From Crisis to Care: Ebola-Era Humanitarian Governance, Trust, RACG, and Routine Health Service Use in Sierra Leone—A B-RACT Perception Study

Abstract: Introduction: Bull’s Resource-to-Access Conversion Theory (B-RACT) proposes that governance signals foster trust, reduce the Resource-to-Access Conversion Gap (RACG), and enable healthcare utilization. This study examined whether perceptions of Ebola-era aid governance predict current trust, RACG, and routine service use in Sierra Leone. Methods: A community-clustered cross-sectional survey (N = 230) was conducted in Ebola-affected districts. Structural equation modeling (SEM) with robust maximum likelihood estimation tested direct, indirect, and sequential paths among PEAG, Trust, RACG, and utilization. Missing covariate data were handled via multiple imputation (m = 20). Indirect effects were estimated using 5,000-sample bias-corrected bootstrapping; moderation by gender and socioeconomic status (SES) was tested with interaction terms. Results: PEAG significantly predicted Trust (β = .38, p < .001), and Trust significantly reduced RACG (β = –.41, p < .001). Trust increased the odds of routine utilization (OR = 1.47), while RACG decreased them (OR = 0.65). Both the simple indirect effect (β ≈ .09) and sequential indirect pathway (β ≈ .04) were significant, consistent with partial mediation. Community accountability showed theory-concordant but imprecise effects, and moderation analyses indicated no meaningful slope variation across gender or SES. Discussion/Conclusion: Findings validate B-RACT’s conversion mechanism: credible governance signals build trust, which lowers perceived access barriers and increases service use. Strengthening post-crisis health systems should prioritize accountability, trust repair, and friction-reducing service design to ensure that resources are converted into realized care. Keywords: Ebola, governance, trust, RACG, B-RACT, Sierra Leone, humanitarian aid, structural equation modeling. Title: From Crisis to Care: Ebola-Era Humanitarian Governance, Trust, RACG, and Routine Health Service Use in Sierra Leone—A B-RACT Perception Study Author: Dr. David Augustine Bull International Journal of Management and Commerce Innovations ISSN 2348-7585 (Online) Vol. 13, Issue 2, October 2025 - March 2026 Page No: 256-284 Research Publish Journals Website: www.researchpublish.com Published Date: 06-January-2026 DOI: https://doi.org/10.5281/zenodo.18161559 Paper Download Link (Source) https://www.researchpublish.com/papers/from-crisis-to-care-ebola-era-humanitarian-governance-trust-racg-and-routine-health-service-use-in-sierra-leonea-b-ract-perception-study