Community engagement for COVID-19 prevention and control: A rapid evidence synthesis

Abstract

Introduction
Community engagement has been considered a fundamental component of past outbreaks, such as Ebola. However, there is concern over the lack of involvement of communities and ‘bottom-up’ approaches used within COVID-19 responses thus far. Identifying how community engagement approaches have been used in past epidemics may support more robust implementation within the COVID-19 response.

Methodology
A rapid evidence review was conducted to identify how community engagement is used for infectious disease prevention and control during epidemics. Three databases were searched in addition to extensive snowballing for grey literature. Previous epidemics were limited to Ebola, Zika, SARS, Middle East respiratory syndromeand H1N1 since 2000. No restrictions were applied to study design or language.

Results
From 1112 references identified, 32 articles met our inclusion criteria, which detail 37 initiatives. Six main community engagement actors were identified: local leaders, community and faith-based organisations, community groups, health facility committees, individuals and key stakeholders. These worked on different functions: designing and planning, community entry and trust building, social and behaviour change communication, risk communication, surveillance and tracing, and logistics and administration.

Conclusion
COVID-19’s global presence and social transmission pathways require social and community responses. This may be particularly important to reach marginalised populations and to support equity-informed responses. Aligning previous community engagement experience with current COVID-19 community-based strategy recommendations highlights how communities can play important and active roles in prevention and control. Countries worldwide are encouraged to assess existing community engagement structures and use community engagement approaches to support contextually specific, acceptable and appropriate COVID-19 prevention and control measures.

Full text

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GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188
Community engagement for COVID-19
prevention and control: a rapid
evidence synthesis
Brynne Gilmore ,1 Rawlance Ndejjo,2 Adalbert Tchetchia,3 Vergil de Claro,4
Elizabeth Mago,5 Alpha A Diallo,6 Claudia Lopes,7 Sanghita Bhattacharyya8,9
Original research
To cite: GilmoreB,
NdejjoR, TchetchiaA, etal.
Community engagement for
COVID-19 prevention and
control: a rapid evidence
synthesis. BMJ Global Health
2020;5:e003188. doi:10.1136/
bmjgh-2020-003188
Handling editor Seye Abimbola
►Additional material is
published online only. To view,
please visit the journal online
(http:// dx. doi. org/ 10. 1136/
bmjgh- 2020- 003188).
Received 17 June 2020
Revised 24 August 2020
Accepted 25 August 2020
For numbered afliations see
end of article.
Correspondence to
Dr Brynne Gilmore;
brynne. gilmore@ ucd. ie
© Author(s) (or their
employer(s)) 2020. Re- use
permitted under CC BY- NC. No
commercial re- use. See rights
and permissions. Published by
BMJ.
ABSTRACT
Introduction Community engagement has been
considered a fundamental component of past outbreaks,
such as Ebola. However, there is concern over the lack of
involvement of communities and ‘bottom- up’ approaches
used within COVID-19 responses thus far. Identifying how
community engagement approaches have been used in
past epidemics may support more robust implementation
within the COVID-19 response.
Methodology A rapid evidence review was conducted to
identify how community engagement is used for infectious
disease prevention and control during epidemics. Three
databases were searched in addition to extensive
snowballing for grey literature. Previous epidemics were
limited to Ebola, Zika, SARS, Middle East respiratory
syndromeand H1N1 since 2000. No restrictions were
applied to study design or language.
Results From 1112 references identied, 32 articles
met our inclusion criteria, which detail 37 initiatives. Six
main community engagement actors were identied:
local leaders, community and faith- based organisations,
community groups, health facility committees, individuals
and key stakeholders. These worked on different functions:
designing and planning, community entry and trust
building, social and behaviour change communication, risk
communication, surveillance and tracing, and logistics and
administration.
Conclusion COVID-19’s global presence and social
transmission pathways require social and community
responses. This may be particularly important to reach
marginalised populations and to support equity- informed
responses. Aligning previous community engagement
experience with current COVID-19 community- based
strategy recommendations highlights how communities
can play important and active roles in prevention
and control. Countries worldwide are encouraged to
assess existing community engagement structures and
use community engagement approaches to support
contextually specic, acceptable and appropriate COVID-19
prevention and control measures.
INTRODUCTION
Community engagement within health is
crucial to achieve primary healthcare and
promote people- centred services.1–3 It can
support buy- in and sustainability of health
interventions,4 health advocacy,5 improved
quality and satisfaction of services,6 and
contribute to health systems responsiveness7
and strengthening.8 Community engagement
refers to involvement and participation of
individuals, groups and structures within a
parameter of a social boundary or catchment
area of a community for decision- making,
planning, design, governance and delivery
of services.9 It is used as a parent notion with
terms like communication, social mobilisa-
tion, community participation, community
action and empowerment10 with emphasis on
the agency of community members or groups,
considering them as active rather than passive
participants.11 12 Community engagement
is seen as critical in many health initiatives,
Key questions
What is already known?
►Community engagement is considered a fundamen-
tal component during outbreaks and is important to
ensure contextually appropriate interventions.
What are the new ndings?
►How community engagement can be used for
COVID-19 has yet to be thoroughly explored.
Findings from this rapid review highlight the main
community engagement actors and approaches and
the interventions that they conduct within prevention
and control of infectious disease. This review also
notes the lack of documented community engage-
ment activities from high- income countries.
What do the new ndings imply?
►These ndings highlight that well- implemented
community engagement strategies can be used to
support designing of interventions, building trust
and community entry, social and behaviour chance
communication, risk communication, surveillance
and contract tracing, and logistical and administra-
tive support during COVID-19 prevention and control
responses.
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2GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188
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such as for communicable disease10 and maternal and
child health initiatives,13 and more recently has been
considered a fundamental component during outbreaks,
largely arising during the 2014–2015 Ebola epidemic in
West Africa.
The way people interact and live with each other
through their structures, as well as their historical path-
ways require considerations on how to effectively adapt
and respond to any disease outbreak. For example,
differences in political–cultural and social structures,
systems and processes among communities and social
norms and beliefs affect health behaviours and outcomes
during outbreaks.14 Experience with public health emer-
gencies of international concern highlight the need for
contextually appropriate community engagement strat-
egies.15–21 Moreover, a recent rapid review noted key
lessons in risk communication for control of outbreaks
to include communities taking a central role in the
response, involving local leaders and groups, tailoring
interventions to communities and ensuring a two- way
communication.17
Early implementation of prevention and control activ-
ities during the 2014–2015 Ebola epidemic had several
barriers, including suspicions regarding the existence
of the disease and motives of the government and inter-
national organisations.15 19 To address these barriers,
community engagement became a key pillar to the
response. Several measures to engage communities were
undertaken, including building partnerships with local
and religious leaders and working with the community
to develop and adjust key messages for behavioural
change,15 22 and initiation of coordinated response mech-
anisms, such as Sierra Leone’s Social Mobilisation Action
Consortium (SMAC), which supported community
engagement activities during the Ebola outbreak from
2014 to 2016.23 These measures significantly contributed
to the success achieved in controlling the outbreak and
ensuring the resilience of the health system.9 15 22
In relation to COVID-19, community engagement can
be critical for creating local and context- specific solu-
tions to prevention and control responses.24 Through
this ‘bottom- up approach’, communities participate in
‘decision- making processes of planning, design, gover-
nance and delivery of services aimed at improving
population health and reducing health inequalities’.9
The COVID-19 pandemic as a total social phenomenon
should include actively engaging and adapting local
views, voices and concerns in health crisis response
efforts.24 Moreover, the WHO’s recommended measures
to prevent and control COVID-19, such as physical–
social distancing, case identification and contact tracing
require understanding of the different social dynamics
in communities and how these can better be leveraged to
minimise the impact of the epidemic.25 26 The measures
have a huge reliance on communities reigniting the
importance of community engagement to build trust
and delay disease spread as drug and vaccine develop-
ment efforts continue.
However, there is concern over the lack of involve-
ment of communities within COVID-19. Rajan and
colleagues note the limited number of WHO member
states reporting to have a COVID-19 community engage-
ment plan.27 The scientific community—mainly drawn by
social scientists—has called for the attention of funders
and implementers on the relevance of community
engagement for COVID-19,24 28–30 with other interna-
tional stakeholders, including WHO, UNICEF and the
International Federation of Red Cross and Red Crescent
Societies (IFRC) echoing its importance.25 This concern
must be understood considering that, at the beginning of
the pandemic, there was a tendency to prioritise biomed-
ical and epidemiological interventions even if interna-
tional stakeholders have early and progressively defined
some guidelines on risk communication and community
engagement.
Recent reviews on global evidence for COVID-19
have focused on community health workers (CHWs)31
providing important evidence and insights to guide
response. However, there is no evidence synthesis that
addresses how community engagement can be used for
COVID-19 prevention and control. Thus, we conducted
a rapid evidence review on community engagement for
infectious disease prevention and control to learn lessons
for COVID-19 and future pandemic response.
Review focus
This review wanted to understand ‘how community
engagement is used for infectious disease prevention
and control during epidemics’. In doing so, we reviewed
evidence from previous epidemics and aimed to identify
what approaches and community actors are involved,
what interventions are conducted, who the target groups
of community engagement are and how equity consider-
ations are incorporated, what the linkages and relation-
ship to other health system stakeholders are, and what
the main implementation considerations for successful
community engagement for infectious disease preven-
tion and control are. To address these questions, we draw
on findings from five previous epidemics: Ebola, SARS,
Middle East respiratory syndrome (MERS), Zika and
H1N1.
METHODS
Given the emergency nature of the recent COVID-19
global pandemic, we conducted a rapid evidence review
to support timely findings. Rapid reviews are a form of
evidence synthesis that tailor the methodology of a system-
atic review to produce contextually relevant evidence on
an arising topic in a timely and efficient manner.32 To
support the expedited nature of rapid reviews, they can
deviate from traditional reviews in several areas, including
narrowing the scope, limiting the number of searches
or electronic databases, using one reviewer for study
screening and selection, and parallelisation of review
tasks.32 This rapid review followed the methodology
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GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188 3
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suggested by the Alliance for Health Policy and Systems
Research.33 A co- production team comprising all authors
of this paper was established through the collaborative
platform ‘Community Health–Community of Practice’,
supported by UNICEF.
A protocol was developed and agreed on by the
research team, which comprises academics, imple-
menters and policy makers from multiple disciplines
and backgrounds. The team then conducted a rapid
evidence review of academic and grey literature in
May 2020. The main focus of the review was to identify
what types of community engagement approaches are
used within infectious disease prevention and control,
which required articles to describe a minimum of one
specific initiative. As such, no criteria for effectiveness
or outcomes were applied. Full inclusion and exclusion
criteria can be found in table 1.
In line with community agency and taking into account
a framework developed by UNICEF and revised by
Community Health–Community of Practice, the defi-
nition of community engagement adopted in this study
covers the range of collaborative processes with commu-
nity actors that transcend beyond CHWs and includes
community groups, informal providers, faith organisa-
tions or social networks.34 We excluded CHW approaches
and interventions as reviews of this nature have already
been conducted,31 though we included articles if they
described community engagement approaches alongside
CHW programmes and narrowed the scope to include
five recent infectious disease outbreaks: Ebola, SARS,
MERS, Zika and H1N1.
Databases and snowballing
In line with rapid review recommendations, we limited
our searches to three databases: PubMed, CINAHL and
Scopus. We conducted an extensive grey literature and
snowball search by reviewing websites of numerous public
health organisations and repositories, as well as emailing
the authors’ respective networks. Online supplemental
file 1 provides a list of snowballing sources and completed
database searches. Search terms were in both French and
English. In addition, all included articles’ references were
checked. To expedite the review process, two authors
conducted the database search; three conducted grey
literature and snowballing searches; and two conducted
reference searching.
Article screening and extraction
All returned results were entered into Covidence, a
systematic review information management system, where
duplicates were removed. The remaining articles were
screened at title and abstract stage, and full- text stage
independently by two reviewers, with a third resolving
any discrepancies. Two team members independently
screened all returned snowballing resources at full- text
stage, with a third reviewer resolving any discrepancies.
All authors participated in the screening.
Predefined and piloted data extraction tables were
developed. Two authors initially extracted data from
the included articles, with other authors reviewing all
extractions for reliability and consistency. Content on
community engagement actors/approaches and interven-
tion focus was extracted directly as the articles reported if
applicable; however, this often did not occur, leaving the
review team to extrapolate and categorise. Given that the
research question seeks to identify what has been used,
no quality ratings were applied to the included articles.
Public and patient involvement (PPI)
There were no funds or time allocated for PPI, so we were
unable to involve patients. We encourage throughout the
findings for programme and policy makers to involve
communities within the design and implementation of
their respective programmes.
Table 1 Inclusion and exclusion criteria
Topic Inclusion criteria Exclusion criteria
Intervention/population Describes a specic community engagement approach or
activity
Exclusively community health worker
programmes
Structures without community members
serving the same community
Focus Prevention and/or control of infectious diseases: Ebola,
SARS, Middle East respiratory syndrome, Zika and H1N1
Not focused on prevention and/or control
of infectious disease
Scope of intervention Community level—dened by ‘the social boundaries
that dene the individuals and households whose health
outcomes matter as a health system goal, and also the
social context for the relationships that underpin the success
of many health systems interventions’.77
Not community focused
Time Published on or after 2000 Published before 2000
Article type Primary, empirical studies, of any design, programme
reports and descriptions that provide learning on specic CE
approaches
Commentaries, abstracts; no specic
community engagement approach detailed
Language All languages included, searching done in English and some
French terms
No exclusion criteria
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4GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188
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RESULTS
Database and snowballing searches occurred between
27 April and 2 May 2020. A total of 1112 articles were
returned, and after duplicate removal, 956 abstracts were
reviewed. In total, 32 articles were identified for inclu-
sion, 5 of which were identified through snowballing
(4 from initial grey literature/snowball search and 1
from reviewing included articles’ references) and the
remainder through database searches. Figure 1 presents
the screening process and results.
In addition to the 32 documents included and
reported within, 11 documents that did not address or
describe a specific community engagement initiative
but did provide overarching guidance to community
engagement or aspects of community engagement were
identified. These documents were retained to support
our interpretation and implementation considerations
for community engagement. Online supplemental file 3
includes these details.
Article characteristics
Of the 32 included articles, all but 3 were published on
or after 2015, with 1 article published in 2009,35 1 in
201036 and 1 in 2012.37 The remaining were published
in 2015 (n=2), 2016 (n=6), 2017 (n=9), 2018 (n=3),
2019 (n=3) and 2020 (n=6). All articles were in English
except for one, which was in French.38 Thirty- two articles
were included, but two articles report three39 and four40
distinct community engagement initiatives. As such, the
remainder of the review will focus on 37 initiatives.
Context and outbreak
Of these 37 initiatives, 28 were for Ebola, with 25 relating
to the 2014–2015 West Africa outbreak from Sierra
Leone (n=11), Liberia (n=9), Guinea (n=2), Nigeria
(n=1), Ghana (n=1) and one mixed- country study. The
remaining three Ebola examples41–43 were related to
the 2018–2020 outbreak in the Democratic Republic
of Congo, two of which focused on efforts in Uganda.
Five community engagement initiatives were used for
Zika within the USA and Puerto Rico (n=3), and one
each in Singapore and Uruguay.44–47 Four articles were
specific to H1N1, with three from Australia and one
from Canada.35–37 48 No articles were found that detailed
community engagement for SARS or MERS. Figure 2
highlights the examples found per country and topic.
Broad contextual concerns preceding the outbreak
refer to poverty, unemployment or economic
crisis,38 49 health system failure, lack of development
infrastructure,49 50 colonial/postcolonial factors, ethnic
and political conflicts,38 39 lack of trust in government
and international agencies,42 traditional practices and
rituals that are resistant to change,15 51 geographical chal-
lenges52 and mobile populations.53
Community engagement approaches and interventions
The review identified six broad types of community
engagement actors or approaches, which addressed
infection prevention and control through six main
channels. As highlighted in table 2, the main actors
included community leaders (traditional, religious and/
or governing); community and faith- based organisations
Figure 1 Preferred Reporting Items for Systematic Reviews and Meta- Analyses diagram.
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GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188 5
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(CFBO); community groups or networks or commit-
tees; health management committees; individuals (no
further clarification provided); and key stakeholders,
which included students, survivors, women representa-
tives, elderly and the youth. These community engage-
ment interventions addressed infection prevention and
control through six main channels: designing and plan-
ning interventions (including messaging), community
entry and trust building, social and behavioural change
communication (SBCC), risk communication, surveil-
lance and contract tracing, and broader logistics and
administration activities, such as procuring and setting
up hand washing stations, constructing facility or record
keeping.
From table 2, it can be seen that community engage-
ment was mostly used for social and behavioural change
communication and risk communication, followed by
surveillance and contract tracing. Many of the reported
community engagement activities involved multiple
actors and took multifaceted approaches for prevention
and control, as can be observed from table 2. For example,
Skrip et al detail the Community- Led Ebola Action efforts
implemented by the SMAC, which involved local radio
stations to provide a platform for engagement with
trusted community leaders, survivors and responders;
community champions and mobilisers recruited from an
existing cohort of CHWs, youth volunteers and people
nominated by their communities; and religious leaders
to promote key messages and role model behaviours to
support community surveillance through standardised
monitoring forms and a structured participatory dialogue
to identify and address community needs targeting areas
of trust building, risk communication and SBCC54;
McMahon et al detail health management committees,
made up of leaders and key stakeholders, and their efforts
in SBCC and risk communication, and also supporting
health facilities by conducting screening and adminis-
trative duties in relation to Ebola55; Ho and colleagues
highlight how resident committees, grassroot leaders and
volunteers conducted risk communication and source
reduction for Zika45; and Mbaye and colleagues high-
light how community groups, faith organisations and
key stakeholders (youth, women and elderly) conducted
trust building, surveillance and SBCC.38
The majority of the community engagement activ-
ities were not reported as a component of a larger
programme, with the exception of surveillance systems
which included community engagement for monitoring
at the community level linked to a structured contract
tracing system. Online supplemental file 2 includes the
extraction data for each article.
Target groups and equity considerations
The majority of community engagement activities had
community- wide focus, with no specific equity consid-
erations reported. One article from Kirk Sell et al47
discusses CFBOs targeting marginalised populations,
including non- English speakers and undocumented
persons, in the USA for risk communication in relation
to Zika. On the contrary, all articles in relation to H1N1
had an equity focus; remote and isolated First Nations
communities in Canada37 and Aboriginal or Torres Strait
Islanders communities in Australia.35 36 48 Important to
note, however, is that community engagement for these
communities was limited to design and planning, with no
reported inclusion in implementation of activities.
Specific make- up of community engagement
approaches was often not detailed or did not include
diversity and representation, though several reported
community engagement structures, including represen-
tation from Ebola survivors,56 women within reproduc-
tive age and students,46 women representatives39 and
youth.38 54 56
Health system linkages and support
Of those that provided details on linkages, very few were
explicitly linked to other health system components
(with the exception of tracing). Community health
committees53 and health management committees that
were supporting health facility activities55 were linked
Figure 2 Number of articles per country and topic.
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Table 2 Community engagement actors and their involvement in epidemic prevention and control activities
Community engagement
actors
Design and
planning
Community entry/
trust building
Social and
behavioural change
communication
Risk
communication
Surveillance,
tracing
Logistics,
provision,
administration
Leaders (traditional,
religious and governing)
Charania and
Tsuji37 2012;
Juarbe- Rey et al46
2018;
Miller et al48 2015;
Kinsman et al
201778
Mbaye et al38 2017;
Le Marcis et al39
2019*;
HC3,40 2017a*;
Munodawafa et al50
2018;
Skrip et al54 2020
Gillespie et al15
2016;
Barker et al9 2020;
Mbaye et al38 2017;
HC3,40 2017a;
HC3,40 2017b;
HC3,40 2017c;
HC3,40 2017d;
Aceng et al41 2020;
Ho et al45 2017;
Skrip et al54 2020;
Gray et al56 2018;
Jiang et al79 2016;
Li et al80 2016
Gillespie et al15
2016;
Barker et al9 2020;
Mbaye et al38 2017;
Le Marcis et al39
2019a;
Le Marcis et al39
2019c;
HC3,40 2017a;
Aceng et al41 2020;
Ho et al45 2017;
Juarbe- Rey et al46
2018;
Sepers et al49 2019;
Skrip et al54 2020;
Jiang et al79 2016;
Li et al80 2016
Barker et al9 2020;
Mbaye et al38 2017;
Le Marcis et al39
2019a;
HC3,40 2017a;
HC3,40 2017b;
Aceng et al41 2020;
Nakiire et al42 2020;
Sepers et al49 2019;
Gray et al56 2018;
Li et al. 2017
Barket et al9 2020;
Gray et al56 2018;
Le Marcis et al39
2019c
H1N1 (n=2), Zika
(n=1), Ebola (n=1)
Ebola (n=5) Ebola (n=12), Zika
(n=1)
Ebola (n= 12), Zika
(n=2)
Ebola (n=10) Ebola (n=3)
Community- based
organisations and faith
organisations
Mbaye et al38 2017 Mbaye et al38 2017;
Santibañez et al51
2017
Mbaye et al38 2017;
Kirk- Sell et al. 2020;
Adongo et al81 2016
Mbaye et al38 2017 Santibañez et al51
2017
Ebola (n=1) Ebola (n=1), Zika
(n=1)
Ebola (n=2), Zika
(n=1)
Ebola (n=1) Zika (n=1)
Community groups Skrip et al54 2020 HC3,40 2017c;
Basso et al44 2017;
Ho et al45 2017;
Skrip et al54 2020;
Gray et al56 2018;
Abramowitz et al52
2017
Le Marcis et al39
2019a;
Ho et al45 2017;
Skrip et al54 2020
Le Marcis et al39
2019;
Gray et al56 2018
Gray et al56 2018
Ebola (n=1) Ebola (n=4), Zika
(n=2)
Ebola (n= 2), Zika
(n=1)
Ebola (n=2) Ebola (n=1)
Health management
committees/community
health committees
McMahon et al55
2017;
Meredith,53 2015
McMahon et al55
2017;
Meredith,53 2015
McMahon et al55
2017;
Meredith,53 2015
McMahon et al55
2017;
Meredith,53 2015
Ebola (n= 2) Ebola (n= 2) Ebola (n= 2) Ebola (n= 2)
Individuals (volunteers) HC3,40 2017c Dada et al76 2019 Barker et al9 2020;
Aceng et al41 2020;
Skrip et al54 2020;
Jiang et al79 2016;
Maduka et al82 2017
Barker et al9 2020;
Aceng et al41 2020;
Skrip et al54 2020;
Jiang et al79 2016;
Barker et al9 2020;
Aceng et al41 2020;
Nakiire et al42 2020;
Ratnayake et al83
2016;
Stone et al. 201684
Barker et al9 2020
Ebola (n= 1) Ebola (n= 1) Ebola (n= 5) Ebola (n= 4) Ebola (n= 5) Ebola (n= 1)
Key stakeholders Massey et al35
2009;
Rudge and
Massey,36 2010;
Charania and
Tsuji,37 2012;
Le Marcis et al39
2019b;
Juarbe- Rey et al46
2018;
Miller et al48 2015;
Kinsman et al78
2017
Massey et al35 2009 Masumbuko et al43
2020;
Ho et al45 2017;
Gray et al56 2018
Masumbuko et al43
2020;
Ho et al45 2017;
Juarbe- Rey et al46
2018;
Li et al80 2016
Li et al80 2016
H1N1 (n=4), Zika
(n=1), Ebola (n= 2)
H1N1 (n=1) Ebola (n= 3), Zika
(n=1)
Ebola (n= 2), Zika
(n=2)
Ebola (n= 1)
Totals 12 9 32 29 20 8
*HC3 and Le Marcis have four and three examples of community engagement, respectively. For the purpose of this table, to demonstrate frequency of approaches, each
example is cited as either a,b,c or d. However, as these come from the same included article, references do not appear this way within the reference list.
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to community care centres, and Ebola survivors, leaders
and youth groups were used for behavioural change and
surveillance, and linked with existing CHWs.56
Best practices for community engagement during epidemic
response
Key barriers and facilitators for community engagement
for COVID-19 prevention and control that were extracted
from the included studies are presented in figure 3. More
broad implementation considerations synthesised from
guidance documents are provided in online supplemental
file 3, which emphasise the need for community engage-
ment, which has to be context specific as per the cultures,
traditions and customs, social norms and collective
beliefs. Understanding local realities may require social
research, including anthropological studies, if possible,
and research to uncover knowledge gaps and existing
sociocultural barriers. Community engagement should
be an ongoing, collaborative process that starts early with
community members who are seen as legitimate actors
able to represent and influence the community. Commu-
nities should be involved in issue identification and code-
sign of interventions and response. A two- way dialogue
with communities and other stakeholders, essential for
trust building, should be established through multiple
channels with transparent, accurate and consistent infor-
mation to help address rumours and misconceptions.
Messages should be imparted which are focused, not fear
inducing, respectful, tailored to local contexts, with relat-
able examples. Regular feedback mechanism for moni-
toring and course correction that reveal how knowledge,
beliefs and practices are changing are also needed for
inclusive and meaningful engagement. These considera-
tions are also discussed in a policy brief on this research
targeted towards implementers.57
Reviewing the aforementioned findings and materials,
in addition to considering the unique attributes of the
COVID-19 pandemic and important guidance put forth
by WHO, UNICEF and IFRC on ‘Community- based
healthcare, including outreach and campaigns, in the
context of the COVID-19 pandemic’,58 had led to devel-
opment of key programme and policy recommendations
for using community engagement in prevention and
control approaches. Box 1 summarises these consider-
ations, which aim to guide best practice.
DISCUSSION
Engagement lies on a spectrum, from more passive to
active involvement. It can consist of providing information
and conducting consultation; having involvement via regular
interactions throughout the project cycle; and collaboration,
which entails working in partnership with shared decision-
making59 60 that involves communities carrying out critical
health systems functions and innovating with localised solu-
tions.9 Within this review, most included articles could be clas-
sified as having involvement, where communities were thor-
oughly brought in but often did not share decision- making
powers. Notably, however, almost all examples of community
engagement from high- income contexts consisted of consul-
tation, demonstrating passive involvement with target ethnic
and minority population. In addition, very few examples
were identified that had an equity focus or strong equity
considerations within target groups and engagement actors.
Figure 3 Components and implementation considerations of community engagement for infectious disease prevention
and control. The main CE actors (who) most common for that specic process are in bold. The length of the bars varies
based on the most common way (what) of community engagement as per the reviewed literature. ‘How’ represents key
activities that were undertaken within each broader intervention classication. HMCs include community health committees.
CFBO, community and faith- based organisation; HMC, health management committees; IEC, information, education and
communication; IPC, interpersonal communication.
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8GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188
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While leadership buy- in is imperative for many community
activities, so too is ensuring a balance between power and
representation of diverse voices.
Findings from this review highlight a need for more
documentation of community engagement activities espe-
cially from more diverse geographical settings and across
different populations. While some activities are under way,
for instance, GOAL Global, based on experience gained
from their Ebola response, is implementing community- led
action for COVID-19 in numerous countries61 or community
action networks in Cape Town working together to identify
and address the needs of community members,62 imple-
menters, policy makers and researchers, and encouraged to
share learnings from past community engagement initiatives
and document ongoing activities for COVID-19.
Interpretation of these findings should be done based on
existing context, as the majority of articles were from Ebola
response. Ebola had many unique considerations, including
lack of trust, fear, rumours and cultural practices around
burials and stigma.15 Engagement of local leaders, those
with high levels of respect, were critical to support disman-
tling some of these notions and working towards prevention
and control activities. However, the COVID-19 response may
parallel Ebola in many ways, given the social spreading and
potential stigma around contracting COVID-19. Additionally,
most examples were implemented in low- income countries
or in high- income countries where community engagement
was used to target minority populations for H1N1 and Zika.
There is a need for more documentation on community
engagement from more diverse geographical settings and
with different populations. Implementers, policy makers
and researchers are encouraged to share learnings from past
engagement initiatives and to document ongoing engage-
ment for COVID-19 activities.
Countries with pre- existing community engagement struc-
tures with strong ties between health teams and communities
can thoroughly and meaningfully embed such actions into
national response plans. Recent modelling in Africa, where
the large majority of articles including this review are based,
has noted that, if not controlled, COVID-19 could result
in up to 190 000 deaths and 44 million infections in 1 year
alone.63 Many South Asian countries, which have recently
seen exponential increases in COVID-19 cases, have a long
history of community health and engagement activities
and were some of the first to document the mobilisation of
CHWs like India’s accredited social health activists (ASHAs),
for COVID-19. Countries without a strong history of commu-
nity engagement need to identify where this may be most
beneficial, for instance, to support ethnic minorities in the
global North who in many countries, because of inequitable
systems, are being infected and killed at a disproportionate
rate.64
Community engagement may be specifically appropriate
and needed for complex contexts, such as for migrants in
humanitarian settings65 or in urban informal settlements.66
It is also needed to address more complex situations, such as
settings dealing with both COVID-19 and risk of hunger67 or
supporting already overburdened health systems.
Worthy of note are the limitations of community
engagement within the COVID-19 context due to restric-
tions related to large gatherings and traditional face-
to- face approaches. Innovative approaches to adapt
traditional community engagement approaches may
be required, and how governments and organisations
overcome these barriers should be well documented,
evaluated and shared. If done physically, COVID-19
prevention and control guidelines around physical
distancing, wearing of masks and practising good respira-
tory and hand hygiene should be ensured. Alternatively,
new innovations within community engagement may be
more suitable, which may relate to technology and digital
tools. Emerging examples of community engagement via
digital methods in the COVID-19 context have included
the involvement of community governance systems and
CHWs in garnering acceptance for quarantine measures
in China,68 mobilising local resources and volunteers
Box 1 Key programme and policy recommendations
for COVID-19 prevention and control though community
engagement approaches
►Early discussions and negotiation with communities to understand
sociocultural contexts and developing culturally appropriate pre-
vention and control strategies, what types of engagement interven-
tions are safe, feasible and acceptable, and what existing platforms
and initiatives can be leveraged to support COVID-19 activities. Best
practice, key actors and approaches for this have been outlined
previously and in gure3.
►Communities should codesign and support delivery of prevention
and control interventions and messaging (interpersonal commu-
nication/information, education and communication), including
the development of appropriate, evidence- based messaging. Best
practice, key actors and approaches for this have been outlined
earlier and in gure3.
►COVID-19 pandemic management teams incorporate community
members into planning, response and monitoring of standard oper-
ating procedures. These plans should be disseminated within com-
munities to ensure support. This should include topics of
– Population movement monitoring, surveillance and contact trac-
ing systems discussed.
– Community remote monitoring and alert systems.
– Community response mechanisms if cases occur, including so-
cial isolation procedures, enacting contract tracing, quarantine
procedures and community quarantine options.
– Lockdown, isolation or quarantine support, especially for vulner-
able populations, including distribution of essential supplies.
– Referral pathways and medical supply procurement for serious
cases.
– Planning and community sensitisation on safe burials.
►Health and safety considerations should be collaboratively iden-
tied and addressed in planning stages. These include the safe
structuring of engagement activities, such as delivery mode of
engagement; appropriate distancing measures for face- to- face in-
teractions; quarantine or isolation procedures of community; avail-
ability of water and sanitation supplies; resource procurement for
engagement actors, such as personal protective equipment; and
protocols for suspected/conrmed contact with COVID-19- positive
persons.
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GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188 9
BMJ Global Health
and using social media tools such as WhatsApp to collect
health information and communicating COVID-19
messages in Syria,69 and working with community local
and religious leaders to deliberate on facilitators and
barriers in the USA and to disseminate COVID-19 infor-
mation using conference calls.70
Key lessons identified (box 1) in additional to early insights
from COVID-19 also highlight the need to seriously consider
how and what, information is being presented to all stake-
holders and especially communities. An overabundance of
information, accurate or not, also called ‘infodemic’, may
have serious consequences for community stakeholders,
not limited to lack of trustworthiness, confusion and resis-
tance. Key to combatting infodemics and supporting proper
communication will be identifying and dispelling rumours
through the use of community leaders, open channels for
two- way communication between organisations/government
officials and community actors who have been prepared to
identify misinformation and to support accurate messaging,
and transparent and honest messaging with communities
that also addresses and explains any changes to information.
Of further importance is that community engagement
does not occur in a vacuum. It should be part of wider systems
approaches and initiatives to address COVID-19. Ensuring
appropriate health systems supports and buy- in will be
fundamental to its success. Additionally, contextual commu-
nity and implementation factors can largely influence the
success of community engagement,71 with approaches being
considered within the wider system of implementation. This
may involve improving community capacity72 and supportive
environments for engagement, supporting linkages and
supportive policy and funding environments73 74 and estab-
lishing environments of respect, trust and shared values and
goals.73 Using existing frameworks or standards for commu-
nity engagement, such as UNICEF’s 16 Minimum Standards
for Community Engagement75 to support planning, imple-
mentation and monitoring, is encouraged to support high-
quality implementation.
Community engagement supports shaping social
dynamics based on power and control that perpetuate the
marginalisation of certain groups. The actors involved in
mobilisation efforts and decision- making need to be seen as
legitimate by the other members of the community. Recog-
nising that power and legitimacy are contested resources that
may be changed over the course of the outbreak is crucial
for effective community engagement.39 It needs to start early
and continue after the critical stages of the health crisis to
contribute to empowerment and building resilient commu-
nities. Addressing COVID-19 will require multisectoral
responses and a variety of approaches from biomedical and
social sciences. Community engagement should be a funda-
mental component within all of these responses. Whether
it be related to prevention and control, vaccine testing and
ethics76 or resilience and recovery,9 community engagement
can support successful efforts. It can also have fundamental
roles in rebuilding a stronger health system after the more
acute phase of COVID-19 and supporting an equity- focused
public health response. However, for all of these to work,
community engagement needs to be meaningful, to follow
best practice recommendations and guidelines, and to be
specific to the context.
Limitations
As this was a rapid review, our database searching and snow-
balling were limited in scope and time, which may have
resulted in missing articles. In addition, while our search
terms attempted to include all relevant topics related to
community engagement, and we did include search terms for
specific community- based interventions (ie, SBCC and risk
communication), this was not exhaustive, which may have
resulted in missing articles. Excluding articles with a predom-
inantly CHW focus may have resulted in missing some inter-
ventions that detail CHWs and other community engage-
ment actors, though this review did attempt to include such
studies. Several articles were limited in detail, and extracting
and labelling content were at the review team’s discretion,
which may have resulted in incorrect coding on the type of
actors and interventions. This may have been particularly
relevant in situations where the engagement approaches
and interventions conducted were of similar nature, for
instance, the distinction between CFBOs and community
groups, and SBCC and risk communication. Nevertheless,
this review shares important lessons regarding community
engagement approaches from past epidemics that should
guide COVID-19 response.
CONCLUSION
COVID-19’s global presence and social transmission path-
ways require social and community responses. This may be
particularly important to reach marginalised populations
and support equity- informed responses. Previous experience
from outbreaks shows that community engagement can take
many forms and include different actors and approaches
who support various prevention and control activities,
including design and planning, community entry and trust
building, social and behaviour change communication, risk
communication, surveillance and tracing, and logistics and
administration. Countries worldwide are encouraged to
assess existing community engagement structures and to use
community engagement approaches to support contextually
specific, acceptable and appropriate COVID-19 prevention
and control measures.
Author afliations
1UCD Centre for Interdisciplinary Research, Education and Innovation in Health
Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University
College Dublin, Dublin, Ireland
2Department of Disease Control and Environmental Health, School of Public Health,
College of Health Sciences, Makerere University, Kampala, Uganda
3Expanded Programme on Immunization, Ministry of Health, Yaoundé, Cameroon
4RTI International, Pasig City, Philippines
5Heller School for Social Policy and Management, Brandeis University, Waltham,
Massachusetts, USA
6République de Guinée Ministère de Santé, Conakry, Guinea
7United Nations University International Institute for Global Health, Kuala Lumpur,
Kuala Lumpur, Malaysia
8Public Health Foundation of India, Haryana, India
on October 15, 2020 by guest. Protected by copyright.http://gh.bmj.com/BMJ Glob Health: first published as 10.1136/bmjgh-2020-003188 on 13 October 2020. Downloaded from

10 GilmoreB, etal. BMJ Global Health 2020;5:e003188. doi:10.1136/bmjgh-2020-003188
BMJ Global Health
9Community Health–Community of Practice Collectivity, United Nations Children's
Fund (UNICEF) Headquarters, New York City, New York, USA
Twitter Brynne Gilmore @brynne.gilmore and Claudia Lopes @cabreulopes
Acknowledgements We thank Community Health–Community of Practice
members and other networks who shared reports, guidelines and tools; Professor
Bruno Meessen and Hannah Sarah F Dini for providing inputs into the protocol
development; and Jiawen Elyssa Liu for supporting dissemination.
Contributors BG, SB and CL proposed and designed the study. All authors
contributed to searching, screening, extraction and synthesis of articles. EM,
RN and BG prepared the rst draft of the manuscript, with all authors reviewing
and providing inputs. All authors prepared and approved the nal version of the
manuscript. This research is a co- production of the Community Health–Community
of Practice of which all authors are members.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in
the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the
article or uploaded as supplementary information. All relevant data are included as
supplementary les.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non- commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the
use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.
ORCID iD
BrynneGilmore http:// orcid. org/ 0000- 0003- 4496- 9254
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Supplementary File 1: Searching Supplements (snowballing sources, completed database searches, data
base results)
Table 1: Snowballing source and number of returns
Email list
Contact
Team member
No. of resources
CH-CoP
SB/AT
5
CORE Group
SB
2
Collectivity / FARAFRA
AT
0
CHW-TWG
SB
0
UNICEF
SB
1
USAID
SB
0
Websites
Websites
Team Member
No. of resources
World Health Organization Covid-19 database
VdC
18
Centre for Disease Control (Atlanta)
AT
10
Centre for Disease Control (Africa)
AT
0
https://www.nccmt.ca/knowledge-repositories/covid-19-
evidence-reviews
AT
5
https://www.evidenceaid.org/coronavirus-covid-19-evidence-
collection/
AT
0
https://www.cochrane.org/coronavirus-covid-19-cochrane-
resources-and-news
VdC
0
http://blogs.lshtm.ac.uk/hppdebated/2020/04/08/evidence-to-
inform-the-covid-19-response-collection-of-hpp-papers/
SB
6
https://www.ids.ac.uk/publications/covid-19-health-evidence-
summaries/?utm_campaign=News%20at%20IDS%208%20April%
202020&utm_source=emailCampaign&utm_content=&utm_me
dium=email
SB
0
Mesh Community Engagement Network
SB
0
British Red Cross Community Engagement Hub
VdC
2
Covid-19 Research Knowledge Hub
VdC
ReliefWeb
AT
3
WHO Website
VdC
6
Google Search - first 10 pages of "community engagement +
(Zika, Sars, etc)
SB
12
John Hopkins University
(https://www.mcsprogram.org/resource-search-
results/?_sf_s=Zika)
2
Total:
64
Duplicates:
29
Taken to Full text
screen:
35
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Table 2: Database Search Terms for PubMed
Full search:
Cluster 1 AND Cluster 2 AND ( #SARS OR #Ebola OR #Swine Flu OR #MERS OR #Zika)
Cluster 1:
audience [Title/Abstract] OR care group [Title/Abstract] OR caretaker [Title/Abstract] OR
change agent [Title/Abstract] OR citizen [Title/Abstract] OR civic [Title/Abstract] OR
community [Title/Abstract] OR champion [Title/Abstract] OR collaborator [Title/Abstract]
OR leader [Title/Abstract] OR marginalised [Title/Abstract] OR member [Title/Abstract] OR
minority [Title/Abstract] OR peer [Title/Abstract] OR representative [Title/Abstract] OR
resident [Title/Abstract] OR service user [Title/Abstract] OR stakeholder [Title/Abstract] OR
target group [Title/Abstract] OR volunteer [Title/Abstract] OR vulnerable group
[Title/Abstract]
Cluster 2
consultation[Title/Abstract] OR communication C4D[Title/Abstract] OR
engagement[Title/Abstract] OR empowerment[Title/Abstract] OR
participation[Title/Abstract] OR behavioural change[Title/Abstract] OR social
change[Title/Abstract] OR social norms[Title/Abstract] OR SBCC[Title/Abstract] OR risk
communication[Title/Abstract] OR RCCE[Title/Abstract] OR PLA[Title/Abstract]
Ebola
Ebola[Title/Abstract] OR Ebola virus disease[Title/Abstract] OR EVD[Title/Abstract] OR
EBOV[Title/Abstract] OR Zaire ebolavirus[Title/Abstract] OR hemorrhagic
fever[Title/Abstract] OR EHF[Title/Abstract] OR maladie virus Ebola[Title/Abstract] OR fievre
hemorragique[Title/Abstract]
SARS
SARS[Title/Abstract] OR Coronavirus disease[Title/Abstract] OR severe acute respiratory
syndrome[Title/Abstract] OR SARS Virus[Title/Abstract] OR SARS-CoV[Title/Abstract] OR
SARS-related coronavirus[Title/Abstract] OR sudden acute respiratory
syndrome[Title/Abstract]
H1N1
swine flu[Title/Abstract] OR swine influenza[Title/Abstract] OR H1N1[Title/Abstract] OR
grippe A[Title/Abstract] OR grippe porcine[Title/Abstract]
MERS
MERS [Title/Abstract] OR Middle East respiratory syndrome[Title/Abstract] OR MERS-
CoV[Title/Abstract] OR syndrome respiratoire du Moyen-Orient[Title/Abstract]
Zika
Zika[Title/Abstract] OR Zika virus[Title/Abstract] OR Zika fever[Title/Abstract] OR maladie a
virus Zika[Title/Abstract]
Table 3: Database Search Terms for CINAHL
Full Search
Cluster 1 AND Cluster 2 AND (Zika OR Zika virus OR Zika fever OR maladie a virus Zika) OR
(MERS OR Middle East respiratory syndrome OR MERS-CoV) OR (swine flu OR swine
influenza OR H1N1) OR (Ebola OR Ebola virus disease OR EVD OR EBOV OR Zaire ebolavirus
OR hemorrhagic fever OR EHF OR maladie virus Ebola OR fievre hemorragique) OR (SARS OR
Coronavirus disease OR severe acute respiratory syndrome OR SARS Virus OR SARS-CoV OR
SARS-related coronavirus OR sudden acute respiratory syndrome)
Cluster 1
audience OR care group OR caretaker OR change agent OR citizen OR civic OR community
OR champion OR collaborator OR leader OR marginalised OR member OR minority OR peer
OR representative OR resident OR service user OR stakeholder OR target group OR
volunteer OR vulnerable group (AB: Abstract)
Cluster 2
consultation OR communication OR C4D OR engagement OR empowerment OR
participation OR behavioural change OR social change OR social norms OR SBCC OR risk
communication OR RCCE OR PLA (AB: Abstract)
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Table 4: Database Search Terms for Scopus
Full Search
Cluster 1 AND Cluster 2 AND ( #SARS OR #Ebola OR #Swine Flu OR #MERS OR #Zika)
Cluster 1
audience OR care AND group OR caretaker OR change AND agent OR citizen OR civic
OR community OR champion OR collaborator OR leader OR marginalised OR member O
R minority OR peer OR representative OR resident OR service AND user OR stakeholder
OR target AND group OR volunteer OR vulnerable AND group ) AND ( LIMIT-TO (
LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "French" ) )
Cluster 2
ALL ( consultation OR communication AND
c4d OR engagement OR empowerment OR participation OR behavioural AND
change OR social AND change OR social AND norms OR sbcc OR risk AND
communication OR rcce OR pla ) AND ( LIMIT-TO ( LANGUAGE , "English" ) OR LIMIT-TO (
LANGUAGE , "French" ) )
SARS
ALL ( sars OR coronavirus AND disease OR severe AND acute AND respiratory AND
syndrome OR sars AND virus OR sars-cov OR sars-related AND
coronavirus OR sudden AND acute AND respiratory AND syndrome ) AND ( LIMIT-TO (
LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "French" ) )
EBOLA
ALL ( ebola AND ( virus OR disease OR maladie ) OR evd OR ebov OR zaire AND
ebolavirus OR hemorrhagic AND fever OR ehf OR fievre AND hemorragique ) AND (
LIMIT-TO ( LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "French" ) )
H1N1
ALL ( swine AND ( flu OR influenza ) OR h1n1 OR grippe AND ( a OR porcine ) ) AND (
LIMIT-TO ( LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "French" ) )
MERS
ALL ( mers OR middle AND east AND respiratory AND syndrome OR mers-
cov OR syndrome AND respiratoire AND du AND moyen-orient ) AND ( LIMIT-TO (
LANGUAGE , "English" ) OR LIMIT-TO ( LANGUAGE , "French" ) )
ZIKA
ALL ( zika AND ( virus OR fever OR maladie ) ) AND ( LIMIT-TO ( LANGUAGE , "English"
) OR LIMIT-TO ( LANGUAGE , "French" ) )
Table 5: Database Returns and Search Date
Community Engagement (C1+C2) +
Database
C1
C2
C1+C2
COVID
SARS
Ebola
Zika
H1N1
MERS
Full search
PubMed
Date: May 01, 2020
1,019,990
293,217
57,498
34
163
57
68
8
306
CINAHL
Date: May 01, 2020
549,771
235,416
76,852
55
128
34
79
29
316
Scopus
May 01, 2020
407,092
338,211
36,201
98
4
108
227
0
451
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Author/Re fere nce Yea r of Publication Country
Worl d Ban k
Clas si fica tion
Epidemic Type and Date
Desc ription o f Community
engagement/structure engaged
Typology class ification
(Community group s, social
networks, informal n etworks,
local go vernance/commun ity
leade rship, e ducation, faith
organ isation s, justice, other)
Prevention and Control
Mea sur e (Risk-
communication , Behavior
Chang e Communication,
Surveillance , Tracing,
Trust-building , Provision,
Source Redu ction
activities, o ther)
Target Group(s)
Gender/Equity
considerations for
targ et grou ps
Implementing Agency
Pre-existing initiative
of new for epidemic
only
Durati on of
programm e
Notes
Abramowitz, e t al. 2017 Liberia Low Inco me
Ebola Virus Disease, 20 14-
2016
CE for disse mination and assimilation of
information accessed th roug h mass media
Community grou ps
Beha vior change
communication
Community wide Not reporte d
Jointly implemen ted by
Governmen t of
Liberia (GOL) and
UNICEF social
mobilization teams.
New Not reporte d
Aceng , et al. 2020 Ug and a Lo w Inco me
Ebola Virus Disease, 20 14-
2016
CE for commun ity-base d surveillan ce
systems, de velop and disseminate risk
communication messages.
Community volun teers and
leade rship
Risk Communication,
Behavior Change
Communication and
Surveillance
Community wide Not reporte d
Ugand a Ministry of
Healt h (MoH) wit h
techn ical assista nce
from WHO, other non-
health ministries an d
partne r orga nisation s
New
Augu st 2018- May
2019
Adongo, et al. 2016 Ghana Lo wer Middle I ncome
Ebola Virus Disease, 20 14-
2016
Social mob ilization a nd risk communication
a for sa fe burial practice s
Faith o rg anisations Risk Communication Community wide Not repo rted
Ministry of he alth and
partne r orga nisation s
New 2014
Baker, e t al. 2020 Liberia Low I ncome
Ebola Virus Disease, 20 14-
2016
Community-base d surveillance te ams
Community lead ership
Community volun teers
Behavior Change
Communication , Risk
Communication ,
Surveillance , Tracing,
Trust buildin g,
Infrastruct ural support t o
health system
Community wide Not reporte d
Ministry of Health and
NGOs
New 2014-15
Basson , et al. 2017 Uruguay Uppe r Inco me Zika Social mob ilisation
Social g ro ups like community
organ isation s, Scho ols
Behavior Change
Communication
Community wide (who le
urban area of th e city
of Salto)
Not reporte d
University of Re public,
partne ring with Ministry
of Hea lth, Ministry o f
Social Deve lopment
(MIDES ) an d th e
Municipality o f Salto
New 2011-2013
Charania and Tsuji. 2012 Cana da Up per Income H1N1, 200 9 Community pa ndemic committee
Local le adership, fa ith g roup
represen tative and
educa tional represe ntative
Planning Community wide Not re ported
Implementin g agency
along with e xisting
Band Council fede rally
funded
No 2010
Dada , et al. 2019 Sierra Leone Low In come
Ebola Virus Disease, 20 14-
2016
Community liaison team and S ocial
science t eam
Locally recruite d members CE for vaccine t rials
Trial site- Community
wide
Not reporte d
The va ccine t rail team
led by EBOVAC1 an d
suppo rted by EBO DAC
Yes 2014-16
Gillespie, e t al. 2016
Guinea, Liberia, and
Sierra Leone
Low In come
Ebola Virus Disease, 20 13-
2016
Communication for
develo pment - social
mobilization and community e ngagemen t
Multiple commun ity pa rtners
including religious leade rs,
journalists, ra dio station s, and
partne r orga nization s
Risk Communication,
BCC
Community wide Not reporte d
United Na tions
Children’s Fun d
(UNICE F) imple mente d
with gove rnment
and civil society
count erparts
New 2014-2015
Gary, et al. 2018 Sierra Leone Low I ncome
Ebola Virus Disease, 20 14-
2015
Community led prevention a nd control
measures
Community members,
particularly th e Ebola su rvivor
and local lea ders suppo rted
by you th groups
Surveillance , tracking,
Provision, q uarantine,
BCC
Community wide Not reporte d Not reporte d New 2014-15
Health Co mmunication
Capacity Co llabora tion
(HC3)
2017 Liberia Low Inco me Ebola: 2014-2015
Community Le aders: tradition al and
religious
Local G overnance/ community
leade rship (chief and religious)
Risk Communication,
BCC, Trust Bu ilding,
Case de tection
Community wide Not reporte d NGOs, MoH, UN New en gage ment Not report ed
This docu ment reports on multiple Socia l
Mobilization and Community En gagement
SM/CE activities that occurred across
Liberia during the Ebola outbreak in 2014-
2015 . We have e xtracted key CE activities
that had sufficien t detail repo rted within
the d ocument. Th ere are other example s,
also ot her considerat ions (such as
Monitoring and Evalua tion for SM/CE) an d
lists of pa rtners and o rgan isation s and
types o f activities the y were invo lved in
(Appen dix 1 and 2).
Ebola: 2014-2016 Community lead ers and CHWs
Local G overnance/Co mmunity
leade rship (chief and religious)
BCC, Surveillan ce Community wide Not repo rted
Carte r Centre , UNICEF,
World Bank, technical
assistance from African
Union , HC3/ CCP, CDC,
Tony Bla ir African
Governa nce Initiative,
UNICEF, and WHO.
New e ngag ement No t repo rted
Ebola: 2014-2017 Care Group s
Community Grou ps,
Community Le aders
BCC Community Wide Not reporte d Concern Wo rldwide New e ngag ement No t repo rted
Ebola: 2014-2018 Community volun teers Individu als BCC, Design Co mmunity Wide Not repo rted PS I and Mercy Corps New e ngag ement No t repo rted
Ho e t al. for Sin gapo re
Zika Stud y Group,
2017 Singapore Upper In come Zika: 2 016
Grassroots le aders, residen t committees,
volunte ers
Community grou ps, community
leade rs, volun teers
Risk Communication,
Source Redu ction
Community wide Not reporte d Not reporte d not reported Not reporte d
Supp lementary File 1 co ntains some
information on Community en gagement
activities, n ot contain ed in manu script
body.
Table 1: Descr iption of Community E ngagement During Epidemic
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Jiang, et al. 2016 Sierra Leone Low Inco me
Ebola Virus Disease, 20 14-
2015
Social mob ilization f or awareness
generation
Village le aders, community
leade rs, religious lead ers, and
community volu nteers
Risk Communication,
BCC
Community wide Not reporte d
District health
man age ment team of
the West ern Area Rural
District and t he public
health team from China
New 2015
Juarbe -Re y, et al. 2018 Pu erto Rico Up per Income Zika Community b ased participa tory research
Women in rep roductive
age, mothe rs, spo rt leaders,
stude nts, and community
lead ers
Plann ing, develo ping,
and implementin g a risk
communication
initiative
N/A N/A N/A N/ A
Janua ry and March
2015
Kinsman, et. al. 2017 Sierra Le one Low Inco me
Ebola Virus Disease, 20 13-
2016
Community pa rticipatio n in d evelopment
of messa ges
Community members
including traditional lea ders,
imams, pasto rs,
women’s lea ders, youth
leaders, health personnel, and
teach ers
Inpu ts in develop ment of
BCC message s
Community wide
Women in rep roductive
age groups and
pregnant are included
Consortium -
Enhancing Learning
and
Research for
Human itarian
Assistance (ELRHA)
New 2014-2015
Kirk-Sell, et a l. 2020 United Stat es Upper Inco me Zika 2016 -2017
Faith Ba sed Organisa tions and
Community Ba sed Groups
Faith Orga nisations,
Community Grou ps
Risk Communication Community wide
Equity - marginalised
populations, non-
English speakers,
undocumented
person s
Governmen t
Engaged pre-existing
community gro ups
Unknown
This article de scribes man y risk
communication strategies th at were take n
in the US during Zika. We have only
docume nted the CE aspects.
Guinea Low In come Ebola: 2014-2015
Comités de veille villageois (CVV), or
village-watch communities AND Cadet s
Sociau x
Community Grou ps, Local
lead ers
Trust-building ,
Surveillance , Risk-
communication
Community wide Not reporte d
CVV esta blished by
UNICEF in 20 14.
Cadets Sociaux were
active d uring early
2000 war.
CVV ne w, cad ets pre-
existing
Not reporte d
This article de scribes t he CE interven tion
of CVV, however it more so describes the
issues it fa ced.
Liberia Low Inco me Ebola: 2014-2015 Community L iaison Commun ity lead er Design Community wide Not reporte d
IRC imp lementing
Ebola Treatment
Centre, and supp orted
discussions
New Not reporte d
Sierra Leone Low Inco me Ebola: 2014-2015 Chie f Community lea der
Risk-Communication,
Shut-downs
Community wider Not re ported Governmen t New Not report ed
This case study briefly no tes ho w chiefs
were use d to supp ort community-level
Ebola activities, and then de scribes a
situation where afte r 2 mon ths of Ebo la-
free, a new case e merged and the
govern me nt shutd own a local market in
the a rea. This was met b y rioting and
violence between co mmunities a nd police
sent in to shut-do wn an d monitor
community. A pparently, th e Chief (who
was supp osed to be link t o communities
for Ebo la related a ctivities) was no t
consulte d abou t the closure and thus
could n ot communicate with community on
this.
Li, et. al. 2016 Sierra Leone Low Inco me
Ebola Virus Disease, 20 14-
2016
Community ba sed response strategy in
conta ct tracing and social mobilisation
Community social mo bilizer
including including co mmunity
and religious leade rs,
community act ivists,
primary health -care workers,
and volunteers
Risk Communication,
tracing, BCC
Community wide Not reporte d
Chinese Cente r for
Disease Con trol and
Prevent ion
New 2014-16
Maduka , et.al 2017 Nigeria Lo w Inco me
Ebola Virus Disease, 20 14-
2016
Community mobiliser
Community members t ra ined
as mobiliser
House-to -house
interpe rso nal
communication (IPC)
Community wide Not reporte d
Federal ministry o f
health set up E bola
Emergen cy Operation
Cent re. It partn ered
with Nigerian
Centers f or Disease
Cont rol (NCDC), in
collabora tion
with partn ers such as
Centers f or Disease
Control a nd Preventio n
(CDC), World He alth
Organiza tion (WHO),
United Na tions
Children’s Fun d
(UNICE F) an d
Médecins
Sans Frontières (MSF).
New 2014-15
Massey, e t al. 2009 Aust ralia Uppe r Income H1N1
Community con sultation fo r app ropriate
and culturally safe ways t o reduce th e
influen za risk in communities
Community members f ro m
aboriginal population
Plann ing, trust bu ilding A boriginal communities Not re porte d
Hunt er New E nglan d
(HNE) Aborig inal
Health P artnership
collabora tion betwee n
the Area Health
Service an d all
Aborigina l Community
Cont rolled Health
Services (ACCHS)
New 2008
Le Marcis, e t al.
2019
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Masumbuko and
Hawkes.
2020
Democratic Repu blic of
Cong o
Low In come
Ebola Virus Disease, 20 14-
2018
Stud ent-led edu cational campa ign t o
increase community a warene ss and
engagement
Medical stu dents
fromUniversité Cath olique du
Graben (UCG),
Risk Communication,
BCC
Community wide Not reporte d
Université
Cath olique du Graben
(UCG a long with
Ministry of Health of the
DRC, th e World Health
Organiza tion (WHO),
UNICEF, and the
Associatio n for
Health I nnovation in
Africa (AFHIA)
Yes 2017-2018
Mbaye, et al. 2017 Guinea Low Income Ebola: 2014-2016
Community Ba sed Surveillance &
Sensitiza tion Committee (SABC in french)
Religious lea ders
Community grou ps, faith
organ isation s, Community
leade rs, Community
members(youth s, women,
elders)
Risk communication ,
BCC, Surveillan ce, Trust-
building
Community wide
Essent ial
commodities(elect ricity,
water...) fo r Local or
ethnic groups and
employment , BCC for
youth s
UN, Mo H, NGO,
Commun itie s
not reported 2 yea rs and more
As the article focuses at th e beginn ing o n
community rea ctions among which
resistance . It is relevant to con sider the
resistance behaviors as a plea for
community en gagement as they man ifest
complaints/ concerns for no t being rea lly
involved
McMahon, et al. 2017 Sierra Leone Low Income Ebola: 2014-2015 He alth Ma nage ment Co mmittee
Community Grou ps,
community lea dership
Provision, S urveillance,
Logistics, BCC, Risk
Communication
Community wide N/A
Not clear f ro m article -
but u sually part of MoH
and often supported by
NGOs, likely IRC in th is
case.
Pre-existing On-going
The majority o f this article focu sed on
HMCs, however, so me non-HMC members
were prese nt within interviews. No tably,
some con tract tracing commun ity
members. Howeve r, given the main fo cus
in this a rticle, an d how it do es not
specifically distin guish betwe en d ifferen t
types o f CE, we only in clude HMC.
Mere dith, C. 2015 Sierra Leone Low Income Ebo la: 2014 Community Health Co mmittees
Community Grou ps;
Community Le adership
Case ide ntification an d
referrals; Risk
Communication ; BCC;
Provision/L ogistics
Community wide N/A
Oxfam, with District
Healt h Man ageme nt
Team, an d District
Ebola Response
Coord inatio n.
Pre-existing WA SH
programmes
N/A
Community lead ers in group too - so
multiple 'typ ology'
Miller, et al. 2015 Australia Upper Inco me H1N1: 200 9
Participato ry Action Resea rch for
redesign ing response
Lead ers, Individua ls Designing
Indige nous Aust ralians:
Aborigina l and Torres
Strait Islan der peop le
Indige nous Aust ralians
dispropo rtiona tely
affect ed by H1N1,
often due to systematic
marginalization .
Acade mia an d Public
Healt h
N/A One off even t
Mun oda wafa, et al. 2018 Liberia Low Inco me Ebola: 2014-2015
Traditiona l lead ers, traditional h ealers and
religious lea ders
Lead ers, Individua ls
Trust-building /
Community en trance
Community wide Not reporte d
County Health
Promotio n Team, UN
Mission in Lib eria, S ave
the Children and Red
Cross
New Not reporte d
Case stu dy of implementa tion of Eb ola
respon se activities in two ru ral coun ties in
Liberia: Lofa and Margibi
Nakiire, et a l. 2020 Ug an da Lo w Income Ebola: 2019 Community Members an d Leade rs
Informal n etworks, community
lead ers
Participato ry Mapp ing
Participan ts and eve nt
location s to ensure
multi sectoral
representation and
incorporat e principle
location s along
community-level
movement plans
N/A
Infect ious Disea se
Institut e (IDI) Uganda,
and Centre for Disease
Control a nd Preventio n
(CDC)
New One time event Eb ola outbrea k in DRC
Ratnaya ke, et al. 2016 Sierra Leone Lo w Income Ebola: 2015 Volunte er Community He alth Monitors Individu als Surveillance Community Wide No
Ebola Response
Consortium
New Initiated Feb 201 5
Rudge and Massey. 2010 Aust ralia Uppe r Inco me H1N1: 2009
Community Members: key informants an d
stakeh olders
Individu als Design Community wide Not re porte d
New Sou th Wales
Depa rtment of He alth
and Aboriginal
Community Cont rolled
Health S ervices
Consulta tions for
specific to pic new
Unknown
Sant ibañ ez, et al. 2017
United S tates - Pue rto
Rico
Upper In come Zika 2016
Faith Ba sed Organisa tions and
Community Ba sed Groups
Faith Orga nisations,
Community Grou ps
BCC, Provision (re pellent,
condo ms), other
(inspecting windows,
dete cting stagn ant wa ter)
Community wide Not reporte d
Over 10 0 organised
joined alliance with
govern me nt
Epide mic o nly Unkno wn
Only Bo x 3 from Article, the rest p rovides
overall gu idance bu t does no t detail a CE
activity
Sepe rs, et al. 2019 Liberia Low In come Ebola: 2014 Community L eaders
Local G overnance/co mmunity
leade rship (chief and religious)
Risk Communication,
Surveillance
Community wide Not reporte d
MoHS W, WHO a nd
NGOs
Lead ers pre-existing,
but engaged for Ebola
purpo ses
Repo rted Feb 2 014 -
Jan 2 015
Evalua ting WHO's Ebola Re sponse
Roadmap in Margibi County, Liberia. The
Road Ma p had ob jectives, with on e be ing:
achieve full geograp hic coverage with
complement ary Ebola respo nse activities
within the most affecte d countie s/areas,
especia lly those activities that promoted
social mobilizatio n through community
engagement.
Skrip, et al. 2020 Sierra Le one L ow Income Ebola: 2014-2015
Community-led Eb ola Action (CLE A)
Approa ch, via community mob ilisers and
Community Champ ions
Social Net works, Ind ividua ls,
Community Le adership
Risk Communication,
BCC, Trust-Building
Community wide Not reporte d
Social Mob ilization
Action Conso rtium
New
November 2 014 to
December 2 015
Stone, et al. 2016 Sierra Leone Low Inco me Ebola: 2014-2015 Community h ealth monitors I ndividuals S urveillance Community wide
Ebola Response
Consortium, US
Centers f or Disease
Cont rol (CDC) an d
Sierra Le one Ministry of
Healt h an d Sa nitatio n.
New
Janua ry 2015 (start),
but full implementation
June 2015.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Author/ Refe rence Na me of E ngageme nt Typology Classi fication
Composition of communi ty
engagement team (including
gender)
Recruitme nt of mem bers
Descri ption of CE/ serv ices deliv ered / co-del ivere d
by CE
Co-delive ring of
services with other
health ac tors
Links and
relationships with
other actors
Monitoring and
supervision
structures
Training and job-aid
provision
Incentives (monetary
and non monetary)
Provision of
Protective Gear
Contextual Factors : Key Le ssons Reported Notes:
Abramowitz S,, et .al
Mass media communicatio ns
and social lea rning
Community groups Not rep orted No t repo rted
Social learning included verba l information sha ring,
peer-to-peer ve rbal and te xt phone communications,
public and private conversat ions, and direct
observation of Ebola morbid ity and mortality.
Not rep orted No t repo rted Not repo rted Not report ed Not reporte d Not re porte d
Facilitator: Urban Liberian neighborhoods shared a
common media market;
Barriers: (1) Seriou s problems of trustin g and
interpreting inf ormation abou t Ebola d ue to prob lems
with mass media campa igns’ credibility, cohe rence
and lack of specificity of messag es (firehose
approach) b y district in governmen t. (2) Past
experiences with the Liberian government and rebel
groups using public hea lth and mass med ia
communications camp aigns to sprea d disinformation
in order to g ain strategic military ad vantage. (3) Local
conditions crea te conflicts be tween belief s and
practices, with be liefs losing streng th to acco mmodate
current practices (vs n ormative ideals).
Under extreme p ublic health co nditions, loca l
communities can rap idly learn and internalize
positive hea lth messages, a bandon negative
health messa ges, and refine known h ealth
messages. A co mbination of the formal mass
communications camp aign and informal social
learning proce sses can have an amplification
effect. Be liefs and pract ices may be incon sistent
with people adopting positive beh aviours when still
holding con spiracy theories. Ch anging b eliefs may
have little impact on chang ing beha viours.
Method is limited, la cking details on data co llection and a nalytical
strategies. So cial learning th eory is applied beyond b ehaviour to
include communicat ion processes.
Aceng J.R, e t.al.
Community engag ement for risk
communication, B CC and
surveillance
Community voluntee rs
and leader
Community voluntee rs, Village
health team
Not rep orted
Carry out communal a nd door-to-do or EVD health
education and community su rveillance
Community
surveillance and
health ed ucation
District health tea m
comprising of district
political, civic, security,
and health leadership
as well as techn ical
advisors
from different p artners
working in the districts.
Supervised b y District
health team
Voluntee rs were
trained on EVD
screening
Not rep orted No t repo rted
Facilitator: Multi-secto ral plan with committee s at
different a dministrative level, to avoid duplicat ions,
identify gap s, monitoring struct ure.
Barriers: Large influx of pe ople from DRC, const rain in
funding a nd resources
A country-wide co mprehensive plan with
committees to mon itor at differen t levels can he lp in
community enga gement for co mmunication and
surveillance.
The method has limited informatio n about data collectio n and
analytical strate gy. Social learnin g theory is ap plied beyon d its
scope from be haviour to co mmunication processe s.
Adongo, et al.
Social mobilization a nd risk
communication
Faith Organisat ions Trad itional and re ligious leaders Not repo rted
Information fo r the community fo r safe burial pra ctices
during EVD
BCC messages of
high risk socio- cultura l
beliefs
working with
committee comprising
of Governmen t and
nongovernmental
partners
Not rep orted No t repo rted Not repo rted
Personal Prote ctive
Equipment wa s
provided to health
facilities, but n o
mentio n if were
provided to community
volunteers
Facilitator: Dece ntralized gove rnance system a nd out
of 5 key a reas for plann ing social mobilization and risk
communication con stituted was in cluded.
Barriers: Risky socio-cultural p ractices for burials,
leading to direct contact with dead. Social norms for
hand sha kes and se lf-medication.
Need for dia logue and involvement o f community
leaders, faith groups to modify high-risk socio-
cultural practices a s part of prep aration eff orts.
Social mobilization t hrough commun ity leaders and
culturally appropriate health education are needed
to contain an Ebola outbreak.
Got information through cross-refe rencing:
https://ap ps.who.int/iris/bitst ream/handle/ 10665/ 145675 /WHO_EV
D_PCV_Ghana_14_eng.pdf
Baker, et a l. Community Su rveillance Team
Community leadership
Community voluntee rs
Community leaders a nd
Community voluntee rs
Community leaders
identified vo lunteers
Information sh aring, plann ing process, co -identify
problems and implement solutions, service provision
Information sh aring,
advice on planned
interventions,
surveillance and
identifying ca ses.
Country hea lth team
and NGOs
Not rep orted
High-quality
information provision (
through f liers, billboard
advertisements a nd
radio messaging )
between co mmunity
members and
members of the formal
and informal health
systems.
Autonomy o f taking
decision and
suggesting solutions.
Not rep orted
Facilitator: Use of community resource s and the ir
ingenuity to come with solutio n for resource
constrained situation, like co mmunity provided fo od
for laboratory t echnicians, bu ilding isolation f acilities
and taking care of fa milies in quarantine ; collecting
funds to keep the local radio statio n function ing for
information sha ring.
Barriers: Limited o r no avenu es for communicatio n
with health o fficials due to understaff ed hotline s, lack
of visibility of cent ral government o fficials.
(1) Building of trust and be tter communication is
key for CE, un derstand co mmunity practices and
draw on existing social structures a nd resources.
Trust and CE f acilitate community bu y-in to health
initiatives and are essential t o health syst em
resilience. (2) Meaning ful CE is a critical compo nent
for building t rust in the he alth system an d ensuring
effective resp onse to crises.To achieve mean ingful
CE, communities sho uld be treat ed as active
participants in—a s opposed to passive re cipients
of—health response ef forts. (3) Underlines th e
importance of communities to carry ou t critical
health syste m functions an d create inn ovative
solutions to perceived he alth need s. (4) preference
for consultat ion-type CE ap proach in which health
actors sough t opinions a nd advice f rom
communities to more e ffectively tailor messag es
and iden tify new appro aches. (5) Health system
actors must work to build public trust and
communication pla tforms for CE ahea d of a crisis.
(6) A fortuitous cycle of increased trust, improved
communication an d continue d meaningf ul CE—all
necessary con ditions for hea lth system resilience.
Basson, e t al. Social mobilisation
Social groups like
community organisa tions,
Schools
Teachers, pa rents,
students,re presentatives o f
different co mmunity
organization s, physicians
Not rep orted
Awareness an d participation in delivering th e
intervention
Intervention teams
University of Repub lic
who were partn ering
with Ministry of Health,
Ministry of Social
Development (MIDES)
and the Municipality of
Salto
A househ old survey
aimed at eva luating
the information level of
the neighbors about
the activity
Broadcasting of
message ab out the
activity by using a car
with loudspea ker.
Not rep orted No t repo rted
Facilitators: High er contact with h ome owner resulte d
in cost effe ctive ways of che cks of unuse d containe rs,
high percen tage of the delivered bags and removal of
breeding areas.
Barriers: Electo ral processes at n ational an d local
levels during th e scaling up activities created
uncertainty a nd non-ava ilability of resident s during
day time home visits. Adjusting th e time of visits ha d
cost-implications.
(1) Community mobilization a nd inter-sectoral
partnerships incre ases the e ffectiveness a nd more
acceptance of an int ervention. (2) To obtain th e
support of public health authorities, and taking into
account th e cost increase caused b y promotional
activities for community p articipation, it is impo rtant
to unde rline the positive impact of this p articipation
on the e ffectiveness a nd accep tance of t he
intervention. (3) Community participation can
contribute t o empowerment if t hese processe s take
place over lon ger periods o f time and a re
accompanied by the creat ion of op portunities an d
environments whe re issues of p ower and con trol
are explicitly add ressed.
Charania an d Tsuji. Community pandemic
committee
Local leade rship, Faith
representative and
education al
representative
Representat ives from health
center, provincia l hospital,
nursing statio n,
Band Cou ncil, education , clergy,
Northern (a store),
water t reatmen t plan t, a nd
emergency medica l services
Not rep orted Joint deve lopment of pandemic plan
Development o f plan
related surveillance ,
supplies, services.
Intervention team Not reporte d
Each member
receiving a pe rsonal
copy of th e pande mic
plan during the
meeting, a computer
projector was use d to
display the p lan and
committee’s feedb ack
Community pande mic
committees are
federally fun ded
Not rep orted
Facilitator: Commun ity Level pan demic committee
already existed .
Barriers: conf usion and lack of prepa redness, ill-
defined ro les and respo nsibilities of gove rnment
bodies ove rseeing the delivery of hea lth care and
insufficient de tails in community-level pa ndemic plans.
Community-level pand emic plans are dyn amic in
nature, so there is nee d to re-assess a nd modified
with community participa tion on an annual b asis
and afte r each pub lic health emerge ncy in order to
meet the e volving need s of the co mmunity.
Moreover community membe rs possess information
from their persona l experiences a nd can p rovide
invaluable insig ht about local values a nd beliefs to
create up-to -date and culturally-appropriate
community-level pand emic plans.
Dada, et al.
Community liaison tea m (CLT)
and Socia l science team (SST)
Locally recruited
members
CLT comprised of n ine locally
recruited staff employed by t he
University of Sierra Le one’s
College of
Medicine and Allied Health
Sciences (CoHMAS) and two
LSHTM supervisors. The SST
was comprised of f our locally
recruited
research assistan ts, a data
analyst, a t ranscriptionist, and an
LSHTM social scientist
Not rep orted
Acted as liaiso n to the community to make t hem
understan d of the trial, its importance, recruit
participants a nd to ad dress any rumours o r
misconceptions of the trial . Co nducted activities
including on e-to-one stake holder meetin gs,
group area meetings, pu blic performances a nd radio
jingles
Not rep orted
To the vaccin e trial
team
University researcher
Team received
background training
on clinical trials and
were responsible for
implement ing th e CE
strategy, monito ring
rumors and con cerns
circulating in the
community, and
providing info rmation
about the trial at
national and
internationa l levels
Paid from the vaccine
trial budget
Not rep orted
Barriers: Delayed response in effectively ad dressing
the outb reak and o ther factors like mo bile
population s, lack of trust in governments, weak health
systems, poor co ordination, in adequat e
communication strat egy, misconceptio ns around the
disease, ign orance of lo cal culture and customs, and
lack of involvemen t of local commun ities in the con trol
strategies
CE approach delivered in va ccine trial establishe s
trust betwee n the te ams and community members
that was reciproca l, relatable, rela tional, and
respectful
Same interven tion description can be fo und in an other article L uisa
Enria et.al]
Gillespie, et al.
Communication for
developmen t - social
mobilization and community
engagement
Multiple community
partners includin g
religious leade rs,
journalists, radio st ations,
and partner
organization s
Varied community n etworks of
religious leade rs, chiefs, heale rs,
mayors and cou ncilors, and o ther
community leaders.
Identifying influential or
trusted influe ntial person
like in rural communities
religious and other
community leaders wh o
have exte nsive reach
unlike in urba n areas
BCC messaging fo r prevention, co ntrol and b uilding
trust
Not rep orted No t repo rted
Local partn er NGOs
manage ke y
messages,micromappi
ng of commun ities to
improve targeting
Strong prot ocols to
guide all asp ects of
the respon se strategy.
Differen t
communication to ols
like Radio facilitate d 2-
way communication
Not rep orted No t repo rted
Barriers: the situation was rapidly unfoldin g and fu ll
of surprises and the communities that were af fected
the most were la rgely low-income and remote, and
they ofte n held trad itional practices a nd rituals tha t
were difficult to change
Engaging communities early on , understan ding
social and b ehavioral dyna mics to shape the
response, a dapting t o the evo lution of th e
epidemic and to feedb ack from communities, a nd
facilitating a mo re central and active role of
communities with mutua l accountab ility
mechanisms. There is n eed iden tifying trusted local
community members to f acilitate community
entrance a nd use ke y communication ne tworks and
channels with wide reach an d relevance t o the
community, such a s radio in low-resource se ttings
or faith-based organization s.
Gary, et al.
Community led preve ntion and
control measures
Community members,
particularly the E bola
survivor and local le aders
supported by youth
groups
Ebola survivors, ch ief of the
village, youth groups
Not rep orted
Health promotion , identifying the sick,conta ct tracing,
isolating, do nated lan d for community care centers,
surveillance and case reporting , provision of hand
wash points a t
entrance t o community and houses
Health promotio n,
surveillance, tracing ,
tracking, isolating
Community health
worker
Not rep orted No t repo rted Not repo rted Not report ed
Facilitator: Lo cal leadership in spired confide nce and
reassurance, h elped implement measures such as
contact tracin g and he alth promotion , and con tributed
to the p lanning, ide as, and so lutions for ef fective
controls.
Barriers: Delay in resp onse led the community
devising self-treat ment or othe r local options
Health messagin g is best con ducted at househo ld
level through local leaders o r people who have
experienced Ebola first-hand , rather tha n mass
media
Health Communication
Capacity Collabora tion
(HC3), 2 017
Community Leade rs: traditional
and religious
Local Govern ance/
community leadersh ip
(chief and religio us)
Local leade rs Pre-existing local leaders
Traditional and community leade rs combated rumou rs
and assisted communities to a ccept message s.
Leaders p art of plann ing, decision-making , discussed
how they co uld best en ter communities, an d then did
the messagin g sharing across variety of settin gs (i.e.
Imam in mosque, leaders holding community meeting s
etc). Suppo rted overcoming community resistance.
They also repo rted suspect ed cases of Ebola.
Wider imple ment atio n
of community level
services.
NGOs and UN bo dies
implementing social
mobilisation and
community
engagement/outreach
technique s
Not rep orted
Training condu cted for
all community and
traditional lea ders in
November 2014 .
Given mobile ph ones. Not rep orted
Community resistance t o Ebola no tices. Pre Existing
democracy and peacekee ping work by NGO, meant
foundat ions were already in place, an d the
relationships e stablished, a nd leaders t rained. Proved
invaluable fo r gaining trust and supp orting
engage ment. Multi-level target ing: messages were
identified b y social mobilisation g roup, then leaders
engage d, and a lso radio message s played, movie
played, info rmation distributed , hand-wash ing stations
set up.
Including leaders supported appropriate targeting
of messages, especially one s that previou s
produced fear.
Community leaders a nd CHWs
Local
Governance /Community
leadership (chief and
religious)
Local Lea ders and g eneral CHWs Pre-existing local leaders
RED Strategy, Re ach Every District: gen eral
Community Health Workers, Chie fs, elders and
religious leade rs were trained on prevention and
surveillance, the n formed watch committees to pro tect
their communities. CHWs would go door to door with
BCC, and commun ity support was fo stered by lea ders.
Not rep orted
Carter Ce ntre,
UNICEF, World Bank,
technical assista nce
from African Union,
HC3/CCP, CDC, Tony
Blair African
Governance Initiative,
UNICEF, a nd WHO.
Not rep orted
Capacity Building
Activities' were
provided
Notes: provision of
logistical suppo rt and
incentives empo wered
communities to
actively protect and
improve their own
health
Not rep orted
Care Gro ups
Community Groups,
Community Leade rs
10-15 community volunteers Not reporte d
Care Group Mod el: Implemented by Concern
Worldwide, care grou ps are comprised o f 10-15
community volunte ers who acted as health educators.
Voluntee rs shared learning with communities an d
helped facilitate behaviour change at the household
and community le vel.
not reported Concern Worldwide
Met regularly with
programme staff
(Concern Worldwide)
for training, su pport
and supe rvision.
Met regularly with
programme staff
(Concern Worldwide)
for training, su pport
and supe rvision.
Not rep orted No t repo rted
Facilitator: Truste d members of commun ity were
involved in Care Group. Community membe rs were
able to rece ive individual cou nselling sessions with
members. Large co verage area with limited staff
resources.
Community voluntee rs Individuals Individual (bu t 15,000 trained) No t repo rted
Listen! Le arn! Act! (LLA ), by PSI, is an innovative,
both-up co mmunity approach that use d community
volunteers fa cilitate discussions a cross three ph ases.
1) Listen: d uring which community membe rs share
experiences, rumours, fears, ho pes and su ccesses; 3)
Learn: du ring which facilitators mad e conne ctions
between t he group and reliable so urces of info rmation
(e.g. the call centre, gen eral community hea lth
volunteers) tha t would provide correct information
supplied by MoH; and 3) Act : where group would
identify ways th ey can make ch anges ba sed on
discussion. Emph asis on promoting communities to
take action s to prevent Ebola. Community workers
were trained a nd mentored to deliver the e
Not rep orted PSI
Community workers
were trained and
mentored by PSI
Community workers
were trained and
mentored by PSI
Not rep orted No t repo rted
This was implemented under the Ebola Community
Action Platfo rm (ECAP), a project de veloped b y Mercy
Corps. All community mobilizers un der ECAP
implemented Liste n!Learn!A ct. The primary aim of
ECAP was to co ordinate socia l mobilization across th e
country and provide supp ort to local NGOs and
community groups.
Bottom-up a pproach, sup porting communitie s to
design own plans, trusting local NGOs with
outreach resp onsibility, building capacity tha t
covered en tire country throu gh effect ive community
engagement and ownership, leading to behaviour
change.
Challenges: t ransportation, community percept ions,
health workfo rce and capa city, poor san itation and
hygiene fa cilities, leadership, funding, p artners in
terms of stand ardizing approa ch and h aving
presence in communities.
Table 2: Com munity Engage ment Technique Descri bed
These last fo ur examples were a ll within one repo rt, which
documente d SM/CE in Liberia during Ebola in 2014-20 15. All were
under the government led 'Social Mobilizatio n' pillar, that wa s s
structured facilitat ed and mo re systematic way of p lanning a nd
monitoring such activity. Readers a re directed to this document for
more details on each type of enga gement proce ss, as well as
monitoring and evaluation and more b ackground t o the SM/CE
structures in Libe ria. Key challen ges/recommenda tions add ressed
across all four exa mples, taken from the docu ment, are as follows.
Challenges: 1 ) partner coordin ation and communication; 2 ) local
partner eng agement; 3) community resistance or challenges
working in communities; 4) limited research/da ta from the fie ld; 5)
logistical/financial co nstraints; an d 6) working in diff icult
terrain/challeng ing environment s. Lessons le arned: 1) commun ity
engage ment and o wnership are key; 2) utilise Ebola survivors in
social mobilization a nd community activities; 2) invest in cap acity
building of community structures an d systems streng thening a t all
levels; 4) systematic, su stainable, a nd target ed approa ches work;
5) develop standards fo r incentives for co mmunity work; 6)
coordination and communicat ion are essen tial; 7) facilitate two way
communication with co mmunities; 8) work in collab oration with loca l
media; 9) deliver co nsistent messag es and d o not ove rsimplify. Key
recommendation s: 1) Maintain clea r and consiste nt messaging; 2)
establish clear ch annels for co mmunication; 3) sup port continu ous
community enga gement; 4) p romote key preve ntive beha viours in
community; 5) set u p effective reporting and data syste ms; 6) build
capacity of lo cal media; 7) improve p artner coordina tion and
communication; 8 ) establish risk communication systems/protoco ls;
9) facilitate strate gic cross-border and intercultural act ivities
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

Ho, et al. fo r the
Singapore Study Group ,
2017
Grassroots leade rs, resident
committees, volunt eers
Community groups,
community leaders,
volunteers
Unknown Unknown
Grassroots leade rs and volun teers distributed
information leaf lets and mosq uito repellent s in their
communities and reminded peo ple to che ck for
mosquito bree ding group s. Resident committee s
organised g arbage/litter co llections and surveyed
environment fo r mosquito bree ding spots.
Unknown Unknown Unkno wn Unknown Unknown Unkno wn
Once Zika ha d moved to mo squito pop ulation,
government u sed community ed ucation a nd
engage ment for vector co ntrol, which con tributed to
the reduce d spread within four weeks. Qu ick,
national, mu lti-sectoral action was req uired.
Jiang, et a l.
Social mobilization f or
awareness generation
Village leade rs,
community leaders,
religious leade rs, and
community volunte ers
Village leade rs, community
leaders, religious leaders, and
community volunte ers
Not rep orted
Improve the p ublic’s awareness in
order to cha nge beh aviors towards EVD co ntrol
Not rep orted No t repo rted Not repo rted
Multiple stages of
intensive trainin g with
a major focus o n
educating the pub lic
on how to prevent th e
transmission of EV D,
as
well as encoura ging
people to promptly
seek medical care in
the even t that the y
experience sig ns and
symptoms associated
with the disea se
Not rep orted No t repo rted
Barriers: Prevale nce of po or behaviors, in cluding an
unwillingness to report Ebola, a preference for
traditional he aling, and unsafe b urials
The training in creased awaren ess of EVD co ntrol
and preve ntion, as well a s community enga gement.
It also esta blished a mech anism for coordina tion
and coop eration be tween the community and a
professional t eam
Juarbe-Rey, et al.
Community based participatory
research
Women in reprodu ctive
age,mothe rs, sport
leaders, stud ents, and
community leaders
Women in reprodu ctive
age,mothe rs, sport leade rs,
students, and community lea ders
Community partners
recruited community
members
Co-developing three risk communication strategy- Zika
awareness he alth fair, hea lth educa tion throug h
theater, a nd community fo rums and workshop s.
Not rep orted
Linkage with
academic/ inte rvention
team
Periodic meeting s
were he ld to upda te
partners, coo rdinate
efforts, exa mine
publicity plans,
distribute
responsibilities, an d
identify nee ds
Use of facilitato r guide Activities were fu nded Not repo rted
Facilitator: Pa rtnering with community members
allowed for con textualizing risk communica tion
strategies to convey hea lth information in formats that
were easily und erstood and well-received by
community members. community members’
involvement in p lanning, d eveloping, a nd
implementing this risk co mmunication initiative
contributed to an increa sed sense of project
ownership
Community-based p articipatory approa ches for the
design of risk communication and community
engage ment strategies enables resid ents in low-
income communities to make informed d ecisions for
the prote ction against Zika virus and ot her
mosquito-borne diseases
Kinsman, et a l.
Community participatio n in
developmen t of messages
Community members
including trad itional
leaders, imams, pa stors,
women’s leaders, yo uth
leaders, he alth
personnel, and teach ers
Imam/pastor, Traditio nal
community leader, youth lead er,
women’s group, Traditional
healers
The study t eam introduced
to respective village chief,
who
then called a meeting with
key stakeho lders, including
traditional lea ders, imams,
pastors,
women’s leaders, yo uth
leaders, he alth personn el,
and tea chers, who late r
was identified as study
respondents
Co-developing messages on topics as
ambulances, burial teams, an d the use of chlorine
Not rep orted
Research Conso rtium
team members,
representative s from
the MoHS, the US
Centers for Disease
Control, and local
NGOs -
Focus 1000 .
Not rep orted Activities were fund ed No t rep orted
Barriers: Lesso ns learned f rom messaging in p revious
viral haemorrhagic ep idemics were not ta ken into
account, a nd which con tributed to prolonging the
outbreak. Also the messag ing was top-d own without
considering th e local social-cultural a spects.
Communication with th e community and message
dissemination sh ould be co nducted o n a two-way
basis, with the use of trust ed messenge rs for each
segment of the pop ulation
Kirk-Sell, et al.
Community and f aith-based
organisation s
Faith organisa tions,
community groups
Unknown Pre-existing groups
Public health officials responsib le for respond ing to
Zika highlight t he importance of partnership s with CBO
and FBO, e specially to improve co mmunication with
non-English sp eakers or hard to reach p opulations.
Targeting a variety of diffe rent community
organisation s (women's clubs, ga rden clubs et c). Also
coordinated with community hea lth workers.
Engaged by
Government
Not rep orted No t repo rted Not repo rted Not report ed Not reporte d
Facilitator: Pre -existing groups in the community, t hat
the Pub lic Health officers would link with to he lp
support act ivities.
Deploying messag es across multiple p latforms,
tailoring nua nced message s for target p opulations.
Note: doe s not describe any more in-dep th what typ e of CE was
done.
Comités de veille village ois
(CVV), or village-watch
communities AND Cadet s
Sociaux
Community Groups,
Community Leade rs
CVVs made up of: local elite s,
official represent atives of you ths
and women, religious leaders,
traditional he alers and Eb ola
survivors. Cadets So ciaux (youth
groups set up during 2 000s in
response to conflict).
CVV were to b e selected
by community members.
Cadets sociau x -
recruitment not reported
CVV: intend ed to creat e a local mecha nism for
resolving issues a round pop ulation resistan ce and
epidemiological su rveillance. However, th e CVV in
itself provoked resistance. CVV me ant to en gage loca l
leaders to 'd evelop trust' and improve co mmunity
acceptability o f response, but had many struggles,
including assa ult and no admittance to communities.
Cadets sociau x challenged and att acked MoH and
other out siders who came into villages. They
established own 'watch committee s' to protect
communities. Community med iation processes
(facilitated by WHO) went in to investiga te history
Ebola de velopment an d enable community
empowerment an d mobilisation.
Not rep orted
CVV supporte d by
UNICEF
Not rep orted No t repo rted Not repo rted Not report ed
Facilitator: Stro ng historical facto rs influenced the
acceptability o f CVVs, and the community (large ly
influenced by cadets so ciaux) response to Ministry of
Health and external acto rs efforts. Outsid ers were met
with violence, lea ding to a rrest of community
members. People had large distrust in outsid er
interventions, and had previous mecha nisms for
community monitoring. Cadets took it upon
themselves to monitor and e nforce rules for E bola.
Lack of histo rical understand ing, and doing pre
'ground work' t o establish co nnections mea nt CVV
implementation d id not succe ed.
CE is not a 'o ne-size-fits-all'. Inflexible or top down
responses a re not app ropriate. CE requ ires
'fundamen tal recognition that within co mmunities
power and legitimacy are always con tested
resources'. CE requ ires dynamic awarene ss of
history, conte xt and po wer.
This article present s three case st udies, each using diffe rent CE
within their own co ntexts of S ierra Leone, Guinea an d Liberia.
Case studies a re detailed individually, but under the same article
heading.
Community Liaison Community leader Wom an Nominated by community
Community representa tive present during plann ing
stages of new Ebola Trea tment Centre, who
expressed co ncerns, priorities, an d negot iated for
services for communities. A lso related con cerns
regarding po st-Ebola and the impact o f the ETC.
Negotiated for hiring quo tas from in the community.
Also led to youth lead ership working with
government/NGO s to raise awaren ess through
outreach p rogrammes, and in cluded training of
community task-forces. Wee kly meetings were h eld to
inform communities of E TC updates. Establishment o f
new community ba sed organisa tion called 'Takin g
Initiatives', an d other initiat ives from youths h ave also
resulted.
Not rep orted
IRC implementing
Ebola Containment
Centre
N/A N/A Not reported Not rep orted
Barrier: Containment measures (cremation of the
deceased , lock-downs and ebola trea tment centres
that did n ot have ca pacity to su pport all tho se
admitted) led t o much rumours, distru st and criticism
towards gove rnment response . A new ETC was b eing
established in a stadium, wh ich was foreseen to be
dangerou s and also take away job s and activities for
people in that area, who already h ad several o ther
treatment cen tres nearby.
Community leadership /representative need to be
present during planning stages, to negotiate on
behalf of community, which will suppo rt more
acceptance and ap propriate services. K nock-on
effects of such enga gement may b e establishmen t
of other co mmunity initiatives tha t represent
community need s.
Article has severa l aspects of CE: new initiatives, co mmunity task
forces, etc. b ut the most discussed was co mmunity representat ion
within the ETC p lanning, which is reported he re.
Chief Community lea der Not reporte d
Pre-existing community
Chief
Community-ownership-model' h ad Chiefs act ivity
involved as ch ief community mobilisers, who would do
BCC but also impo se unpop ular measures (like fine s).
For the most p art, this was accep ted as Chie fs were
from the communities and were alrea dy an au thority
figure. When new Ebola ca se emerged, the
government t ook action t o shut-down markets in town,
without eng aging the Chief community mob ilisers.
Not rep orted
Government E bola
task force
Not rep orted No t repo rted Not repo rted Not report ed
Chiefs were initially recruited to suppo rt Ebola
activities within communities, however when a new
case emerged the gove rnment took a ction via closing
markets without co nsultation with Chief, and thus
Chief did no t get opp ortunity to co mmunicate with
community. Additio nally, large mistrust in E bola
response to begin with - man y community members
considered it a money-making op eration for
organization s and hea lth workers
Meaningful e ngagemen t of leade rs/CE activities
needs to be embedded throughout, and not
abando ned during peak crisis times (i.e. ne w Ebola
case in this inst ance).
Li, et al.
Community based response
strategy in co ntact tracing a nd
social mobilisation
Community social
mobilizer including
including community and
religious leade rs,
community activists,
primary health-care
workers, and volu nteers
Community and religio us leaders,
community activists,
primary health-care workers, and
volunteers
Community and religio us
leaders and activists who
had a h igh school or
higher edu cation level o r
had some h ealth
educational background
were recruited an d trained
to form the lo cal
community
response te am
Alert case repo rt, contact tra cing, and so cial
mobilization.
Contact tracing ,
house-to-ho use visits,
prepare he alth facility
reports, and
community report;
Impart messages of
EVD preventio n to
their community
members via face-to-
face, and also
distributing
posters and brochures
Not rep orted
The community
mobilisers were
supervised by
experienced senior
supervisors and field
supervisors
from the Western Area
District Health
Manag emen t
Team. They were
systematically trained
on their roles a nd how
to implement th eir task
in the community
Training workshop on
EVD messages like,
infection pre vention in
the community, a nd
skills needed f or social
mobilization
Not rep orted
Provision of soa p and
hand san itiser
Facilitator: Commun ity education and social
mobilization could facilitate pub lic awareness an d
improve the comp liance of community members with
prevention and control me asures in the ir communities
Barriers: in ab sence of a n effective EVD vaccine,
community-based risk red uction measures were
among the best ways to interrupt Ebo la transmission
and can be effective even in a reas with weak he alth
infrastructure
Community-based e ducation fo r the local reside nts
with face to face communication ,especially for th e
influential commun ity persons is an effective mea ns
for BCC. Need to tailor community ed ucation to the
context of the community.
Maduka, et al. Community mob iliser
Community members
trained as mob iliser
Not rep orted
community mobilizers who
already had experience
working as community
mobilizers during
supplementa l immunization
activities
Record keepin g of the area which includ es the nu mber
of house holds where
IPC sessions he ld, demonstrat ions, Information ,
Education , and Communicat ion (IEC) materials
distributed, ca ses of non -compliance and issues/
rumours raised during the session . For IPC community
mobiliser visited house -to-house with EVD prevention
and cont rol messages relating to the ca uses of
EVD, its symptoms, pre vention, trea tment, and care
Not rep orted
The data manager
collated da ta from all
the community mob ilier
and transmitte d them
to UNICEF and the
operations manager of
the communicatio n
and social
mobilization tea m at
the EOC.
One supe rvisor was
provided to a cluster
of five tea ms and two
supervisors to ea ch
state. Also, members
of the co mmunication
and
social mobilization su b-
team condu cted
regular field visits to
provide supp ortive
supervision for th e
teams.
one-day train ing
covered ba sic facts
about E VD, its
causes, sympto ms,
and preve ntion. The
training empha sized
early
presentatio n for
treatment an d care in
the even t of someon e
developing EVD
symptoms. It also
emphasized st igma
prevention, safe burial
practices, and hand-
washing
demonstration . The
methods emplo yed for
the training included
lectures, role pla y,
individual and group
exercises
Not rep orted No t repo rted
Facilitator: Use of earlier develo ped IPC strate gy used
during infect ious disease o utbreak in Ug anda
Barriers: Existing risky Cultural practices like self-
medication, o pen-defeca tion, ceremonie s and mass
gatherings washing and staying overn ight with dea d
bodies, un hygienic ways of slaughtering domestic
animals, the h andling of
body fluids d uring childbirth, a nd washing the corpse
of a man
IPC althoug h resource inte nsive and t ime-
consuming,th is strategy has t he pote ntial to
contribute t o improved knowled ge on mod es of
spread, sympto ms, and practices on prevent ion of
EVD
Massey et al.
Community consultat ion for
appropriate and culturally sa fe
ways to reduce the influe nza
risk in communities
Community members
from aboriginal
population
Not rep orted
Key stakeh olders in these
communities identifie d by
the ACCHS and key
informants were
approached to input into
the influen za consultat ion
Community inputs were provided on issues of redu cing
the risk of influ enza at h ome and a t community
gatherings such as fun erals; and p roviding access to
health services. Key inputs we re provided o n the
issues of significa nce of a lo cal resource pe rson, Clear
communication, A ccess to hea lth services, fune rals
practice and Social and co mmunity support issu es.
Inputs fo r joint
developmen t of plans
for aboriginal
population
Policy and p rogram
division of the country
Not rep orted
The implemen tation
team provided input
about the nature of
influenza, its
transmission, and the
evolving epid emic
during the
consultation .
Not rep orted No t repo rted
Facilitator: Au stralian Health Man agement P lan for
Pandemic Inf luenza was pre pared to p rotect all
Australians an d reduce th e impact of a pandemic o n
social function and the economy.
Barriers: Indig enous pe ople are ap proximately five
times more likely than non-Indigen ous Australian s to
be hospita lised for swine influ enza and a similar
proportion req uired intensive care treatment. There is
no measures t hat appro priate to be devised fo r this
group.
Measures to red uce the risk of influenza in
communities must be developed with the
communities to maximise th eir acceptance . The
process of engagement and ongoing respectful
negotiatio ns with communities is critical to
developing culturally approp riate pande mic
mitigation and managemen t strategies
Masumbuko an d
Hawkes.
Student -led education al
campaign to increase
community awarene ss and
engagement
Medical studen ts
fromUniversité Catholiqu e
du Graben (UCG),
Medical studen ts Not rep orted
Community outreach activities included a parade with
branded t-shirts and ban ners through the main stre ets
and market, sp eeches with lo udspeake r, one-on-one
interactions
with community members in p ublic
spaces,prese ntations at faith-based gatherings
(Sunday chu rch service), and rad io annou ncements
Not rep orted
Link with ministry of
Health and
interna tiona l
organisation s
Not rep orted
Student s were
provided training (one
half day) in
the biolog y,
transmission modes,
and social d imensions
of EVD, together with
pragmatic strateg y
and sched ule for the
community outrea ch.
The social mobilisation
and the campaign was
funded
Not rep orted
Barriers: Pove rty, HIV/AIDS, an d ongoin g violent
conflict following civil an d internatio nal wars, fear of
EVD since the last outbrea k in West Africa, mistrust o f
national government and international agencies and
security concerns
Medical studen ts appea r to be well po sitioned to
act as‘opinion leaders’ and ‘social mobilizers’ given
their tacit cultu ral understand ing and b iomedical
knowledge, they can ta ilor health messa ges, build
rapport, increa se interpersona l communication,
empower community membe rs, and promote
optimal health outcomes
Mbaye, et a l.
Community Based Surveillance
Committee (SABC in fren ch)
Community Leade rs
Groups
Youths, o ther community
members, faith a nd other
community leaders
Community driven with th e
support of internationa l
partners
Community death reporting, Se nsitization, Con trols at
entry and exit points of communities, safe corpse
management and burials
Anthropolo gists used
as mediators be tween
communities and the
health sect or
Community meetings No
Funding from
interna tiona l partn er
for community
projects, foo d
distribution, h and
washing kits
distribution, free
consultation s
71% of rural p opulation, Poor access(38 .9%) and
utilization (18.8 %) of health services, Poor ge ographic
reach of h ealth facilities (abo ut 1033 health fa cilities
for 10.95 millions people. E thnic and p olitical conflicts,
Poverty and Youth u nemployment.
Community resistance a s being a form of
expression fo r populations during an e pidemic can
prompt community en gagement ; Communities are
not passive during an e pidemic, they t ake initiatives
the state of their kno wledge and health syste m/
State/ In ternational co mmunity supports;
Le Marcis, et al.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance
Supplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health
doi: 10.1136/bmjgh-2020-003188:e003188. 5 2020;BMJ Global Health, et al. Gilmore B

McMahon et a l.
Health Manag ement
Committee s
Committee
Voluntee rs from community, who
work togethe r, often in
collaboration with health fa cility
staff, to improve community
health an d give voice t o
community's need s. Typically
include: community chief, female
leader, tea cher, and se veral
health mob ilizers.
Not disclosed, b ut specific
representation needed
(i.e. community lead er).
Often HMCs have some
positions tha t are electe d
(i.e. female lea der) a nd
some by def ault (i.e. if the y
have hea lth facility in-
charge in th em)
Various roles across the count ry. Not standa rdised
intervention. Prior to Ebola: Regular meeting s,
fundraising, health promotion, engagement with other
health workers, a ccountability (i.e. medicines). During
Ebola: Manu al labour (buildin g walls, cleaning facilities,
digging gra ves, manning ch eckpoints). Ad ministration
and out reach (records, con tract tracing, scree ning
upon en try to health facility), navigatin g interactions
with community members (BCC an d trust-building).
Acted as link to health workers (i.e. explained
community concerns, asked hea lth workers questio n
on beha lf of community) an d from health workers to
community (built trust, e xplained pre vention an d
control measures to community for acce ptability).
Pre-ebola, would
travel with hea lth care
workers to deliver
services, communicate
health messa ges etc.
During Ebola, support
health fa cility activities
(see roles/types of
services).
Health facility,
Community Health
Voluntee rs, Contract
Tracers
Linked to Health
Facility. During Ebola ,
some HMCs were
supported by NGOs,
others were no t.
Training by NGOs
(IRC) mentioned as
source of motiva tion
for HMC members.
Specifics of train ing
unclear. Pre-existing
HMC that likely had
some initiation, and
were supporte d by
NGOs at times for
some activities within.
Varies - sometimes
NGO an d/or
government su pport in
terms of moneta ry and
non-monetary
incentives. Con tract
tracers were to b e
given month ly
allowance, th ough this
did not a lways
happen.
For health worke rs
and burial team
members. Not clear if
any HMC members
were part of t hese
teams.
Facilitators: Man y listed, see d ocument for more
details. Key contextual f actors: 1) Pre-existing
relationships b etween HMCs and Health Facility which
supported trust and timely a ction; 2) Exte rnal inputs
(i.e. trainings by NGOs and IPC su pplies) provide
direction and support; a nd 3) specific n ature of E bola
and recog nition of inte rnal action g alvanized
community action. Article identified f acilitators (via
intrinsic and ext rinsic motivation) and f acilitators.
Intrinsic motivation: desire to serve a nd lead, fear of
Ebola, pride /trust in hea lth facility and p roviders.
Extrinsic motivation: co mpensation, recognition o f
governments limited capacity, recog nition of Eb ola
severity, and NGO support.
Barriers: Intrinsic - sa dness, grief a nd loneline ss, fear
of contractin g Ebola, co ncern that government h as
forgotten them. Extrinsic - community miscon ception
about p ayment, and community ange r at them fo r
'collaborating' with health syst em.
Article articulates 4 key lessons lea rned (Table 3,
pg 8), directly q uotes as fo llows: 1) Community
leaders, volun teers, and home committee membe rs
can perform vital f unctions du ring public hea lth
emergencies; 2 ) The importance o f community
leaders, volun teers and h ealth committee members
rests not on ly in their capacity to carry out man ual
labor and administrative tasks, b u also in th eir
capacity to me diate betwe en communities an d the
health syste m; 3) Positive pre-existing relationships
between co mmunities and h ealth workers are a key
enabler fo r community voluntee rs to engag e in
difficult tasks du ring crises, particularly tasks that
violate social no rms (e.g. burial rituals); an d 4)
During emergencie s, the resilience a nd capa city of
community leaders, volunteers an d health
committee members can be suppo rted by en suring
clarity among stake holders abo ut compensa tion,
reassuring community wo rkers that they are not
forgotten, providing trainings and equipment, and
creating spa ces for dialogu e between health
workers and community workers.
This article elabora tes further on role and resp onsibility of HMCs
during Ebo la, contextu al factors, ba rriers and facilitators. Re fer to
article for more specific d etails and e xpansion o f points rep orted
here.
Meredit h, C. Community Health Committees Committee ; Lea ders Not disclosed . Not disclosed
Identified barriers to effect ive prevention , case
management and safe burials. Committees de veloped
action plan s to address such barriers. This rang ed
from logistical (fuel fo r ambulances, wat er access) to
Behaviour Cha nge Communicatio n, and Risk
Communication (i.e. d ismantling beliefs t hat bath ing in
salt water can cure Ebola, a nd sharing knowledge o n
burial practices). Also, in one case . noted , conducte d
case identifica tion and re ferrals.
Community Health
Committees linked with
Community Care
Centres
Support b y DHMT and
District Ebola
Response
Coordin ation.
Linked to Community
Care Cen tre
Training o n
communication, to
build confide nce of
Committees, and to
build 'kango sa' or
gossip chan nels.
Training o n Ebola
case identifica tion and
referrals.
N/A N/A
Disbelief and d istrust from some community me mbers
prior to initiating Committees. Pre-existing
implementation a nd relationsh ips by NGO in th e
context. Howe ver, they no te Challenge s as
"coordinatin g social mobilisation a ctivities in a con text
where multiple ag encies are act ive in the same
communities, each with their own way of working".
This was helped in Sierra Leon e due t o existing
'Social Mobilisation P illar (SMP) led by Ministry of
Health that is an umbrella struct ure for all community
operations. Logistical issues rela ted to g eography
cover and remo te areas, also need to have stron g
relationships b ut also be ready to de ploy quickly.
Actively involving co mmunity health co mmittees in
the deve lopment of p revention a nd protectio n
approache s built trust an d increased co mmunity
willingness to refe r and seek tre atment.
Communities members are a ble to eng age in so cial
mobilisation with ha rder-to-reach or less likely to
disclose popu lations (i.e. ta xi drivers, drug users).
Active case fin dings with social mob ilisation
important proa ctive element.
There are two examples in this o ne article. The y are from differen t
countries (Sierra Le one and Liberia) and different exa mples. Sierra
Leone re ports on CHCs, wherea s in Liberia th ey discuss case
findings using community health voluntee rs. For the secon d, it is
unclear if the se are 'CHWs' or if the y are from the co mmunities. Not
enough details, so it is e xcluded.
Miller, e t al. Participatory Design L eaders, Ind ividuals Not repo rted Community lea ders
Focus Group Discussio ns, interviews and workshops
using participa tory action resea rch, specific to H1 N1
pandemic pla ns. Community members an d leaders
identified ke y consideration s for current an d future
pandemic pla ns.
N/A N/A N/A N/A N/A N/ A
Facilitator: Commun ities have previou s experience
with PAR, involvemen t of Aborigin al Health and
Medical Research Cou ncil, multi-disciplinary and
staged rese archers.
Pandemic respo nse plans n eed to co nsider: social
aspects of communities including cultural values,
norms, family ties, an d social networks.
Munod awaf a, e t al .
Traditional lead ers, traditional
healers and religious leaders
Leaders, I ndividuals Not rep orted Commun ity leaders
Advocacy meet ings with Chiefs, tra ditional leade rs and
other influe ntial people to obtain support fo r the Ebola
response e ffort.
UN, Inte rnatio nal
Organisations and
Government.
UN, Inte rnatio nal
Organisations and
Government.
Not rep orted No t repo rted Not repo rted Not report ed
Facilitator: St rong relationsh ips with county health
teams, multi-sectoral pa rtnerships and interventions.
Context of implementation (lack o f facilities, roads,
infrastructure, wat er and sanita tion etc) at community
level left families more vu lnerable, an d introduced
many challeng es for care see king. Infectio n control for
safe burials h ad much resistan ce, as these were
incompatible with traditional practice s.
Multi-sectoral approa ches which include social
mobilisation were map ped to red uced inciden ce of
EVD. Key lesso ns reported, relevant to CD: 1)
social mobilisation a nd community en gagement
(e.g. involving chiefs, elders, religio us leaders) were
critical for bringing a bout community/syst em
changes a nd services. Ke y recommendation s
reported 1) a ssure early and intense CE a ctivities
at the loca l level (i.e. eng age chiefs a nd elders,
religious leade rs, women and yo uth and Ebola
survivors in key activities su ch as investiga ting
rumours and d iffusing myths)l 2) build capacity and
sustained le adership within co mmunity health
committees throug h training an d technica l support
for essential co mmunity processes (e.g .
assessment, p lanning, de veloping inte rventions,
intersectoral actio n, monitoring a nd evalua tion).
Nakiire, et al.
Community Members and
Leaders
Members; Lead ers
community leaders, informal
traders
Purposefully se lected
Focus Group Discussio ns and Ke y Informant
Interviews with Participa tory mapping. Community
participants d escribe movement p atterns across
borders specifically fo r: those see king refuge e status,
conducting trade or bu siness, seeking health care ,
visiting family. Also mapp ed health care facilities tha t
receive patien ts from DRC.
Not rep orted No t repo rted Not repo rted Not report ed Not reporte d Not re porte d
Findings used to scale-up p revention e fforts (via risk
communication, co mmunity surveillance, screen ing of
travellers etc).
Multiple stakeho lders involved in p articipatory mappin g - unclear
specific community con tribution
Ratnayake, et al. Vo lunteer Community Mo nitors Individua ls N/A
Voluntee rs or existing
Community Health Workers
Responsible fo r their own village, or if necessary a few
small villages within walking d istance. Trained to dete ct
6 trigger even ts suggestive of Ebola, and the n report
any to sup ervisor who did primary inve stigation.
Community
Surveillance
Supervisors and
Community Health
Officers (MoH staff)
Ebola Respo nse
Consortium,
Internation al Rescue
Committee
Monitors reported
events to community
surveillance
supervisors via mobile
phones, the
supervisors then
conducted preliminary
investigations.
Job specific train ing
month prior to actions.
Some districts
provided info rmal
refresher training.
Trained to d etect 6
trigger events
suggestive o f Ebola
Not rep orted No t repo rted
Wider contract tracing was ongoin g, this system was
to suppo rt more efforts at community level. Some of
the monitors were previously trained CHWs, and some
were also cont ract tracers. Context ual considerat ions
include: ho w monitors classify and understand illness,
awareness of burial practices an d how to
identify/importan ce of reporting , piloting o f illness
classifications, stron g links to wider he alth system.
CEBS gene rated alerts fo r about 1 /3 EVD cases.
Found to have low sen sitivity and positive
predictive value , however this is mea nt as a
supplement to a wider tracing system, and t he
authors no ted this was a positive result.
Additionally, co mmunity monitors foun d other
health issue s, including th ree measles cluste rs and
chickenpox. S ystem may be go od to ide ntify cases
with no epid emiological links (that co ntract tracing
would usually fin d), or newly emerging outbreaks.
However, still need s thorough coverage, a dequate
training, an d strong links with wide r community
systems. Before rolled out, validity of the 6 trigger
categories n eed to b e tested, and explo ration of
burial practices wou ld be required , as the mon itors
did not ide ntify many such incidences.
Rudge an d Massey. Participatory Design Individuals Unknown Unkn own
Focus Group Discussio ns with 6 diffe rent communities
on pote ntial solutions f or addressing H1N1 in their
communities. Their inpu t influenced design/a pproach
to intervent ions.
N/A N/A N/A N/A N/A N/ A
Facilitator: Pre -existing relationship s with communities
meant ability to have rapid discussions on such
topics.
- identify local 'g o to' peo ple, who are trusted and
easy to acce ss and who community may turn to for
advice; simple, clea r information tha t demonstrate s
respect; pe ople need information on where to g et
help and control proced ures; infection control
messaging sho uld be align ed to rea lity of
Aboriginal communitie s; people n eed to have a say
in the sup port provided
Santibañ ez, et al.
Faith-based a nd community-
based groups
Faith organisa tions,
community groups
Unknown Pre-existing groups
In 2016 , over 100 FBO and CBOs joined an a lliance
with the go vernment. They had main du ties of: 1)
establing te ams that can inspect the ir neighbou rhoods
weekly 2) plann ing ahead for mission trips and travel
to areas with Zika, 3) building a culture of so lidarity
and commitment t o helping o n anoth er, 4) educa ting
and empo wering community members to help preven t
the spread of Zika. the y did things such as "zika
Action Days' whe re education was spread a nd
repellent give n, inspecting of stagna nt water sou rces
and hou ses with brown scree ns, educa tion on ho w to
eliminate mosquito breeding site s, distributing
condoms an d repelle.t
Over 100 FBO and
CBOs
Not rep orted No t repo rted Not repo rted Not report ed Not reporte d
Facilitator: FBO s and CBOs ha d direct and existing
relationships with communities. They kno w who is
pregnant , where peop le live, key area s in community
etc. They were recognized a s first responders in any
emergency. Grou ps joined to gether, ide ntified
common goals and agreed upon roles for groups.
Only reporting B ox 3 from article, which describes a CE approach.
Rest of article h as CDC recommendations for CE, helpfu l with
lessons learne d.
Sepers, et al. 2019 Community Lead ers
Local
Governance /community
leadership (chief and
religious)
Individual lea ders Pre-existing individu als
Several eng agement a ctivities: convene d a natio nal
consultative me eting with traditio nal community
leaders; con ducted commun ity advocacy mee tings
with local and religious leaders; co nducted an
engage ment programme with co mmunity leaders to
mobilize them for a ddressing EVD o utbreak;
implemented a survivor reintegration programme.
Article notes th at "[In] Liberia, there was less reliance
on community isolat ion (quarantin e) but rathe r there
was emphasis on community self-policing o r
monitoring, where by each trad itional leade r (chief or
religious leade r) took it upon themselves to enforce
policies on visitors, st rangers and reporting of sick o r
decreased. "
Several othe r
mobilization activities
enacted, though many
not through
community
engagement.
Ministry of Health,
Sanitation and
Welfa re, WHO, T he
Council of Chiefs and
Elders, NGOs
Not rep orted
Meetings and
sensitisation tra inings
conducted
Not rep orted No t repo rted
Multi-sectoral enga gement. CE was part of wider
activities including: 1) surveillance, con tact tracing a nd
case investiga tion; ii) case mana gement; iii) safe
burials; iv) social mobilization and community
engage ment and v) d elivery of basic services. Prior
bad expe rience with law en forcement, an d strong
focus on le aders (chief or religiou s), including sup port
from NGOs and WHO, h ad governmen t relying on
leaders to e nsure adhe rence from communities.
Engage ment of community le aders (chief an d
religious) to supp ort adheren ce, educa tion,
monitoring and reporting within communities.
Table 1 de tails all implementation componen ts, elements a nd
engage d partners in E bola respon se implementation , including a ll
aspects of CE.
Skrip, et al.
Community-Led Abo la Action,
with community mobilisers and
Community Champions
Community Champions,
Individuals
Community Champions,
supported by Mobilizers (youth
workers (18-2 years) who h ad
previously bee n involved in
HIV/AIDS community p rogramme)
Mobilizers: through
previous progra mme.
Champions: Id entified via
community facilitated
sessions by mob ilisers.
Champions: Unkn own.
CLEA Approa ch, a structu red participatory a pproach:
Initial visits by mobilisers to communities, mobilisers
use structured tools with community g roup to fa cility
community inquiry, to facilitate and support co mmunity
to condu ct analysis and develop a ction plans t o
prevent tran smission. Community Champions are
identified, wh o are focal p oints and support
communities to de velop plans. Mobilisers make
subseque nt visits to communities. Expected that
communities identifyin g priority actions a nd
implementing strate gies to ad dress would aff ect
behavioura l outcomes.
CLEA appro ach used
within Sierra Leo ne's
Social Mobilization
Action Conso rtium
(SMAC).
Follow-up visits by
mobilisers