IDS | Njala University | Colectiv 2025
As Sierra Leone’s mpox outbreak grew in 2025, Njala University, IDS, and Colectiv used AI-assisted WhatsApp interviews to understand how frontline health workers were engaging communities, adapting lessons from Ebola and COVID-19, and identifying gaps in the response.
Sierra Leone confirmed its first mpox case in January 2025. Within months, thousands of cases had been recorded. The response drew on public health infrastructure strengthened after Ebola and COVID-19, including surveillance systems, district coordination mechanisms and community engagement networks.
The research explored how frontline workers understood the role of community voices in mpox planning and action. It focused on how national agencies, district health teams, health workers, chiefs, NGOs and community actors coordinated; how community feedback shaped care, messaging and local policies; and what had changed since Sierra Leone’s Ebola and COVID-19 responses.
Researchers from Njala University, IDS and Colectiv co-designed a semi-structured interview guide, delivered through Colectiv’s AI interviewer over WhatsApp. Thirty-seven frontline and community health personnel completed interviews with voice notes and text responses. The interviews were conducted across multiple districts between September and November 2025.
Five themes surfaced across the interviews.
Surveillance worked through relationships, not just systems.
Sierra Leone’s mpox response built on the lessons of Ebola and COVID-19, but did not simply repeat them. Frontline workers described a response adapted to a different disease, a different level of perceived risk, and a different relationship between communities and the health system.
Electronic reporting, dashboards and response protocols helped teams identify and track cases. But participants repeatedly pointed to the people who made those systems work in practice: CHWs, chiefs, religious leaders, youth groups, traditional healers and health workers who could translate national guidance into trusted local action.
In participants’ accounts, communities were not passive recipients of messaging. They helped detect cases, report concerns, reinforce prevention behaviours, support referrals, encourage vaccination and shape how response measures were understood. For future epidemic preparedness, the lesson is clear: communities need to be involved early, listened to seriously, and supported with the trust, communication channels and practical resources needed to act quickly.
