Designing Ebola responses: 5 key lessons

19 February 2021

Recent Ebola outbreaks remind us that COVID-19 is not the only epidemic that countries around the world currently face. It is now timely to consider what lessons from previous Ebola epidemics can be useful for responding to the recurrence of that disease in both DRC and Guinea today.

ALNAP recently published a Lessons Paper that synthesises existing evidence about responses to previous Ebola epidemics in DRC and West Africa, with 18 concrete lessons aiming to help humanitarian staff who design and implement programmes. Here we highlight five important factors that should be incorporated into the design of future responses:

1. Appropriate resources, wages and psychological support to healthcare workers

Photo credit: EU ECHO

In addition to members of the community in which an outbreak occurs, health workers and volunteers are on the front line of an Ebola response. Ebola is contracted through contact with infected bodily fluids; health workers caring for patients and handling infected bodies regularly risk that contact occurring.

In previous responses, a lack of protective equipment and adequate training put health workers and volunteers at risk and led to fatalities among responders. As well as physical risks, the long hours, insufficient living conditions and loss of life can place a high psychological burden on health staff. Adequate living conditions to allow for rest and psychosocial support are required to support staff as individuals with personal needs. Their pay should also adequately reflect their value and the hazards they face.

2. Trained and specialised teams for safe burials adapted to cultural and emotional needs

Alongside attempts to stem the spread of the disease, communities need to mourn and say goodbye to the people they love. Contact with the bodies of people who have died from Ebola can present risk of infection, which means the bodies need to be buried safely by specialised teams trained to maintain good practice in body management.

There are ways of adapting these safe processes to provide dignity to the deceased and acknowledge cultural traditions; discussing burial processes with cultural leaders and family members is important. Taking the dignity of the diseased into account, while protecting the safety of the living, can also help to create acceptance of Ebola responders in communities and support broader efforts to contain the disease.

Photo credit: EU ECHO

3. Epidemic surveillance and case detection efforts based on local contexts and community involvement

Communities are essential components of an effective early warning system to enable a swift response and stop an outbreak taking hold. They understand the different individuals who are more likely to come in contact with potential sources of infection (for example, they can identify local networks of traders when infections are linked to markets) and they know the idioms and language used locally that hint at an infection occurring. In addition to having that knowledge, trained local actors may also be better accepted than outside actors. Outside efforts to help should try to understand and support these existing information systems and networks.

4. The political, sociological and economic context in which an outbreak occurs

The environment in which an Ebola outbreak occurs will likely have an impact upon the way any response is received by populations and its ultimate success. For example, a community’s previous experiences with the government or the military may affect people’s willingness to follow government messages, their tolerance for outside influence or their perception of health centres built or supported by the military.
It is also important to recognise that in places where people have seen much political and economic upheaval in recent years, a focus on tackling Ebola may cause frustration among individuals who prioritise other important socio-economic needs.

Photo credit: UN Photo

5. The needs of Ebola survivors

The effects on survivors of the disease are multi-faceted. Survivors can experience longer-term physical problems that require care. The experience of the disease itself, losing loved ones and societal stigma surrounding survivors can be traumatic for individuals and communities. Stigma can also affect the livelihood potential for survivors, which can compound the previous loss of income during sickness and quarantine measures. These challenges necessitate longer-term solutions; ongoing healthcare, psychological and economic support for survivors may be required.

Several of the paper’s other lessons contribute learning under the key themes of community engagement and ownership of responses, the multi-faceted nature of Ebola’s impacts on populations, the need for strong coordination, and the importance of early action. Those lessons remain vital considerations for future Ebola responses, in addition to being transferable to the COVID-19 response as summarised in this useful ODI blog last year.

Producers of humanitarian learning products face a paradox: we want our products to be useful, but we also hope that nobody actually needs to use them because future crises fail to emerge. Sadly, the new Ebola cases reported in DRC and Guinea make the publication of our recent Lessons Paper all too timely. Important lessons about health care, burial practices, community engagement, political contexts and the needs of survivors have all been learned from previous responses. That learning should be used to strengthen responses to the current outbreaks.