OP-ED: Regaining the People’s Trust in the Health System: What Will It Take?

Community engagement helped turn the tide of Ebola, and will be critical in combatting this latest outbreak. But there’s a broader lesson here. If we are to prevent future epidemics, communities need to remain actively engaged in efforts to strengthen the health sector.

This is not to say we don’t also need to look at quality. We do. We need more trained health workers and doctors. We need more clinics in very remote areas. We need better water infrastructure and latrines.

All of these things are critical for health gains, just as treatment centers and medical staff on the ground were fundamental to the Ebola response. But success will only be achieved if we also take the time to strengthen relationships at the community level, which means improving communications with clinics and health personnel.

When Ebola first came to Liberia, people resisted the information they received from the health community. Many denied the existence of Ebola or thought it was a plot or a curse. Had a trusting relationship with communities existed, it would have been much easier to share crucial prevention messages, which could have saved thousands of lives.

This is why, through the second phase of the Ebola Community Action Platform, also known as ECAP 2, Mercy Corps and its partners, including the Ministry of Health, have focused on training and mentoring local Community Health Committees.

In addition to doing health campaigns, these groups meet regularly with clinic staff and health workers and provide feedback from the community. Their role is to strengthen accountability while also building local ownership, dialogue, and demand for viable health services.

We have seen very promising results. Communities report significant increases in usage of clinics – in some areas, visitations have doubled. Mothers are visiting hospitals to get vaccinations for their children, often for the first time, and pregnant women are getting the check-ups they need to protect against early death and ill health.

Beyond uptake of such behaviors, communities also report that they now feel they can take charge of their health. This means they are mobilizing to take action on health issues and feel more confident to handle outbreaks of infectious disease.

From my experience with Mercy Corps, I have seen how resourceful communities can be. This is not surprising. Communities themselves are best placed to identify the issues that impact their lives, and many come up with innovative solutions to the problems they face.

Working with the clinics, some are helping to develop maternal waiting rooms so that expectant mothers who live far from the hospital can have a safe delivery; others are tackling open defecation, or leading clean-up campaigns to protect against Lassa Fever and other devastating diseases.

This is why I hope that health players will ensure there is sustained involvement from communities when delivering programs, selecting and training health workers, or developing policies.

In addition to Community Health Committees, partnerships with local NGOs and community radio can help make this happen. They have connections with communities, they speak the same languages, they are embedded in the communities they serve. This was a key lesson from Ebola but it should not end there.

To protect Liberia against future epidemics, it will be necessary to improve both quality and accountability to truly restore people’s confidence in their health services. This is imperative. Rebuilding trust in Liberia’s health system will help ensure that it is used when the country needs it most.

What do you think? What steps are necessary to rebuild trust in the health system?

About the author

Laura Keenan

Laura manages Communications on the Ebola Community Action Platform (ECAP). Led by Mercy Corps and funded by USAID, ECAP is a network of NGOs and media outlets which was established in 2014 as part of the Ebola response. Currently, ECAP is working with 1600 communities to strengthen Community Health Committees and running campaigns to prevent Ebola and other infectious diseases.