BMJ: Ebola in Sierra Leone and DRC (2)

28 August, 2019

Thank you for sharing this discussion []. There is good reference to the origins of reluctance: colonialism, mistrust of government and habituation to disease-related deaths. It is important as well to note the published materials that discuss the use of this outbreak by non-state actors to generate tension and community mistrust, as the NSAs strive toward non-related political aims. A good part of Ebola’s success can be attributed to the ongoing violence and attacks on health facilities and workers as well as on communities.

And the proposal to pay people for accepting vaccinations is interesting, as would be the elaboration of this idea with payment or a stipend for care-seeking/accepting care. My fears in this regard are:

- If one is compensated or rewarded just for Ebola care-seeking or vaccination, would that need to trickle to all health care/services?

- If not just for Ebola, then where does the rewarding for care-seeking and care acceptance stop?

- Would it still be perceived as exploitive and as a scheme by external forces?

- Does this approach increase the community’s understanding of the dangers and of the need for care-seeking? Does it increase trust overall?

- Can the system handle the demand that compensation would generate?

Perhaps on a broader scale, it’s intriguing to imagine a world where we could, writ large, afford to pay not only all workers delivering health services by all patients seeking these services. As we are in the midst of striving to provide primary health care as a guaranteed human right in the quest for universal health coverage, imagine what happens when we have the resources to incentivise actions for healthy lives. … but also imagine the needed resources.

What are other community-focused approaches that are founded in the quest to understand community reluctance more fully?

Catherine Kane

Community Health Worker Guideline Communications & Advocacy

Human Resources for Health Policies & Standards

Health Workforce Department

World Health Organization

Avenue Appia 20, CH-1211 Geneva 27

HIFA profile: Catherine Kane is a member of the WHO Health Workforce team, responsible for advocacy and dissemination of the Guideline on health policy and system support to optimize community health worker programmes. She has experience with community health worker programmes at strategic and operational levels through WHO, the International Federation of Red Cross and Red Crescent Societies and at one point as a social worker supporting migrant communities. She is a member of the HIFA working group on CHWs. Twitter: readycat