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Annals of Global Health





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Trust is a concept that we often take for granted. But as much as it serves as glue for human relationships, trust lies, albeit subtly or sometimes hidden, at the crux of all global health interventions and is critical to their success or failure.1,2 The recent Ebola pandemic in West Africa shows how distrust among the community, public health officials and government institutions can lead to a massive failure in the delivery of health care and response to a disease outbreak. Media articles and commentaries attributed the slow response to the Ebola crisis to a lack of trust on many levelsdin the government, health care systems,3 health care professionals,4 foreign health care providers, and political leaders.5 Generally, there have also been a recent decline of public trust in institutions of government, business, media and NGOs.6-8 A number of factors lead to distrust in public health, including leadership influence, lack of understanding of cultures, existing myths about health, lack of transparency, lack of accountability, and ineffective communication.2 Distrust has been cited also as a major factor in the ongoing polio pandemic.9 Northern Nigeria provides a solid case where the polio vaccination initiative struggled because community concerns and myths about immunization have been allowed to perpetuate. This is attributed to community distrust and ineffective engagement by government health officials, especially with religious leaders

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