”For this one, let me take the risk”: why surgical staff continued to perform caesarean sections during the 2014–2016 Ebola epidemic in Sierra Leone

Drevin, Gustaf; Mölsted Alvesson, Helle; van Duinen, Alex; Bolkan, Håkon A; Koroma, Alimamy P; Von Schreeb, Johan

Drawing lessons from CS provision in Sierra Leone might help improve routine health services in future epidemics. This study found that when international 'leadership, solidarity, and systems' failed during EVD, local CS providers were punching above their weight. 58 Human resources are at the core of a resilient health system, and policymakers need to consider that staff have different motivations and fears. Health ministries can prepare for future shocks by ensuring that the health system understands these motivations, because EVD, Lassa fever, and plague resurface cyclically in low-resourced settings. 6-8 59 Top-down initiatives can harness the bottom-up resourcefulness displayed by staff during EVD. For instance, policymakers can support staff with PPE, EVD vaccines, rapid EVD tests, surgical materials and equipment, payment of salaries, and protection against burn-out. 7 Sterilisation and waste management will further improve the safety of CS surgical providers, who have been nicknamed 'the unprotected workforce' in Sierra Leone. 20 Leadership training for key health workers will improve hospital management and local stewardship in future outbreaks.