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In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community.

Background Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness. Results On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms. Conclusion As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.

Ebola Virus Disease in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern on July 17, 2019. The first case to cross the border into Uganda in June 2019 demonstrates the importance of better understanding border dynamics in a context of Ebola. This paper adopts a political economy approach to contextualize epidemic response programs conducted in moderate- and high-risk border districts in Uganda, through a qualitative study with 287 participants. To that end, our aim was to describe the historical underpinnings of the borderlands context; the role of livelihood strategies in constraining risk avoidance decisions; and the dynamics of trust in authority figures, including health workers. This paper reports that border communities are highly connected, for a variety of social and economic reasons. These daily realities are in direct opposition to guidance to limit travel during an active Ebola epidemic. We argue that an ability to limit movement is constrained by the economic need to seek livelihood strategies wherever that may be. Moreover, border regions are populated by communities with long-standing distrust in authority figures, particularly in fishing areas. This distrust spills over with consequences for Ebola prevention and control activities. This research indexes the importance of tailoring Ebola programming and policies to consider the political and economic dynamics of borderlands.