Overall, visits to primary health facilities decreased by a third in June–December 2014 compared to the same period in 2013. Most districts show an initial drop at the onset of the Ebola outbreak in June, and a further decline as the epidemic reached its peak in November–December.
The decline in health service utilisation is not uniform across key health services. Malaria and diarrhoea services are the most affected. In December 2014 suspected malaria cases decreased by half compared to December 2013, and only 20% were receiving treatment. In the same period, treatment of diarrhoea decreased by about 60%.
By December 2014 only half of all pregnant women were receiving antenatal care and delivering in primary health facilities.
In September 2014 half of children under 12 months did not receive the recommended vaccinations, compared to about 70% coverage before the outbreak. Vaccination rates have remained low until the end of the year.
Key health service utilisation has been most affected in Kenema, Port Loko, and Kailahun districts.