Guide to Community Engagement in WASH: A Practitioners' Guide, Based on Lessons from Ebola

“Community engagement requires a sound understanding of differences and vulnerabilities, and a genuine desire to understand community perspectives.”

This guide offers a compilation of best practices and key lessons learned from Oxfam’s experience of community engagement during the 2014–15 Ebola response in Sierra Leone and Liberia. It aims to inform public health practitioners and programme teams about the design and implementation of community-centred approaches during a disease outbreak by looking at what worked, as well as some of the challenges. As explained in the guide, the lessons learned can be applied not only to any future disease outbreaks, but also more generally to Oxfam’s community-focused water, sanitation and health (WASH) programming.

The document draws on semi-structured interviews and input from practitioners within Oxfam and various other agencies, as well as a literature review. It provides guidance and ideas for all stages of an intervention, highlighting the following:

• the importance of assessing the context - for example, the existing health care systems, community leadership dynamics, community capacity, and community access to information; 
• principles and methods for community engagement - looking at who to work with and what approaches to use;
• communicating with affected communities - includes guidance on addressing information gaps, getting the content right, and conducting effective health communication though, for example, telling local stories, radio programming, and storytelling;
• the challenges of scaling-up responses - highlights the need to ensure that the response is still context specific and based on accurate epidemiological data, as well as the need to measure and monitor engagement;
• the importance of co-ordinating social mobilisation activities - looks at strategies used by organisations during the outbreak to avoid duplication; and
• the need to lobby governments, donors, and other non governmental organisations (NGOs) - for example, to advocate around the need for community engagement, or to ensure that the rights of communities are being respected.   

The following are ten key lessons offered by the guide: 

1. "Many of the lessons from the Ebola response can be applied to Oxfam’s WASH programmes, especially cholera responses. Equally, Oxfam’s experience with public health promotion (PHP) and WASH interventions means that it is well placed to support and develop capacity in community engagement and social mobilization.
2. A sound understanding of the diversity and varied vulnerabilities within affected communities is vital. Resources must be devoted to understanding community perspectives and advocating for community-focused interventions. Specialists, such as anthropologists and epidemiologists, may be required for information to be collected, documented and used effectively.
3. One-size-fits-all models of community engagement are not the best solution. It is better to recognize the potential capabilities of communities in each situation and provide context-specific support. This allows communities to take action to protect themselves using a ‘menu’ of different strategies, developed using a community-led approach. To do this effectively, key groups (e.g. male and female leaders, traditional healers, religious leaders, older people, youth and children) need to be identified.
4. Advocacy efforts should be directed at promoting inclusive and representative ideas, concerns, questions and solutions of communities, and ensuring that only useful and practical information is given to communities by humanitarian actors.
5. The information given to communities must be prioritized to ensure that the crisis affected population understands and uses the most effective protective actions (e.g., in the case of Ebola, early isolation and referral, and not touching the dead). The uptake and use of these specific actions must be monitored, and rumours about diseases and treatment processes should be documented in order to track progress.
6. It is important to work with others (from all sectors) to increase the transparency of medical and burial processes, especially where there is a lack of understanding and/or trust in the healthcare system. This can include step-by-step guides for referral or burial management, and showing videos to illustrate what to expect.
7. Support, training and supervision for newly recruited staff are vital to ensure responses are community-centred, effective and accountable.
8. Community engagement supports every other aspect of a response (e.g. testing and treatment, safe burials, etc). Therefore, active coordination and planning with other sectors is crucial at the local and district levels, as well as with national collaborators.
9. Programme managers should actively support and foster regular information exchanges between programme teams within and between organizations (e.g. daily debriefs).
10. Using fear to encourage changes in behaviour can be counterproductive. It is better to promote self-reliance and self- help among affected populations."