Evaluation of community-based Ebola control interventions in the Democratic Republic of Congo

What did the study set out to achieve?

The study aimed to describe and evaluate the epidemiological and decision-making impact of two community-based interventions implemented by the International Federation of Red Cross and Red Crescent Societies (IFRC) to control Ebola in DRC. These are i) a system to collect and analyse community feedback on the epidemic and the response and ii) the Safe and Dignified Burials (SDB) programme.

The study analysed the evolution of community perceptions regarding Ebola and the response, and explored how community feedback informed the response. The study sought to identify factors associated with negative community perceptions in the EVD response, identified as key factors in the current EVD epidemic and provide actionable insights for the current and future outbreaks.

An evaluation the intervention fidelity and performance of the SDB intervention was also conducted, to estimate its effect on EVD transmission.

What were the key findings?

Key findings on community feedback mechanism were:

• The Red Cross’ community feedback data was a new qualitative data stream in the DRC Ebola response and was in competition with many other forms of (largely quantitative) evidence.
• Decision makers were largely quantitatively trained. Qualitative feedback data had to be presented in a way that was more palatable to this audience.
• “Evidentiary inertia” was a feature of the response. This meant even when there was a need to change practice, the size and scale of the response made it difficult to change course within a reasonable time frame.
• Decision makers were more willing to adapt response policy and practice when they understood that responding to community feedback could build community acceptance and enable responders to complete their work. Involving the decision makers in developing recommendations from the feedback helped facilitate this understanding.

What does this mean for policy makers and practitioners?

Since listening to views of communities affected by crisis is a core humanitarian principle, and can facilitate improved outbreak response, future outbreak
responses should include community feedback systems like that of the Red Cross. However, the scale of those systems should be commensurate with the severity of the outbreak and resources available.

Policy makers in outbreak response should consider how to integrate community feedback into the response from the onset of the crisis. Recommendations should be tracked, from that feedback, through to policy implementation.

Where multiple organisations have community feedback systems, these should be complementary. Data should be triangulated and cross-analysed to create coherent recommendations, considering challenges faced by policymakers to absorb evidence during outbreak response, particularly qualitative evidence.

Trialing different approaches to the presentation of community feedback data for various audiences (including those qualitatively trained) can help develop templates which can be used in future outbreaks. Outbreak leadership could also be trained in qualitative (as well as quantitative) sources of evidence, so that they can capitalize on all data streams.