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Background: Infectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014–16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response. Methods: We analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014–16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes. Results: We find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at $42 m per year) and peaked immediately after (at $77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased. Conclusions: Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels. [ABSTRACT FROM AUTHOR]

The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact. Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed. The present paper focuses on Sierra Leone, and provides cross sectional data on the least understood part of the epidemic-the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure. Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties. A concluding discussion relates the information presented to plans for halting the disease. Local consultation and access are seen as major challenges to be addressed.

Ebola Virus Disease struck Sierra Leone in May 2014. An international response was instrumental in ending the epidemic by December 2015 and has been extensively documented. Less attention has been paid to local responses. Here, we focus on a case in which there was no infection despite high infection in neighbouring areas. This brings into focus the role of customary public authority in implementing successful controls. We pay particular attention to the activities of a chiefdom Ebola Task force committee chaired by the Paramount Chief. Meetings were characterised by protocol and ceremony, but 'face time' served to reinforce, in ritual terms, important messages about quarantine and social distancing. The committee's pronouncements had illocutionary force. Local volunteers translated this ceremonial message into practical action to block imported cases. The analysis of ceremonial competence, we conclude, opens a window into how public authority addresses developmental shocks in Africa. [ABSTRACT FROM AUTHOR]

This case study focuses on two epidemic diseases in Sierra Leone. Ebola in 2014–15 drew international response, but was contained within the Upper West African region. COVID-19 reached Sierra Leone in April 2020 as part of a global pandemic. Local social knowledge has been an important factor in shaping responses to both diseases. In the case of Ebola, infection was concentrated in families, and responders needed a good knowledge of family interactional dynamics. COVID-19 is a more public disease. Responders have to assess risk factors in workplaces, markets, and places of worship. Comparing and contrasting the two cases also draws attention to different aspects of the historical context. Ebola response indexes Sierra Leone's history as a humanitarian project associated with the abolition of the slave trade. The pandemic challenge of COVID-19 draws attention to Sierra Leone's nodal position within a global diaspora rooted in Atlantic slavery and emancipation. Responders are forced to consider the ways in which the two infections articulate different aspects of calls for global social justice. [ABSTRACT FROM AUTHOR]

This paper assesses the extent to which customary governance in Sierra Leone can be held responsible for an increasingly unstable two-class agrarian society. A case is made for regarding the civil war (1991-2002) as being an eruption of long-term, entrenched agrarian tensions exacerbated by chiefly rule. Evidence is presented to suggest that the main rebel movement embodied in its plans to reorganize agricultural production some grasp of these longer-term agrarian problems. Postwar attempts to implement co-operative farming and mining are then described. The failure of these schemes is linked to the reinstitution of customary land law and local patronage systems. Current struggles over land now involve international capital. Deep agrarian reforms will be required as the price of keeping international capital engaged in the Sierra Leone countryside. [ABSTRACT FROM AUTHOR]

Those who intervene in crises must take care to ensure that assistance does not undermine the processes through which social cohesion is generated or restored. From a neo-Durkheimian analytical perspective, feeding creates social loyalties as well as saves lives. Humanitarian agencies provide practical assistance to livelihoods, but they need also to create space for the ritual agency on which social cohesion depends. Attention to the rituals of food distribution helps humanitarian actors to address a potentially damaging dissociation between social and material facts. A post-war food security project in Sierra Leone is used to illustrate the point. The lessons of this intervention have implications for the organisation of humanitarian assistance at all levels, both international and local. The paper argues that establishing space for ritualisation within humanitarian programmes is an obligation for those who wish to do no harm. [ABSTRACT FROM AUTHOR]

Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse "systems of care" and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers – or arrangers – in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved. • Multiple, dynamic, co-existing systems of care shaped Sierra Leone's Ebola response. • Political/historic context, resources, conflict and compromise all shaped care systems. • Diverse local actors negotiated relationships to reconfigure healthcare arrangements. • It is local arrangements that lead and shape crisis-response at the decentralised level. • Health systems need to engage with "arrangers" to reconfigure locally responsive care. [ABSTRACT FROM AUTHOR]