Rebuilding Trust in Health Care through Community Dialogues

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Even before the Ebola outbreak, Guinea had some of the worst maternal and child health indicators in the world. Trust and confidence in health services were already low, and the rapid spread of the epidemic further fueled the fear and distrust of these services. After the release of the last Ebola patient in mid-November, Guineans tensely waited for the 42-day period to pass so they could finally be declared free of Ebola.

A facilitator leads a community dialogue in Ratoma, a neighborhood in the capital city, Conakry

A facilitator leads a community dialogue in Ratoma, a neighborhood in the capital city, Conakry.
Photo credit: Guillaume Bakadi

As the country slowly begins to mend, the Health Communication Capacity Collaborative (HC3) team in Guinea is working with the hardest-hit communities to rebuild both the communities’ trust in the health system and the quality of care that they receive. HC3’s approach incorporates evidence-based social and behavior change communication (SBCC), capacity-building and quality-improvement interventions. Over the next few months, we will highlight different parts of the process, from facilitating community dialogues to promoting Gold Star branded revitalized quality health centers.

The first, and arguably most important, activity to rebuild trust in the health system is the community dialogue — a process to bring together patients and health providers to discuss how to make health services better. By involving both community members and health providers in the early stages of the health center revitalization process, they are not only able to identify the key problems and concerns, but they are also more likely to be engaged as part of the solution.

“Looking at the health situation in Guinea, it is very important to keep the community informed. As a result of this community dialogue, we health providers should know now what we should improve and what we should not do. Through this community dialogue, people were permitted to talk frankly in front of health providers on what they do not like regarding our behaviors and rea-sons why they are resentful to seek care in health structures.”

Dr. Fatoumata Yansane, Matam Health Center, Conakry

In November and December, HC3 organized four community dialogues in the capital city, Conakry. Neighborhood leaders, representatives from women’s and youth groups, and religious leaders were invited to meet with health-center supervisors, doctors, nurses and other health staff to share their concerns. These dialogues were very successful. Over 270 participants engaged in lively discussions about the kinds of barriers to service utilization and how to improve the care provided to their communities. Participants identified the high cost of services as a key barriers to use – including providers unofficially charging extra for services, unfriendly welcome by health providers and lack of information given to patients by providers.

After the event, participants from both groups expressed their gratitude for opportunity that the dialogue provided to improve communication in the community. Community leaders pledged to address the problems raised by: 1) reinforcing communication efforts to reach more people with positive messages about service utilization; 2) creating networks of youth, women, community leaders and health providers to give credibility to the messages and instill confidence in health services; and (3) involving local radio stations to promote quality community health services.

HC3 will continue to support these community dialogues across Guinea, as the crucial first step of the quality improvement activities.

Respond Quickly to Ebola with Community Mobilization

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UNICEF Guinea

UNICEF and partners took to the streets of Conakry today to combat the Ebola outbreak with information on how to keep families safe and to prevent the spread we distributed soap and chlorine. Courtesy of UNICEF Guinea

At this stage of Ebola outbreak, health communication is important but it must include a heavy social mobilization component if we expect quick results. Looking at all three Ebola countries (Guinea, Liberia and Sierra Leone), we know the rapid spreading of the disease can be attributed to risky behaviors performed by people due to lack of information about the cause of the sickness, denial and rumors.

In some cases, the information delivered was plain wrong, such as in Guinea where people were officially informed at the beginning of the outbreak that Ebola could not be treated. This misinformation prompted people to keep the sick at home, a risky practice that likely contributed to further spread of the disease.

Ebola countries need accurate information about its transmission (human interaction, nonhuman contact). With the right information, we can define key practices to be promoted at the community level regarding prevention and care seeking.  Then, we can identify appropriate communication channels to spread this key information.

Knowing that in all Ebola countries people do not always trust the governing bodies, it will be important to identify trustworthy sources of information that are able to convey messages and convince people to act very quickly. A strong community mobilization approach will be needed to collaborate with community  leaders who have the power to quickly influence other people.

In Guinea for instance, groups of “wise people” known as “les hommes sages” are located in the capital city to represent the interests of their constituents back home and continually seek resources to contribute to the development of their regions or counties. These  groups do not have any political bias and are comprised of political leaders, civil society, religious leaders, women leaders and youth. They can play a key role in Ebola fight, from relaying messages to the constituencies back home to facilitating a dialogue with those who want to air their concerns and respond to questions about Ebola disease. Other influential leaders to be considered are tribal and religious leaders. People listen to them more than they do government appointed leaders. This social mobilization effort should be backed by other communication materials including radio, written materials, mHealth and TV.

Since we know today that all people suffering from Ebola do not die, personal stories from people who cured after suffering from Ebola being presented on TV may help to convince people that early isolation can help to manage and treat the disease. These stories could be part of an overall strategy that also includes community mobilization activities. That is assuming the services and manpower needed are available to take care of the people who then rush to the health facilities.