Untouched: How 284 Liberian Communities Remained Ebola-Free

Untouched: How 284 Liberian Communities Remained Ebola-Free
By Piet deVries, Senior Advisor, Global Communities

Piet deVries speaks to local Liberian community members about new sanitation processes.
For four years, we were busy creating access to safe sanitation for communities in Liberia. And if not for an unprecedented epidemic of what is now one of the world’s most feared diseases — Ebola — almost no one outside of the country would have known about it.
That wouldn’t have been surprising. We were making making solid, consistent progress with Community-Led Total Sanitation, but it was one of those projects unlikely to generate much excitement outside the development community. We began this work through the USAID-funded Improved Water, Sanitation and Hygiene (IWASH) program in 2010 in the three Liberian counties of Nimba, Lofa, and Bong. Our program gained the support of the national government, and we worked with them to develop their sanitation strategy to improve the health of rural communities across the country. By early 2014, we had helped 284 communities become “open defecation-free,” and were working on more.
All that changed with Ebola.
Suddenly, Global Communities and our partners in the Liberian County Health Teams and the Ministry of Health found ourselves at the center of a maelstrom. We scaled up our community engagement work, and then, at the request of the Ministry of Health, began supporting burial teams. This was crucial, since unsafe burial practices were widely identified as the source of 50–70 percent of infections. By October of last year, we were training, equipping and compensating more than 500 volunteers who were dedicated to the emotionally and physically demanding job of ensuring safe and dignified burials. The teams were able to bury 98 percent of bodies within one day of death, and not one of our burial team members was infected with Ebola.
It was at that same time that we received reports of an astonishing statistic. All 284 open defecation-free communities were reporting that they were also Ebola-free — despite being surrounded by Ebola hotspots.
Was there a link between being open defecation-free and Ebola-free? Or between our program’s process and Ebola resistance?
Earlier this year, we employed two independent public health consultants to conduct research into the informal reports we had received, they came back with extraordinary findings. Focusing their research on 551 households in Lofa County, they established with a representative sample that the communities that had reached open defecation-free status were indeed Ebola-free.
Amazingly, they also found that communities that had even begun the Community-Led Total Sanitation process — but not reached full open defecation-free status — were 17 times less likely to experience a single case of Ebola. This suggests a statistically significant correlation between our work to become open defecation-free and being Ebola-free.
Still, we would be remiss in assuming that these findings mean that simply becoming open defecation-free stops Ebola. Rather, they suggest that people who had been exposed to the program’s education were far more likely to develop healthier behaviors and practices that lead to Ebola resistance — especially when led by a member of their own community.
Small investments in the community-led approach were able to save thousands of lives and millions of dollars in curative and humanitarian interventions. Such methods are inexpensive; in Liberia, incentives of only $130 per community can result in far better sanitation practices. Make household latrines, hand washing facilities, garbage pits, and dish racks available, and you have a safe, hygienic, and resilient community.
The resulting behavior changes don’t only defend against Ebola, they help prevent water, insect-borne, and diarrheal diseases, some of the other biggest killers in the developing world today.
While the recent news of a vaccine for Ebola is certainly encouraging, strengthening health systems across Africa and other vulnerable countries will be vital in helping to prevent future outbreaks. In the aftermath of the the crisis, it is essential to improve hospital access and clinical infrastructure, but Ebola — like many other diseases — spreads at the community level.
We must focus our efforts on curbing infections by empowering those at risk to make wise decisions that prevent disease in the first place.
Piet deVries is Senior Advisor for Water, Sanitation and Hygiene at Global Communities, and was Liberia Country Director during the height of the 2014–15 epidemic.