Healthy communities: Ebola left Sierra Leone with a legacy of youth engagement

Key takeaways:

• Ebola wasn't just a contained phenomenon for Sierra Leone. It shone a light on wider deficiencies in the health system.
• One positive change to emerge was a structured approach to training young people to effect change.
• The model could be rolled out into other African nations.

When Sierra Leone was hit by the worst-ever outbreak of Ebola in 2014, the epidemic was compounded by a lack of trust in public services. The civil war had ended in 2002, leaving the country with severely damaged transport and health infrastructures. Poor communication about the disease, coupled with the high fatality rate, meant rumours were spread that public hospitals should be avoided as places of infection and death.

The mass mobilisation of volunteers, led by the ministry of health, proved crucial in ending the epidemic, with thousands of young people trained to go door-to-door raising awareness about the services available and counter-acting false claims, such as that Ebola was incurable.

When the country was officially declared Ebola-free in 2016, discussions were held on what lessons could be learned. A youth-development charity, Restless Development, gathered over three hundred young volunteers together to discuss how they could continue to help the recovery and further the development of Sierra Leone. The conference led to the birth of SABI, a community-led accountability program that aims to increase awareness and demand for improved public services.

Re-building trust

“The Ebola epidemic put a spotlight on how weak the country's systems were,” said Glynnis Cummings-John, head of Restless Development’s Sierra Leone hub. Over half of the population is under the age of 25. "It made sense to engage young people in rebuilding that sense of trust and accountability, bridging the link between the user and the service provider.”

SABI, which stands for Strengthening Accountability, Building Inclusion, is a consortium funded by the UK government and led by Christian Aid, linking Restless Development’s young volunteers with national and international partners, including NGOs focusing on empowering women and people with disabilities.

It has trained 122 young people each year since it was founded.

"This was a deliberate design to ensure more young people get to go through the training and get to develop skills, empowerment and agency to be leaders within their own community after their placement period,” said Saiku Bah, SABI team leader.

The young volunteers work in pairs, with more experienced young people matched with those from the SABI communities, which are spread across the country’s sixteen districts. They go door to door conducting surveys, using mobile phones to collect data on the availability and quality of health as well as education and social protection services.

One of the major challenges is the country’s poor public education levels. Under a third of adults are literate. Bah, said using young, local volunteers prevents any sense of “intimidation”.

“Our experience was some NGOs said they are engaging with communities, they meant they go to the head man or chief,” Bah said. “In SABI we of course do talk [to them] but we take the extra step to make sure everyone in the community is engaged.”

In the first three years, the programme collected over 80,000 responses. These are turned into simple infographics to be discussed in large community meetings where everyone is encouraged to speak.

“It’s so interesting how lack of communication creates unnecessary tension”

These meetings lead to action plans that can be presented to district councils, ministries or charities. For example, in one village, SABI helped the community identify the need for clean drinking water in a school, leading to an NGO and the ward councillor working together to facilitate the building of water facilities.

The data also identifies where communities are failing to access services that are already available, so that gaps in knowledge can be addressed. A greater understanding of free public healthcare for mothers has led to more pregnant women seeking ante-natal care in wards that had previously suffered from high rates of maternal death. Health centres are monitored to help ensure the right drugs are available and prevent shortages.

“It’s so interesting how lack of communication creates unnecessary tension,” said Saiku Bah. He recalls how SABI facilitated a visit by a representative of the education ministry to a village with a school that was waiting for state approval.

The villagers were becoming desperate, as their children weren’t able to take public exams in the school. “The first thing the official said was that the school had been approved for over a year,” Bah said. “Nobody told the community. Imagine that!”

Surviving and expanding

Bah believes that the SABI model could be adopted across sub-Saharan Africa. Guinea and Liberia, having experienced civil war and been hit by the same deadly Ebola epidemic, could draw particularly useful insights.

"There are so many areas just waiting for someone to do something"

“After the results of the war and Ebola, and a high influx of NGOs, there are so many areas with a tendency to be just waiting for someone to do something,” said Bah. “But in areas where we're operating, we see that sense of cohesion, social capital, communities are coming together to demand things and engage.”

There’s also potential for youth and community engagement. As with Sierra Leone, over half of the population in Liberia and Guinea is under the age of twenty-five.

SABI has faced challenges, including the change of government in 2018. The program had to create new relationships with ministers and administrators across the board. Bah advises starting any similar program at the beginning of a new government.

As the four-year program is ending this summer, SABI’s legacy relies on some of these relationships surviving. “We’ll still have those same trained young people living in the communities, keeping the momentum, and helping others to learn along the way,” Cummings-John said. “My only concern would be of the level of engagement from the external stake-holders.”

The SABI program has placed its faith in young people, having witnessed their crucial role in fighting the Ebola outbreak. But without the pressure of SABI and its consortium of partners, will representatives from the ministries and health centres take account of citizen action plans and continue to attend community meetings?

While there is some evidence that social capital has increased in Sierra Leone since the Ebola outbreak, this is a difficult metric to measure. The coming years will show whether SABI has produced sustainable results and whether this innovative model can be usefully replicated elsewhere. — Niki Seth Smith

Further reading

Social Mobilisation and Community Engagement Central to the Ebola Response in West Africa — National Institutes of Health

Accountability: Powered by Young People — Restless Development/Christian Aid/SABI

(Picture Credit:EU/ECHO/Isabel Coello)