Rapid response to hemorrhagic fever emergence in Guinea: community-based systems can enhance engagement and sustainability.

Since the 2013-2014 Ebola virus disease outbreak, Guinea has faced recurrent epidemics of viral hemorrhagic fevers. Although the country has learned from these epidemics by improving its disease surveillance and investigation capacities, local authorities and stakeholders, including community actors, are not sufficiently involved in the disease-emergence response. As a result, measures are not fully understood and have failed to engage local stakeholders. However, recent research has shown community-based response measures to be effective. For this study, we used a qualitative participatory research approach to (i) describe and analyze the health signals that alert local stakeholders to a problem, (ii) describe the outbreak response measures implemented in Guinée Forestière from local to national levels, and (iii) identify obstacles and levers for implementing responses adapted to the local sociocultural context. Local stakeholders receive a variety of health, environmental, and sociopolitical signals. When dealing with health signals, their next step should be to follow a flowchart developed using a top-down approach and disseminated by national stakeholders. However, our interviews revealed that local stakeholders found this official flowchart difficult to understand. To address this issue, we used a bottom-up approach to co-construct with local stakeholders a response flowchart based on their perceptions and experiences. The resulting diagram opens the door to the development of a community-based response. We then identified six main obstacle categories from the interviews, including insufficient logistical and financial resources, lack of legitimacy of community workers, and inadequate coordination. Based on these obstacles, we suggest ways to develop a response to emerging zoonotic diseases that would enable local stakeholders to better understand their roles and responsibilities and improve their commitment to the outbreak response. Ultimately, this study should help to build an integrated, community-based early warning and response system in Guinée Forestière.