Lawrence Sao Babawo, School of Community Health Sciences in the Department of Nursing, Njala University, described the experience from Ebola where the initial response was heavily led by the top tiers of government but later found success when local leaders were brought in as partners to work on a solution.
According to Babawo, there was a lack of trust in the Ebola response due to several factors:
- Ebola virus disease was new to the area
- People's limited understanding of the disease
- Mixed messaging with too many different definitions being issued
“We also want to look at the trust and the engagement as far as the government was concerned. Did the people trust the government? No, they didn’t. Because there was a very narrow kind of understanding between what the government was doing and what the governance of health system was all about.”
“So, because the community were not engaged, were not involved in this system, we came to realize that a lot of social mobilization messaging [was] distorted, and people would give their own interpretation about what the messages were. And therefore, it did not feel like the right decisions or the right effect that it was supposed to create.”
“One of those things that was done to [remove] distrust in the people was that there was [a] new communication strategy that involved the people themselves.”
“The lessons learned from the Ebola outbreak actually helped a lot in the COVID pandemic response in Sierra Leone…. Once the government heard that there's the pandemic, all the pillars and people were put into strategic positions, specialists, medical people were put into strategic position. So that once the pandemic arrived in Sierra Leone, we are in a better position when you compare it to the Ebola outbreak.”
Guillermo Sequera, Ministry of Public Health and Social Welfare, Paraguay, described examples of community self-organization, the issue of equity and its different aspects, and grassroot efforts to address engagement.
“In this country, and the same applies to other Latin American countries, health policies are highly centralized. They’re in the hands of the government…. Communities really do not get involved in a critical sense. Civil society really isn’t involved in defining priorities or establishing policy, financial control, or provision of service either.”
However, Sequera described the positive outcome of Paraguayan community-led efforts that included “polladas”—which raised money and gathered resources—to support individuals in need during the pandemic. Community organizations, such as the Protestant and Catholic church, were also influential in increasing community trust.
“Here, it’s not only that we all see the population as a beneficiary of our measures. No, it is important that we realize that the community controls what we do. Without that perspective, I don’t see possibilities for reform. And the pandemic has been a time of reform of the health care system here in Paraguay and that would have been unthinkable without participation of our citizenry.”