Ebola one year on: Hearts and homes were key to breakthrough said Oxfam

The over emphasis on an almost exclusive medical approach at the start of the Ebola crisis hampered progress against the disease, according to Oxfam. The international agency said governments and aid agencies, including Oxfam, got the balance wrong in the early stages of the Ebola response and should have devoted more effort to community engagement work.

Marking the first anniversary of the outbreak, Oxfam said that technical solutions – more beds, more medical workers, more medicines - while vital were never going to be enough to tackle the outbreak. The agency stressed that both treatment and prevention of the disease were of equal need and should work hand in hand.

Sue Turrell, Head of Oxfam’s Ebola response said: “We are still a long way from getting to zero cases, but the direction of travel is positive and we cannot take the foot off the accelerator. This progress could not have happened without the remarkably brave medical effort, but what has happened in the hearts and homes of people at risk of Ebola has been equally crucial. Once people were fully involved, understood what they had to do to remain safe and were helped to do the things that they knew would work, the tide began to turn against Ebola. If a greater emphasis in community engagement had happened much earlier it is more than likely that many fewer lives would have been lost.

“Given that this was an unprecedented crisis it is not surprising those involved in the aid effort learnt as they went along. At Oxfam we struggled in the early part of the crisis to try to balance the need to protect our staff and deliver what people needed, and we had to adapt our work rapidly to help make a difference.”

Ebola upended the most intimate aspects of everyday life: how people treat their families, their neighbours, their sexual partners, their dead, and their own bodies. To convince people to fundamentally change their ways of dealing with these intimate issues and understand the disease, an understanding, compassionate approach was vital.

The international agency said that in general the emphasis on community engagement and ‘buy-in’ has now been recognized as a crucial part of the Ebola response by governments and aid agencies. Without community acceptance aspects of the fight against Ebola, such as treatment, safe burials, contact tracing, are difficult to carry out and be effective.

Oxfam carried out an anthropological study late last year which suggested that negative perceptions and fear of Ebola response efforts contributed to non-compliance and resistance in some areas. Based on formal and informal interviews, focus group discussions, site visits, and participant observation, this enquiry found that in Liberia people’s early experiences with the Ebola response created distrust of government agencies, a fear of outsiders and ambulances and medical facilities all which led to a reliance on self-treatment for illnesses.

The agency said that the challenge of getting to zero Ebola cases will not be easy and will require governments and agencies to give priority to community engagement and coordination right down to the district level. It will also require keeping the capacity to treat people in place until we reach zero Ebola cases.

Looking forward Oxfam said the community networks that have been developed in the Ebola response have laid the foundation to tackle other health and social issues from cholera and malaria to female genital mutilation once Ebola has been beaten. The agency hoped that the community involvement will also lead to communities participating in decisions and planning around the recovery needs, in local governance and in the decisions that affect their lives.