Trust in medicine after the EVD epidemic: street-level health bureaucrats, the institutionalization of care, and the creation of preparedness in Sierra Leone, Uganda, and Ghana

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The scale of the EVD epidemic in the West African countries has been unprecedented. Lack of trust in medicine has been identified as one of the major factors in the scientific literature, in media reports, and global health discourses, which accelerated the spread of EVD and posed a central challenge to the Ebola response. Our project investigates the social, medical, and historical conditions of the formation of trust in medicine in Africa contexts. Taking the EVD outbreak in Sierra Leone as our empirical starting point, we conduct a comprehensive case study of trust in medicine in Sierra Leone, a site of prolonged EVD epidemic and radical insecurity. This will be complemented by studies in Uganda and Ghana, evaluating previous experiences of short-term EVD outbreaks (Uganda) and recent preparedness interventions in a neighbouring country (Ghana). In these three country case studies we analyse how and to what extent trust is built in health service delivery. We ask how trust relations have been shaped by the EVD outbreak, how trust is being (re)built in health service delivery after the EVD epidemic, and to what extent trust forms the social basis for epidemic preparedness. Comparing individual and collective experiences of the institutionalisation of care in Sierra Leone with Uganda and Ghana enables us to produce a systematic and in-depth analysis of trust in contexts of radical insecurity and poverty. Such an analysis grounded in the lived everyday realities in African countries is urgently needed in order to devise culturally appropriate and locally accepted epidemic preparedness measures. To achieve these goals we combine quantitative and qualitative research methods. Our research activities are embedded in a comprehensive framework of scientific capacity building in Africa.