Amid a worldwide pandemic, with cities and even entire countries in lock down, many of us are in regions that have already been severely affected by COVID-19, and others are bracing for what will come. And all of us are watching the news or reading newspapers and wondering, “What is going to happen to the world?”. Thus, it is not merely a pandemic of disease, but also one of fear, panic, misinformation and so on.
But if we look at the trends in the past decades, we have noticed a significant increase in disease outbreaks at diverse scales: Ebola, Zika, Cholera, Marbereg fever, Nipah virus, yellow fever, Lassa fever, Severe Acute Respiratory Syndrome (SARS), H1N1 influenza, Middle East respiratory syndrome (MERS), are a few among them. These outbreaks of different scales have produced a lot of knowledge that could be successfully used in the prevention and containment of the pandemic and its impact today. Besides this, given the fact that we live in a world where every territory is very much interconnected than a century ago during the time of Spanish flu, there are a couple of things that were repetitively highlighted, which is paramount to prevention and containment of disease outbreaks, and the COVID-19 pandemic is no exception.. However, it has been also noticed that the lessons learned are often forgotten and, at the onset of every outbreak we tend to start from the very beginning and go through a cycle of trial and error. This was manifested in many places in the COVID-19 response.
The Ebola epidemic in West Africa, being one of the most recent crises the world has encountered, has produced some fresh, extremely useful lessons relevant to the management of COVID-19 – especially in relation to assisting sustainable behaviour change, highlighting the importance of looking thoroughly and profoundly at the information ecosystem of the geographies hit by the outbreak, investing in communication with communities (CWC), the importance of community participation, inter-connected interventions spread across the social ecology, building trust and partnerships with formal and informal leaders, close coordination among all actors, working with psychologists, anthropologists and sociologists, and integrating protection, gender and inclusion in order to facilitate sustainable and effective behaviour change.
The bitter truth about the perception of ‘innovation’ of many of those who are in the aid-sector is that the introduction of new gadgetry of communication – cellphones, tablets, radios or some game-changing application – to the people with whom they work with “, would enhance the communication and facilitate the information flow, than already existing local level law tech mechanisms. This couldn’t be more far from the truth. The innovation ‘process’ begins with one basic premise: listen first.
Before designing a social behavioural change communication strategy, and designing information education and communication (IEC) tools, and thinking “we know all”, it is imperative to understand how communities are accessing information, speaking with humanitarian responders and communicating with families and loved ones.
It is paramount that we start with looking at the information and communication needs of the communities and see the larger picture of what information sources are most influential, what are least influential, what are the most trusted, what are the least trusted sources, what has the most outreach, what has the least outreach, and what means of information the target population has access to, whether the existing sources of information are reaching out to minorities and marginalized populations, whether they are trusted by them or if they have a positive or negative influence on them. Therefore it is vital that, before setting up SBCC strategies, to understand better the information ecology and not forget the social ecological model when communicating with communities.
Setting up an SBCC campaign targeting different layers of the society, or in other words, targeting the whole ecology of the individual, is vital so that the ‘barriers’ at different levels could be better addressed and that the “agents of change” could also be identified and mobilized at every layer. One of the lessons learnt during the West African Ebola crisis was that the Protection Motivation (PMT) approach in behaviour change showed results at the response phase, and then Health Benefit Theory (HBT) to behavioural change was amalgamated at the recovery stage – resulting in a trans-theoretical approach to behaviour change, which has shown immense success in the Sri Lankan context in the prevention and containment of COVID-19. This helped the communities to adhere to the desired behaviours swiftly and then to sustain them for a longer term.
It is important to address misinformation to avoid increasing anxieties around the disease outbreak, rather than throwing information at the public. One of the unpredicted challenges reported in the Ebola response, for example, was the misinformation surrounding Ebola at the time of the outbreak. Community dialogue could help community leaders understand perceptions, tackle misinformation and adjust their approach accordingly. It can also help to reduce the stigma associated with the disease and facilitate social integration. And working with social scientists such as sociologists, anthropologists and psychologists have proven to be an added strength – especially in understanding the diverse nuances of different religious and ethnic groups and adapting messages toward effective behaviour change.
When everything shuts down, daily life is severely interrupted, and all four aspects of “Community sense of place” (ecological, cultural, human capital and problem-solving sense of places) is threatened. Therefore, facilitating the establishment of sense of place by empowering communities, engaging them in community-led and owned prevention and containment strategies, where people could participate in solving their own problems, can be instrumental in the success of a programme. Communities play a vital role in the support for screening, referrals of suspected cases, contact follow-up, monitoring of the outbreak, and communication initiatives. Involving actively and meaningfully community leadership in risk communication, understanding disease and desired behaviours have proven to be quite successful in several outbreaks in recent history.
For diseases like COVID-19, where communities are not familiar with what it is and how to prevent and treat it, the behaviour change messaging must come from a trusted source. Therefore, it is imperative to identify the most trusted and influential information sources (individuals, channels or nodes) through an information ecosystem assessment (IEA) and communicate with communities through those sources in a culturally appropriate way so that the ownership of the SBCC campaign is always with the communities. Also, in conflict and political crises, communities can be skeptical of governmental or international non-governmental organizational (INGO) responses and may trust only their community leaders. Therefore, developing trust in communities is paramount to the success of any sustainable intervention.
Disease outbreak affects men, women, children, elderly and the especially-abled differently, and if they belong one of the marginalized groups such as ethnic minorities, minority religious groups, families of missing persons, economically insecure individuals, people in movement or refugees, they are affected worse. As such, their information needs, their accessibility to information and the sources they can trust could be different from the general population – therefore, investing in mainstreaming protection, gender and inclusion and “leaving no one behind” is key.
Unless there is strong coordination with the local, national, regional and international partners (government institutions, inter-governmental bodies, international non-governmental organizations and local level formal and informal groups), realization of the above mentioned is not possible. And the partnerships ensure that the interventions are built on more trustworthy demographic and context formation utilizing validated strategies without duplication and, the mean people affected by the outbreak can be reached sooner and effectively.
At last, having said all the above, there is one more thing left: an ‘openness to change’ is one of the life-savers in outbreak prevention and containment. As the disease itself changes swiftly in terms of scale and epicentre, having the openness to change and adapt swiftly to new strategies suiting the dynamics on the ground is important. The messages developed today targeting a specific behaviour of one ethnic group confined in a geographical location, would not be relevant tomorrow as the outbreak has spread to another group of people whose language, habits, beliefs, and lifestyle are completely different.
In conclusion, the previous outbreaks have highlighted time and time again that investing in communication with communities (CWC) is key in the prevention and containment of disease outbreaks, and as mentioned before, COVID-19 is no exception.
Pramudith D Rupasinghe ©