A community-engaged infection prevention and control approach to Ebola

Abstract

The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS.

The Ebola outbreak, 2013–2016: old lessons for new epidemics

“…Drawing on conversations with communities in the most affected countries, local experts and international actors, the main steps identified in achieving community engagement in Ebola response efforts include: identifying both male and female community leaders to champion key messages; organizing regular community meetings; using varied communication methods; tailoring global policies to local settings; and involving family members in care actions which do not expose them to increased risk [121]. …”

“…Effective community engagement benefited policy-making: strategies designed when incorporating cultural values, customs and concerns of affected communities were more effective [121]. Implementation also benefited: at various stages of this outbreak, transmission was fuelled by a reluctance of populations to seek care in designated facilities, to engage in adequate contact tracing, to respect quarantine regulations, or to reveal deaths in order to allow safe burial [104]—all of which improved after programmes of community engagement [122].…”

“…None of the six Sierra Leonean districts visited by a CDC-led monitoring team had standard operating procedures or adequate equipment [129]. Progress was hindered by delays in importing personal protective equipment and a lack of engagement with community partners [121]. Thus, effective implementation on the ground was impossible despite extensive training [130].…”

“…The proven interventions—exhaustive contact tracing, strict infection control measures (during burials and in healthcare settings) and community engagement—are not novel strategies. All were established during the response to the first Ebola outbreak of 1976 and they remain the mainstay of Ebola control today [116,120,121,139,140]. These traditional public health measures remain critical and need to be communicated and reinforced early on during future epidemics, especially in resource-poor settings.…”

Nigeria’s Ebola Outbreak Response: Lessons for Future Epidemic Preparedness

“…The community must be seen by health workers as an interested ally and not just as a beneficiary, and must take ownership of its health including responding to epidemics [11]. Communities are better poised to mobilize themselves and identify resources that could be rapidly deployed at the onset of an outbreak to stop further propagation.…”