Kampala manifesto: Building community-based One Health approaches to disease surveillance and response-The Ebola Legacy-Lessons from a peer-led capacity-building initiative
International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based heal...
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| Published in: | PLoS neglected tropical diseases Vol. 12; no. 4; p. e0006292 |
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| Abstract | International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate.
The Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. |
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| AbstractList | Overview International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate. Background The Ebola outbreak in West Africa, 2014–2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing ‘evidence-based’ solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate. The Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. OVERVIEWInternational activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate.BACKGROUNDThe Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate.The Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. Overview The Ebola outbreak in West Africa, 2014-2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing 'evidence-based' solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. Overview International activities to respond to the Ebola crisis in West Africa were mainly developed and focussed around the biomedical paradigm of Western health systems. This approach was often insensitive to societal perception, attitude, and behavioural determinants and clashed with community-based health traditions, narratives, and roles, e.g., of community health workers. In this peer-led capacity-building initiative, these deficiencies were identified and analysed. Innovative, more locally focussed, community-based solutions were articulated. The new approaches described put local people at the centre of all preparedness, response, and recovery strategies. This paradigm shift reframed the role of communities from victims to active managers of their response and reacknowledged the strength of community-based One Health. We conclude that strategies should aim at empowering, not just engaging, communities. Communities can improve short-term crisis management and build longer-term resilience and capacities that are much needed in the current global health climate. Background The Ebola outbreak in West Africa, 2014–2016, was unprecedented in scale, extent, and duration. The international community was slow to step up its assistance in this global public health emergency and then faltered when its infection control management approaches clashed with West African realities [1]. Outbreak response evaluations have identified the need to better integrate social science intelligence [2], better collaborate with communities [3,4], more effectively draw on the strength of community health workers [5], and critically question the paradigm of Western health systems, which focus on imposing ‘evidence-based’ solutions that lack external validity in affected communities; i.e., they too often recommend actions that are inconsistent with, ignore, or violate traditional behaviours [6]. While there appears to be a consensus now on what needs to be done, how to achieve these goals remains a challenge. |
| Audience | Academic |
| Author | Kitua, Andrew Apfel, Franklin Lightfoot, Nigel Dickmann, Petra |
| AuthorAffiliation | 1 dickmann risk communication drc |, London, United Kingdom 6 Chatham House, Centre on Global Health Security, London, United Kingdom Institute for Disease Modeling, UNITED STATES 4 World Health Communication Associates (WHCA), Compton Bishop, United Kingdom 2 Jena University Hospital, Jena, Germany 3 Southern Africa Centre for Infectious Disease Surveillance (SACIDS), Morogoro, Tanzania 5 Connecting Organizations for Regional Disease Surveillance (CORDS), Lyon, France |
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| Author_xml | – sequence: 1 givenname: Petra orcidid: 0000-0002-3282-7614 surname: Dickmann fullname: Dickmann, Petra organization: Jena University Hospital, Jena, Germany – sequence: 2 givenname: Andrew surname: Kitua fullname: Kitua, Andrew organization: Southern Africa Centre for Infectious Disease Surveillance (SACIDS), Morogoro, Tanzania – sequence: 3 givenname: Franklin surname: Apfel fullname: Apfel, Franklin organization: World Health Communication Associates (WHCA), Compton Bishop, United Kingdom – sequence: 4 givenname: Nigel surname: Lightfoot fullname: Lightfoot, Nigel organization: Chatham House, Centre on Global Health Security, London, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29608561$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1186_s13031_023_00560_7 crossref_primary_10_1371_journal_pntd_0009246 crossref_primary_10_1007_s00103_022_03529_8 crossref_primary_10_1016_j_puhe_2023_09_007 crossref_primary_10_1371_journal_pone_0292248 crossref_primary_10_1007_s43832_024_00066_0 crossref_primary_10_1136_bmjgh_2020_002769 crossref_primary_10_1016_j_ijid_2022_11_032 crossref_primary_10_1371_journal_pstr_0000052 |
| Cites_doi | 10.1016/S0140-6736(15)60119-2 10.1016/S0140-6736(14)62479-X 10.1016/S0140-6736(15)60075-7 10.1016/S0140-6736(14)62382-5 10.3201/eid2105.142016 10.1016/S2214-109X(15)70010-0 |
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| Copyright | COPYRIGHT 2018 Public Library of Science 2018 Dickmann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2018 Dickmann et al 2018 Dickmann et al |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Dr. Petra Dickmann, MD/PhD, is managing director of dickmann risk communication drc |—an international risk communication consultancy specialising in risk communication in public health and health security—working for both private and sector. She worked under a consultancy contract to develop and carry out the Ebola Intensified Preparedness Programme that was funded by the Rockefeller Foundation. There are no conflicts of interest in regards to this publication. |
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| References | ref13 SA Abramowitz (ref2) 2015; 385 ref12 ref11 P Dickmann (ref7) 2015; 21 ref10 ref8 ref9 R Kutalek (ref4) 2015; 3 (ref5) 2017; 5 MP Kieny (ref3) 2015; 385 A Petherick (ref1) 2015; 385 C Chandler (ref6) 2015; 385 |
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| Title | Kampala manifesto: Building community-based One Health approaches to disease surveillance and response-The Ebola Legacy-Lessons from a peer-led capacity-building initiative |
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