The social response to Ebola in DRC: Five recommendations for successful community engagement in emergencies

What could drive a vulnerable community to oppose efforts to stop an epidemic that had a 60% fatality rate?

Under certain complex circumstances, this perplexing reaction may not be as illogical as it seems at first. When the large outbreak of the Ebola virus disease was declared in eastern DRC in August 2018, the government mobilized quickly with support from humanitarian agencies to contain the epidemic amidst other, existing challenges. The region has been subjected to protracted military conflict since the 1990s, and dozens of armed groups remain active. Yet parts of local communities turned against the response  and more than 450 acts of violence or threats against health workers were reported over the course of the outbreak. Overall, a sentiment of distrust of the externally-funded Ebola response prevailed. This dynamic merited examination so it could be avoided, or at least minimized, in the future.

Looking at community resistance from a human rights angle

Leveraging a grant from the Human Rights, Inclusion and Empowerment trust fund at the World Bank, we analyzed the way people’s rights were affected during the response to the epidemic. The work drew on existing data and was complemented by consultations with local community members, civil society, journalists, and government officials. The research helped identify several human rights deficits that contributed to community resistance.

First, the heavily biomedical approach, which centered on containing the virus, effectively sidelined other community grievances about insecurity, living conditions, and other endemic diseases. Second, restrictions of movement, local inflation caused by the influx of outside actors, and additional hygiene and sanitation requirements further reduced people’s purchasing power. Third, the coordination between health workers, security forces, and local armed militias—while deemed necessary for safety reasons—was not always well-perceived by local communities.

As such, the response often failed to fully include local communities in important decisions and in addressing their priorities and grievances. The top-down communication approach did not offer sufficient opportunities for people to seek information, ask questions, or share concerns. Progressively, parts of the population started to perceive not just the virus, but also the response to the outbreak, as interfering with their rights, which likely contributed to the community resistance . 

Restoring trust through social protection 

Starting in April 2019, the World Bank supported the DRC government to roll out a new cash-for-work program to provide temporary jobs in Ebola-affected zones while also improving social infrastructures under the Eastern Recovery Project, or STEP. By generating quick and visible results, the intervention helped improve trust and acceptance for external actors, including those involved in the Ebola response and immunization efforts. The government also adjusted its strategic response plan to place a higher focus on community engagement, which eventually helped contain the epidemic.  

What lessons can we learn from the 2018-2020 Ebola epidemic in DRC? One key take-away is that placing community rights at the center of interventions is essential to achieving desired results. Here are five key recommendations for development practitioners to better integrate human rights in engagements in fragile and emergency contexts:

1. Ensuring transparency and access to information about the “whys” and “hows” of interventions is a prerequisite for successful community engagement . Strategies should include an analysis of appropriate communication channels; ongoing community-level activities to share information, explain, and raise awareness; and transparency mechanisms in the targeting and use of resources. For instance, to dispel perceptions of corruption and elite capture, participants in the STEP project’s ongoing cash-for-work program are selected through a public lottery that anyone can join. 
2. Encouraging the active and meaningful participation of local communities through open consultations, interactive information campaigns, and community-led oversight committees can help ensure that people are aware of their rights and can claim them. It also helps make sure that those rights and concerns are better integrated into program design and implementation. To build local governance capacity, the STEP project has encouraged the establishment of local development committees responsible for community outreach and infrastructure planning.
    
3. Ensuring access to independent grievance mechanisms and upholding accountability of duty-bearers is equally important to build trust , i.e. ensuring that tools are accessible to log complaints when rights are violated and that those responsible for these violations are prosecuted. To date, the STEP project has instituted over 370 grievance management committees, with special attention to gender-based violence.   
4. Promoting equality and non-discrimination through specific measures accounting for the differentiated experiences of vulnerable groups is also critical . This starts with a detailed vulnerability analysis to understand their risk profiles. From there, the intervention can be adjusted to appropriately protect the rights of these groups. For instance, when a person with disabilities or a senior citizen is selected in the STEP project lottery, the work is waived or adapted to their specific situation without impacting the level of benefits.   
5. Finally, in particularly fragile and conflict-affected contexts, there is a need to transition from a short-term emergency response to longer-term development strategies that ensure continuity and sustainability of programs that protect and promote human rights. To this end, the World Bank leveraged the STEP project to promote policy dialogue and partnerships in DRC towards the development of a nationwide social safety net system. 

Ultimately, a human rights-based approach to development implies a change of paradigm. Interventions are being designed to support individuals’ rights, not only needs. Communities are not passive beneficiaries, but active agents of their own development . Speed, scale, and results remain important, but must be achieved through a legally grounded, transparent, and inclusive process. When the next crisis hits, let us prioritize rights for the benefit of all.