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Respond Quickly to Ebola with Community Mobilization

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.

Communication Plays a Critical Role in Ebola Crisis

© 2005 Emmanuel Esaba Akpo, Courtesy of Photoshare

© 2005 Emmanuel Esaba Akpo, Courtesy of Photoshare

During a capacity building workshop in Freetown, Sierra Leone, this past June, the mood was understandably tense as Ebola continued to spread from the East. Tea-break conversations became heated about regional responses to it. While no one agreed on how long it would last or the toll it would ultimately take, one thing was universally accepted: there was a strong need for social and behavior change communication (SBCC) in communities.

One of the workshop participants, Reverend Alimamy Kargbo of the Inter-religious Council of Sierra Leone and Chair of the Global Fund Country Coordinating Mechanism in Sierra Leone, put it this way, “We are troubled and confused about the rate of the spread and the major reason for the spread has been denial [of Ebola]  and not taking heed of instructions issued by the Government and other health workers,” he said. “Now that many people have accepted the reality of its existence and its deadliness, it is as they say ‘out of control’ and still beyond the scope of government to contain it.”

The SBCC challenges related to Ebola are many: the virus can be transferred through local customs and practices such as funerary preparations, including washing the dead, and by eating bush meat that carry the virus. Improper handling of Ebola victims by family members and health workers and avoidance of hospitals and health centers are also major causes of the spread.

“People are too afraid to go to the hospital or health facilities for fear that they will be diagnosed with Ebola,” Kargbo continued, and since there is no known cure, going to a health facility is not an attractive option for many. “Besides, some nurses and health workers are running away for fear of contracting the disease as little or no protective gear are available in some health facilities.”

The Harvard Business Review (HBR) and the World Bank blog both ran articles this week on the critical need for SBCC in Guinea, Liberia, Sierra Leone and other countries in the region where Ebola may be spreading, highlighting entertainment-education (EE) as one approach that helps people consider changing current behaviors and attitudes. As the articles point out, EE has been used with good results for other health issues such as HIV/AIDS, malaria, and nutrition.

The HBR cited drama theory research from Lawrence Kincaid, a health communication expert with Johns Hopkins Bloomberg School of Public Health Center for communication Programs (JHU.CCP), which is a leader in the field of SBCC and entertainment-education. Kincaid has found that “audiences empathize with characters and vicariously live their conflicts through them, even riding with them through their change of mind.” Like many communication strategies, the ones for Ebola, according to the World Bank article, include a variety of communication vehicles such as text messaging via mobile phones, community mobilization and door-to-door outreach.It also reported that UNICEF and partners are engaging in participatory theater to spread messages, giving message-driven theater performances in communities and bus terminals.

“The more that people are transported into the world of the narrative, the more they feel immersed in the story, the more likely they are to change their beliefs to be more consistent with those expressed in the world of the narrative,” said researcher Melanie Green, in a quote from the HBR.

As of August 4, there have been 1,711 infections and 932 deaths from Ebola in these countries, and even more have been affected by the toll the virus is taking on people’s everyday lives. Last week, the World Health Organization declared the outbreak a global health emergency. SBCC must be a critical component of any global public health strategy to stop Ebola from spreading further in the region – or the world.

“I hope that we start our communication programs sooner rather than later in countries that may be affected in the coming days such as Nigeria, before people are too fearful or panicked,” said Caroline Jacoby, Senior Program Officer with JHU.CCP who teaches a course called Entertainment Education for Behavior Change and Development in Johns Hopkins Bloomberg School of Public Health. “Shifting long-held practices and behaviors is difficult, but once people start taking the appropriate actions to keep themselves, their families and their communities safe, these actions can start becoming the ‘norm,’ and have an impact on lives.”

Reprinted with permission from the Health Communication Capacity Collaborative on August 14, 2014