Following the news of an Ebola outbreak in the DRC, here’s a summary of lessons learned from Oxfam’s community engagement during the 2014–15 Ebola response in Sierra Leone and Liberia.
The Ebola response in Sierra Leone, Liberia and Guinea demonstrated that community engagement is critical in responding to epidemics. This was not always a guiding principle in an outbreak, which initially prioritized biomedical and militarized responses.
After the 2014-15 epidemic Oxfam organized an inter-agency workshop to share experiences and learning. The following guidelines for public health practitioners and program teams were informed by this workshop, with input from various agencies involved in the Ebola response, as well as a literature review. For more information download the full Guide to Community Engagement in WASH.
1. Understand diversity and varied vulnerabilities within communities
Resources must be devoted to understanding community perspectives and advocating for community-focused interventions. Specialists, such as anthropologists and epidemiologists, may be required for information to be collected, documented and used effectively.
2. Avoid one-size-fits-all models of community engagement
It is better to recognize the potential capabilities of communities in each situation and provide context-specific support. This allows communities to take action to protect themselves using a ‘menu’ of different strategies, developed using a community-led approach. To do this effectively, key groups (e.g. male and female leaders, traditional healers, religious leaders, older people, youth and children) need to be identified.
Oxfam's hand-washing training in Clara Town, Sierra Leone. Credit: Pablo Tosco/Oxfam, November 2014
3. Ensure advocacy is inclusive and represents communities
Advocacy efforts should be directed at promoting inclusive and representative ideas, including the concerns, questions and solutions of communities, and ensuring that only useful and practical information is given to communities by humanitarian actors.
4. Prioritize providing information about protective action and monitor uptake
The information given to communities must be prioritized to ensure that the crisis affected population understands and uses the most effective protective actions (e.g., in the case of Ebola, early isolation and referral, and not touching the dead). The uptake and use of these specific actions must be monitored, and rumours about diseases and treatment processes should be documented in order to track progress.
5. Ensure medical and burial processes are transparent and understood by communities
It is important to work with others (from all sectors) to increase the transparency of medical and burial processes, especially where there is a lack of understanding and/or trust in the healthcare system. This can include step-by-step guides for referral or burial management, and showing videos to illustrate what to expect.
Reednel Kun, Oxfam Community Health Volunteer, talking with Alma Tomás, who received an Oxfam kit distribution in New Kru Town, Liberia. Credit: Pablo Tosco/Oxfam, November 2014
6. Support staff to deliver community-centered approach
Support, training and supervision for newly recruited staff are vital to ensure responses are community-centered, effective and accountable.
7. Co-ordinate with other actors to put community engagement first
Community engagement supports every other aspect of a response (e.g. testing and treatment, safe burials, etc). Therefore, active coordination and planning with other sectors is crucial at the local and district levels, as well as with national collaborators.
8. Organize inter-agency daily debriefs
Program managers should actively support and foster regular information exchanges between program teams within and between organizations (e.g. daily debriefs).
9. Encourage self-help, not fear
Using fear to encourage changes in behaviour can be counterproductive. It is better to promote self-reliance and self-help among affected populations.
10. Apply these lessons to all water, sanitation and hygiene (WASH) programs
Many of the lessons from the Ebola response can be applied to Oxfam’s WASH programs, especially cholera responses. Equally, Oxfam’s experience with public health promotion (PHP) and WASH interventions means that we are well placed to support and develop capacity in community engagement and social mobilization.
Therese*, Public Health Promoter talking to a child in Kalunga IDP camp, Kalemie, Tanganyika, DRC. Credit: Diana Zeyneb Alhindawi/Oxfam, September 2017
Oxfam’s response to Ebola in the Democratic Republic of Congo (DRC)
Oxfam has launched a public awareness drive to help keep the Ebola outbreak in Mbandaka, DRC, under control. Oxfam is providing door-to-door information to the most vulnerable people, working with communities and carrying out mass awareness activities including film screenings and working with local community radio stations. It also plans to work with religious and traditional leaders.
Oxfam is installing chlorinated water points in hospitals, health centres, schools and ports, and helping to disinfect houses in which Ebola cases have been detected. It also provides disinfection kits and hygiene kits to communities.
- Marion O'Reilly - public health promotion team leader for Oxfam's global humanitarian team. She has worked for Oxfam since 1995, first in Angola and then in Oxford. She focuses on community mobilisation and health and hygiene promotion in humanitarian crises.
- Eva Niederberger - public health promotion adviser at Oxfam working on humanitarian response, and co-author of Oxfam's Guide to Community Engagement in WASH.
- Suzanne Ferron - public health program consultant and co-author of Oxfam's Guide to Community Engagement in WASH
Top photo: Community Health Volunteers receiving training in Clara Town, Liberia, November 2014. Credit: Pablo Tosco/Oxfam