The recent West African Ebola epidemic has drawn global attention to the challenges of generating an effective health crisis response. Polygeia’s researchers have been working with the Africa All Party Parliamentary Group (APPG) to consider the role of communities in the recent Ebola epidemic and to examine the lessons for community engagement in health crises and health systems strengthening.
Communities have been shown to play a crucial role in the acceptance, effectiveness, and ultimate success of the response. Yet, initial approaches by Ebola responders and the international community did not sufficiently prioritise community engagement .
Africa APPG and Polygeia worked with Restless Development in Sierra Leone and the Public Health Development Initiative (PHDI) to conduct 23 key informant (KIs) interviews with community leaders to gain their insight into the role of communities in the Ebola response. One key informant was Samuel Borbor Vandi, a NGO worker from Kailahun District, Sierra Leone.
Samuel described the missing link between communities and NGO’s when he said:
“…most agencies do not spend a lot of time in communities, particularly vulnerable communities, so it has been difficult for them to know the real issues posing threat to the lives of community people…organisations need to spend more time to discuss with community people regarding issues that affect them, and involve them in developing the design of the project.”
The medical response of prevention and treatment also requires successful community engagement . Basic Ebola response activities such as contact tracing were restricted by rumours, mistrust and resistance . By bypassing communities, Ebola responders forfeited opportunities to counteract mistrust and to increase the social legitimacy of infection control measures. Consultation with communities during planning stages facilitates the design of health programmes that are responsive to need and relevant to the social context . A clear example of the importance of engaging communities in the planning of health interventions is visible in the redesign of Ebola treatment units (ETUs). Acceptance of ETUs and a sense of ownership of the facilities grew when communities’ legitimate concerns were addressed by involving them in all stages including design, site selection and construction .
The media narrative surrounding Ebola highlighted initial clashes between medically safe burials and many local and religious practices, which resulted in families hiding the bodies of the deceased from public health authorities . However, secret burials were in part a parallel response to safe burials generated by inadequate attention to community priorities. The WHO eventually recognised this by instituting safe burials which recognised the importance of maintaining the dignity of the deceased . Community-led approaches to health typically differ from standard practice insofar as they regard communities as co-partners in the provision of health information and services rather than as passive beneficiaries .
On Saturday 14 November we will be presenting our research and recommendations at Polygeia’s annual global health conference. Our report draws on qualitative research highlighting local perspectives on the Ebola response and submitted evidence from organisations working on the ground to recommend the promotion of community ownership of response efforts during health crises and in health systems strengthening.
We will also be running a workshop to give participants the opportunity to analyse programmes used in the Ebola epidemic, to consider their theoretical underpinnings and reflect on alternative solutions to the problems encountered. Through this exercise participants will develop a greater understanding of the concept of ‘community ownership’ and the significance of community engagement in health crises.
Our report Community engagement in health crisis response and health systems strengthening: lessons from Ebola will be published in November 2015. We hope to see you at the Polygeia Conference to further discuss responses to health crises that recognise the resources communities offer as experts on their social context.
Maisy Grovestock is a recent Cambridge graduate with an interest in access to medicines and research and development policy. She has previously worked on projects for the NHS and for Médecins Sans Frontières Access Campaign.
 Restless Development. Written evidence on community led health systems & the Ebola outbreak – Submission. 2015;(June):1–18.
 Kutalek R, Wang S, Fallah M, Wesseh CS, Gilbert J. Ebola interventions: listen to communities. Lancet Glob Heal [Internet]. Elsevier; 2015 Jan 21 [cited 2015 Feb 12];3(3):e131. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25618243
 Institute of Development Studies. Response to Africa APPG inquiry: Call for written evidence on community led health, Submission from the Institute of Development Studies (IDS). p. 499–501.
 International Rescue Committee. Communities and Health in the Ebola Epidemic [Internet]. 2015 [cited 2015 Jul 5]. Available from: https://drive.google.com/drive/search?ltmpl=drive&q=irc
 How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease [Internet]. [cited 2015 Oct 30]. Available from: http://apps.who.int/iris/bitstream/10665/137379/1/WHO_EVD_GUIDANCE_Buria...
 African Diaspora Healthcare Professionals for Better Health in Africa initiative. Response to Africa APPG inquiry: Call for written evidence on community led health.
Image Credit: Community Ofrenda, Flickr