Ruth Kutalek,Syed Masud Ahmed,David Kaawa-Mafigiri,Tamara Giles-Vernick
Community engagement: learning from low-income countries
Community engagement: learning from low-income countries

We welcome Winnie Byanyima and colleagues’ comment on community pandemic response emphasising the importance of community-led efforts for pandemic prevention, preparedness, and response, and highlighting the central role of social sciences in achieving this goal. Indeed, multiple actors involved in epidemic response have advocated involving communities, stakeholders, and civil society organisations in epidemic response efforts, particularly because top-down interventions cannot tackle underlying structural shortcomings that lead to distrust, rumours, and non-compliance. During the Ebola virus disease epidemic in west Africa during 2014–16, for instance, a massive lack of staff and stuff and shortcomings in community engagement led to disastrous outcomes. Learning from this failure to engage communities, public health actors, and institutions now often ensures that response efforts are accompanied by community engagement activities—most notably in low-income and middle-income countries, and far less frequently in Europe. However, the COVID-19 pandemic response showed that community engagement models, largely developed for health crises in low-income countries, could be equally important in high-income countries. This knowledge transfer from low-income to high-income countries would be a genuinely welcome development in global health, which is largely dominated by high-income country institutions and their conceptual underpinnings. Moreover, despite evidence for the effectiveness of community engagement in the pandemic response, precious little has been implemented in Europe's COVID-19 response to encourage non-pharmaceutical interventions to control transmission or to improve vaccine acceptance. As leaders of European, Asian, and African projects on community engagement, social science preparedness, and response to epidemics, we have investigated how community engagement can be meaningfully integrated into the COVID-19 response in Europe—and put our insights into action. We and our partners have collaborated closely with civil society organisations representing marginalised or excluded groups (eg, people who are homeless, older people, clients who are cognitively impaired and their caretakers, asylum seekers, and sex workers). We use community engagement to translate our findings into recommendations and new policy measures to improve the lives of marginalised groups. In our on-the-ground experience, we have found it challenging to implement community engagement that accounts simultaneously for all of the relevant standards defined by WHO, UNICEF, and other stakeholders and to operationalise these standards into daily practice. Even more challenging is to implement community engagement activities across a longer—and necessary—time period to achieve sustainable results. Funding is too often short term, seeking quick results. We agree with Byanyima and colleagues that there remains much for social scientists to do to strengthen community engagement, not just in low-income and middle-income countries, but in Europe and other high-income regions of the world. We need more implementation research on the transferability of community engagement models from low-income countries to high-income countries; more effective strategies for reaching marginalised groups to integrate them into community engagement; more robust evidence collected through monitoring and evaluation programmes of community engagement effectiveness; better indicators of successful community engagement efforts; and, most important, high-level commitment from relevant institutions (eg, ministries, public health institutions, and civil society organisations). Community engagement specialists and social scientists must have a place on decision-making boards and need to be involved at all project levels from planning to implementation so that meaningful community engagement before, during, and after epidemic emergencies is achieved. For more on social science preparedness see https://www.sonar-global.eu