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.
community
Community Responses to the Ebola Response: Beni, North Kivu
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.
Communities are the Real Heroes – Doing Social Mobilisation Differently: Lessons and Recommendations from the Ebola Outbreak
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?
The First Mile: Community Experience of Outbreak Control during an Ebola Outbreak in Luwero District, Uganda
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.
Community Led Ebola Management and Eradication (CLEME)
The CLEME (Community Led Ebola Man- agement and Eradication) programme aims at triggering the behavioural change needed by the communities to strengthen community resilience to the outbreak and prevent further resurgence by ensuring real and sustainable improvements through:
Providing the communities with the means to conduct their own appraisal and analysis of the Ebola outbreak, their safety regarding the disease and its con- sequence if nothing is done;
Instilling a feeling of urgency in engaging in community actions that will prevent the community experiencing infections;
Supporting technically the communities in the implementation of the identified solutions and actions adopted.
CLEME (Community Led Ebola Management and Eradication) is an approach developed under the initiative of Action Contre la Faim (ACF) Sierra Leone hygiene promotion field teams, at the start of the Ebola outbreak, based on extensive experience with the Community Led Total Sanitation (CLTS) approach.
Community-Based Ebola Care Centres: A Formative Evaluation
The Ebola outbreak in West Africa differed from others in its unprecedented size and the high proportion of human-to-human transmission occurring in the community. This report presents an analysis of the impact of Community Care Centres (CCCs) on communities in Sierra Leone. Much has been written about the leadership and coordination of the response – or the lack of it. The emphasis of this evaluation is on the views on the development, implementation and relevance of the CCCs from the perspective of the communities next to and near where they were located. The key questions explored are divided into two categories: (1) Community engagement with the development and management of the CCC; and (2) Post- Ebola uses of the CCC.
Africa APPG inquiry: Community led health systems & the Ebola outbreak
The Ebola crisis of 2014-15 has brought questions around the roles of communities and health systems into sharp relief – both in relation to crisis response, and to the challenges of post-crisis recovery and building resilience to future epidemics. The Institute of Development Studies is pleased to make this submission to the APPG inquiry on these crucial questions.
This submission draws upon this work and highlights the need for developing health systems and health crisis response mechanisms that actively seek, engage and adapt to local voices and concerns in the communities they serve. We emphasise the key role that anthropologists can play in facilitating these processes and recommend their inclusion in all future humanitarian crisis responses. In addition, we call for a long term commitment to developing local anthropological expertise, focusing on those countries vulnerable to humanitarian crises.
We present our submission concisely in bullet points and primarily refer to our work in Sierra Leone.
Village Responses To Ebola Virus Disease In Rural Central Sierra Leone
Bawuya is a small, isolated Kpa-Mende farming village about 3 hours walking time from Taiama, headquarters of Kori chiefdom in Moyamba District, Southern Sierra Leone. Bawuya experienced an Ebola outbreak in September 2014, in which 9 people died and 3 infected persons survived, connected to a prior outbreak in a neighboring village, Fogbo. No further cases have since occurred. Bawuya serves as a representative example of how an isolated rural community becomes infected, and how such outbreaks end, where outside intervention or assistance is limited. The report analyzes randomly-sampled questionnaire data situating Ebola within the context of village social networking and patterns of health seeking behavior. Changes are documented in local understanding of Ebola, from earlier media-led conceptions of an epidemic driven by bush-meat consumption towards an experience-based understanding of the risks posed by body-to-body contact. The case makes clear that transmission of Ebola can be ended by local acceptance of a range of externally-determined and locally self-imposed restrictions on movement and contact with dead bodies.
Increasing early presentation to ECU through improving care
Current Ebola epidemic control policy in Sierra Leone focuses on (a) triage and isolation in decentralised, ideally community-based Ebola Care Units (ECUs), leading to (b) transfer to Ebola treatment units (ETUs) for those diagnosed as positive. Increasing early presentation to ECUs is essential for this strategy to be effective in reducing Ro. This note outlines ways in which improved and socially-appropriate care – in ECUs, and at home – can assist this.
Sierra Leone: Gift giving during initial community consultations
This brief summarises appropriate gift giving during initial community consultations in Sierra Leone. It is intended to provide an overview of good practices to support UNICEF, the WHO and other agencies as they interact with Paramount Chiefs prior the implementation of CCCs. It does not focus on the community consultation process more broadly, but specifically on gift giving during the first meeting.
The details have been collated from suggestions and insights provided by networks of anthropologists in the UK and US who
work in Sierra Leone (both in-‐country and remotely). These are general considerations that are broadly relevant for the Sierra Leone context, but teams should check with local counterparts for regional specificities.
The French version of the brief is available here.
Field situation: How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease.
WHO has developed a protocol to provide information on the safe management of burial of patients who died from suspected or confirmed Ebola virus disease. These measures should be applied not only by medical personnel but by anyone involved in the management of burial of suspected or confirmed Ebola patients. Twelve steps have been identified describing the different phases Burial Teams have to follow to ensure safe burials, starting from the moment the teams arrive in the village up to their return to the hospital or team headquarters after burial and disinfection procedures. These steps are based on tested experiences from the field.
Liberia: handling of bodies and national memorials – community perceptions from Monrovia
This brief summarises attitudes of community leaders and residents in and around Monrovia. It is intended to provide an
evidence-base to support the SOP on safe and dignified burials, and to contribute to ongoing discussions about mass-graves and national memorials.
The French version of the brief is available here.
