Browsing by Author "Mayhew, Susannah H"

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Did aid to the Ebola crisis divert aid for reproductive, maternal, and newborn health? An analysis of donor-reported data in Sierra Leone
(BioMed Central, 2024-04-27) Mayhew, Susannah H
BACKGROUND: Infectious disease outbreaks like Ebola and Covid-19 are increasing in frequency. They may harm reproductive, maternal and newborn health (RMNH) directly and indirectly. Sierra Leone experienced a sharp deterioration of RMNH during the 2014-16 Ebola epidemic. One possible explanation is that donor funding may have been diverted away from RMNH to the Ebola response. METHODS: We analysed donor-reported data from the Organisation for Economic Cooperation and Development (OECD)'s Creditor Reported System (CRS) data for Sierra Leone before, during and after the 2014-16 Ebola epidemic to understand whether aid flows for Ebola displaced aid for RMNH. We estimated aid for Ebola using key term searches and manual review of CRS records. We estimated aid for RMNH by applying the Muskoka-2 algorithm to the CRS and analysing CRS purpose codes. RESULTS: We find substantial increases in aid to Sierra Leone (from \$484 million in 2013 to \$1 billion at the height of the epidemic in 2015), most of which was earmarked for the Ebola response. Overall, Ebola aid was additional to RMNH funding. RMNH aid was sustained during the epidemic (at \$42 m per year) and peaked immediately after (at \$77 m in 2016). There is some evidence of a small displacement of RMNH aid from the UK during the period when its Ebola funding increased. CONCLUSIONS: Modest changes to RMNH donor aid patterns are insufficient to explain the severe decline in RMNH indicators recorded during the outbreak. Our findings therefore suggest the need for substantial increases in routine aid to ensure that basic RMNH services and infrastructure are strong before an epidemic occurs, as well as increased aid for RMNH during epidemics like Ebola and Covid-19, if reproductive, maternal and newborn healthcare is to be maintained at pre-epidemic levels.
Making progress on One Health policies and programmes: Perspectives on community engagement and gender equity in four West African countries
(Elsevier BV, 2026-07-17) Mayhew, Susannah H
**Introduction:** Gender equity and community engagement are increasingly recognised as important for the implementation of equitable One Health (OH) actions, yet no published studies examine how these are operationalised in policies and programmes. We analyse policy content and stakeholder perspectives on community engagement and gender equity in OH policies and programmes in Guinea, Liberia, Nigeria and Sierra Leone. **Methods:** = 34 FGDs) to examine perspectives on gender and engagement. Inductive and deductive analyses were conducted, and interpretation of findings were discussed at all-team meetings to enhance validity. **Results:** All countries have national OH strategic plans. All except Liberia contain substantive mention of community engagement, but only Sierra Leone provides any operational details. No country operationalises gender equity in their OH policies, although Sierra Leone has taken steps towards this and has a Gender Equality Act.Across all countries, policy stakeholders highlighted community engagement as indispensable to OH implementation but showed little urgency in tackling challenges and completely overlooked gender equity, which highlights a critical gap.Community members revealed how community engagement in OH is gendered across all contexts. Cultural norms often limited women's full participation, though this improved over time, while women's lower literacy limited their leadership roles and ability to report disease cases, with Nigeria an exception.Trust emerged as fragile but foundational to OH engagement. In all countries, community trust was mediated by chiefs, elders, and religious leaders, but trust in surveillance activities could be lost when government response or action to OH reporting was lacking. **Conclusions:** Gender-equitable community engagement is a structural necessity for effective One Health programmes. Our research has shown that there is potential for OH actions to be transformed at the community level through strong, inclusive engagement with women as equal partners.
(Re)arranging “systems of care” in the early Ebola response in Sierra Leone: An interdisciplinary analysis
(Elsevier BV, 2021-07-05) Mayhew, Susannah H
Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse "systems of care" and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers - or arrangers - in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved.
Responding to the 2018–2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches
(Dove Medical Press, 2021-04-01) Mayhew, Susannah H
The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018-2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC's Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC's 2018-2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were "engaged" to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to "non-experts". To transform humanitarian responses, international responders can no longer be regarded as "experts" who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.