk of infection.
Facing the gravity of the outbreak and the scarce resources at hand, the Government of Sierra Leone developed innovative but untested approaches to confront the Ebola threat. One such model was the development of community care centres. Based on experience in Liberia,6 these centres were designed to enable rapid isolation and palliative care for people with suspected Ebola virus disease pending availability of beds in Ebola treatment units, thus reducing household exposure and community transmission. In view of the scale of the outbreak, the promise of this approach, and the lack of alternatives, the model was launched in November, 2014, with support from the UK Department for International Development and implementing partners.
We did a rapid cross-sectional assessment of community care centres in December, 2014, assessing 11 purposively selected centres through direct observation, a site assessment survey, and review of on-site data and documents. Additionally, we did 58 key informant interviews with national and regional stakeholders including governmental officials, implementing partners, staff at community care centres, and community members. The study was approved by the Sierra Leone Ethics and Scientific Review Committee and the Columbia University Medical Center Institutional Review Board.