Preparing for the next Ebola: A community- engaged approach to infection prevention and control

Critical reflection on the worst Ebola outbreak in human history suggests that while rigorous adherence to infection prevention and control precautions and safety standards was essential, a  key missing link lay in the in the failure to adequately apply principles of community engagement. These include the early, active and sustained involvement of affected communities, and their trusted leaders, networks and lay knowledge, to help inform what control teams do, and how they may better do it, in partnership with communities.

Drawing on the experience of health care workers and residents in Sierra Leone, Liberia, South Africa, Kenya and other African nations; organizations including CDC, WHO and the Infection Control Africa Network; and of leaders in community engagement and infectious disease, we present an eight step model for creating an environment emphasizing reciprocal learning and trust, multi-method, bi-directional communication, assessment, and building for sustainability.  Using examples of changes in burial and other practices in west Africa that were culturally relevant yet maintained safety, we illustrate how often minor adjustments to the IPC protocol, taking  into account the “community protocol” (cultural values, customs and practices) were able to improve community receptivity and discourage practices such as the hiding of ill family members and unsafe burials.

 Outbreaks of Ebola tend to occur in 4 year cycles, with similar cyclic patterns seen with other Viral Hemorrhagic Viral Fevers (VHFs).  Although preparation for the next such outbreak must include greatly improved health and social care infrastructure, particularly in informal settements and other deeply impoverished areas,  methods for approaching and actively engaging community leaders and members must also be a much greater part of infection prevention and control efforts.