Ebola: Intensified preparedness programme

In order to identify practical ways to enhance the capacity of health workers and influencers to develop and articulate local and sustainable Ebola response, control, and recovery solutions for affected and not yet affected communities, an Ebola: Intensified Preparedness Programme (IPP) was set up in 2015. This initiative was funded by The Rockefeller Foundation, using its emergency funds, and managed by Connecting Organizations for Regional Disease Surveillance (CORDS). This approach worked in addition and alongside other initiatives, such as those by the United Nations (e.g., UNMEER) and other international organisations (i.e., International Federation of the Red Cross, UNICEF, World Health Organisation). These also included biomedical capacity support such as mobile laboratories by clinical research institutions, the United States Centers for Disease Control (CDC), and the German Robert Koch Institute, to name just a few. The coordination of various response capacity-building initiatives proved to be very challenging, and an International Interagency Ebola Communication Coordination Call (IIECCC) was set up that was chaired by the US CDC. The IPP contributed frequently to this interagency briefing and used other opportunities during meetings with specific agencies to share its approach and outcomes.

IPP brought together community-based health ‘shapers’ with specific experience from previous Ebola outbreaks in Uganda and DR Congo [7]. These ‘shapers’ included a mix of health professionals, community leaders, journalists, policy makers, religious leaders, and traditional healers, who influence the narrative of infectious disease management, risk communication, and community outreach in their local and national environments. A series of two-day training programmes to be held in different countries was designed for these ‘shapers’. They worked in facilitated small interactive groups using analytical matrix tools to elicit and capture insights on the underlying assumptions, perceptions, and beliefs of infection control management in their communities and countries and identify ways to shift the agenda and narrative to a more people-centred and community-based health paradigm.

The IPP analytic matrix tool was built on five action principles that were identified in a scoping meeting (in Dar es Salaam, Tanzania; 1–2 September 2014), with selected ‘shapers’ from Eastern and Central Africa with firsthand experience during Ebola outbreaks [7]:

• Community—work with communities, not against them;
• Communication—listen and gain insights into community assets and needs; develop respectful, culturally sensitive, two-directional risk-communication and awareness-raising approaches;
• Capacity building—build the capacity of local community leaders and local healthcare workers (lHCWs) in case detection and management;
• Coordination—build local multi-stakeholder networks, which coproduce action plans modifying/adapting a generic response plan for their specific Ebola preparedness contexts; and
• Culture—understand it as a key driver of community resilience and as a potential enabling or limiting factor to infection control.

Building on these principles, the IPP workshops were organised around a series of key questions:

1. Risk communication and risk management
   • Risk management—what specific considerations need to be taken on the local community level for infectious disease management in small-, medium-, and large-scale outbreaks?
   • Risk communication—how can we frame/shape/broaden communication to reflect different conceptions and perceptions of risks and respect the cultural drivers of communities?
   • How can we ensure that risk communication is not only about ‘giving health messages’ but also includes listening to and understanding local concepts and beliefs and works towards building relationships with communities to create supportive environments where people build their skills and make good decisions?
2. Infection control
   • What are the specific infection-control training needs at different levels of the community (e.g., healthcare workers [HCWs] on sub-district and district levels)? How can coordination with international organisations best be organised?
3. Collaboration
   • How can we strengthen generic response plans that build on existing infrastructures?
   • How can we encourage networking that effectively and efficiently shares information and expertise and develops sustainable collaborations between stakeholders?

This article reports on the outcomes of the first IPP held as a pilot training in Kampala.

Results: Pilot training IPP Kampala

The pilot training in Uganda, Kampala (25–26 November 2014), resulted in a series of practical action insights and recommendations on ways to frame and promote the use of community-based outbreak response to bolster current approaches to infectious disease management and recovery on all levels. Findings are presented here as key recommendations and short video narratives by participants explaining the points made. The training was attended by participants from Uganda, Burundi, Zambia, Mali, DR Congo, Kenya, Zimbabwe, Ghana, and Tanzania.

Training workshop insights, recommendations, and video narratives

Conclusion

Participants suggested a much broader and more creative approach to response management and recovery. They engaged in socioeconomic and political thinking about ownership, confidence, and independence that could support both the short-term crisis management and longer-term resilience and capacity building in the region. They called for a Kampala manifesto that shifts power to the people and promotes a community-based One Health approach.