”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

The Free Health Care Initiative was introduced by the Ministry of Health and Sanitation (MoHS) in 2010 to guarantee free healthcare for children under 5 years and pregnant and lactating women. [27] [28] [29] However, with fewer than three surgical care providers per 100 000 people in 2012 -which is 10 times lower than recommended-Sierra Leone's capacity to increase CS volumes has remained low. 10 30 Most operations, including CS, were performed by non-specialised medical officers, and most surgical care providers were based in the capital, Freetown. 14 19 26 study design This study is based on qualitative, semistructured interviews with surgical care providers. The COnsolidated criteria for REporting Qualitative (COREQ) research tool has directed the reporting. 31 Five public hospitals were purposively sampled from Sierra Leone's four geographical areas. Hospital selection was guided by facility-level data on CS volumes from a prior study. 32 Three hospitals, whose weekly CS volumes increased by ≥15% compared with a nationwide baseline survey performed prior to the EVD outbreak, were selected for inclusion (table 1). To allow cross-validation, two hospitals whose volumes decreased by at least 15% were also included. Information about the profession, period worked at the given health facility during the EVD crisis, experience from healthcare, age and the length of the interview. EVD, Ebola virus disease; SACHO, surgical assistant community health officer.