Editor's Note: This article was first published by the Lancet on July 6, 2015.
The largest Ebola epidemic in history, in 2014–15, profoundly disrupted three west African countries that bore its brunt: Guinea, Liberia, and Sierra Leone. Effects include more than 10,000 deaths, more than 26,000 people infected, and high social and economic costs. Religious beliefs and practices shape (positively and negatively) ways of caring for the sick, patterns of stigma, and gender roles. Throughout the crisis, religious institutions have provided services including health, education, and social support.
Despite religions' deep-rooted health and social roles and contributions to resilience and peace-building during lengthy conflicts in the region, and  national governments and international actors were late to appreciate the vital roles of religious actors in addressing Ebola and supporting health systems. Three lessons stand out: first, strengthening of knowledge of religious demography, institutions, and relationships would facilitate more effective engagement of faith communities; second, public health communities need more systematic and multidisciplinary community engagement approaches; and third, religious dimensions of behaviour change, for example on burials, highlight the value of community expertise and the need to draw on it more purposefully and systematically. These lessons are especially relevant when looking to public health initiatives post 2015.
Knowledge gaps about west Africa's diverse religious communities (table) delayed partnerships, obscured potential ways to mobilise their assets (ie, knowledge, trust, infrastructure, and networks), and complicated assessment of the impact of interventions. Wide-ranging estimates of different religious communities reflect the complexities arising from overlapping religious affiliations and poor data. Identification of roles of religious actors, robust mapping of their presence and work, and forging of operational, institutionalised links between partners could contribute to fast, organised responses. Many faith-inspired initiatives started quickly and delivered wide-ranging support (eg, Caritas Internationalis and the Methodist Church); these initiatives included (besides health care) training of pastors and mobilisation of volunteers, texting of health messages to congregations, and care for abandoned orphans. and  However, coordination was restricted and many opportunities were missed. If better equipped for public health challenges than at present, inter-religious structures could more readily coordinate efforts of both local denominations and international groups. Rich knowledge of, and appreciation for, the many roles of religious actors could enhance both health service delivery and public health approaches more generally.
This crisis and long HIV experience show how and why improved interdisciplinary approaches to public health are needed. Complex interrelationships of culture, tradition, stigma, and discrimination affect uptake of health services and health systems' interface with communities. Practical multidisciplinary approaches can achieve results; for example, the World Vision's Channels of Hope programme in Sierra Leone combines scientific information and theology and engages religious leaders (Muslim and Christian). Christian Health Associations active in Liberia and Sierra Leone engaged international volunteers, organised training, and imported medical supplies, but unclear relations with government health systems resulted in inadequate support to faith-run hospitals and clinics. Strategies to strengthen basic health systems and public health approaches will benefit if they take full account of the on-the-ground presence of religious institutions and draw in an integrated way on relevant disciplines (for example, anthropology, religious studies, and social and behavioural sciences).
Health messages, crucial in public health approaches to infectious disease, are more readily accepted if developed with communities through two-way communication and respect for community expertise that is concentrated prominently in religious institutions. Ebola's close association with cultural and religious practices makes active community engagement especially important. Change of funeral practices was imperative to reversing the epidemic and religious leaders (modern and traditional, Muslim and Christian) had to be involved. The resulting WHO Safe and Dignified Burial Protocol was vital in halting spread of the disease and laying foundations for community trust., and  In many respects, the protocol was a game changer in the overall trajectory of crisis response. Organisation of home care and guarantee of proper quarantine procedures likewise demand religious communities' involvement.
These lessons apply to the Ebola-affected countries and beyond. They affect preparedness, strengthening of health and community systems, and development of meaningful partnerships, notably looking towards implementation of the post-2015 Sustainable Development Goals. Faith communities, omnipresent in Africa, can be part of the solution if included as full partners, engaging their powerful communications networks and local knowledge. Assessment of how faith resources were, and were not, engaged should be reflected on by the governments concerned and international partners.
We declare no competing interests. Research described in this Comment was supported by the Henry R Luce Foundation.
2014 Ebola outbreak in west Africa
http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ (accessed May 1, 2015).
Ebola situation report
http://apps.who.int/ebola/current-situation/ebola-situation-report-29-april-2015 (April 29, 2015) (accessed May 3, 2015).
3 PS Conteh
The role of religion during and after the civil war in Sierra Leone
J Study Relig, 24 (2011), pp. 55–76
4 J Haynes
Conflict, conflict resolution and peace-building: the role of religion in Mozambique, Nigeria and Cambodia
Commonw Comp Polit, 41 (2009), pp. 52–75 View Record in Scopus | Full Text via CrossRef | Citing articles (11)
5 The World Bank Group
http://data.worldbank.org/indicator/SP.POP.TOTL (accessed April 15, 2015).
6 C Corman, L Horikoshi, S Crawford
Response to Ebola: mapping religious networks and faith-inspired organizations.
Berkley Center for Religion, Peace and International Affairs http://repository.berkleycenter.georgetown.edu/141008BCWFDDResponseEbolaMappingReligiousNetworksFIOs... (accessed April 16, 2015).
7 R Vitillo
On the front line of a deadly fight
The Tablet (Oct 18, 2014) http://www.timothypflaniganmd.com/wp-content/uploads/2014/10/TheTablet-Liberia-article.pdf (accessed April 15, 2015).
8 JD Auerbach, JO Parkhurst, CF Cáceres
Addressing social drivers of HIV/AIDS for the long-term response: conceptual and methodological considerations
Global Public Health, 6 (suppl 3) (2011), pp. 293–309 View Record in Scopus | Citing articles (79)
9 K Marshall
A discussion with Christo Greyling, Director of Faith Partnerships for Development at World Vision
http://berkleycenter.georgetown.edu/interviews/a-discussion-with-christo-greyling-director-of-faith-... (Feb 17, 2015) (accessed May 1, 2015).
10 J Ekwensi
Why this epidemic is different and long-term solutions
MedCrave Online J Public Health, 1 (2014), pp. 1–2
11 A Pandey, KE Atkins, J Medlock, et al.
Strategies for containing Ebola in west Africa
Science, 346 (2014), pp. 991–995 View Record in Scopus | Full Text via CrossRef | Citing articles (14)
12 CF Nielsen, S Kidd, ARM Sillah, E Davis, J Mermin, PH Kilmarx
Improving burial practices and cemetery management during an Ebola virus disease epidemic—Sierra Leone, 2014.
Centers for Disease Control report; Jan 16, 2015 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6401a6.htm (accessed April 15, 2015).
How to conduct safe and dignified burial of a patient who has died from suspected or confirmed Ebola virus disease.
Global alert and response. Geneva: World Health Organization, 2014 hhttp://apps.who.int/iris/bitstream/10665/137379/1/WHO_EVD_GUIDANCE_Burials_14.2_eng.pdf?ua=1 (accessed April 16, 2015).
New WHO safe and dignified burial protocol—key to reducing Ebola transmission
http://www.who.int/mediacentre/news/notes/2014/ebola-burial-protocol/en/ (Nov 7, 2014) (accessed April 15, 2015).