Appendix B: Lack of trust

Lack of trust

Key Considerations

When there is a confidence issue, consider the following:

Identify trusted sources of information: usually these are religious leaders and often community leaders, but consider that high-level political leaders might not be the best spokespeople if there is a confidence crisis.

People are always afraid of what they do not know: provide information about Ebola early on and the concrete steps people can take to protect themselves. Speak about how early treatment can increase chances of survival, but that to date there is still no specific cure.

Give community members a role in their community: hold community dialogues and seek input about compassionate care of Ebola, Ebola treatment centers and burial practices—include messages about how everyone is “in this together.”

Important people to involve in your communication efforts

HWs, CHWs and volunteers, Ebola task forces, district health teams, Ebola survivors, local champions, religious and community leaders and mass media

Common Causes/ Contributing Factors

Sample Message Response

Sample Activities and Implementation

Untimely or lack of accurate and appropriate communication about Ebola and Ebola interventions in the community (e.g., new ETUs in community, intimidating appearance of workers in PPEs, etc.)


Effects of years of civil strife and wars


High fear, low confidence and skills to take action to protect oneself



Provide messages about what Ebola is, how it spreads and what people can do about it. Include messages about how Ebola is not spread, for example, through witchcraft, Westerners and governments. Always give them an action they can take, such as calling a hotline or informing a community leader.


Also important are messages that foster community ownership, for example, “We are in it together.”


Include messages on ETUs or other treatment centers, health care workers and burial teams, for example:

ETUs are special and safe health centers that give the best care for Ebola.


HWs in the ETU can give treatment for the signs and symptoms of Ebola. Early treatment for the signs and symptoms of Ebola can help the person to survive—right now, there is no special cure.


Many new ETUs are being built so that sick people can get the care that they need to keep families and communities safe.


The HWs in ETUs wear special protective clothing called PPE (overhaul suits) to keep them safe while they are taking care of the sick people.


The burial teams know this kind of safe burial is very difficult for the family and the community and are trained to show respect to the body and the family.


While you cannot visit your sick friend/family member in the isolation part of the center (red zone), you will be called to tell you how he/she doing OR you can go to the center and talk to the staff who take care of him/her.


Convene and train national- and local-level community and religious leaders to share Ebola messages and dispelling rumors

Broadcast call-in radio show and radio drama series with trusted sources (e.g., religious leaders) dispelling rumors and restoring trust


Create community Ebola task forces and assign trusted community leaders who can serve as point persons for Ebola information


Produce community ETU Entry Guidelines that include language on informing community members in advance about the arrival of ETUs, the role of the treatment centers, HWs, burial teams, etc.


Ensure community ownership of community-level Ebola treatment centers and burials, hold dialogues with communities to get their input and communicate results back to the community


Produce a sermon guide that includes the facts about Ebola and what community members can do to prevent it, get treatment and support a loved one


Ensure feedback mechanisms (provide phone credit for family to call, ensure on staff of the center to be the liaison, allow family to come to the center) from the center to the family or friend of the patients

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