Final Program Results Report

Headquarters Information Field Contact Information Coy Isaacs Bonome Desire Nturo Technical Director, Crisis Response Crisis Response Coordinator, DRC 1825 Connecticut Avenue 44, Av. De l’Auberge, Quartier MUTIRI, Cellule Maghala, Washington, D.C. 20009 Commune de BULENGERA, Ville de BUTEMBO, [email protected] Province du Nord Kivu, DR Congo [email protected]

Country/Region of Country: Democratic Republic of the Congo Submission Date: December 18, 2019 Program Title: Rapid Response to the Ebola Outbreak in the Democratic Republic of Congo OFDA Award Number: 720FDA19CA00012 Award Period: March 20, 2019 – Sept 19, 2019 Reporting Period: March 20, 2019 – Sept 19, 20191

Community Leader Sensitization session at Kaniyi Demonstration by the SDB team during Health Center in Masereka Health Zone engagement meeting with cemetery host community

1While this report covers the entire period of the award, please note that many FHI 360 activities as of September 1, 2019 are funded through follow-on Award No. 720FDA19CA00074 and accordingly will be reported under that project. Data presented is from the project start through August 31, 2019 unless otherwise noted.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Executive Summary

This report covers FHI 360’s Rapid Response to the Ebola Outbreak in the Democratic Republic of the Congo (DRC) project. During this project, which took place between March 20 and September 19, 2019 in the eastern regions of the DRC, FHI 360 supported the overall Ebola Virus Disease (EVD) response through Social Mobilization and Community Engagement (SMCE) and Safe and Dignified Burial (SDB) activities. While this project ended on September 19, 2019, activities in this report primarily cover up to August 31, as activities after this time are funded by and thus will be reported on in FHI 360’s follow-on project (Award No. 720FDA19CA00074).

At the onset of this project, the epidemic was entering its seventh month. From August 2018 to March 2019, responders had struggled to control the rapidly changing epidemic due to its expansion to new health zones and the unique factors present in the eastern regions of the DRC. At the onset of FHI 360’s project on March 20, 2019, 960 cases had been reported, with 603 proving fatal (fatality ratio of 63%), making this the largest EVD outbreak in the history of the DRC and the second largest recorded in the world behind only the West Africa Outbreak of 2014 -2015. Towards the end of FHI 360’s initial project in August 2019, the total number of reported EVD cases had expanded to 3,036. Of these cases, 2,035 proved fatal (fatality ratio of 67%). While this expansion initially appears shocking, the 59 new cases confirmed over the last week of August was a marked improvement over the height of the outbreak in mid- to late- April, when over 120 new cases were being reported each week.

Throughout the initial stage of the outbreak, the World Health Organization (WHO) and other response actors identified SDB and SMCE as two areas that were underrepresented in the overall EVD response. To fill this gap, FHI 360 designed its project to address these shortcomings using proven methods and expertise from the West Africa EVD response. The proposed activities included engaging with local and traditional leadership to create acceptance and promote locally owned and led response activities; the training of Civil Protection teams in SMCE techniques; fully training, equipping, and supporting multiple SDB teams in Ituri and North Kivu Provinces; and working to resolve disputes and improve trust between communities and burial teams, amongst a myriad of other tasks.

In the first months of the program (March to April), FHI 360 began SDB and SMCE activities in four Health Zones spread over North Kivu and Ituri Provinces (Bunia, Butembo, Katwa and Komanda). As the Ebola outbreak evolved, FHI 360 continued its planned activities in the original health zones while adapting and expanding its programming to fill critical gaps identified by the FHI 360 Crisis Response team and its partners. For SDB activities, FHI 360 identified new health zones threatened by the outbreak, trained and supported new teams in at-risk communities and took over coffin supply and grave digging activities when the previous actor was unable to continue. As was the case with the SDB activities, FHI 360’s SMCE teams adapted programming to fit new areas and problems, worked to build new relationships with traditional leaders and communities, and expanded efforts to learn from the communities directly affected by the outbreak through dialogue and feedback session. By the end of the project, FHI 360 had worked or was working in a total of 14 Health Zones and had adapted its programming to include the new activities and operations areas discussed above.

Throughout the duration of the project, FHI 360 EVD response teams were confronted by a wide set of challenges. Beyond the rapid territorial expansion of the outbreak into hard to reach areas such as the Biakato-Mambasa belt— with high levels of insecurity and deplorable road conditions—and Ariwara—where the use of high-risk commercial planes was a necessity—FHI 360’s teams continuously worked in dangerous regions known for high levels of distrust of international and national actors. Additionally, these regions were home to countless armed groups and community defense forces (Mai Mai). As a result of these difficulties, many SDB and SMCE activities faced roll-out delays and were postponed in order to protect both staff and beneficiaries.

Despite these difficulties, FHI 360 met and exceeded many of the project targets. This included involving over 600 traditional leaders and community influencers in the EVD response through SMCE and SDB activities. This involvement of traditional/influential leaders in community engagement activities paved the way for SDB teams to enter previously resistant or closed off areas and meet the ever-changing demands in affected communities and the overall Ebola Response. Later, the FHI 360-supported radio broadcasts strengthened community understanding of the response, supporting the sustainability of gains made. In terms of SDB activities, FHI 360 trained a combined 156 Civil Protection workers in SMCE techniques. Following these trainings, FHI-supported teams were able to successfully resolve community resistance to burial attempts 88% of the time. Finally, and perhaps most importantly when it comes to containing the outbreak, SDB teams were able to bury 672 EVD alerts assigned to them according to FHI 360 SDB protocols (see Annex A for FHI 360’s SDB procedure) they had been trained in.

Sector Cumulative Targeted Cumulative Reached Health 949,127; IDPs: N/A 744,843

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Sector: Health Objective: To improve community engagement in Ebola-affected areas and reduce populations’ exposure through safe and dignified burial. Number of Beneficiaries Targeted: 949,127, IDPs targeted: N/A FHI 360’s activities in the Health Sector focused on two sub-commissions of the overall response, Risk Communication, Social Mobilization and Community Engagement (hereafter referred to as SMCE) and SDB. In response to high levels of community resistance to Ebola response activities, FHI 360 proposed a SMCE strategy, presented at both the national and health zone levels of coordination, to: identify and build rapport with traditional, influential, community and special group leaders in at-risk areas; conduct SMCE meetings, follow-ups and feedback sessions in EVD-affected communities; support events-based reporting sessions with leadership; and conduct training sessions with local leaders that empowered them to organize, conduct, and facilitate community level meetings and produce radio call-in shows on EVD-related topics. These activities were aimed at a wide audience across North Kivu and Ituri Provinces and covered a variety of topics, including: EVD messaging on transmission and prevention; the importance of SDB activities in controlling EVD; and discussions with communities on their specific needs beyond the EVD response. FHI 360’s SDB activities, working in conjunction with the overall response coordination/sub-coordination and actors such as Civil Protection, the International Federation of the Red Cross (IFRC), the DRC’s Ministry of Health (MoH), and WHO, were to: identify health zones in need of SDB teams; train, equip and support the identified teams in proper SDB techniques; provide follow-up training; teach SMCE techniques to SDB teams; and integrate local leadership into the Community Death Alert System.

Sub-Sector 1.1: Public Health Emergencies of International Concern and Pandemics

1.1.1: Engage with multiple tiers of community-based leadership structures to build ownership and acceptance of the EVD response. At onset of the project, FHI 360 Crisis Response leaders met with and presented the project strategy at various levels of the EVD Response, including the national, health zone and sub-coordination levels. As the project progressed, FHI 360’s staff continued to meet with partners and EVD coordination at all levels, working to ensure the efficacy and efficiency of the project and react to the growing geographic and thematic needs of the response. At both the coordination and sub- coordination levels, these meetings were held based on need. When EVD alerts were at high levels, coordination meetings were held on a daily basis. As the levels of outbreak decreased, the frequency of the meetings would subside accordingly. These meetings had the added value of ensuring that FHI 360’s activities did not overlap with other actors and important lessons learned, best practices, and relevant up-to-date information was shared throughout the response.

During these meetings, coordination and sub-coordination leaders discussed the current trends of the outbreak, strengths and weaknesses of the response and identified evolving areas of need. As the outbreak spread to new zones and weaknesses were identified, coordination leadership would work with response actors to fill in gaps according to their relevant resources, expertise, and ability. In response to needs identified in these coordination meetings, FHI 360 expanded its existing zones of operation, spreading from the original health zones of Komanda and Bunia in Ituri Province to include Butembo in North Kivu as the result of the significant progress achieved by FHI 360 along the Komanda-Lunar belt (border areas of Ituri-North Kivu). Following this expansion into North Kivu, FHI 360’s Community Engagement strategy paved the way for other response actors to gain entry into communities that had been considered “red/hostile zones,” including Wayne, Bwinongo, Makerere, Kinbulu, and Rhuendar Health Areas of the Katwa Health Zone. As a result of these early successes of the FHI 360 intervention, EVD coordination requested FHI 360 to intervene in Masereka, Vuhovi, and Musienene Health Zones, where the FHI 360 community engagement strategy again proved successful. Towards the end of the project, this strategy was applied to begin making headway in the heavily forested remote areas along the Biakato-Mambasa belt.

By the end of August, FHI 360’s activities had spread from the Komanda and Bunia health zones discussed above to include a total of 14 total health zones across North Kivu and Ituri where FHI 360-suported teams conducted SMCE and/or SDB activities at some point during the life of the project. This geographic expansion included the health zones of Butembo, Katwa, Masereka, Vuhovi, Musienene, Ariwara, Aru, Rwampara, Kalunguta, Mambasa, Mandima, and Mangina.

Identification, Building Rapport/Planning with Identified Community and Special Group Leaders: FHI 360’s project strategy revolved around the utilization of existing community, traditional leadership and influencer structures in order to engage with communities in a culturally acceptable manner. This approach encouraged acceptance of the EVD response within affected communities and promoted the future involvement of these influencers and leaders as EVD responders. To accomplish this, FHI 360 worked with the Communication Commissions in locations across Ituri and North Kivu, holding formal and informal discussions to determine trusted leaders in areas of operations.

Due to the large geographic area of the response, the leadership targeted by FHI 360 was prioritized to active hot zones and the rings of villages around these zones, similar to the ring strategies used in EVD vaccination campaigns. These leaders were chosen using a predetermined set of criteria, including: being accepted in their communities; being able to

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report read and write; and having influence within the target community. After identifying which leaders to target, FHI 360 staff contacted these traditional community leaders in accordance with existing structures. In Ituri province, this started at the level of Collectivity Chief, followed by Groupement and Village Chiefs. For North Kivu, it started at the level of the Nande Kings, followed by Groupement, Paramount and Village Chiefs (see Annex B).

In areas where the traditional leadership structures were identified as non-existent or weak, including displaced communities and some urban areas, less traditional community leaders were targeted. For urban and non-traditional areas, these leaders included the mayor, quarter chiefs, and community/avenue chiefs. In addition to these leadership structures, special groups such as women’s and youth groups, religious leaders, Nandes, Pygmies, and economic and trade groups such as taxi and motorcycle driver associations and farmers guilds were identified and engaged through community dialogue sessions. These sessions aimed to gain the participation of these groups, thus reducing/eliminating resistance and promoting community acceptance.

After identifying and contacting the relevant community leaders, FHI 360 staff worked with them to establish and plan programming, identify SMCE and SDB staff that was known and accepted in the community, and involve them as community-based EVD responders. While progress was at times slow due to the strong community beliefs and long-held distrust against the national government and UN, FHI 360 community engagement activities were able to increase the involvement of traditional leadership in the EVD response, improve access to resistant communities and increase the effectiveness of SDB activities.

One such example can be seen in the Katwa Health Zone. Following FHI 360 community engagement sessions, a community who had proven highly resistant to EVD response activities formed a local EVD committee and began conducting its own sensitization sessions. It is especially worth noting that this committee was composed of members from some of the most resistant groups in the community to EVD response teams, demonstrating that a community-led approach such as the one used by FHI 360 is a viable approach to increase acceptance and promote ownership within communities.

A total of 368 traditional leaders were sensitized through community engagement activities, and by the end of the project, 88% of traditional leaders in areas of operations who participated in FHI 360 SMCE activities were actively involved in EVD response activities at some point during the project. Notably, 68 participants of FHI 360 programming—19 traditional leaders and 49 other community influencers—organized EVD-related radio shows. Further, 304 traditional leaders attended SDB services (a total of 679 community leaders and influencers participated in SDB activities, further reported on in the SDB section, below).

Community Engagement Meetings: Following the initial introduction stages with community and special group leaders, FHI 360 staff began SMCE activities in the identified communities. At the onset of the project, this included the affected health zones of Komanda, Katwa, Bunia, and Butembo. These zones were identified and targeted due to their high levels of community resistance to EVD response activities and in particular, SDBs. It was believed that by engaging with traditional and community leaders, FHI 360 would be able to encourage acceptance for these vital activities. As the outbreak spread to new zones, additional communities with high levels of resistance were identified by FHI 360 and its partners. In response, SMCE activities were expanded to these newly identified health zones, which included Masereka, Musienene, Vuhovi, Ariwara, Aru, Rwampara, and Kalunguta.

The SMCE activities implemented by FHI 360 were for the purpose of reducing resistance, promoting acceptance of the EVD response activities and empowering traditional/influential and group leaders to proactively engage their community members to take the necessary actions to stop the spread of the EVD. FHI 360 from the onset actively engaged the Walese Vunkutu Collectivity of Komanda Health Zone due to the fact that the area hosted large Nande communities, including those displaced due to conflict, and Pygmies who reside in the jungles of the area. This area borders North Kivu and had seen some of the highest resistance in all of Ituri. The SMCE activities covered 20 large communities including Ndalya, Idhou, Bunasula, Ofaye, Madbenigar, and Mafifi. The Pygmies and the Nandes, especially the displaced populations, were the main resistance groups. In these cases, SMCE and follow-up dialogue meetings were used to persuade them to accept response activities.

In North Kivu, the SMCE activities were concentrated in Katwa, which was of the most resistant health zones in the province. In particular, sessions were held in health areas that were considered “red” zones, such as Kalemire, Kimbulu, Bwinongo, Rhuenda, and Wayne. These areas were experiencing increased positive EVD cases as the result of their refusal to seek medical attention and/or allow any form of response activities. Due to successes in these areas, the Butembo sub- coordination requested FHI 360 to expand/extend its activities into Masereka, which at the time was a “no go” zone following the collapse of the health care system due to the burning down of health facilities and threats to the lives of health care workers. Through FHI 360 SMCE activities, these communities began accepting health workers, having realized that the health facilities were for their own use. At this point, they even began to protect some from being vandalized. In another health zone, Vuhovi, insecurity made it difficult for community meetings to be held. Through FHI 360 intervention, the regular weekly meetings of Chiefs of the area were resumed at the health zone level.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Activities conducted by SMCE teams included training sessions for community members on EVD-related topics such as: prevention and risk management, transmission, and vaccines; the role of community engagement in the response; and the importance of SDB activities in controlling the EVD outbreak. Additionally, some discussions centered more generally around methods of community engagement, communication techniques, and discussions about FHI 360’s SMCE approach.

During the implementation period, security events caused delays to some planned SMCE activities. In April 2019, when a medical doctor was killed in Butembo, EVD Response activities were suspended for four days by the coordination. Due to fear, many organizations hadn’t resumed activities a week after the event. While FHI 360 did not schedule formal meetings, it was in touch with communities that were experiencing increased cases of EVD and began to serve as liaison between community leadership and their youth in crucial Health Areas/Quarters in Katwa, including Kimbulu and Kalemire. FHI 360 was contacted on two occasions for suspected cases and community deaths, following which FHI 360 informed and collaborated with the relevant coordination sub–commissions to intervene. Another incident in May 2019 saw the Butembo prison come under attack by Mai Mai to free four of their members who were in the prison. This attack led to the cancellation of planed activities for the week. In August 2019, Butembo experienced attack on the city following the death of a motorcyclist killed by a police officer while providing security for an SDB team supported by WHO. This event led to EVD response activities been shut down for another week. Other security events, including the occupation of the jungle areas of Komanda (along the Komanda- Lunar road), caused further reductions in conducting SMCE meetings and responding to death alerts.

An additional problem stemmed from the changing situation and needs within the EVD response. As the outbreak was brought under control in certain areas and shifted towards others, FHI 360’s resources were required to shift as well. As a result, less time and resources were able to be spent in the originally planned communities, limiting the exposure of these communities to EVD messaging and community engagement. This is highlighted in Table 1 below, where activities, which were originally only planned for Butembo, Katwa, Bunia and Komanda, ended up including a total of 11 health zones.

In total, 137 community engagement/ dialogue sessions were conducted with different tiers of community leadership across 11 health zones in Ituri and North Kivu (Table 1). Despite hosting fewer sessions, FHI 360’s SMCE events managed to engage a large number of people, with some sessions being so large that collecting accurate attendance lists was not feasible. Thus, despite the more limited amount of sessions, FHI 360 was able to achieve some of the goals behind this indicator, weakening community resistance levels and increasing acceptance of activities in targeted areas. This included convincing highly resistant populations to embrace vaccinations; accept SDBs, decontamination, and surveillance activities; and commence transferring sick people to health centers.

Table 1: Community Engagement Sessions, March- August 2019 # Number of Health Zone Sessions Male Female Total Ariwara 6 211 6 217 Aru 2 63 2 65 Bunia 6 215 6 221 Ituri Province Komanda 12 458 12 470 Rwampara 1 69 1 70 Sub-Total Ituri 27 1,016 27 1,043 Butembo 5 176 5 181 Kalunguta 11 345 11 356 Katwa 53 1,616 52 1668 Masereka 22 2,400 22 2422 North Kivu Province Musienene 5 132 5 137 Vuhovi 14 534 14 548 Sub-Total North Kivu 110 5,203 109 5,312 Total General 137 6,219 136 6,355

Regular Community Feedback and Follow-up: Following the engagement meetings discussed above, FHI 360 SMCE teams held 20 follow-up dialogue and community feedback sessions. These operations were vital in ensuring that FHI 360’s programming was reaching the intended audience, meeting the goals set in the project proposal and reacting to the needs expressed by community leaders.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Through these sessions, FHI 360 was able to collect community feedback and encourage community ownership of the response. This facilitated better community engagement and allowed FHI 360 staff to search for creative, community-led solutions when encountering resistance to the EVD response. Additionally, these dialogue and feedback sessions allowed the community to suggest further concerns and needs to FHI 360 staff, which was used in the creation of the project proposal for FHI 360’s follow-up project in the Ebola response.

In total, 137 community engagement/ dialogue sessions and 20 follow-up sessions (total 157 sessions) were conducted with different tiers of community leadership across 11 health zones in Ituri and North Kivu, falling short of the of 200 sessions originally targeted. This underperformance in hosting community engagement sessions may have had an effect on behavioral change practices surrounding knowledge, attitudes and practices in the targeted areas, as can be seen in the indicator achievement for percentage of target population who can recall 2 or more protective measures (OFDA mandatory indicator) targeted at 95%, although the final results showed a 72% success rate in Komanda, 85% in Butembo, 85% in Katwa, and only 43% in Bunia. Note that FHI 360 did not independently measure this data, and used available information from UNICEF surveys, which measured the percent of the population who can recall three or more protective measures, rather than two. FHI 360 also notes that the main purpose of its SMCE activities is to improve community engagement in and acceptance of the response, rather than impart information about protective measures (although prevention was addressed in different fora).

Events-Based Reporting: Throughout the life of the project, traditional/influential leaders and SDB team members engaged in FHI 360’s activities were involved in events-based reporting sessions where they learned how to identify and report possible EVD cases within their communities. This included sessions on logging community deaths and movements, as wells as enabling these members to properly identify EVD triggers. This helped to create a community-led surveillance system where community members were able to identify possible cases and movements of affected people within their communities.

This component was intended to empower traditional /influential leaders and community members to contact the EVD response for any suspected cases or community deaths, aiding investigation and the corresponding response. This was done by calling partners of the EVD Response teams directly to report community deaths, a sick person not seeking medical treatment within the community and the unusual movement of family members (who could be escaping from different locations or moving a sick person to traditional healers at night or under cover).

EVD-related Radio Call-in Shows: FHI 360’s SMCE teams conducted training sessions in North Kivu in July 2019 with traditional and community leaders on the production and emission of EVD-based radio programming. These radio programs helped to spread EVD messaging throughout target communities and increase buy-in of community leaders by encouraging community ownership of these programs. Additionally, these programs proved an effective way to spread EVD awareness surrounding transmission and prevention, reaching a wider audience than could be reached through traditional community engagement strategies. A total of 68 (55 male, 13 female) traditional leaders and community influencers were involved in this training and went on to conduct radio call-in shows.

Table 2: Radio Call-in Show Trainees by Health Zone Health Zone Male Female Total Masereka 12 3 15 Katwa 15 2 17 Butembo 2 2 4 Vuhovi 12 3 15 Musienene 14 3 17 Total General 55 13 68

Throughout the project, a total of 160 radio broadcasts on 10 radio stations were held across five health zones in North Kivu by leaders who participated in these training session (from Butembo, Katwa, Vuhovi, Masereka, and Musienene Health Zones). These trainings were limited to North Kivu due to the fact that UNICEF was already covering this activity in Ituri Province. Due to a lengthy process of identifying appropriate zones of operations, radio stations, and leaders, training sessions did not start until July. In August, following these trainings, the 10 stations supported by FHI 360 averaged four radio sessions per week.

Responding to Requests to Reduce Resistance: FHI 360 provided assistance to requests from MoH/WHO/sub- coordination across seven Health Zones (Musienene, Masereka, Vuhovi, Katwa, Aru, Ariwara, and Butembo), conducting SMCE and SDB services. One example of this came as a result of the gains made by FHI 360 in Komanda and Butembo

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Health Zones, where FHI 360 was requested to conduct SMCE activities in Masereka, Musienene, and Vuhovi Health Zones. Another example took place in the Katwa Health Zone where FHI 360 was requested to intervene in Wayne, which prior to FHI 360’s intervention had burned a health center and threatened health workers. Finally, FHI 360 moved into Makerere Health Area of Katwa to conduct CE activities and SDB services and as a result of a request from the Butembo sub-coordination.

Sub-Sector 1.1: Community Engagement Indicators Target Cumulative Reached Percentage of target population who can recall 2 or more 95% Komanda: 72% protective measures Butembo: 85% Katwa: 85% Bunia: 43% Percentage of traditional leaders in targeted location (collectively 88% chief/king, groupement chief, paramount chief and village chief) 90% and leadership structures actively engaged in the EVD response 160 2 Number of radio call-in shows organized 86 157 Sessions Number of dialogue sessions conducted at different tiers of 200 sessions community leadership

7 Instances Number of instances per health zone where FHI 360 provided (one instance each in assistance following request from MOH/WHO/sub-coordination to N/A Musienene, Masereka, Vuhovi, reduce resistance Kalunguta, Aur, Ariwara, and Butembo)

1.1.5: Provide safe and dignified burials and disinfection services through trained and equipped community members In designing the project, FHI 360 worked with Civil Protection and multiple levels of Response Coordination to identify health zones and activities in need of support. As a result of this coordination, FHI 360 and its partners identified Katwa Health Zone as the first area of operation for additional FHI 360-supported SDB teams, adding to the two original teams that FHI 360 had already trained and equipped. However, as EVD continued to spread and effect new zones, FHI 360’s worked with its partners to identify new at-risk health zones and activities in need of further support. FHI 360’s SDB programming expanded from the original health zones of Komanda and Bunia to eventually include Katwa, Ariwara, and Mandima Health Zones.

Training and Equipping of SDB teams: FHI 360 worked with Civil Protection to identify two complete SDB teams to be fully trained, equipped, and incentivized following official requests from the IPC Commissions in the Komanda and Bunia Health Zones prior to the project start in January and February 2019, respectively. The selection process of these teams was a collaborative one between FHI 360, Civil Protection, UNICEF, and Collectivity Chiefs and sought to build a team that represented the community in which it would conduct operations. As an example, in Komanda this process involved the Collectivity Chief putting forward candidates that were known and accepted within the proposed area of operations. These candidates were than screened by FHI 360 and its partners. At the end of the process, the team consisted of members from all major groups inhabiting the area, with three members from the Bira tribe, two Lese, and two Nande. Additionally, the team represented multiple religious faiths (including multiple Christian denominations and two Muslims) in order to ensure that sensitive religious practices were understood and followed. Finally, to ensure gender representation, the team had two female members. A gender balance was essential to ensure that gender norms were respected in conservative communities and to assuage resistance from female mourners, who were regularly noted as amongst the most resistant to SDB activities.

From March to August, FHI 360 trained a total of 156 health care workers (129 male, 27 female) in SDB techniques. Over the course of the project, five training sessions were held with 14 teams across six health zones identified through the coordination process.

2 The target was originally set as 222 at the time of original proposal submission, but adjusted to 86 in FHI 360’s M&E Plan and baseline data report.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Table 3: FHI 360 Safe and Dignified Burial Trainings, March-August 2019 Province Health Zone SDB Team # Trainings Number of People trained Location Conducted

Male Female Total Ariwara Ariwara 13 1 14 1 Aru Aru 10 2 12 Bunia Bunia 1 8 2 10 Komanda Komanda 1 8 3 11 Ituri Mandima Mandima 6 2 8 Some 9 3 12 Alima 1 8 1 9 Mayuwano 6 2 8 Lwemba 11 1 12 Katwa Makerere 10 2 12 Kaviva 10 2 12 North Kivu Wayene 1 10 2 12 Mutchanga 10 2 12 Vuthetse 10 2 12 Total 14 5 129 27 156

Of those trained by FHI 360, four teams were supported and operated by WHO, and nine were supported by FHI 360. FHI 360’s support for Civil Protection teams extended to supervisory support, phone credits, water supply for all team members, chlorine for sterilization, and logistical support (including cars and drivers). These teams also received a regular supply of Personal Protective Equipment (PPE) consisting of coveralls/plastic suit, an apron, rubber boots, latex and heavy-duty gloves, goggles and a mask, which was donated to FHI 360 by WHO. Finally, FHI 306-supported SDB team members were provided a monthly stipend and incentive payments in line with the national coordination guidelines. Providing these teams with water, phone credits, incentive payments, and a steady supply of PPE on a consistent bases proved difficult, due to the long distances between locations, lack of banks/monetary institutions in rural communities, and PPE supply chain management issues with WHO.

FHI 360-supported Civil Protection SDB teams worked in Ariwara, Bunia, Komanda, and Mandima in Ituri Province and Katwa in North Kivu. There were four mobile teams comprising eight members and five community-based teams comprising 12 members. One additional team (in Ariwara) that was trained by FHI 360 was on standby during the project due to lower caseloads in the area. These teams consisted of a team leader, a team communicator, hygienists/disinfectors and a group of carriers.

Throughout FHI 360’s programming, efforts were taken to not only make sure that SDB teams were properly equipped and trained, but that this training was retained and practiced as long as the SDB teams were active. To ensure that this was the case, FHI 360’s SDB team supervisors held refresher sessions for SDB teams monthly. Over the course of the project, four refresher sessions were held with nine FHI 360 supported-teams. The majority of these took place in the Komanda and Bunia Health Zones, which were identified as hot zones by EVD coordination and FHI 360. (Komanda was the training point for Ituri province until the emergence of Mandima as the new hot zone, after which the sessions were held in Mambasa).

Community Engagement Enhancement Training: In order to breed community ownership in the response and ensure that community and family members were actively participating in the safe dignified burial services, FHI 360 worked with Civil Protection and the EDS sub-commission at coordination and sub-coordination levels to identify SDB teams in target Health Zones for training and mentorship in community engagement practices. Originally, FHI 360’s plan was to fully support two SDB teams, while extending the community engagement enhancement training to additional teams supported by other response actors. As the evolving context demanded full support for many more SDB teams, the majority of teams trained on community engagement continued to be supported by FHI 360 for the duration of the project. These teams were chosen from health areas where community resistance to SDB activities was considered highest. FHI 360 provided SMCE and communications trainings to supported SDB teams, introducing them to the proven methods espoused by FHI 360 (Annex A).

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Following these trainings, the teams using the strategy were able to operate in the highly resistant environments in which they were needed. By the end of the project, FHI 360 had trained 14 SDB teams in enhanced SMCE techniques and were actively working with community leaders. As seen above, four of these teams had been trained in SMCE techniques by FHI 360 but were being operated by WHO, with one other on standby.

As a result of this training, the nine FHI-supported Civil Protection SDB teams were able to resolve 14 out of 17 (88%) instances of community resistance to SDBs encountered. These events often revolved around strong community distrust and resistance to the overall EVD response stemming from a general disbelief in the existence of Ebola or belief that Ebola was spread by response actors for various nefarious purposes. As a result of this distrust, the engagement of community and traditional leaders espoused by FHI 360 proved vital in mitigating and reversing these beliefs. Once an understanding was achieved with the target community that Ebola is a disease that has occurred in many places where native animals harbor the disease, work could begin on acceptance of specific disease containment activities that go against traditional practices – like SDB.

Integration of Local Leadership into Community Death Alert System: In order to effectively identify cases in need of SDBs within local communities, FHI 360 offered training sessions on events-based reporting for community leaders identified through the SMCE process. Following these sessions, local leaders were empowered to report any illnesses or deaths considered suspicious or suspected of being EVD-related.

When a suspicious case/death was identified in the community, these leaders would use an open number to inform local coordination, surveillance teams and/or FHI 360-supported SDB supervisors. Local health centers were also involved in this system, alerting the appropriate authorities when suspicious illnesses or deaths took place in their health centers. Upon notification of a suspicious death, coordination members would assign cases to an SDB team. After receiving these alerts, the SDB team would notify the traditional leader of their arrival in the community. The leader would then accompany the team to the home of the bereaved, making the necessary introduction and providing support to the team throughout the burial process, ensuring the safe burial of the dead body. The presence of the highest chief or his designee helped reduce resistance and promote acceptance among family members and the community.

One example of the Community Death Alert System working in the EVD response came from the Katwa Health Zone. Following engagement with FHI 360 SMCE staff, a traditional leader in one community received a report of a suspicious death in his community. In this instance, the traditional leader not only proved instrumental in alerting the community SDB team of a suspicious death in the community but also helped counsel the family on the importance of allowing the SDB team to enter their home and disinfect contaminated areas.

Throughout the project, 542 leaders were integrated into the Death Alert System from seven health zones. In total, 95% of all alerts assigned to FHI 360-supported teams came through this established channel between March and August.

Table 4: Community Leaders Involved in Death Alert System, by Location Province Health Zone Total Ariwara 47 Bunia 167 Ituri Komanda 284 Mandima 22 Subtotal Ituri 520 Butembo 1 North Kivu Katwa 21 Subtotal North Kivu 22 Total Overall: 542

Burial Team Activities: Throughout the duration of the project, there were 1,244 alerts received in health zones where FHI 360 supported SDB activities. Of these alerts, 672 were assigned and responded to by FHI 360-supported SDB teams through the coordination mechanism. Following FHI 360’s community-led approach, there were 679 community leaders involved in these responses.

These alerts for the most part came through the Community Death Alert System discussed above. The number of alerts

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report and SDBs mirrored the trends of the outbreak in the zones where FHI 360 was active, with the majority coming in the Komanda (531 alerts, 303 SDBs) and Bunia (491 Alerts, 193 SDBs) Health Zones, both considered hot zones throughout the project. Responding to these alerts did face some restrictions, however, including the fact that burial teams were normally only active between 08:00-17:00 and surveillance teams often did not operate after 17:00.

With all alerts presented to FHI 360-supported teams, EVD swab tests were performed. Of the swabs conducted in the health zones where FHI 360 had SDB teams, 47 came back as positive, 191 as unknown, and 940 as negative cases. However, due to delays in obtaining results for the swab tests, which varied based on distance of the incident from testing facilities (located in Komanda, Beni, Butembo, and Katwa) and infrastructure restraints present throughout many hot zones, all cases were presumed to be positive and buried according to SDB best practices. FHI-supported teams conducted burials according to SDB best practices for all burials conducted.

One additional activity, the replenishment of household items following decontamination in homes, was originally proposed for FHI 360 SDB teams. However, upon commencing this project, WHO had taken on this role across Ituri and North Kivu provinces. In order to prevent overlap, FHI 360 did not conduct this activity during this project. Thus, the indicator for this activity in the indicator table has the value of zero percent.

Table 5: Supported SDBs3 by Health Zone, March 20-August 31, 2019 Province Health Zone Alerts Total Positive Negative Unknown SDBs by FHI-60 Leaders Swabs Cases Cases Cases Supported Involved in Teams Supported SDBs Ariwara 104 102 1 40 61 59 61 Bunia 491 473 4 403 66 193 213 Ituri Komanda 531 489 12 413 64 303 322 Mandima 58 55 15 40 0 58 52 North Kivu Katwa 59 59 15 44 0 59 31 Total 1,243 1,178 47 940 191 672 679

Provision of Coffins for EVD Response: In addition to the geographic expansion of the originally planned activities, FHI 360 was approached in May 2019 by EVD coordination in Ituri and Butembo to fill gaps in coffin supply and grave digging when the previous provider, IFRC, could no longer conduct this activity. By the end of the project, FHI had agreed to support coffin supply in all active EVD health zones in Ituri Province as well as support coffin supply and grave digging in Butembo and Katwa Health Zones (North Kivu). For the remainder of the project, 1,482 coffins were supplied across seven health zones and support for grave digging was expanded to Butembo, Katwa, Komanda and Mambasa Health Zones.

Table 6: Coffin Provision, by Location and Month Province Health Zone April May June July August Total

Butembo N/A 29 38 42 45 154 North Kivu Katwa N/A 25 72 75 60 232 Sub-Total North Kivu 0 54 110 117 105 386 Bunia N/A 50 73 80 80 283 Komanda 13 163 193 171 207 747 Ariwara N/A N/A N/A N/A 46 46 Mambasa N/A N/A N/A N/A 11 11 Ituri Mandima N/A N/A N/A N/A 9 9 Sub-Total Ituri 13 213 266 251 287 1,096 Total 13 267 376 368 392 1,482

3 Note that statistics for alerts, total swabs, positive, negative, and unknown cases represent data related to all alerts in the health zone, not only the alerts assigned to FHI 360-supported burial teams.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Sub-Sector 1.1: Safe and Dignified Burial Indicators Target Cumulative Reached Number of health care trained 160 156 (129 M; 27 F)

100% Percentage of dead bodies buried according to safe burial 100% protocols 100% Percent of Safe and Dignified Burial team identified, trained, 100% equipped and incented to carry out SDB services

Percent of civil protection burial team trained in enhanced 100% community engagement approach and working with traditional 100% leaders 0% Percent of households provided with replenishment of household 100% items within 4 to 6 hours of decontamination Percent of burial attempts met with community resistance and 88% 90% successfully resolved

Security Context, Challenges, and Risk Mitigation

Since the beginning of the outbreak in August 2018, one of the most daunting obstacles facing responders in the eastern reaches of the DRC stemmed from the instability that has plagued the region for years. The mix of armed groups and local militias (Mai Mai) has complicated the response at almost every turn, slowing or halting operations at times when speed is of the essence. As a result, the EVD response has been operating in areas subject to clashes between the FARDC and armed groups, protests in urban centers and attacks on UN and response organizations by both local communities, Mai Mai groups and unknown armed assailants.

At the onset of FHI 360’s project in March, the EVD response was operating amidst increasing security challenges including pockets of distrust and direct attacks on response workers and sites. During the first few weeks of FHI 360’s operations, threats and attacks against health centers took place in the Katwa and Butembo Health Zones as well as on health workers in the Kalunguta and Butembo Health Zones. This included one attack on an Ebola center in Katwa and one on the Clinic Universitaire de Butembo that resulted in the death of a WHO doctor.

In May, the tension between local populations and the Ebola response continued to escalate, with EVD responders being targeted and Mai Mai attacks being reported in Butembo. Early in the month, this situation was exacerbated when a group of policemen killed a person in Butembo while accompanying an SDB team on a burial, leading to confrontations between police and the local population and halting response activities for a limited time. In the following weeks, as the hot zones of the outbreak spread to Vuhovi and Kalunguta Health Zones, a sub-secretary of a quarter was attacked by youth over his involvement in the EVD response and the Vihulli Health Center in Butembo Health Zone was burned by community members after they learned of the nurses’ involvement in the EVD response. In this already tense situation, FARDC and MONUSCO forces attacked militia from the ADF-NALU, killing 23 members and leading local populations to flee their homes, further complicating response efforts.

In June, the situation in North Kivu remained tense but quiet. Ituri Province, on the other hand, saw increasing security challenges as FHI 360’s activities shifted to Bunia and Komanda Health Zones in response to EVD trends. At this time, an FHI-supported SDB team in Bunia was attacked by a group of youth while carrying a dead body for burial in a nearby cemetery. This came after the team in question failed to follow FHI 360 SDB protocols. In this case, the team was instructed by the coordinator to bury the body in the specified cemetery. However, the deceased was not from the community and the community refused the request to have the body buried in their cemetery. At this point, the team should have accepted the denial by the community, but the coordinator instructed them to proceed with the burial due to the presence of protection in the area. This contradicted two main elements of the FHI 360 approach: community acceptance and operating without the assistance of security. As a result of these breach in protocols, the SDB team supervisor was beaten and the rest of the team was forced to flee to compounds of community members in the area, where they were able to take shelter. The body in their care was taken back to the general hospital from whence it came, where later that day a team supported by the Red Cross was able to conduct a burial. These increasing tensions would negatively affect FHI 360’s activities, making regular visits to important health zones increasingly difficult. Following the attack, FHI 360 teams met with the youth and apologized for not respecting their wishes and the organizations procedures, resolving the conflict between the community and the burial team.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

July saw an increase in clashes between Mai Mai forces and FARDC troops, particularly in Ituri Province. The Ebola response also experienced further direct attacks, including when two local WHO workers were killed near their homes in Beni. It was later established that the attackers had been envious of the fact that the WHO employees had been able to secure a job in the response. Later in the month, two WHO vehicles were attacked by Mai Mai in the Kalunguta Health Zone, but no casualties were reported. Not surprisingly, response activities in security affected health zones remained tense and suffered from delays at this time.

In August, insecurity and tensions between local populations and the response continued, with Mai Mai and other armed groups restricting access to and delaying response activities across the Komanda and Kalunguta Health Zones. Over the same time period, direct attacks against response actors and sites continued, with reports of numerous attacks on checkpoints in the Butembo Health Zone and an attack on a WHO convoy travelling from Oicha to Beni, which resulted in the temporary suspension of movement by all UN agencies. It was in response to the increased tensions and attacks involving armed groups that the response began exploring ways of involving armed groups in response efforts, hoping to ease tensions with resistant groups in the region and open access to hot spots in Ituri and North Kivu.

Thus, throughout the life-cycle of the project, FHI 360’s operations were forced to operate in tense environments where threats of violence were a common occurrence. Many activities, including community meetings and SDBs in hot zones, faced countless delays throughout the project. Yet at the end of the project, FHI 360 continued to operate in all target health zones, using SMCE techniques in order to increase community acceptance and fulfill stated project objective.

To mitigate the above security issues, FHI 360 took a multi-faceted approach. To start with, the backbone of FHI programming focused on SMCE activities designed to involve local community leaders and members from the beginning of response activities. Engaging local leaders and populations the early stages of operations, as well as hiring locally known and accepted staff, helped FHI 360 create varying degrees of acceptance before entering resistant areas. The continued involvement with target communities ensured that FHI 360 teams were not only able to increase community buy-in and ownership in the response but use these contacts to stay abreast of community sentiment, respond to community demands/requests and make informed decisions based off real-time knowledge.

In cases of particularly high resistance, FHI 360 engaged the support of strong and influential influencers. In Butembo, the mayor assisted with community access. Once he had helped introduce FHI 360 to the community, conveying a basic trust with his presence, SMCE teams could begin working to convince resistant leaders about the intentions of EVD response.

While the community-centered engagement was the main component used by FHI 360 to mitigate the security threats, FHI used various other methods in order to increase preparedness and reduce risks. During the program, FHI brought in a security consultant to assess the situation and conduct staff trainings. Additionally, FHI 360 participated in response wide security platforms with the UN (headed by OCHA), as well as with other NGO actors active in the response.

The combination of these mitigation measures and community-level focus worked to increase acceptance amongst the target populations and mitigate some of the risks associated with operating in in highly-resistant zones. However, in the particular context of the EVD Response in the Eastern DRC, security risks cannot be completely avoided and as a result, FHI 360 teams often worked in tense environments where threats and attacks on EVD responders were a part of daily lives.

Other Key Challenges

Beyond the security issues discussed above, FHI 360’s EVD efforts in North Kivu and Ituri met other challenges throughout the program. This included: access issues; community resistance and distrust of the response, the national government and the UN; the necessity to rapidly adapt to the changing context and evolution of the outbreak; and challenges associated with the general population and EVD’s movement in the region.

First, FHI 360’s response efforts met continuous challenges related to accessing affected areas. With infrastructure in the region suffering from years of neglect, trips to remote regions affected by the epidemic often took many hours. While this is understandable with larger and more remote zones, even short trips of under 100km could at times take upwards of eight hours. This issue was exacerbated during the frequent storms that affected the region and further deteriorated the state of roads and bridges, complicating logistics and slowing time-sensitive response activities vital to FHI 360’s project goals.

While the infrastructure was in a general state of disrepair, Ituri and North Kivu both have high levels of population movements due to trade and ongoing conflicts. As a result, EVD trends proved hard to predict, with one infected person able to spread the outbreak from one community across a wide territorial expanse in a matter of days. The result of these unexpected breakouts in new areas meant that FHI 360 had to be prepared to rapidly respond as the outbreak spread to new areas, including maintaining the ability to establish new SDB and SMCE teams with little warning. The establishment of new SDB teams in affected areas was of particular importance, as improper burial techniques could rapidly spread EVD

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report throughout the population. FHI 360 aimed to respond as quickly as possible to the demands in new areas, however, as the original project and budget was designed to fully support only two SDB teams and in a more limited geographic area, FHI 360 struggled to implement within the project budget and ultimately contributed internal funds to this project.

Another challenge came from the high levels of community resistance and general distrust found in many operational areas, particularly towards the national government and MONUSCO (and by extension other UN organizations). As a result, commencing activities in resistant zones often took extra time and effort, requiring extended field deployments for teams in areas that showed little desire to work with the response. As was the case in confronting security challenges, FHI 360 sought to counter-balance this distrust with its community-based approach. When entering a new zone, FHI 360 teams first sought to work with established community leaders and enlist their support in achieving vital community engagement. Once this relationship had been established, it was the community leaders, in collaboration with the Communication Commission and FHI 360, who would be responsible for nominating people from within their communities for SDB teams. As a result, FHI-supported teams represented the communities in which they were working, including women and religious minorities. Upon activation, FHI-supported teams would contact local leaders after receiving an alert and enlist their aid in the response, showing the support of the local chiefs and leaders. This helped to break down resistance and ensure that response activities were able to be active in hot zones. With this, when a particular group was identified as especially resistant to FHI 360 activities, as was the case with women’s and youth groups and motorcycle associations at different points in the response, special care was taken to engage these groups and bring them into the response. Finally, FHI 360 instituted and stood by the policy of not using armed escorts in order to distance FHI 360’s EVD activities from long held notions and distrust of other actors developed over many years.

Monitoring and Evaluation and Accountability

During the project, FHI 360’s Monitoring and Evaluation (M&E) team worked to understand project strengths and weaknesses as well as collect lessons learned. At the onset, the biggest challenge associated with M&E was associated with data entry and collation. At this time, all data was collected, inputted, calculated, and reviewed manually in order to avoid double counting the number of community leaders engaged in the EVD response. However, this led to many delays in reporting and analyzing data. To address this challenge, the M&E team spearheaded the shift towards Kobo Toolbox, a mobile, online data entry platform to increase the efficiency and accuracy of reporting in the project.

The M&E team also encountered the difficulty of acquiring timely reporting from FHI 360-supported Civil Protection SDB teams that were spread out across a broad and geographically diverse territory. This challenge is ongoing; however, the digitalization of data collection and reporting, along with the provision of mobile devices to SDB team leads, are solutions being implemented with the aim of alleviating this problem in the next FHI 360 project.

Another issue faced by the M&E team surrounded limitation in some baseline indicators used in the project. To start, the baseline study for this project only covered the implementation areas from the first months of the project, that is Katwa, Komanda, Bunia, and Butembo Health Zones. As the project shifted and grew, these indicators no longer reflected the actual reality on the ground, either in target zones or populations targeted. Thus, the endline data of the project did not align with the original baseline data across many of the indicators.

With respect to indicator interpretation, the project indicator titled “percentage of dead bodies buried according to safe burial protocols” presented unique challenges. Initially, the indicator was measured using a denominator based on the total number of SDB alerts that were assigned to FHI 360-supported SDB teams. However, following EVD swab tests, many of these cases would come back negative, thus negating the need to follow SDB protocols. Yet these alerts were still included in the overall denominator, making it appear that FHI 360 SDB teams were falling short of the 100% targeted according to SDB protocols, despite burying all positive and unknown cases accordingly. To address this issue, the measurement of this indicator was adjusted to include only the alerts assigned to FHI-supported teams that had positive or unknown EVD swab results. Further complicating the measurement of the indicator however is the fact that there is sometimes a significant lag time between conducting the swab and when swab results become available, whereas there is a necessity to safely bury the bodies to contain the spread of EVD. Therefore, many SDBs were conducted before knowing the final results of the swab tests. As can be deduced, some of these unknown tests eventually came back as negative for EVD, meaning that some bodies that did not require SDBs were, nonetheless, buried according to these protocols. In order to correct this for the future, the M&E team has further refined this indicator to include more detailed data from SDB teams, including whether a swab test was conducted (and if not, why?), whether the test result was known at the time of SDB, and other information. This will hopefully result in a more accurate and easily understood results moving forward.

During the project, the M&E team created a series of feedback mechanisms. In May and June, the team started by conducting an analysis of community influencers (including women and youth associations and community-based organizations) in Butembo, Bunia, and Ariwara. This information was then used to increase the effectiveness of SMCE activities in these areas. In July, M&E improved FHI 360’s community engagement strategies by developing a system for community feedback and complaints data collection. This was used for the Focus Group discussions held throughout

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report operations areas and later contributed to the Social Science in Humanitarian Action Platform brief. In August, feedback sessions analysis was completed with the Ebola Feedback Working Group/Communication Sub-Commission. Information gathered through this mechanism was later shared with other NGOs and UN agencies in Butembo. Additionally, at this time, FHI 360’s M&E team was able to conduct data reviews, staff learning and reflection sessions between M&E, programs staff and Civil Protection staff in Butembo and Komanda. Finally, at the end of the project, FHI 360’s M&E team collected and analyzed project data in order to understand the effectiveness, strengths and weaknesses, and overall success of the project.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Annex A: FHI 360 SDB Procedure

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Annex B: Traditional Leadership Structures of N. Kivu/Ituri

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Annex C: Success Stories

Success Story One: A series of community engagement activities were held on April 13. These meetings marked significant progress towards improving communities’ acceptance of EVD prevention, surveillance, and burial activities. In the community of Nyaksanza, a community dialog session planned with a community youth group was expanded due to increased interest from community members, including young people, community leaders, and women. The meeting included a presentation by FHI 360 staff, which utilized educational visual aids explaining the safe burial process, as well as time for community members to ask questions and express concerns. During this time, individuals expressed concerns about rumors that burial teams were harvesting and transporting human organs from the bodies of the deceased for illegal trade.

Through visual aids and discussion, the FHI 360 staff was able to reassure community members that there is no truth to these rumors. By the end of the meeting, the community had pledged their support for EVD-related activities in their community, including welcoming communication, vaccination, and psychosocial teams. In addition, community members agreed to alert surveillance teams if/when there were cases of EVD-suspected illness or death in Nyakasanza or its surrounding areas.

Success Story Two: FHI 360 actively incorporates key lessons learned from the West Africa Ebola Outbreak into all project activities in the DRC. One such takeaway was the importance of utilizing survivors of EVD–individuals who became infected with the virus, were treated at an ETC, recovered, and discharged—in EVD community engagement activities. As such, FHI 360 collaborated with an Ebola survivor in Mutembo Health Area (Vuhovi Health Zone) to educate community members about Ebola. Through FHI 360 coordination, the survivor–a man by the name of Kaserek—shared his personal testimony about the reality of the virus and his experiences with an ETC to nearby communities.

Kasereka recounts: “11 out of 17 of my family members died from Ebola. I am among six people of my family that survived. Since I was informed of the FHI 360 Community Engagement and dialogue meeting, I have taken a decision to speak out on the EVD resistance within my community.”

Kasereka boldly told participants at FHI 360 community dialogue sessions that they must believe that the virus is real and work with Ebola response teams, as resistance to response efforts would only cause more people to die of Ebola. In addition, Kasereka urged communities in Vuhovi to support and accompany Ebola response teams in their communities so that they may achieve their mission of eradicating Ebola.

Response to Kasereka’s participation in community engagement meetings was overwhelming positive, with community members expressing interest and appreciation for Kasereka’s testimony. Several participants described that hearing Kasereka’s first-hand account of Ebola led them to recognize that the virus is real and that communities must partner with Ebola response team to put an end to the virus.

Success Story Three: Over the course of the project, Ebola prevention and control efforts were repeatedly hindered by communities’ rejection and distrust of Ebola response organizations. To counter this, FHI 360 developed a strategy of engaging directly with traditional leaders in order to establish a relationship of trust and empower them to take responsibility and ownership of the Ebola response in their communities. Through this strategy, FHI 360 provided leaders with the knowledge and tools to help them influence their communities to accept health seeking behaviors that prevent the spread of Ebola.

On June 24, the positive impact of this strategy was demonstrated in Katwa Health Zone. At this time, a suspicious death occurred in a community within Rughenda Quarter. A traditional leader there, who had learned about the importance of reporting suspicious deaths to authorities in order to prevent spread of Ebola, called the FHI 360 response team to report the death. When the FHI 360 team arrived in the community, the family of the deceased initially refused to allow the team to disinfect the area and collect an oral swab from the body in order to test for Ebola. The traditional leader who had reported the death then counseled the family on the importance of these measures in protecting the entire community from Ebola. Ultimately, the family consented to having the body tested for Ebola and for a safe and dignified burial to be performed by the FHI 360 team.

Through the strategy of training and encouraging traditional leaders to take ownership of the Ebola response in their communities, FHI 360 successfully increased acceptance of Ebola control activities. Moreover, this strategy has proven effective at averting the clashes between communities and Ebola responders that have hampered activities and helped fuel the outbreak.

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report Annex D: Program Photos

Radio Call-in Show Practice part at Masereka in Masereka Health Zone

Demonstration by the SDB team during engagement meeting with cemetery host community

Training of Ariwara and Aru burial teams in Ariwara, July 23-25, 2019

FHI 360’s Rapid Response to the Ebola Outbreak in the DRC Final Program Results Report

Poor road conditions faced by

teams travelling to the field.

Women in Dele take part in a

presentation and discussion on EVD.