Rapid response to haemorrhagic fever emergences in Guinea: toward a community-based system to enhance commitment and sustainability

Since the 2013-2014 Ebola virus disease outbreak, Guinea faced recurrent epidemics of viral haemorrhagic fevers. Although Guinea has learned lessons from these epidemics by improving its disease surveillance and investigation capacities, local authorities and stakeholders, including community, are not sufficiently involved in response of disease emergence. This led to measure poorly adapted to the local context and consequently less understood and engaging by these local stakeholders. However, recent research has shown that community-based response measures have already demonstrated their effectiveness. By using a qualitative participatory research, this study aimed to (1) describe and analyse the health-related signals that alert local stakeholders, (2) describe the outbreak response measures implemented in Forest Guinea at local and central level, and (3) identify the obstacles and levers for implementing responses adapted to the local socio-cultural context. Ultimately this study should help to build an integrated, community-based early warning and response system in Forest Guinea. Local stakeholders are alerted by a variety of signals: sanitary, environmental and socio-political signals. Regarding health signals, the local stakeholders are supposed to follow a flow chart developed at the central level with a top-down approach. However, our interviews showed that local stakeholders poorly understood this official flow chart. Consequently, we developed, with these local stakeholders, a response flow chart based on their perception and experiences. This diagram, co-constructed with local stakeholders, opens the door to the development of a community-based response. We then identified six main obstacle categories from the interviews, among them lack of logistical and financial resources, lack of legitimacy of community-workers and lack of coordination. Based on the obstacles, we have proposed recommendations for developing a response to emerging zoonotic diseases that would enable local stakeholders to better understand their roles and responsibilities and improve their commitment to the outbreak response.