The already weak health care delivery sector in Sierra Leone has been further overburdened with the Ebola outbreak. All efforts made towards strengthening the health system and working towards providing equitable access to healthcare for all has suffered a major setback. The Ebola outbreak has further highlighted the gaps in the health system namely lack of infrastructure in terms of health facilities and accommodation for health workers particularly in the rural parts of Sierra Leone, poor working conditions, lack of resources and logistics, inadequate and ill equipped human resource for health, poor sanitation, non-existence of infection control and inadequate levels of health education and promotion. It has further exacerbated the lack of trust between service users and health service providers, with service users being more accustomed to seeking health services from traditional healers instead of health facilities, particularly in the early phase of the outbreak.
The majority of the available and willing human resource for health is at the forefront of the Ebola fight meaning other ailments are being overlooked. This has resulted in an increase in nonEbola related deaths due to more men, women and children dying at home from preventable illnesses. Health facilities have been abandoned by both service users and service providers due to fear on both parts. Overall this has had a negative impact on health outcomes and reduced access to health care services. The findings from the human resource for health project conducted by ReBUILD are relevant in addressing some of these issues namely rebuilding the trust between health care service users and health care service providers. A prerequisite in achieving this is ensuring that the health work force is motivated and confident in executing their duties. This will also be of relevance in the immediate Ebola period in ensuring that underlying workforce issues that have prevented the health system from responding to the outbreak effectively can be addressed.