Setting: All community health workers (CHWs) in rural
Kenema District, Sierra Leone.
Objective: CHW programmes provide basic health services
to fill gaps in human health resources. We compared
trends in the reporting and management of childhood
malaria, diarrhoea and pneumonia by CHWs before,
during and after the Ebola outbreak (2014–2016).
Design: Retrospective cross-sectional study using programme
data.
Results: CHW reporting increased from 59% pre-outbreak
to 95% during the outbreak (P  0.001), and was sustained
at 98% post-outbreak. CHWs stopped using rapid
diagnostic tests for malaria mid-outbreak, and their use had
not resumed post-outbreak. The average monthly number
of presumptive treatments for malaria increased from 2931
pre-outbreak to 5013 during and 5331 post-outbreak (P 
0.001). The average number of monthly treatments for diarrhoea
and pneumonia decreased from respectively 1063
and 511 pre-outbreak to 547 and 352 during the outbreak
(P = 0.01 and P = 0.04). Post-outbreak pneumonia treatments
increased (mean 1126 compared to pre-outbreak, P
= 0.003), and treatments for diarrhoea returned to pre-outbreak
levels (P = 0.2).
Conclusion: The CHW programme demonstrated vulnerability,
but also resilience, during and in the early period
after the Ebola outbreak. Investment in CHWs is required
to strengthen the health care system, as they can
cover pre-existing gaps in facility-based health care and
those created by outbreaks.