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

Abstract Background Epidemic 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 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 used Muskoka-2 estimates. Results We find substantial increases in aid to Sierra Leone (from $484 million in 2013 to $1 billion at the height of the response in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. Overall, RMNH aid was sustained during the epidemic (at $42m per year) and peaked immediately after (at $77m 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 aid for routine RMNH services and infrastructure before and during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels.