There is unequivocal evidence in the literature that epidemics adversely affect the livelihoods of individuals, households and communities. However, evidence in the literature is dominated by the socioeconomic impacts of HIV/AIDS and malaria, while evidence on the impact of the Ebola virus disease (EVD) on households’ livelihoods remains fragmented and scant. Our study investigates the effect of the EVD epidemic on the livelihoods of Liberian households using the Sustainable Livelihood Framework (SLF). The study also explores the effect of the EVD epidemic on agricultural production and productive efficiency of farm households using Spatial Stochastic Frontier Analysis (SSFA). We collected data from 623 households across Liberia in 2015, using a systematic random sampling design. Our results indicated that the annual income of sample households from communities where EVD occurred did not differ from the annual income of households from communities where EVD did not occur. Nonetheless, the majority of sample households reported a decrease in their income, compared to their income in the year before the survey. This suggests that the impact of the EVD epidemic might not only have been limited to communities directly affected by the epidemic, but also it may have indirectly affected communities in areas where EVD was not reported. We also found that the community-level incidence of EVD negatively affected crop production of farm households, which may have exacerbated the problem of food insecurity throughout the country. Moreover, we found that the EVD epidemic weakened the society’s trust in Liberian institutions. In a nutshell, our results highlight that epidemics, such as the recent EVD outbreak, may have long-lasting negative effects on the livelihoods of a society and their effect may extend beyond the communities directly affected by the epidemics. This means that the nation’s recovery from the impact of the epidemic would be more challenging, and the social and economic impacts of the epidemic may extend well beyond the end of the health crisis.
There is a plethora of evidence in the literature that epidemics such as HIV/AIDS and malaria have profound implications for the livelihoods of the affected society. The impact of HIV/AIDS on livelihoods has been intensively investigated and there is universal consensus that HIV/AIDS adversely affects the livelihoods of individuals, households and communities [1–2], and has macro-level implications for poverty, economic growth, unemployment and political stability [3–7]. Similarly, malaria has been found to have a strong negative effect on the socioeconomic status of households [8–11]. In contrast, the socioeconomic impacts of the Ebola virus disease (EVD) epidemic, specifically the most recent and largest ever EVD epidemic recorded in West Africa from 2014–2016, have not been systematically analyzed. Due to the differences in transmission mechanisms, latency, and mortality rate between EVD and other infectious tropical diseases, such as HIV/AIDS and malaria [12–14], EVD outbreaks likely impact the livelihoods of a society differently. For example, EVD can wipe out an entire family or village within a relatively short period of time. In areas affected by EVD, economic activities may cease completely, as people no longer work on their fields, nor trade or even travel (because of check points and travel restrictions) [15]. HIV/AIDS infections and resultant mortalities, on the other hand, occur over a longer time period; and as such, their effects on livelihoods and the economy are more subtle at first. HIV/AIDS and malaria result in higher costs in terms of the opportunity cost of the time spent caring for the sick household member [16–18], medical expenses and, for the unlucky ones, funeral expenses. In contrast, EVD lowers livelihood outcomes by weakening the ability of the households to earn their living rather than by increasing the expenditure on the sick person and funeral ceremonies. For example, the medical costs of the EVD epidemic in Liberia were mostly covered by the government and the international community, as the epidemic presented a global health emergency. These and other disease-specific characteristics necessitate specific research to investigate the effect of different infectious diseases on the livelihood of the affected societies. In light of this, we analyze the impact of the recent EVD epidemic on the livelihoods of the Liberian society. There are few studies that explored the impact of the EVD epidemic on the agricultural sector in Liberia [19–20]. These studies reported that the EVD epidemic negatively affected employment in the agricultural sector. At the peak of the epidemic, almost half of the country’s labor force was out of work [19–20]. Farmers were less likely to work on their farms during the EVD epidemic [19]. These studies found that most of the households returned to their farms during the survey, which was conducted from October, 21 to November, 7,2014, and concluded that the impact of the EVD crisis on the agricultural sector may not have been as severe as predicted [19–20]. Nonetheless, these studies used phone surveys to collect data, which could have resulted in selection bias, as households without mobile phones were systematically excluded from the survey. In addition, the emphasis of the studies was focused on the impacts of the EVD epidemic on the employment in the agricultural sector. However, employment and whether or not households were working on their farm tell only part of the story. Even if households were working on their farms during the EVD epidemic, the productivity of their agricultural inputs, and hence their efficiency may have been compromised by the epidemic. Therefore, our study provides evidence on how the Ebola crisis affected the efficiency of farm households, and the concomitant effects on agricultural production in Liberia. Moreover, our study explores the impact of the EVD epidemic on livelihoods of the Liberian society using the sustainable livelihood framework (SLF) [21–22]. The EVD epidemic affects the livelihoods of individuals, households and communities by weakening the household assets upon which the households’ ability to enhance their livelihood, depends [21]. These assets can broadly be categorized into five categories: physical capital (e. g. , infrastructure, tools, equipment), human capital (e. g. , knowledge and ability to work), financial capital (e. g. , available stocks, access to financial services, regular inflows of money), social capital (e. g. , networks for cooperation, trust, support) and natural capital (e. g. , land, forests, water) [21–24]. Shocks, such as epidemics, that weaken some or all of these household assets, negatively affect livelihood [2,25]. Therefore, a complete understanding of the effects of epidemics, such as EVD, on the livelihood of households requires the investigation of their influence on the assets owned by the households. The EVD epidemic may have weakened the resource base of the Liberian society for various reasons. First, the incidence of the epidemic in the households and/or their communities may have weakened the different categories of assets owned by households directly [2,24]. Second, measures taken by the Liberian government to contain the spread of the disease may have further dampened the households’ assets and affected their welfare [15,26,27]. For example, the government declared a state of emergency and established quarantine zones in most of the affected communities. Schools and markets were closed in several districts and communities. Restrictions on domestic and international travels were imposed [15,19,26,27]. Thus, the mobility restrictions and complete closure of markets might have considerably hampered the livelihoods of individuals, households and communities by reducing their access to different livelihood assets [15,26]. Third, fear of contracting the disease may have coerced people into avoiding social gatherings and participation in different activities and organizations, thereby weakening the social capital that the Liberian society possesses [27]. Furthermore, during crises, people may increasingly seek support from different social networks such as friends, families, the community, and the government, but the prospect of receiving the needed help may have been significantly hampered by an epidemic, which strains the social cohesion. Stigmatization of survivors of the disease may also contribute to the degradation of the social capital. Our study uses a systematic nationwide random sampling design to explore the effect of the EVD epidemic on the livelihood assets possessed by Liberian households, and the livelihood outcomes they achieved during the EVD epidemic. In addition, we emphasize the effect of the epidemic on the agricultural sector. We are interested in the effect of the EVD epidemic on agricultural production for two main reasons. First, the agricultural sector plays a crucial role in Liberia and contributes more than 35% of the country’s GDP [28]. Moreover, the majority of Liberians live in rural areas (50%), and are primarily engaged in the agricultural sector to earn a living [20]. Almost 80% of rural households and 18% of urban households are agricultural households in Liberia [29]. Second, we are not aware of any study that examined the effect of the recent EVD epidemic on agricultural production in Liberia or elsewhere accounting for the productive efficiency of farm households.
Liberia is one of the poorest countries in Africa with per capita GDP of $457. 9 as of 2014 [30]. Nevertheless, after the end of the civil war in 2003, the country’s economy has been steadily growing. For instance, the economy grew by an annual growth rate of 8% in 2006 and 8. 7% in 2013 [30]. Although most of the population lives in poverty (68. 6% of the population lives on less than $1. 9 a day), Liberia had one of the fastest growing economies in Africa over the past 10 years [31]. This gain of momentum in terms of macro-economic performance was disrupted in 2014 by the epidemic of EVD [32], which affected the country from 2014 to 2016 and resulted in the tragic loss of 4,809 lives (45% of reported cases) [33]. All 15 counties reported incidences of the disease, but the severity of the epidemic varied from place to place [33]. For example, based on the number of EVD cases per 1,000 inhabitants, counties such as Margibi, Montserrado, Grand Cape Mount, and Bomi were more severely affected by the epidemic than Grand Gedeh, River Gee, Sineo and Maryland [33] (Fig 1). We conducted a systematic nationwide household survey from February to June, 2015. The survey was administered in person by trained Liberian enumerators. Sample households were randomly selected following a “random walk” procedure [e. g. , 34,35]. Starting from the center of a village/town/city (hereafter ‘interview location’), the enumerators walked in different directions and randomly selected households to be interviewed. We aimed at interviewing 5–10 households per location, depending on their size (i. e. , more interviews in larger locations). The random walk technique was used to reduce non-response rates, as the enumerators would walk until they found enough households that were willing to participate in the interview. This method is particularly useful in sensitive times like the EVD crisis, when people may have been more reluctant to interact with strangers out of fear of contracting the EVD. Nonetheless, we acknowledge that in larger locations, the random walk method may have resulted in some biases, as households closer to the center of locations were more likely to be sampled than those living farther away from the centers. Whenever possible, household heads were selected and interviewed. A total of 623 sample households were interviewed. We collected data through face-to-face interviews with sample households across Liberia using a questionnaire (S6 Appendix). We were granted permission to conduct the survey by Liberian authorities after careful evaluation of staff safety, data collection procedures and agreements on data sharing (see S7 Appendix). Additional data on EVD deaths and cases were obtained from the World Health Organization (WHO) and the Liberia Institute of Statistics and Geo-information Services (LISGIS). To explore the impact of EVD on the livelihoods of Liberian society, we applied the Sustainable Livelihoods Framework (SLF) used by the Department for International Development-United Kingdom (DFID-UK) [21–22]. We used the SLF as it enables us to understand not only the effects of the EVD epidemic on livelihood outcomes, but also the mechanisms driving the effects of the epidemic [21–22]. Thus, our study provides important insight into policies aiming to avert or reduce the impact of future epidemics on livelihoods by addressing the important factors that drive these effects. Although there is a scarcity of studies that applied this framework to investigate the impact of EVD, several studies employed the SLF to explore the livelihood effects of other epidemics, mainly HIV/AIDS [1,2]. Traditionally, the SLF has been applied to understand differential capabilities of rural families to cope with stresses or shocks [36] and their ability to achieve sustainable livelihoods. A livelihood is defined as a means of living, and the assets required to achieving it [21–22]. The different types of assets that a household needs to achieve better livelihood outcomes are broadly categorized as human, physical, financial, social and natural capitals [21,22,24]. Hence, the likelihood of a household to achieve improved livelihood outcomes (such as income, food security and others) depends on its access to different livelihood assets. The livelihood of a household is deemed sustainable when it copes with, and recovers from stresses without compromising the abilities of future generations [21]. Factors that weaken some or all of the livelihood assets of households, adversely affect their livelihood [2,25]. Therefore, a complete understanding of the effect of shocks, such as epidemics, on the livelihood of households necessitates the investigation of their influence on the assets owned by the households. Employing the SLF, we investigate the impact of the EVD epidemic on different categories of assets possessed by Liberian households, and the livelihood outcomes they achieved during the EVD epidemic (i. e. , in the 12 months preceding our survey). Here, we focused on the effect of the EVD epidemic on three categories of household capitals (natural, financial, and social capitals), and their total income and agricultural production. See Table 1 for the definition of the household assets included in our study. To analyze the data, we used descriptive statistics, a factor analysis and regression models. We used Stata 10. 1 [53] and R 3. 2. 4 [54] for our analysis. In our analysis self-reported incidence of EVD in the community of the respondent was used as a proxy for EVD occurrence. Respondents were asked whether they knew anybody in their own or nearby communities who had contracted EVD. We used self-reported incidence of EVD in one’s community instead of EVD cases reported by WHO, as the publicly available WHO reports are at the spatial resolution of the county-level and not community-level. In our understanding, community-level incidence might be more relevant for household-level decisions, because the EVD incidence at the community spatial scale may have a larger impact on household livelihood than the EVD occurrence at the county spatial scale. Our analysis is divided into two parts. First, we analyzed the effect of the EVD epidemic on livelihood outcomes, such as total annual household income and agricultural production, using descriptive statistics and a regression analysis. Second, we analyzed the impact of the epidemic on the households’ assets. Here, we used descriptive statistics to summarize the effect of the EVD epidemic on the resource bases of households, and a regression analysis to analyze changes in social capital. For the summary of the methods used see S1 Appendix Table A. In our regression analysis, we employed spatial econometric models to account for potential spatial dependencies in the data using the “spdep” package in R [55]. Before we ran the models, we tested for the significance of the spatial correlation of the residuals obtained from the mixed-effects models (with random slopes and intercepts) using Moran’s test (see S1 Appendix Table D). The test results suggested that there was a significant spatial correlation in our data, justifying the use of spatial econometric models. We further checked for the suitability of spatial-lagged models and spatial-error models, but found no significant difference between these models. Hence, we report results from spatial-lagged models here and include the results from the spatial-error models in the appendix (see S1 Appendix Table E Models 3 and 6; and Table G model 3). To estimate the effect of the EVD crisis on agricultural production, we used a spatial stochastic production frontier model with the “ssfa” package in R [39]. The application of the stochastic frontier model (instead of the classical linear regression model) was justified after testing for the significance of the existence of inefficiencies in our agricultural production data using the likelihood ratio test (LR test: chi-bar square (1) = 6. 396, p = 0. 006). Finally, we conducted power analyses and found that the power of our tests ranged from 73–98%, indicating a relatively low probability of conducting Type II error.
The majority of our respondents (90%) were male with an average age of 43 years. Almost 64% of the respondents were literate, which is comparable to 66. 7% reported by LISGIS [56]. Respondents had attended school for an average of six years. Sample farm households owned, on average, 1. 53 hectares of farm land, which is similar to the average farm size of 1. 54 hectares reported by the FAO [57]. Forty-two percent of the sample respondents were from urban areas and 58% from rural areas (for more detail see S1 Appendix Table B). Thirty-one percent of the sample households reported the incidence of EVD in their community or nearby communities and almost 20% of these were households that relied heavily on farming for their livelihoods. Our study offers important insights on the effect of the EVD epidemic on the livelihoods of Liberian society and the mechanisms underlying them. We found that the incidence of EVD did not influence the total annual household income depending on whether or not the households were located in/near communities where EVD occurred. However, the majority of the sample households reported that their income was lower during the EVD crisis, as compared to their income before the outbreak. This suggests that the effects of the EVD epidemic were not limited to the communities where EVD occurred, but that the EVD crisis affected communities throughout the country. These results are in line with the findings of Bowles et al. (2016) [63] who reported that during the EVD epidemic, there was a remarkable decline in economic activities across Liberia, but that in most cases, there was little association between the decline in economic activities and the number of Ebola cases. Thus, post-epidemic rehabilitation measures should not only be limited to communities directly affected by EVD, but should also target those indirectly affected by the epidemic. We also found that the incidence of Ebola significantly reduced total crop production of farm households, which is in line with other studies [see also 15,26,58,64]. As farm households in our sample had consumed about 85% of their own production, they heavily depended on their own agricultural production for survival, which is a typical characteristic of subsistence farmers. Thus, the reduction in their agricultural production likely had an adverse effect on their food security, which is in line with the existing literature [15,20,26,35,58,64]. Most of these studies reported that the agricultural sector was one of the most severely affected sectors by EVD, and food security was significantly hampered by the epidemic in Liberia. Our results also revealed that the incidence of EVD negatively affected the trust of the citizens in Liberian institutions. Respondents who reported the incidence of EVD in/near their community, were more likely to report a decrease in their trust in the government and village chief (s). Our results suggest that in the long term, the deterioration in the social capital resulting from the EVD epidemic, may have adverse effects on the stability of the country’s political system [60]. Degradation of social capital may increase the likelihood of social conflict and crime. Moreover, distrust in state institutions may render recovery efforts more challenging and make the country more susceptible to future outbreaks, as citizens may no longer comply with the recommendations of the state institutions [27]. Finally, although we controlled for most of the relevant factors in our analysis, there may still be some confounding effects, as our results were based on cross-sectional data collected at a single point in time. In addition, as it is customary to the surveys of our type, there could be limitations associated with retrospective memory, as respondents may not have accurately recalled information from the previous year, though we believe that one year is short enough for respondents to accurately report the events in their household. We believe that our results could help Liberia and other countries in the developing world with similar socioeconomic conditions, as well as the international community, to be better prepared for future crises and distribute livelihood rehabilitation efforts more effectively, thereby facilitating the affected nation’s speedy recovery after such crises.
Epidemics such as HIV/AIDS, malaria and Ebola virus disease (EVD) may adversely impact the livelihoods of the society affected by the epidemics. Nonetheless, the mechanism behind the effects of the epidemics may differ depending on different factors, such as the transmission mechanisms, latency, and mortality rates associated with the diseases, which requires specific research to investigate the effect of each epidemic. In light of this, we analyzed the impact of the recent EVD epidemic on the agricultural production of farm households and its impact on the livelihoods of Liberian society. We collected data from 623 households throughout Liberia during the EVD crisis in 2014–2016, and found that there was no significant difference in the annual income of sample households from communities where EVD occurred and did not occur. Nonetheless, the majority of the sample households reported a decrease in their income compared to the year before our survey. We also found that the community level incidence of EVD had a significant negative effect on crop production of farm households, which might have exacerbated food insecurity in the country. Moreover, the EVD epidemic negatively affected the Liberian society’s trust in Liberian institutions. Our results underline that epidemics, like EVD, might have long-lasting negative effects on the livelihoods of a society, and they may have adverse effect beyond the communities directly affected by the epidemics.
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The impact of the Ebola virus disease (EVD) epidemic on agricultural production and livelihoods in Liberia