The response is like a big ship': community feedback as a case study of evidence uptake and use in the 2018-2020 Ebola epidemic in the Democratic Republic of the Congo.

INTRODUCTION: The 2018-2020 Ebola outbreak in the Democratic Republic of the Congo (DRC) took place in the highly complex protracted crisis regions of North Kivu and Ituri. The Red Cross developed a community feedback (CF) data collection process through the work of hundreds of Red Cross personnel, who gathered unprompted feedback in order to inform the response coordination mechanism and decision-making. AIM: To understand how a new CF system was used to make operational and strategic decisions by Ebola response leadership. METHODS: Qualitative data collection in November 2019 in Goma and Beni (DRC), including document review, observation of meetings and CF activities, key informant interviews and focus group discussions. FINDINGS: The credibility and use of different evidence types was affected by the experiential and academic backgrounds of the consumers of that evidence. Ebola response decision-makers were often medics or epidemiologists who tended to view quantitative evidence as having more rigour than qualitative evidence. The process of taking in and using evidence in the Ebola response was affected by decision-makers' bandwidth to parse large volumes of data coming from a range of different sources. The operationalisation of those data into decisions was hampered by the size of the response and an associated reduction in agility to new evidence. CONCLUSION: CF data collection has both instrumental and intrinsic value for outbreak response and should be normalised as a critical data stream; however, a failure to act on those data can further frustrate communities.

New Mixed Methods Approach for Monitoring Community Perceptions of Ebola and Response Efforts in the Democratic Republic of the Congo.

BACKGROUND: Efforts to contain the spread of Ebola in the eastern Democratic Republic of the Congo (DRC) during the 2018-2020 epidemic faced challenges in gaining community trust and participation. This affected implementation of community alerts, early isolation, contact tracing, vaccination, and safe and dignified burials. To quickly understand community perspectives and improve community engagement, collaborators from the DRC Red Cross, the International Federation of the Red Cross, and the U.S. Centers for Disease Control and Prevention explored a new method of collecting, coding, and quickly analyzing community feedback. METHODS: Over 800 DRC Red Cross local volunteers recorded unstructured, free-text questions and comments from community members during community Ebola awareness activities. Comments were coded and analyzed using a text-coding system developed by the collaborators. Coded comments were then aggregated and qualitatively grouped into major themes, and time trends were examined. RESULTS: Communities reported a lack of information about the outbreak and the response, as well as concerns about the Ebola vaccination program and health care quality. Some doubted that Ebola was real. The response used the feedback to revise some community engagement approaches. For example, 2 procedural changes that were followed by drops in negative community responses were: using transparent body bags, which allayed fears that bodies or organs were being stolen, and widening the eligibility criteria for Ebola vaccination, which addressed concerns that selectively vaccinating individuals within Ebola-affected communities was unfair. DISCUSSION: This system is unique in that unstructured feedback collected by local volunteers in the course of their work was rapidly coded, analyzed, and given to health authorities for use in making course corrections throughout the response. It provides a platform for local voices to be heard throughout an emergency response and provides a mechanism for assessing the effects of program adjustments on community sentiments.