The 2014-2015 Ebola outbreak in West Africa is the largest ever recorded. Post-mortems on the crisis assert that engaged and accountable health personnel slowed transmission by encouraging early isolation and treatment—a major challenge given fears about sub-standard care and stigma. We take advantage of a unique opportunity to experimentally test this “lesson learned”: roughly a year before the outbreak in Sierra Leone, two interventions were randomly assigned to government-run health clinics, one focused on community monitoring of clinics and the other on status awards for nurses. We and that these programs substantially increased the reported number of Ebola cases in the sections where they were implemented.

We explore three possible explanations: the programs (1) unintentionally increased incidence; (2) improved surveillance ešfforts; and/or (3) increased the likelihood that patients sought care. We only and evidence consistent with the last. By improving the perceived quality of healthcare, the programs may have encouraged patients to report and receive treatment.