Rebuilding Trust in Health Care through Community Dialogues

Even before the Ebola outbreak, Guinea had some of the worst maternal and child health indicators in the world. Trust and confidence in health services were already low, and the rapid spread of the epidemic further fueled the fear and distrust of these services. After the release of the last Ebola patient in mid-November, Guineans tensely waited for the 42-day period to pass so they could finally be declared free of Ebola.

A facilitator leads a community dialogue in Ratoma, a neighborhood in the capital city, Conakry

A facilitator leads a community dialogue in Ratoma, a neighborhood in the capital city, Conakry.
Photo credit: Guillaume Bakadi

As the country slowly begins to mend, the Health Communication Capacity Collaborative (HC3) team in Guinea is working with the hardest-hit communities to rebuild both the communities’ trust in the health system and the quality of care that they receive. HC3’s approach incorporates evidence-based social and behavior change communication (SBCC), capacity-building and quality-improvement interventions. Over the next few months, we will highlight different parts of the process, from facilitating community dialogues to promoting Gold Star branded revitalized quality health centers.

The first, and arguably most important, activity to rebuild trust in the health system is the community dialogue — a process to bring together patients and health providers to discuss how to make health services better. By involving both community members and health providers in the early stages of the health center revitalization process, they are not only able to identify the key problems and concerns, but they are also more likely to be engaged as part of the solution.

“Looking at the health situation in Guinea, it is very important to keep the community informed. As a result of this community dialogue, we health providers should know now what we should improve and what we should not do. Through this community dialogue, people were permitted to talk frankly in front of health providers on what they do not like regarding our behaviors and rea-sons why they are resentful to seek care in health structures.”

Dr. Fatoumata Yansane, Matam Health Center, Conakry

In November and December, HC3 organized four community dialogues in the capital city, Conakry. Neighborhood leaders, representatives from women’s and youth groups, and religious leaders were invited to meet with health-center supervisors, doctors, nurses and other health staff to share their concerns. These dialogues were very successful. Over 270 participants engaged in lively discussions about the kinds of barriers to service utilization and how to improve the care provided to their communities. Participants identified the high cost of services as a key barriers to use – including providers unofficially charging extra for services, unfriendly welcome by health providers and lack of information given to patients by providers.

After the event, participants from both groups expressed their gratitude for opportunity that the dialogue provided to improve communication in the community. Community leaders pledged to address the problems raised by: 1) reinforcing communication efforts to reach more people with positive messages about service utilization; 2) creating networks of youth, women, community leaders and health providers to give credibility to the messages and instill confidence in health services; and (3) involving local radio stations to promote quality community health services.

HC3 will continue to support these community dialogues across Guinea, as the crucial first step of the quality improvement activities.

Training Health Workers for Ebola Response and Community Support Webinar Series

A team of organizations, led by mPowering Frontline Health Workers and IntraHealth International, are coming together to share tools and information on how to support health workers responding to and rebuilding from the Ebola crisis.

Please join in a three-part webinar series beginning April 1

Health workers in West Africa have been responding to Ebola since 2013, and, according to the latest WHO situation report, the pace of the outbreak is beginning to decline. This calls for relief and celebration. However, this is far from final for those who have been affected by Ebola.

The virus has left indelible marks on their lives, and their stories are many and severe:

“The Ebola situation is once more improving in terms of infection rate, but the socio-economic needs are enormous.” (Moses Khanu, Pastor, Sierra Leone)

Health workers remain at the center of community response and support. At the same time, the governments and international organizations that support health workers are seeking answers for how they can restore health services in West Africa, strengthen health systems, and prepare for future health emergencies.

What’s next for Ebola affected countries?


Distributing fresh water to families; Photo credit: Moses Khanu

Many organizations are working closely with all actors across the health sector. What comes next for Guinea, Liberia and Sierra Leone, the three most affected countries? And how can countries nearby and in the region plan for future potentially deadly outbreaks? In the second series of Training Health Workers for Ebola webinars in April, a group of colleagues who have been working in the affected countries will talk about lessons learned and planning for rebuilding and strengthening health systems. Participants are invited to join in the discussion during the webinars.

Reviewing lessons learned, and looking ahead

These webinars will focus on tools and strategies that health workers, as well as the governments and organizations that support them, can use to continue the response, protect their communities and help rebuild health systems. Free training and information resources are concurrently being posted on the Ebola Resources for Health Workers website.

Here are the details:

Webinar 1 April 1, 10:00 -11:00 am EDT Working with Youth, Volunteers, and Vulnerable Populations
Webinar 2 April 8, 10:00 -11:00 am EDT Community Mobilization and Preparedness Planning
Webinar 3 April 15, 10:00 -11:00 am EDT Effective Use of Data

These webinars will bring together more than 15 international health organizations, led by mPowering Frontline Health Workers and IntraHealth International. Registration and more information are available here. The webinars are open to all, and will build upon the presentations and discussion in the first Training Health Workers for Ebola series. All of the webinars will be available for viewing at after the air dates.

The webinar series has been made possible by the generous support of the USAID-supported Health Communication Capacity Collaborative.