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Liberian Lessons from the Ebola Epidemic
The West African nation has much to teach us about how local community groups can help fight COVID-19
By Ibrahim Al-bakri Nyei
In many countries, the outbreak of the COVID-19 pandemic has exposed the fragility at all levels of “organized” and “formal” society—from state institutions to large financial firms to private producers and retailers. With this virus devouring many established institutions and overrunning response mechanisms, the last defense is often the sector widely referred to as “informal”—that is, the civil society and community organizations we all interact with daily.
This is not the first time we’ve seen this dynamic at work. During the Ebola outbreak in West Africa (mainly in Guinea, Liberia, and Sierra Leone) from 2013 to 2015, these informal organizations stepped up and delivered the most effective defense against the spread of the virus. The success of these groups offers valuable lessons to the many countries in the midst of the COVID-19 pandemic.
Rising to the challenge
When Liberia confirmed its first case of Ebola in March 2014, the government was already in the midst of a fiscal crisis, struggling to balance its budget and fund public services. Its hospitals were in a deplorable state, and the entire country of 4.5 million people had only about 150 registered medical doctors, who had very limited equipment and supplies.
In an effort to avoid panic, the government initially concealed information on the nature and severity of the virus. But this backfired. Due to the lack of transparency and credibility on the number of confirmed infections, Liberians were confused and anxious, and people felt vulnerable. Before the epidemic reached its peak in July, it became apparent that the government alone would not be able to contain the spread of the virus, let alone eradicate it. The Liberian government turned to the international community with a cri de coeur (an impassioned plea) for assistance.
But before the government and international organizations could rouse their respective bureaucracies, local community groups had already mobilized. These groups—mostly neighborhood associations and women’s and youth clubs—organized young volunteers into task forces and specialized working groups on sanitation, information dissemination, and contact tracing. The volunteers spread messages and posters about prevention, Ebola’s symptoms, and treatment options. It was through these organizations that the majority of Liberians learned the nature of the epidemic and the required safety measures to stop it, such as regular hand-washing, quarantining, and social distancing.
To facilitate regular hand-washing, community organizations installed hand-washing buckets (customized with faucets) at strategic locations and urged their installation at the entrances of homes, shops, and public buildings. Soon, people were routinely washing their hands before entering a building, and this became such a social norm that many households retained their chlorinated hand-washing stations long after the virus was eradicated.
Community groups also enforced social distancing and quarantining. Individuals showing symptoms and bereaved family members self-quarantined and got support from the rest of the community. And with the government overwhelmed with providing care for the infected, these groups stepped in to provide essential household supplies and food to those quarantined and counseling services to survivors. Without such services, it would have been impossible for community members to isolate themselves from others when they needed to do so.
Community volunteers also maintained regular contact with health authorities, calling to their attention probable and suspected cases. But rather than stigmatizing or bullying, these community groups rose up to support those with symptoms, thereby making it easier for them to quickly report suspected and probable cases to the health authorities for further observation. This helped ambulances to locate people with symptoms and provide them with the needed care at treatment centers.
These measures resulted in a dramatic decline in human-to-human transmission of the virus in Liberian communities. Experts had initially predicted a grim picture for Liberia and its neighbors, and had suggested, based on models, that there would be 113,000 cases and 67,000 deaths in Liberia’s capital of Monrovia alone. But by the end of the epidemic, there were far fewer—10,678 infected and 4,810 deaths—in the entire country. Ultimately, Liberia became the first affected country to be declared free of the virus in May 2015. This was due in part to the productive partnership between the government and local, self-organizing community organizations.
According to evidence so far, COVID-19 has a much lower fatality rate than Ebola. But they are both very contagious and can be transmitted mainly through contact with fluids from an infected person. As a result, the prevention protocols and social mobilization strategies that proved effective in Liberia can be useful in the fight against the spread of COVID-19.
The first lesson we can learn from the Liberian experience is that government agencies, nonprofits, and private enterprise must partner with community networks. The success of such partnerships, however, will depend above all on transparency and the flow of credible information from government agencies to community organizations, and by extension, the public. For local organizations, in turn, to be trusted by the people they serve, the information these groups give out must be accurate. Failure to deliver the truth will erode trust and complicate the collective response.
Second, public agencies must delegate authority and responsibility to community groups. Top-down central planning cannot quickly or effectively respond to a rapidly spreading epidemic. Instead, government agencies must delegate some services to local organizations that have demonstrated self-organizing capabilities and competency in delivering services. This will reduce red tape and make it easier for individuals to access the specific services they need in time—such as getting appropriate information, monitoring while in quarantine, and accessing healthcare, psychosocial counselling, and food and basic supplies.
Already, many “informal” organizations across the world are doing incredible things to assist people during what is now a global lockdown. For example, when the UK government announced a partial lockdown, people organized local community aid groups to support the elderly and those who were vulnerable by doing their shopping and collecting essential medicines. By mid-March 720 such local support groups had been set up across the country.
Weeks before Sierra Leone confirmed its first case of COVID-19 on March 31, traditional leaders in rural areas like Koinadugu, after hearing of the outbreak in neighboring Guinea, had already begun working with the local clinic to educate residents on preventive methods and symptoms of the disease. In Syria, days before the beleaguered government announced a nationwide quarantine, community organizations led a mass distribution of hand sanitizer and translated COVID-19 manuals into Arabic for local distribution.
Finally, local organizations will need to be given the appropriate resources and tools to respond to this pandemic. Without adequate financial and material resources, the potential for these groups to serve local populations will be limited. Governments, corporations, and the bigger nonprofits must therefore help strengthen the delivery capacity of community-based organizations if they are to mobilize and support the epidemic response in their neighborhoods.
As the success in Liberia shows, these steps can help ensure that community organizations everywhere play a constructive role in fighting COVID-19. In this time of pandemic, when all of society’s resources must be brought to bear, governments must engage and work with community groups as full-fledged partners in the fight.