Understanding the role of community resilience in addressing the Ebola virus disease epidemic in Liberia: a qualitative study (community resilience in Liberia)

Abstract

Background: There is an increasing recognition that community resilience plays a significant role in addressing health shocks like the Ebola virus disease (EVD) epidemic. However, the factors that constitute community resilience, and how these operate dynamically with other health system factors are less understood. Objective: This paper seeks to understand key factors that constitute community resilience and their role in responding to the EVD outbreak in Liberia. Methods: Key informant interviews were conducted between November 2017 and April 2018 with community representatives in Bomi, Margibi and Montserrado counties, and other national stakeholders involved in the EVD response in Liberia from 2014 to 2016. A national stakeholder meeting was conducted to verify and interpret information emerging from the interviews. Results: Factors that were critical for addressing the EVD epidemic in Liberia were identified as: strong leadership, tight bonds and sense of kinship at the community level; trusted communication channels; and trust among various health system stakeholders. These factors facilitated collective actions within communities and helped to direct response initiatives from other levels of the health system to the community. Foreign assistance was seen as crucial for recovery and revitalization of affected communities. However, such aid is often not targeted at addressing critical challenges in a sustainable way, especially when the assistance is highly restricted to specific activities, and those activities are determined without consultation with local actors and community groups. Conclusion: Efforts to systematically build responsible leadership and social capital at community level, including those that strengthen bonds in communities and trust across key actors in the health system, are needed to address health shocks like EVD outbreaks. Without building such capabilities in community resilience, it will be difficult to reap the expected gains from investments focusing on building physical capital and technical capabilities in health services and emergency preparedness.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

“…General practitioners and other health professionals are also important stakeholders as the public often trust information received from health professionals over that received through public health campaigns ( 6 ) or other community sources ( 51 ). The government, particularly those government officials involved in disseminating public health advice, are also vital stakeholders given the way in which trust might be built or eroded depending on the conduct of these communicators ( 52 ). Governments and public health officials produce pandemic response plans which guide government action and communication to the public.…”

“…During pandemics, responsibility for management falls to government working in consort with public health officials and the health professions. Within the pandemic-trust literature, this has contributed to a focus on trust in government ( 42 , 50 , 51 ), healthcare industry ( 42 ), public health organizations ( 6 , 42 , 54 , 55 ), communicators of public health messages ( 22 , 52 , 56 ), and the communicated messages themselves ( 57 ). Effective pandemic management has been associated with “agreed communication strategies, [a] clear division of responsibilities” and agreed policy guidelines (35, p. 21).…”

Can neighborhoods protect residents from mental distress during the COVID-19 pandemic? Evidence from Wuhan

“…They may also indirectly boost psychological well-being by offering a buffer against the adverse consequences of individual or contextual stress (Diez Roux and Mair 2010; Liu et al 2017). Previous studies have revealed that neighborhoods with more developed social infrastructure are more resilient to disasters, such as earthquakes, hurricanes, extreme weather, and the Ebola epidemic, because they preserve a higher level of cooperation, trust, and mutual support (Alirol et al 2011;Alonge et al 2019;Klinenberg 2018;Norris et al 2008). Scholars have also observed that strong neighborhood governance, civic participation, trust in institutions, willingness to follow the government's advice and instructions, can influence how COVID-19 epidemic unfolds in a neighborhood (Djalante, Shaw, and DeWit 2020;Hynes et al 2020;Wu 2020).…”

“…A study in Hubei province revealed that trust in government increased public acceptance of and compliance with control measures during COVID-19 pandemic (Wu 2020). Maintaining a positive outlook can, in turn, promote residents' mental health (Alonge et al 2019).…”

A Holistic-Comprehensive Approach: Best Practices to Improve Health Policy for COVID-19 Pandemic

“…The surveillance system is a priority during the outbreak 10 Sepers, et al, 34 (2018) Participatory study Needs a comprehensive monitoring and evaluation system 11 Alonge, et al, 18 (2019) Interviews with stakeholders Leadership, social bonding, trusted information, social trust affected community resilience during the outbreak 12 Rabelo, et al, 28 (2016) Focus group discussions Feeling worried, lack of respect, motivation, hope, isolated 13 Siu, et al, 30 (2016) Phenomenology Sociocultural factors using personal protective equipment 14 Respati, et al, 14 16,17 To achieve a holistic-comprehensive goal of community planning, thus discussions among the local government and stakeholders are needed in the first weeks of the pandemic. 18 A holistic-comprehensive surveillance system helps health professionals and policymakers to better understand the pandemic disease and develop public health policy for preventing the spread of infectious disease and promoting health behaviors. Information on the COVID-19 collected should include sufficient information on the current state of pandemic disease and the epidemiology of the infectious disease.…”