"Communities themselves have the power and the agency to halt the spread of Ebola, and their collective actions are the heart of an effective Ebola response."
This field guide is a resource book for community mobilisers, field staff, and trainers to support planning, implementing, and following up of Community-Led Ebola Action (CLEA) social mobilisation activities developed by the Social Mobilisation Action Consortium (SMAC) throughout Sierra Leone. It is also intended for use by agencies within the Social Mobilisation Pillar of the Sierra Leone National Ebola Response Centre, led by the Ministry of Health and Sanitation (MoHS), and other agencies wishing to implement the approach in Sierra Leone and other affected countries.
The field guide provides tools and ideas to empower communities to carry out their own analysis and take their own action to become Ebola-free. The CLEA approach recognises that communities alone have the power to stop the spread of Ebola through their collective decisions and actions. "Unlike previous mobilisation efforts, which have mainly used health education and one-way communications to raise awareness among individuals, CLEA focuses on the community as a whole, and on the collective benefits of a cooperative and community-led approach. As in any society, Sierra Leonean communities will modify norms, beliefs and behaviours in response to the conditions around them. CLEA Community Mobilisers simply ignite communities to take these necessary steps."
Using detailed descriptions and examples, the resource outlines the CLEA approach, which draws on successful examples of community participation and the use of Participatory Rural Appraisal (PRA) in HIV and AIDS and other health programming. In particular, CLEA builds on the lessons and experience of over six years of Community-Led Total Sanitation (CLTS), a participatory approach to sanitation improvement that has gone to scale in Sierra Leone and is already institutionalised within the MoHS national approach (see Related Summaries, below). CLEA starts by enabling people to do their own appraisal and analysis of the Ebola outbreak, its current effects, and the likely future impacts if no action is taken. This helps to create a sense of urgency and a desire to develop a community action plan. Communities themselves decide how they will protect families, ensure safe and dignified burials, respond to sick people, utilise available health services, and create a supportive stigma-free environment for Survivors, vulnerable children, and others directly affected by the disease. The significant change in mindsets and attitudes required on the part of frontline mobilisers and others are summarised in Table 1. "When CLEA works well, it should:
- Be based on collective community decision-making and action by all;
- Be driven by a sense of collective achievement and motivations that are internal to communities, not by coercive pressure or external payments;
- Engage women, men, youth and children in time-bound specific activities that will result in Ebola-free communities;
- Lead to emergence of new Community Champions and/or new commitment of existing leaders;
- Generate diverse local actions and innovations that support protection of communities, safe and dignified medical burials, utilization of health services, and stigma-free environments;
- Build on traditional social practices of community cooperation and create new local examples that can be shared with other communities;
- Focus on and celebrate community-wide outcomes, such as number of safe burials; number of early-reported cases; and Ebola Action Plans and community committees in place;
- Gain momentum and scales up to Ebola-free sections, chiefdoms and districts as communities gain confidence and other pillars of the Ebola Response improve;
- Recognise the rights of communities to proper, appropriate, free services as outlined by the Government of Sierra Leone;
- Rely on clear, accurate two-way information flow that builds trust and positive feedback-loops between communities and health authorities."
The resource outlines key attitudes and behaviours on the part of community mobilisers, followed by a description of the steps in the CLEA approach: (i) preparation - identifying and mapping communities, gaining permission to enter communities, and planning triggering events; (ii) triggering - entering communities and building rapport, facilitating participatory analysis, and supporting community action planning (e.g., which may involve nurturing community champions and/or forming a community board) if communities decide to make a plan; and (iii) follow-up - supporting and encouraging communities to implement their action plans, and sharing up-to-date information about available health services. Each of the subsequent chapters in the field guide explores the steps in detail, with concrete actions to take, role play examples, and many specific communication tips - e.g., "Emphasize questions that try to get people to empathize with Survivors – can they imagine if that was them or their families? If done well, and in a participatory style, this can be a powerful moment of self-reflection and emotion. Allow this to happen, and don't shy away from high emotion if people do feel ready to talk about this pain and suffering."
The field guide is not intended as a blueprint and should be adapted if needed. It is intended that community mobilisers using the Field Guide should be trained in its use as part of a comprehensive training covering all aspects of working in communities. The agenda for the SMAC CLEA training is included in Annex A. Other annexes include: Community Visit Monitoring Forms, Danger Discussion Cards, Ebola Survivor Posters, and Safe and Dignified Medical Burial Flyers.
SMAC is comprised of BBC Media Action, the United States (US) Centers for Disease Control and Prevention, FOCUS 1000, GOAL, and Restless Development.
Ebola Communication Network, April 25 2016.