Community engagement for health system resilience: evidence from Liberia’s Ebola epidemic

Abstract

<jats:title>Abstract</jats:title> <jats:p>The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014–15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in—as opposed to passive recipients of—health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE—all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.</jats:p>

Community engagement for COVID-19 prevention and control: a rapid evidence synthesis

“…It can consist of providing information and conducting consultation ; having involvement via regular interactions throughout the project cycle; and collaboration , which entails working in partnership with shared decision-making 59 60 that involves communities carrying out critical health systems functions and innovating with localised solutions. 9 Within this review, most included articles could be classified as having involvement, where communities were thoroughly brought in but often did not share decision-making powers. Notably, however, almost all examples of community engagement from high-income contexts consisted of consultation, demonstrating passive involvement with target ethnic and minority population.…”

“…23 These measures significantly contributed to the success achieved in controlling the outbreak and ensuring the resilience of the health system. 9 15 22 In relation to COVID-19, community engagement can be critical for creating local and context-specific solutions to prevention and control responses. 24 Through this 'bottom-up approach', communities participate in 'decision-making processes of planning, design, governance and delivery of services aimed at improving population health and reducing health inequalities'.…”

“… 8 Community engagement refers to involvement and participation of individuals, groups and structures within a parameter of a social boundary or catchment area of a community for decision-making, planning, design, governance and delivery of services. 9 It is used as a parent notion with terms like communication, social mobilisation, community participation, community action and empowerment 10 with emphasis on the agency of community members or groups, considering them as active rather than passive participants. 11 12 Community engagement is seen as critical in many health initiatives, such as for communicable disease 10 and maternal and child health initiatives, 13 and more recently has been considered a fundamental component during outbreaks, largely arising during the 2014–2015 Ebola epidemic in West Africa.…”

“… 23 These measures significantly contributed to the success achieved in controlling the outbreak and ensuring the resilience of the health system. 9 15 22 …”

“… 24 Through this ‘bottom-up approach’, communities participate in ‘decision-making processes of planning, design, governance and delivery of services aimed at improving population health and reducing health inequalities’. 9 The COVID-19 pandemic as a total social phenomenon should include actively engaging and adapting local views, voices and concerns in health crisis response efforts. 24 Moreover, the WHO’s recommended measures to prevent and control COVID-19, such as physical–social distancing, case identification and contact tracing require understanding of the different social dynamics in communities and how these can better be leveraged to minimise the impact of the epidemic.…”