Social Mobilization Lessons Learned: The Ebola Response in Liberia

Evaluation and Lessons Learned
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Overview of Response

In March 2014, Liberia was in the process of rebuilding its health system after decades of civil war—which had significantly damaged both the infrastructure and the population’s trust in the government—when the first Ebola Virus Disease (Ebola) case was identified in Lofa County. During the next year and a half, more than 10,670 people in the country would become infected, and more than 4,800 of them would die from the disease.

During the first few weeks of the outbreak, the Government of Liberia (GOL), the Ministry of Health and Social Welfare—now the Ministry of Health (MOH)—and supporting and implementing partners on the ground hoped to manage and isolate the infections, but it soon became clear that a biomedical response alone would not be enough to turn the tide of the epidemic. Methods such as patient isolation, contact tracing, infection control, case management, safe burials, social mobilization, and community engagement were quickly recognized as the keys to preventing Ebola transmission. In particular, social mobilization activities that engaged communities and their leaders became critical to increasing Ebola awareness, changing unsafe health-related behaviors, and addressing stigma.

From July 2014, as the number of Ebola cases increased, outreach efforts expanded, and more partners and donors became involved, the MOH response structure also changed in order to better organize and manage the coordination of all partners contributing to the Ebola response. The new incident management system (IMS) included six technical working groups/pillars—case management, contact tracing, safe burials, surveillance, laboratory, and social mobilization—and clearly defined the lines of authority and accountability within the system. By the end of the year, the number of partners contributing to and the magnitude of the response was massive—for social mobilization activities alone, over 120 international, national, and local organizations, community networks, and groups collaborated with and supported the MOH.

In early 2015, as the incidence of Ebola decreased, national priorities shifted to focus on health systems strengthening, surveillance, and preparedness. At the same time, Ebola eradication strategies narrowed from a country- and county-level focus to approaches that targeted district- and community-level hot spots.

The emergence of new cases after Liberia was first declared Ebola free on May 9, 2015, tested the country’s ability to address future health crises—further underscoring the importance of infectious disease preparedness at all levels—and emphasized the need to increase the population’s trust in the health-care system and to maintain key health-seeking behaviors. Because Liberia is still at risk for recurrent Ebola infections from animal and human reservoirs, Ebola and other infectious diseases, such as measles and Lassa Fever, will likely continue to present a challenge to the region.

The impact of the disease on the country’s already weak health system was considerable. Hundreds of health workers died, trust in the health system was further diminished, and work in other key heath areas, such as maternal and child health, malaria, and HIV, suffered because of the loss of crucial staff and resources. The Ebola epidemic also revealed weaknesses in global health agency/organization response systems, from acknowledging the emergency to having the mechanisms in place to quickly respond to an evolving public health crisis in countries without strong and resilient health systems—and the importance of rebuilding health systems after such a crisis.