Social Science Considerations for Building Trust in Epidemic Response
This briefing provides practical recommendations for improving community trust prior to, during and after Ebola outbreaks.
This briefing provides practical recommendations for improving community trust prior to, during and after Ebola outbreaks.
Since July 2013, a series of massacres have occurred in the Beni territory of North Kivu province, Democratic Republic of Congo, an area heavily affected by the current Ebola outbreak. More than 1,000 civilians have been killed and tens of thousands have been displaced (Congo Research Network, 2016, 2017). The kidnappings and mass killings transformed Beni from an area of relative calm to a violent hotspot. What has been historically troubling about these armed attacks is the lack of knowledge surrounding them.
With the constant shifting of political alliances, the emergence of new armed groups and political scapegoating, the identity and motives of perpetrators remain highly ambiguous and contested. In the face of this complexity, civilians are left with the constant fear of being killed, kidnapped, or conscripted. In addition, tensions between the government and ethnic groups in the region have further intensified people’s mistrust in state institutions and activities.
The Ebola outbreak in West Africa has reinvigorated the debate about the role of ‘social mobilisation’ and ‘community engagement’, not only in response to devastating disease but a range of other intractable issues affecting Africa and the rest of the developing world. But what do we mean by ‘social mobilisation’?
And why are we only learning now that community leadership is important?
A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). This paper documents how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. It asks to what extent the community became a resource for early detection, and identifies problems encountered with community health worker and social mobilization strategies. Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper’s authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish.