By Gray Kalindekafe:
Why is it important to include Risk Communication and Community Engagement (RCCE) as part of a national public health emergency response?
One of the major lessons learned during major public health events of the 21st century – including outbreaks of the severe acute respiratory syndrome (Sars), the Middle East respiratory syndrome (Mers), influenza A(H1N1), and Ebola virus disease – is that RCCE is integral to the success of responses to health emergencies.
Every public health emergency faces new communication challenges and can benefit from lessons learned previously. The Covid-19 outbreak challenges public health systems and their ability to effectively communicate with their populations.
Failure to communicate well leads to loss of trust and reputation, economic impacts, and, in the worst case, loss of lives. Although there are always new lessons to be learned, there are actions we know will work. This is a call to leaders to ensure that RCCE is an essential component of health emergency readiness and response activities.
One of the most important and effective interventions in a public health response to any event is to proactively communicate what is known, what is unknown, and what is being done to get more information, with the objectives of saving lives and minimising adverse consequences.
RCCE helps prevent “infondemics” (an excessive amount of information about a problem that makes it difficult to identify a solution), builds trust in the response and increases the probability that health advice will be followed. It minimises and manages rumours and misunderstandings that undermine responses and may lead to further disease spread.
Regular and proactive communication and engagement with the public and at-risk populations can help alleviate confusion and avoid misunderstandings. People have the right to be informed about and understand the health risks that they and their loved one’s face. The perception of risk among affected populations often differs from that of experts and authorities.
Effective RCCE can help bridge that gap by determining what people know, how they feel, and what they do in response to disease outbreaks, as well as what they ought to know and do to bring the outbreak under control. Effective RCCE helps transform and deliver complex scientific knowledge so that it is understood by, accessible to, and trusted by populations and communities.
Effective RCCE uses community engagement strategies to involve communities in the response and develops acceptable and beneficial interventions to stop further amplification of the outbreak and to ensure that individuals and groups take protective measures. RCCE is essential for surveillance, case reporting, contact tracing, caring for the sick, delivering clinical care, and gathering local support for any logistic and operational needs for the response.
Effective RCCE can minimise social disruption. Therefore, in addition to protecting health, it can protect jobs, tourism and the economy.
Risk communication ensuring the general public is aware of the seriousness of Covid-19 outbreak is of paramount importance. A high degree of population understanding, community engagement and acceptance of the measures put in place (including more stringent social distancing) are key to preventing further spread. It should be made clear through public risk communication and health education that although this is a new and highly contagious disease, outbreaks can be managed with appropriate measures, and the vast majority of infected people will recover.
Easily accessible information should be available on the signs and symptoms (i.e. fever and dry cough) of Covid-19, contact details of local health services, the population groups at risk, self-isolation, social distancing measures, travel advice and the need to rigorously implement frequent hand washing and always covering mouth and nose with tissues or elbow when sneezing or coughing.
Risk communication strategies should target different audiences and a monitoring system should be put in place to observe public perceptions and opinions of both the outbreak and the response to the outbreak. Risk communication strategies should clearly provide the rationale behind non-pharmaceutical countermeasures.
To facilitate the adherence to and implementation of self-isolation by the public and healthcare workers, a support system should be prepared to provide essential services and supplies (e.g. food and medication), and to monitor vulnerable individuals. In order to optimise adherence to these demanding public health measures, consideration should be given to providing compensation for those who have suffered financial loss as a result of them.
Messaging should be factual and focused on informing key stakeholders about the evolution of the situation globally. Key messages for the public should include facts about the disease, transmissibility, severity and preventive measures available. Messaging should prepare for the introduction of individual cases or clusters and highlight the existence of pandemic preparedness and crisis management plans.
There should be preparations made to communicate via the appropriate channels (including social media channels) to policy makers, healthcare workers, particular risk groups and particular hard-to-reach (such as minority language groups, disabled and migrant) groups. Coordination mechanisms between policy makers, public health authorities, multi-sectoral crisis coordinators and healthcare providers should be reviewed and established to ensure consistent and coherent messaging.
Risks should be communicated in a transparent and consistent way to stakeholders and to the public, according to the unfolding epidemiological situation. Communication on the first cases in country or region should be used as opportunities to convey key messages about the disease and local and international risk assessments. Messages should include the actions (including isolation, contact tracing, and use of personal protective equipment) being taken with acknowledgement of uncertainty.
Mechanisms for feedback from key stakeholders and the public to ensure impact of communication should be developed. Efficient risk communication is essential, as is the monitoring of public perception so that concerns are addressed and misinformation and rumours can be challenged.
Frequency of risk communication to the general public has to be daily or continuous and abundant in nature in the early part of this scenario, tailored for specific target audiences in content and in communication methods. Messaging should focus on localised situational awareness, addressing concerns, highlighting individual actions for prevention and should also include positive messaging on recoveries and local efforts in a balanced manner.
There is need for substantial risk communication efforts to ensure that the public know how to respond in case of a suspected infection. This phase requires complex and locally tailored messaging which is dependent on the local healthcare capacity situation which needs to be considered in national and international communication efforts.
The close collaboration between healthcare providers, public health organisations and the general public becomes crucial. Priority messaging should be on individual measures that can be taken to protect the vulnerable and healthcare workers. Individual, religious and societal concerns around deaths and funerals need to be considered as well.
The current Covid-19 civic education programme in Malawi is facing astronomical and a myriad of challenges which include the following:
The National Covid-19 Preparedness and Response Plan to Covid-19 is more government-centric and general monopoly by the Ministry of Health and it is not inclusive enough to involve adequately, political parties, traditional leaders CSOs, FBOs, CBOs, private sector, communities etc.
The National Covid-19 Preparedness and Response Plan indicates that the Ministry of Information, Civic Education and Communications Technology will lead the Public Communication Cluster in collaboration with the Ministry of Health, Ministry of Disaster Management Affairs and Public Events, WHO, Unicef and other agencies. Under this cluster, a national Covid-19 communication plan has been developed to guide the communication needs of the preparedness and response plan. Nice Public Trust is neither mentioned nor included
Public health response to the Covid-19 pandemic has been accompanied by an infodemic, which is an over-abundance of information – some accurate and some not – that makes it hard for people to find trustworthy sources and reliable guidance when they need it. This misinformation hampers public health responses to epidemics and prevents people from taking adequate measures to effectively prevent disease transmission. Some misinformation may also lead to dangerous behaviours, such as self-medication with harmful substances.
The National Covid-19 Preparedness and Response Plan under public education cluster is more sectoral oriented and allowance driven hence has not embraced other sectors and actors with added competitive advantage. We view this as a lost and missed opportunity.
The other constraints in the sensitisation campaigns against this virus the beliefs, fears, rumours, questions and suggestions circulating in communities about the new coronavirus this is becoming an impediment in the civic education endeavour.
During this period there were multiple campaigns happening including political campaigns by political parties, civic and voter education campaign hence the air was saturated with electoral related campaigns hence Covid-19 awareness campaigns were put in the peripheral. Furthermore there was no united stand about the pandemic by the political leaders hence this caused confusion among the citizens.
In order to deal with these challenges, the author is proposing the following recommendations to ensure a robust and comprehensive civic-education programme on Covid-19:
There is need to use participatory and transformative approaches that will lead to behavioural change such as the Learner Centred Problem Posing, Self-Discovery and Action Oriented approach (Lepsa approach which is empowering and leading to demystification using evidence based approached such as picture codes, video codes, plays songs whose content is drawn from research and the sessions are so moving that participant’s or the audience can break into tears and regret their past actions and behaviours.
Counter rumours, myths and misinformation with facts shared through trusted channels and sources.
Identify and support community-led activities and solutions to contain the outbreak using indigenous knowledge and community assets and community networks.
To manage the infodemic, the communication around Covid-19 has been monitored to detect as early as possible misinformation or gaps in information. Close partnership with various sectors and their respective members such as faith-based organisations, sporting event organisers, travel and trade sectors, international employers’ organizations, trade unions organisations, health care delivery sector and others – existing trusted sources of information have been amplified and tailored for particular audiences. This has allowed for the timely corrective action such as displacing misinformation through a high output of public health messages that inform individuals and populations how to protect themselves and support outbreak control activities. The Covid-19 pandemic continues to evolve rapidly.
There is need for national unity working across party lines, religion , beliefs, ideologies and any other difference, because according to the World Health Organisation, “When there is a crack at national level between political parties, religious groups or between other groups, it’s when the virus gets the space which it can exploit to defeat us.”
There is need for a multi-sector, harmonised, collaborated, all inclusive, aligned public education cluster framework within the National Covid-19 Preparedness and Response Plan that embraces a wider section of civic education players such as political parties, traditional leaders CSOs, FBOs, CBOs, private sector, communities etc, government to embrace an all-inclusive approach by involving all strategic key stakeholders in fighting the pandemic beyond government machinery.
The national level public education cluster composition should also be reflected at district level where the District Covid-19 preparedness and response team should also be all-inclusive and might include information officers, social and community affairs officers, health personnel, Nice Public Trust, Public Affairs Committee, CCJP, Mhen, CHRR, MHRC, ACB, Pastors Fraternal, politicians, traditional leaders, Dodma, education, CSO network, vendors associations, the police, etc.
There is need for social science and community insights, including perception surveys and feedback from communities affected by physical distancing and movement restrictions. They must be rapidly synthesised to ensure that future response measures are informed by and calibrated according to the ongoing experiences of affected communities.
Centre for Social Research as partners can support this effort through the creation of a repository of risk communication and community engagement data collection tools (surveys, questionnaires, rapid assessment methods) to aid researchers and public health organizations to roll out quick assessments in their communities of interest.
The author is writing in his own capacity as a governance, elections, human rights and civic education specialist