IN 2013, THE INCIDENCE of tuberculosis (TB) inSierra Leone, Liberia and Guinea was 313, 308 and 177 cases per 100 000 population, respectively.
Recent political instability and civil wars haveresulted in fragile health systems. Before 2014, SierraLeone had 136 doctors and 1017 nurses for apopulation of 6 million, and Liberia had 51 doctorsand 978 nurses for a population of 4.2 million. Developing robust TB control frameworks is challenging in such settings.

From 2014 to 2015, an unprecedented outbreak ofapproximately 28 141 cases of Ebola virus disease(EVD) caused 11 291 deaths across the threecountries. As that epidemic is now, hopefully, in afinal decline phase, the impact on health infrastructure to tackle other infections, such as TB and thehuman immunodeficiency virus (HIV), requires assessment. In this issue of the Journal, Zachariah et al.issue a timely call for operational research on TB