Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone

Susannah H Mayhew; Kirkley Doyle; Lawrence S Babawo; Esther Mokuwa; Hana Rohan; Melisa Martinez-Alverez; Josephine Borghi; Ebola Gbalo Research Team; Catherine Pitt

doi:10.1186/s13031-024-00589-2

Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone

Confl Health. 2024 Apr 27;18(1):38. doi: 10.1186/s13031-024-00589-2.

Authors

Susannah H Mayhew^{1

2}, Kirkley Doyle³, Lawrence S Babawo^{4

5

6}, Esther Mokuwa^{5

7}, Hana Rohan⁸, Melisa Martinez-Alverez⁹, Josephine Borghi¹⁰; Ebola Gbalo Research Team; Catherine Pitt¹⁰

Collaborators

Ebola Gbalo Research Team:
Dina Balabanova, Johanna Hanefeld, Tommy M Hanson, Bashiru Koroma, Gelejimah Alfred Mokuwa, Melissa Parker, Paul Richards, Ahmed Vandi

Affiliations

¹ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK. Susannah.Mayhew@lshtm.ac.uk.
² Adjunct Professor, Njala University, Bo, Sierra Leone. Susannah.Mayhew@lshtm.ac.uk.
³ Independent Consultant, Washington DC, USA.
⁴ Department of Nursing, School of Community Health Sciences, Njala University, Bo, Sierra Leone.
⁵ Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone.
⁶ Mattru School of Nursing, Bonthe District, Mattru, Sierra Leone.
⁷ University of Wageningen, Wageningen, The Netherlands.
⁸ Non-resident affiliate of the Center for Global Health Science and Security at Georgetown University, Washington DC, USA.
⁹ Independent Consultant, London, UK.
¹⁰ Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.

Abstract

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.

Keywords: Aid tracking; Development assistance for health; Donor aid; Ebola; External financing; Fungibility; Health financing; Maternal and newborn health; Official development assistance; Reproductive health; Sierra Leone; West Africa.

Abstract

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