Community engagement in outbreak response: lessons from the 2014–2016 Ebola outbreak in Sierra Leone
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Abstract
Documentation of structured community engagement initiatives and real-time monitoring of community engagement activities during large-scale epidemics is limited. To inform such initiatives, this paper analyses the Community Led Ebola Action (CLEA) approach implemented through the Social Mobilization Action Consortium (SMAC) during the 2014–2016 Ebola epidemic in Sierra Leone. The SMAC initiative consisted of a network of 2466 community mobilisers, >6000 religious leaders and 42 local radio stations across all 14 districts of Sierra Leone. Community mobilisers were active in nearly 70% of all communities across the country using the CLEA approach to facilitate community analysis, trigger collective action planning and maintain community action plans over time. CLEA was complemented by interactive radio programming and intensified religious leader engagement. Community mobilisers trained in the CLEA approach used participatory methods, comprised of an initial community ‘triggering’ event, action plan development and weekly follow-ups to monitor progress on identified action items. Mobilisers collected operational and behavioural data on a weekly basis as part of CLEA. We conducted a retrospective analysis of >50 000 weekly reports from approximately 12 000 communities from December 2014 to September 2015. The data showed that 100% of the communities that were engaged had one or more action plans in place. Out of the 63 110 cumulative action points monitored by community mobilisers, 92% were marked as ‘in-progress’ (85%) or ‘achieved’ (7%) within 9 months. A qualitative examination of action points revealed that the in-progress status was indicative of the long-term sustainability of most action points (eg, continuous monitoring of visitors into the community) versus one-off action items that were marked as achieved (eg, initial installation of handwashing station). Analysis of behavioural outcomes of the intervention indicate an increase over time in the fraction of reported safe burials and fraction of reported cases referred for medical care within 24 hours of symptom onset in the communities that were engaged. Through CLEA, we have demonstrated how large-scale, coordinated community engagement interventions can be achieved and monitored in real-time during future Ebola epidemics and other similar epidemics. The SMAC initiative provides a practical model for the design, implementation and monitoring of community engagement, integration and coordination of community engagement interventions with other health emergency response pillars, and adaptive strategies for large-scale community-based operational data collection.
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The Ebola outbreak severely disrupted the healthcare system's operation and economic activities due to government-enforced measures such as lockdown or stay-at-home orders.
“Studies reported that this outbreak severely disrupted healthcare system’s operation and economic activities due to government-enforced measures such as lockdown or stay-at-home orders [33–35].”
From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [33]
The Introduction (page not provided) says the Ebola outbreak posed new challenges for Sierra Leone’s already fragile health system. The reach of the CLEA approach (page not provided) describes community bylaws restricting movement, but the paper does not say that government-enforced lockdowns or stay-at-home orders severely disrupted healthcare operations and economic activities. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe unchanged proportion of reproductive-age women facing financial barriers to healthcare access in 2013 and 2019 may be linked to recurrent outbreaks in Sierra Leone over the past decade, particularly the Ebola outbreak.
“A plausible reason for the unchanged proportion of reproductive-age women who faced financial barriers to access healthcare in 2013 and 2019 may be linked to the recurrent outbreaks in Sierra Leone over the past decade.”
From Financial barriers to healthcare access among reproductive-age women in Sierra Leone: evidence from demographic health surveys of 2008, 2013, and 2019 (2026) · cites this paper as [33]
The Introduction (page unavailable) says the Ebola outbreak challenged Sierra Leone’s fragile health system and that some people failed to seek medical care. It does not link outbreaks to financial barriers for reproductive-age women, establish that those barriers were unchanged between 2013 and 2019, or document recurrent outbreaks in Sierra Leone over that period. (LLM, conf=0.78)
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- Authors
- Bedson, J., Jalloh, M. F., Pedi, D., Bah, S., Owen, K., Oniba, A., Sangarie, M., Fofanah, J. S., Jalloh, M. B., Sengeh, P., Skrip, L., Althouse, B. M., & Hébert-Dufresne, L.
- Affiliations
- Gates Foundation (US)
- FOCUS 1000, Freetown, Sierra Leone
- Restless Development Sierra Leone, Freetown, Sierra Leone
- GOAL, Freetown, Sierra Leone
- British Broadcasting Corporation (United Kingdom) (GB)
- Institute for Disease Modeling (US)
- New Mexico State University (US)
- Vermont Complex Systems Center, University of Vermont, Burlington, Vermont, USA
- Corresponding author
- Althouse, Benjamin M
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2020-08
- Volume
- 5
- Issue
- 8
- Pages
- e002145
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC7445350
- OpenAlex
- W3080271465
- Cited by
- 112
- References
- 29
- Citations by year
- 2026: 32 · 2025: 11 · 2024: 19 · 2023: 12 · 2022: 14 · 2021: 15 · 2020: 9
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Global Health (publishedVersion, cc-by)
- bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health (1P20 GM125498-01)
- Bill and Melinda Gates Foundation
- United Kingdom Department for International Development
- Bill and Melinda Gates through the Global Good Fund
- Age International
- UNICEF
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Social Sciences › Communication › Public Relations and Crisis Communication
- Health Sciences › Health Professions › General Health Professions › Community Health and Development
- Keywords
- community participation, Ebola outbreak response, Sierra Leone, community action plan, real-time monitoring, case referral, community-based data collection, health emergency response
- MeSH terms
- Disease Outbreaks, Humans, Retrospective Studies, Sierra Leone, Hemorrhagic Fever, Ebola, Epidemics
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