that treated sections connected to more controls via the road network see a larger increase in total cases.

Finally, information or people may move more easily between areas that are proximate in both geographic and cultural terms. We use the household survey to determine the plurality ethnic group in each section. Sections tend to be homogeneous: in the median section, 95 percent of respondents report the same ethnicity. For each section, we then count the number of control sections with the same plurality ethnic group and within 10 kilometers. Table E.24 provides no indication that spillovers occur due to movement of patients between proximate co-ethnic areas.

# **4.2.2 Mechanisms**

Concerns about sub-standard care deterred patients from utilizing clinics during the Ebola crisis. Fearful that seeking care would condemn their loved ones to death, households “engaged in practices of hiding sick family members, running away from local communities, or attempting to manage the course of Ebola within local households and communities” (Abramowitz et al. 2016, 24). If the CM and NFA interventions generated persistent improvements in the perceived quality of healthcare and utilization, this would help explain increased reporting in treated sections.<sup>38</sup> Using our endline surveys but restricting attention to the 160 clinics in the Ebola sample (see Table D.20 for estimates using our full sample), in Table 5 we estimate treatment effects on general utilization; satisfaction with public health workers; and households’ beliefs about the efficacy of western (“white-man”) medicine relative to traditional or religious remedies, the primary alternatives to government-run clinics in rural Sierra Leone. The effects on general utilization remain positive and significant when we pool the treatments and in CM alone; the effect attenuates in the NFA arm relative to the full sample (see Table 1). We continue to find positive effects on satisfaction, focusing here on satisfaction with public health workers, which is asked of all households.<sup>39</sup> Both treatment arms generate roughly equivalent increases in satisfaction with public health workers, on the order of a tenth of a standard deviation. Finally, we find sizable (0.3 standard deviation) improvements in households’ attitudes towards western medicine, particularly its effectiveness relative to traditional healers or spiritual remedies. While this index is not listed among the outcomes in our analysis plan, its inclusion was motivated by assessments of the Ebola crisis stressing the importance of trust in western medicine (e.g., Kruk et al. 2015).<sup>40</sup>

> 38 An alternative channel would be that improvements in physical health made people less susceptible to Ebola. However, recall that we only find health improvements for children and not adults who comprise over 70% of the confirmed Ebola cases.

> 39 The satisfaction family specified in the analysis plan includes one other variable that is asked of all households at endline: whether the household is satisfied with their family’s health. We do not analyze this variable, as contentment with health outcomes during “normal times” seems unlikely to shape whether one seeks care following a major adverse shock like the Ebola crisis.

> 40 The importance of (dis)trust is tragically underscored by the violence facing western health providers responding to Ebola in Guinea ( `https://www.bbc.com/news/world-africa-29256443` ) and the Democratic Republic of the Congo ( `https://www. nytimes.com/2019/05/19/world/africa/ebola-outbreak-congo.html` ).

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