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 combat Ebola virus disease in the Democratic Republic of Congo from 2007 to 2022. We synthesized 12 outbreak reports, conducted qualitative interviews with 36 managers, organized three focus groups, and adapted an analytical framework (MATCH) to evaluate three essential dimensions: the integration of the One Health approach, community involvement, and bottom-up approaches. This study evidences progressive improvement in all domains. The first outbreaks (2007–2009) were marked by moderate community engagement and a One Health approach that was largely limited to the human health sector, 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) demonstrate an “optimal” implementation of the “One Health” approach through effective collaboration between those in charge of ensuring human, animal, and environmental health and that of the community. This study demonstrates that success is largely dependent on bottom-up initiatives in which local populations, their leaders (both traditional and religious), 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 trusts and accepts them. However, many issues still need to be addressed, including poor coordination among 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.