Current Experiences and Practices of Surveilling and Managing Ebola Virus Disease Outbreaks in the Democratic Republic of Congo by Involving the Community in a “One Health” Approach

This study examines the community integration and One Health strategies employed to fight Ebola virus disease in the Democratic Republic of Congo in the years 2007–2022. We synthesized twelve outbreak reports and conducted qualitative interviews of thirty-six managers and three focus groups and adapted an analytical framework (MATCH) to evaluate three essential dimensions: integration of the One Health approach, community involvement, and bottom-up approaches. This study found evidence of progressive improvement in all domains. The first outbreaks (2007–2009) were marked by moderate community engagement and a One Health approach that was mostly limited to the human health sector, which was deemed suboptimal. The 10th outbreak represented an era of transformation, when the Incident Management System (IMS) was adopted to better manage the response to the virus. The latest outbreaks (13th to 15th) show “optimal” implementation of the “One Health” approach through effective collaboration among those in charge of ensuring human, animal, and environmental health and the community. This study demonstrates that success is largely dependent on bottom-up initiatives where local populations, their leaders (both traditional and religious leaders), community liaisons, and specific groups (women and youth) are involved in the design and implementation of such measures. The inclusion of anthropologists and psychologists in addressing the psychosocial dimensions—fear, stigma, and distress—has been critical in ensuring the success of these initiatives and the degree to which the public trust and accept them. However, there are many issues that still need to be addressed, including poor coordination between sectoral ministries and the partial implementation of IMS at the grassroots level. In summary, the authors of this study propose that these integrated and participatory models are sustainable and imperative to building the resilience of the Congolese health system to future outbreaks.