From Words to Action: Towards a Community-Centered Approach to Preparedness and Response in Health Emergencies

"Across the world, communities have great agency and ability to act, and we must support them to do so - this is what it means to have communities at the centre of preparedness and response."

It has been well documented that community engagement is vital for containing epidemics and shifting the epidemic curve. Communities have existing competencies, systems, and knowledge that, when ignored, can lead to ineffective interventions or can cause mistrust, tension, and the perpetuation of disease transmission. This report advocates for a coordinated and considered community-centred approach taken by all actors across preparedness, response, and recovery interventions to reduce the spread of infectious disease. It was commissioned by the Global Preparedness Monitoring Board (GPMB), which is an independent monitoring and accountability body co-convened by the World Health Organization (WHO) and the World Bank to ensure preparedness for global health crises.

Particularly in fragile contexts in which trust in state authorities has been eroded, interventions in health emergencies will only be their most effective when they are relevant, contextually appropriate, and co-owned by affected populations. It is necessary to find ways to build mutual trust, effectively engage in meaningful two­way dialogue, work with local structures, and adjust interventions over time based on the feedback and perceptions of affected and at-risk communities. Acknowledging communities and local actors as equal partners and active participants means supporting them with the necessary resources and complementing their existing skills and competencies.

Specifically, effective approaches to community engagement discussed in the report - illustrated by a series of case studies - include:

• Communicating with communities through multiple channels
• Using new media to communicate and receive feedback
• Building health literacy, health promotion, and behaviour change
• Gathering data to understand context
• Collecting real-time community feedback and using it to shape interventions and ensure accountability
• Cultivating participatory approaches to inform communication strategies and programme design
• Ensuring participatory and community-led planning, design, and implementation
• Engaging in long-term capacity-building and systems strengthening

The most successful examples are multifaceted and multisectoral, incorporating a range of approaches tailored to the specific context and need.

The paper explores progress made over recent years, including:

• Increased visibility of community engagement on the global stage - Community engagement gained greater visibility and traction during the West Africa Ebola outbreak and in other disease outbreaks since, such as Zika. Various global and institutional strategies and guidelines have been produced, with global, national, and local initiatives calling for an increase in community engagement and noting its effectiveness. The Joint External Evaluation (JEE) process has also expanded the role of risk communication and community engagement assessments.
• More attention paid to contextual realities and adapted, agile response efforts - There is increased recognition of the need to adapt response measures to better fit the needs of affected communities, to ensure interventions are contextually appropriate and sensitive to socio-cultural norms and local authority structures, and to mitigate potential barriers to effective collaboration within communities. Social science has been increasingly valued by development and humanitarian agencies, with approaches and initiatives developed to support its operationalisation within emergency response and development settings.
• Greater focus on collecting perception and feedback data - Perception and feedback data are now more routinely collected to inform epidemic response efforts, with some approaches to collecting community perception data at scale showing promise. These data sets can help preparedness and response efforts better understand the priorities and perspectives of at-risk and/or affected populations and can form a baseline to measure the impact and challenges of a response at the community level.

The paper also highlights ongoing gaps and challenges, including:

• Lack of consistent engagement of communities and local actors before, during, and after an epidemic - Much community engagement work remains ad hoc and reactive. There is only piecemeal (and often delayed) investment in prevention and preparedness work at the community level (e.g., to develop health literacy, build trust and understanding, and support broad community-led health programmes that integrate components of epidemic preparedness).
• Ongoing failure to fully act on local knowledge and community feedback - The architecture of response to community perceptions and feedback, which often remains bio-medically focused, does not enable socio-behavioural information to be systematically incorporated so as to shape the trajectory of interventions. Mechanisms for accountability to affected communities remain weak, and there are significant gaps in how underlying anxieties and injustices are recognised, reported, and addressed in preparedness and response efforts.
• Weak coordination and lack of impact evaluation and continuous learning - There is a need to improve rigorous monitoring, evaluation, and continuous learning; lessons learned are not systematically collected and absorbed. Evaluations should keep at the forefront the perspectives and assessments of the community and link these insights to accountability. Investment is required to upskill a cadre of senior coordination experts to effectively manage information flow, enable collaboration, and avoid duplication.

Priority actions or achieving a community-centred approach to preparedness, response, and recovery in health emergencies include:

1. Enshrine the commitment to making communities the centre of preparedness and response at international, national, and local levels through global public health governance and coordination frameworks, as well as in prevention, preparedness, response, and recovery strategies. This action would mean, for example, reforming leadership and governance structures so they are more explicitly accessible and responsive to the influence of at-risk and affected peoples. Strong advocacy across the sector, within agencies and with donors, will be required.
2. Enable consistent engagement of local actors and communities before, during, and after an epidemic. Through participatory planning, collaborative learning, and capacity strengthening processes, communities can identify the resources they need to complement their existing sets of skills and competencies. In this way, the capacity of communities, frontline workers, volunteers, and local organisations to prevent, prepare, respond, and recover is strengthened through the course of any event, and they create and maintain greater levels of resilience to epidemics and other potential shocks.
3. Make funding for community engagement more predictable and sustained.
4. Act on local knowledge and community feedback. Social science needs to be an integral, cross-cutting component of preparedness and response, and community knowledge (e.g., regarding the use of local languages, alignment with public authority structures, preferred communication channels) must be kept at the forefront. Modifications to response architecture must be agreed at all levels so that it becomes feasible and accepted practice to systematically use socio-behavioural data to shape strategies and interventions according to emerging evidence over time. Community engagement must be mainstreamed and understood to be the responsibility of all response actors, who should receive training in interpersonal engagement techniques.
5. Bolster mechanisms for accountability to affected communities. A concerted effort is required to establish fit-for-purpose structures that build on key humanitarian and human rights principles for recognising, reporting, and addressing concerns and injustices. Agreed measurement frameworks should include indicators based on communities' participation and satisfaction levels and should require partners to evaluate the extent to which they systematically collected, reported, and acted on feedback from affected people.
6. Measure community engagement approaches and define standard indicators. Reviewing what does / does not work, why, when, with whom, and in what contexts should become a routine component of all preparedness and response action. Beyond that, 360-degree measurement approaches for community engagement indicators must be defined, tested, and taken up by all actors.
7. Strengthen leadership, coordination, and technical expertise around community engagement as both a core and cross-cutting component of preparedness and response. Communities and local actors need to be better represented within governance structures.