Politics of Poverty

Controlling Ebola in Liberia: 3 reasons local communities were (and still are) indispensable

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Betty Kruah (pink top), Moses Dahn, Helena Dahn are community health volunteers in Lorplay community, Tappita district, in rural Nimba county in eastern Liberia. Moses: “When we first started making house visits to talk to people about Ebola, people were afraid. They didn’t understand, they thought we brought Ebola. We talk to them about how to stay safe – wash your hands, no shaking hands, send sick people to the clinic. It takes time, but little by little they understand. Now you see the difference. Everyone washes their hands now. If someone gets sick, they will send them to the health centre. Before, people would do their own medicine at home. Now people come to us to hear about other sicknesses like cholera and malaria, and we talk to them about immunisations for the children to keep good health. I do this job because I want to care for our community.” Photo: Melanie Kramers / Oxfam

Liberia’s local systems have set the country up for success and will help them get to the goal of fully eradicating Ebola.

Rebecca Gilbert is the Fueling Investment Campaign Coordinator at Oxfam America.

Last month, Mr. Cain Prince Andrews, Director General of the Monrovia city government, spoke to staff here at Oxfam America’s Washington, DC office. The conversation centered on the Ebola virus, and Liberia’s efforts to control and stop the outbreak that devastated West Africa over the last 20 months.

And while we’ve heard many stories of the actions of heroic leaders and individuals during the epidemic, what inspired me most from Mr. Andrews’ remarks was the critical role of local leaders and everyday citizens in communities throughout the country in gaining control of the disease.

  1. Local leaders were essential to spreading critical, life-saving information about Ebola.

From the start, people in communities across Liberia denied the existence of Ebola. This denial led to widespread rumors and misinformation, and according to Andrews, “was the basis for spreading the disease.” Some believed evil spirits possessed their bodies and if a person died, it was the spirits, not disease, that lead to their ultimate demise. Seeing the devastating effects such beliefs were having, local community and government leaders quickly set to work to debunk the theories with facts – sharing information about how Ebola is contracted, spread, and treated to save their friends and neighbors. And even though the national government was spreading the same messages, it was the work of local leaders who made the difference because they were known and trusted in their communities. As Mr. Andrews explained, the community leaders were reliable because, as opposed to national leaders, “they had eaten together, played football together, gone to school together… People want to listen to people they interact with every day…The best solution is to empower the local leaders.” Familiarity made all the difference.

  1. Community action and engagement was key to halting Ebola’s spread.

Learning lessons from the beginning, Liberia was able to successfully control the Ebola outbreak because they relied throughout on a localized approach. Local community engagement teams increased outreach and handled issues by going door-to-door to households. And since each of the teams was managed within the communities themselves, they had the freedom to design responses they knew would be effective in their particular context. As Mr. Andrews described, “The best way to handle the situation was for the locals that were closest to the communities to engage them and see how best to create a lot of awareness on Ebola because there were a lot of perceptions, doubts and denials. The way to do that is to get the people who frequently interacted with people, who always told them about issues of national concern to be the ones carrying the message.”

While the national government laid out the initial framework for containing and eliminating Ebola, it fell to local communities to actually implement these strategies. For example, to execute the national government’s sterilization goal, local communities placed hand washing kiosks in markets, stores, and schools, and stressed the importance of frequent use. To carry out the government’s goal to increase disease awareness, communities improved education on the spread of Ebola and the measures taken to combat its impact.

  1. Prevention of future outbreaks is in the hands of communities.

As part of their National Incident Management System, Liberia created smaller local teams of individuals to allow for a more flexible and rapid response to the Ebola virus – wherever it was found. This allowed communities to track and monitor their own Ebola cases and contacts. Local governments performed temperature testing and monitored hand washing kiosks at local schools and elsewhere to ensure frequent use. The teams also cleaned the environment in their communities by, for example, sterilizing schools and latrines, rehabilitating public areas in their neighborhoods. Due, in large part, to this method of monitoring and quick response, 284 Liberian communities are now Ebola free.

And while Liberia’s fight to fully eradicate Ebola from within its borders is unfortunately not yet over, the systems they’ve established at the local level have set the country up for success and will no doubt get them to that goal.

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