Civil society engagement can help win the fight against Ebola

The Liberian Red Cross distribute food aid provided by the U.S. Agency for International Development in Monrovia’s West Point neighborhood for people affected by the Ebola outbreak. The government should tap the civil society to scale up the response to the epidemic. Photo by: Liberian Red Cross / USAID / CC BY-NC

Despite the Liberian government’s claim that $12 million have been spent on the prevention and treatment of Ebola, infected bodies lie on Monrovia’s street corners, neglected and overshadowed by stigma.

The corpses continue to pile up as the government has issued strict instructions that no one is allowed to care for sick relatives. Rather than face quarantine — or worse, community stigmatization — the sick are abandoned and they eventually die alone. There are simply not enough ambulances to collect the bodies, so these are left to rot on the streets for days until mass protests force the authorities to collect the corpses.

In late August, Liberia reported having spent $12 million to contain the epidemic. In the capital, the only two operating ambulances were purchased with the help of international nongovernmental organizations by Saah Joseph, a local politician.

In addition, the government has refused to invest a meager $300,000 out of the $20 million allocated to combat the disease in testing medical supplies — including technical assistance to train health workers in how to use the supplies. If there are no ambulances to pick up dead bodies and sick patients, where did the money go? It certainly hasn’t gone to strengthening an already weakened public health system. Of this $12 million, only $1 million is accounted for. This was given to the military so it could declare and implement a nationwide state of emergency — enforcing quarantines in communities affected by Ebola.

Liberian civil society is now calling for a total breakdown of this money.

Misdiagnosis has led to further deaths

In Liberia, more than a thousand people were infected by Ebola between May and early September, and half of them died.

When it comes to diagnosis, however, the government has yet to confirm if the bodies lying in the street are in fact victims of the disease. Since there are no machines to test and confirm the presence of the virus, if you’re sick you’re just presumed to have Ebola. By the time the authorities declare you as a patient, no one will be willing to help you.

In effect, you are on your way to an early grave even before you set foot in a clinic, which isn’t likely since most medical centers had been shut down by early September. All the doctors and nurses had fled; health workers were afraid to touch patients and people were terrified that if they went to hospital they could die.

As a result, scores of Liberians are now dying from preventable diseases like malaria, typhoid fever and cholera, most of which involve water, sanitation and hygiene. Only 5 percent of the population practices safe hygiene and just one-third of Monrovia's 1.5 million residents have access to clean toilets.

On top of the worrying public health impact, airlines have been shut down and neighboring countries have closed their borders. This can have devastating effects on food and medical supplies, and food insecurity is a reality in the poorest regions.

If Liberia had testing terminals at all ports of entry, everyone could be screened. The economic implications of sealing the country’s borders are immense and could lead to even more deaths.

Although this all paints quite a grim picture, progress is being made to build partnerships between the government and civil society to address public fears surrounding the epidemic.

Regaining the public trust

Amid this disaster, the Liberian government is trying to regain public trust. But how can that be accomplished? By engaging civil society — of which authorities have a deep-rooted mistrust.

The Liberian government needs to see civil society not as its enemy but its ally. When President Ellen Johnson Sirleaf established a nationwide Ebola task force, the national civil society council was not invited. This only serves to widen the gap.

With more than 1,500 civil society organizations and over 900 community-based organizations in the country, the government must tap into this framework to ensure that its messages reach even the most marginalized and isolated communities. Civil society is critical to reaching communities that would otherwise take months to contact.

This pervasive distrust of government stems from rampant corruption, mismanagement of public funds and abuse of public resources. The belief in many communities is that Ebola is a hoax invented by the government to prevent an uprising. These rumors can only be debunked with the full engagement of the citizens themselves. Adequate information provided by both civil society and the government can prevent further panic and suspicion.

Public outcry over the lack of cohesive action on how to handle the dead has already led to protests. In late August, masses stormed one of the two Ebola centers in Monrovia. The revolt at West Point, an overpopulated and impoverished slum, has raised severe concerns about how the government is handling the crisis.

Although West Point recently lifted its quarantine, the district is still home to more than 75,000 people living in cramped and squalid conditions, with access to only four toilets. The risk of further contamination is extremely high in an already overcrowded environment that lacks adequate WASH facilities.

After the government becomes open to civil society, the next step is to set up appropriate mechanisms for civil society to be included in the national strategies to fight Ebola. To be empowered, one must be a part of the plan. We need the ability to be able to move freely around the country, with government-allocated resources to combat this and other infectious diseases.

Control the outbreak

Ebola is a real wake-up call for Liberia, where the government relies too heavily on foreign aid and INGOs to respond to public health needs.

There is a dire need for emergency response funds and intervention plans. Most hospitals lack basic equipment and are chronically understaffed. Health systems strengthening is crucial. We need to decentralize and diversify our health systems, and increase our human resource capacity.

We lack enough specialized health workers equipped to deal with the onslaught of a crisis like Ebola. For instance, when patients came from infected areas, they were treated without any protective clothing. Health workers are on the front lines, interacting with people who have infectious diseases, making them even more vulnerable, and that’s why we need a clear regulation for health workers and doctors to wear protective gear at all times. The spread of Ebola could have been slowed with more vigilance from health workers. Instead, the government decided to shut down medical centers and now diseases that can be cured are causing countless deaths.

We can’t lose this battle. We need to scale up the response immediately to ensure that people do not continue to die of preventable diseases and neglect.

Right now, what we do have is a strong civil society platform with the mechanisms, capacity and strategy to reach out to the most marginalized communities throughout Liberia. If civil society can get the message across that public health workers are working to eradicate the virus, it can mobilize communities to work alongside governments in the fight against Ebola.

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About the author

  • Prince kreplah profile

    Prince Kreplah

    Prince Kreplah is chair of Liberia’s CSO WASH Network. An expert on water, sanitation and hygiene, Kreplah is working on the ground with communities to tackle the ongoing Ebola crisis, advocating for increased collaboration between civil society and governments, adequate provision of WASH and the improvement of public health systems.