This spring, when my team from the Ebola Response Anthropology Platform evaluated Community-Based Ebola Care Centres (CCCs) in Sierra Leone, one thing we constantly heard complaints about was human-resource management. Residents of the communities where the Centres were located grumbled about favouritism: well-paying jobs in the Centres were given to friends and family of the local paramount chiefs. Local health authorities questioned the medical competency of CCC staff. Staff in primary health units complained about unequal pay and benefits. We focused on the views on the development, implementation and relevance of the CCCs from the perspective of the communities next to and near where they were located.
Meanwhile, a different evaluation team which focused on the quality of care in the Centres was coming to a very different conclusion. They did report that the Ministry of Health and Sanitation, implementing partners, staff at Community Care Centres, and community members agreed that the initial intention to hire local laypeople had been abandoned. But they concluded that the human-resource management model that had been used was acceptable and feasible. Both evaluations found that the medical care, the provision of food for patients and the attention and skills of medical staff in the CCC were highly appreciated by the residents.
How can these different findings be understood? It is perhaps useful to start with a distinction between the process of establishing the CCC and the result.