Use of a community-led prevention strategy to enhance behavioral changes towards Ebola virus disease prevention: a qualitative case study in Western Côte d’Ivoire

Lara Gautier, Koffi Ange Houngbedji, Jeanne Uwamaliya, Megan Coffee

Starting in December 2013, the Ebola virus disease (EVD) epidemic spread in West Africa through five countries (Sierra Leone, Liberia, Guinea, Nigeria, and Mali), killing over 11,300 people. In partnership with Côte d'Ivoire's Ministry of Health, the International Rescue Committee instigated a community-led strategy aimed at promoting behavior change in order to prevent potential Ebola outbreaks in the country. The strategy was implemented in Western districts bordering Liberia, Guinea, and Mali. This study aims to analyze the community-led strategy, to document lessons learned from the experience, and to capitalize on the achievements. A case study in four districts of Western Côte d'Ivoire, i.e. Biankouma, Danané, Odienné and Touba districts was carried out. Qualitative data in 12 villages (i.e., three villages per district) was collected from 62 healthcare workers, community leaders, and ordinary community members. Data was de-identified, coded and analyzed using a thematic approach. The community-led strategy was socially accepted in the villages. Even though some community leaders reported that sensitization had been, at times, constrained by a lack of equipment, the people interviewed demonstrated accurate understanding of information about prevention practices. Some practices were easily adopted, while others remained difficult to implement (e.g., ensuring safe and dignified dead body management). This research demonstrates that sensitization efforts led by well-integrated and respected community leaders can be conducive of behavior change. Lessons learned from the community-led strategy could be applied to future disease outbreaks.