Lack of Cultural Competency in International Aid Responses: The Ebola Outbreak in Liberia

Abstract

A cornerstone of effective disaster management is that response should always begin and end at the local level (1). The response to the Ebola virus disease (EVD) outbreak in Liberia, West Africa, was a combination of independent efforts by many nations and organizations. Many of these independent efforts ignored or were not able to work with the local levels of emergency management in Liberia. This oversight occurred because of the Liberian’s mistrust of both their government and foreign aid groups, as well as the lack of cultural competency demonstrated by the aid groups. The health-care and emergency management infrastructure in Liberia appeared to be non-existent at the beginning of the EVD outbreak. However, there were resources available at the community level: the Liberians and their culture. Although these resources were rarely used, there were some instances in which communities were included in response efforts. It was in these instances that possible improvements to international disaster response protocol were found.

Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia

“…Although utilisation of these services has improved in most developing countries [ 2 ], disparities in coverage of maternal health services have continued, with the most rural areas recording lowest coverage [ 3 ]. Similar to most developing countries [ 4 , 5 ], deficiencies in the use of key maternal services in Zambia persist, with the poorest and most remote communities being least likely to benefit from these services [ 6 ]. In these communities, utilisation of key maternal health services is very low, much lower than the national estimates [ 6 , 7 ].…”

“…Similar to most developing countries [ 4 , 5 ], deficiencies in the use of key maternal services in Zambia persist, with the poorest and most remote communities being least likely to benefit from these services [ 6 ]. In these communities, utilisation of key maternal health services is very low, much lower than the national estimates [ 6 , 7 ]. For instance, in a recent study in selected remote areas, utilisation coverage for focused ANC, SBA and PNC within 48 hours were 30%, 37%, and 28% respectively [ 6 ], compared to 56%, 89%, and 81% for ANC, SBA and PNC respectively in urban areas [ 1 ].…”

“…In these communities, utilisation of key maternal health services is very low, much lower than the national estimates [ 6 , 7 ]. For instance, in a recent study in selected remote areas, utilisation coverage for focused ANC, SBA and PNC within 48 hours were 30%, 37%, and 28% respectively [ 6 ], compared to 56%, 89%, and 81% for ANC, SBA and PNC respectively in urban areas [ 1 ].…”

“…Structural factors such as distance to the health facilities [ 8 ], cultural beliefs, income [ 9 ], mother’s livelihoods [ 6 ], and health system factors such as inadequate numbers and distribution of skilled health workers and poor quality of services [ 10 ], have been associated with poor coverage of maternal and neonatal health services in rural and remote areas. The human resources for health crisis in most developing countries, including Zambia, pose a significant challenge to the achievement of universal health coverage and the Sustainable Development Goals.…”

Quality improvement of health systems in an epidemic context: A framework based on lessons from the Ebola virus disease outbreak in West Africa

“…Finally, important obstacles were identified related to cultural aspects and community engagement . Burial traditions where relatives and friends are to wash, touch, or even kiss the deceased, distrust of population towards health services and politics, lack of solidarity among neighbors in urban areas, and reluctancy to report cases seriously hampered the epidemic control . An extreme case occurred in a remote area of Guinea at the beginning of the outbreak where eight officials and journalists were killed by a mob due to fear and distrust of the local population .…”