Moving from reactive response to proactive prevention of emerging infectious diseases: Socio-ecological systems mapping in the Democratic Republic of the Congo

Abstract

Emerging infectious diseases such as Ebola and Mpox pose significant public health challenges in the Democratic Republic of the Congo (DRC). Effective prevention policies require a clear understanding of the socio-ecological systems (SES) in which these diseases emerge. This study examined the SES influencing emerging infectious disease prevention in the DRC through five participatory modelling workshops conducted at national, provincial, and community levels using causal loop diagrams (CLDs). Participants were selected through stakeholder analysis to ensure cross-sectoral representation. A structured process guided the co-creation of integrated system maps, beginning with disease-specific models and culminating in validated shared maps. A total of 162 stakeholders participated across the workshops, most of whom were affiliated with government institutions (83%), with smaller proportions from civil society, academia, and technical assistance organizations. The Agriculture and Animal Health sector represented 36% of participants, followed by Human Health (31%) and Environmental Health (13%). Most participants had over 10 years of experience. Analysis of the CLDs revealed that while the number of infected individuals remained the central driver triggering feedback responses, the mechanisms of influence differed by governance level. National and provincial systems were shaped by public investment in One Health systems, political commitment, and governance capacity, whereas community-level dynamics were dominated by socio-economic conditions, hunting practices, and local sensitization. Overall, the findings highlight that current governance remains largely reactive, emphasizing response over prevention. Strengthening One Health governance will require a shift toward proactive health promotion supported by institutionalized coordination, sustained investment, and inclusive community engagement.