Fighting Epidemics in Complex Emergencies: The Ebola Crisis Response and Recovery through Safety Nets and Community Engagement in the Democratic Republic of the Congo

Challenge

From August 2018 to June 2019, Eastern Democratic Republic of the Congo (DRC) fought the second largest Ebola outbreak in history. It took place amid overlapping crises including food insecurity, massive forced displacement, and persistent armed conflict. With a total of 3,420 cases, the outbreak claimed 2,287 lives in 29 health zones across the provinces of Ituri, North Kivu, and South Kivu. These hosted 8.5 million poor people, including 6 million people in need of humanitarian assistance, thus stretching traditional coping mechanisms to the limit.

MONUSCO, the United Nation's (UN) peacekeeping mission, had been deployed since 1999 and over 70 organizations mobilized to provide relief. However, these efforts were hampered by violent community resistance and deadly attacks against first responders. After decades of conflict, communities had developed an entrenched distrust of state institutions and external actors. The absence of redistributive impacts for the poor, despite the unprecedent mobilization of resources, also fed conspiracy theories about hidden interests behind the so-called 'Ebola business.'

Approach

The World Bank supported the DRC government through its financing instruments, technical support, and convening power. Echoing the tenets of the World Bank Group's Strategy for Fragility, Conflict, and Violence 2020-2025 - remain engaged in active crises and lay the foundations for long-term recovery - the World Bank financed an emergency cash-for-work program, implemented by the DRC Social Fund (FSRDC), to: (i) strengthen community resilience by providing temporary jobs to beneficiaries in Ebola hotspots; (ii) use public works to address long-standing gaps in community infrastructure that were hampering medical and humanitarian responses; and (iii) improve the acceptance of medical teams by delivering quick results.

The program incorporated innovations in: (a) design - works adapted to the target population (unskilled) and the urgency of the situation (quick and visible results); (b) procurement - relied on local resources to maximize the economic impact in local communities; and (c) remote supervision through 'MARTA' (a Monitoring Automated for Real-Time Analysis system).

Results

The Ebola - Community Engagement in Emergencies program was crucial in bringing relief and much needed income support to communities to recover from the crisis and build resilience:

• Between April and December 2019 (pilot), the cash-for-work program provided temporary employment to over 12,000 vulnerable people (50 percent women) in hard-hit communities and rehabilitated rural roads in five health zones.
• Between January and September 2020, the program was scaled up and reached an additional 23,000 vulnerable people (50 percent women) in an additional six health zones.
• Overall, more than 35,000 direct beneficiaries have worked more than a million days (as of September 30, 2020) and received about $3 million in stipend.

The program provided technical assistance to help FSRDC develop the customized remote supervision system MARTA, by leveraging the use of simple and open source technologies:

• From September 2019 to September 2020, more than 111,400 surveys on beneficiaries, worksites and community perceptions were collected via MARTA (more than 14 million data points).
• The information collected on beneficiaries from MARTA allowed to build a basic registry of poor and vulnerable individuals (70,600 people), draw the vulnerability profile of beneficiaries, and validate the program's targeting mechanism.

Finally, although FSRDC had accumulated years of expertise on public works interventions and was accepted by local communities, technical assistance further allowed FSRDC to maximize these assets in the Ebola context by reinforcing its capacity to forge new alliances and set up protocols with public health agencies, humanitarian actors, and peacekeeping forces:

• FSRDC was placed at the forefront of the overall Ebola Integrated Response Plan and formally co-led the 'Community Support' pillar of the plan with the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the United Nations Children's Fund (UNICEF).
• FSRDC formally reported on key program indicators and contributed to the 3W mapping (Who does What Where) that was publicly shared on the humanitarian response website and the government's emergencies portal.

World Bank Group Contribution

The Ebola - Community Engagement in Emergencies program activities were piloted through a $3 million allocation from the Project Preparation Advance of the Second Financing of the DRC Eastern Recovery Project (2020) and a $50 million Contingent Emergency Response Component of the DRC Education project (2015).

Technical assistance to the program, including to FSRDC, its implementing agency, has been funded (total of $1.2 million) by several multi-donor trust funds:

• $700,000 from the State and Peacebuilding Fund
• $300,000 from Rapid Social Response Fund
• $200,000 from the Human Rights Development Trust Fund
• $50,000 from the Early Learning Partnership

Partners

The implementation of the program was largely possible through the effective collaboration and partnerships with humanitarian, development, and peacebuilding actors. This fostered synergies and ensured alignment in the coordination of activities, including:

• Working with the World Food Programme (WFP), the cash-for-work program rehabilitated or maintained strategic humanitarian road corridors, thus facilitating the access of aid personnel and medical teams to local communities.
• The United Nations Children's Fund (UNICEF) donated hand-washing kits and thermometers to monitor project beneficiaries on works sites, thus ensuring that public preventive health measures were maintained throughout the program.
• The UN Humanitarian Air Service (UNHAS) facilitated flights for joint World Bank-FSRDC missions to remote communities in hard-to-reach areas.

Moving Forward

The innovative approach and partnership model adopted to deliver the program have informed a $445 million additional financing to the Eastern Recovery Project (2020). It will continue to finance public works, while also funding unconditional cash transfers and technical assistance to establish a unified social registry that can be used to reach the poor and vulnerable in any emergency. Furthermore, the registry developed through MARTA has helped actors responding to the COVID-19 crisis quickly and identify beneficiaries, allowing for efficient humanitarian intervention, thus fully aligning with the 'protecting Pour and Vulnerable People' pillar of the Framework for World Bank Group COVID-19 Crisis Response.

Beneficiaries

Like many men and women living in the daily anxiety of conflict and unemployment, struggling to make ends meet, Esther was not as worried about getting infected by Ebola as she was about putting food on the table for her family. When asked about the program, Esther said: 'We were told that we would get paid $3 'just to sweep'. I cannot adapt to such an activity. $3 are enough for me to get organized, since I did not have a job. Before, I was just trying to 'get by' by selling tomatoes.'

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