• No results found

The Community-Centered Solution to a Pandemic : Risk Communication and Community Engagement for Co-Production of Knowledge in Health Emergencies and Infodemic Context

N/A
N/A
Protected

Academic year: 2021

Share "The Community-Centered Solution to a Pandemic : Risk Communication and Community Engagement for Co-Production of Knowledge in Health Emergencies and Infodemic Context"

Copied!
56
0
0

Loading.... (view fulltext now)

Full text

(1)

The community-centered solution

to a pandemic

Risk Communication and Community Engagement for co-production

of knowledge in health emergencies and infodemic context

Antonio Palazuelos Prieto

Communication for Development Two-year master

15 Credits Autumn 2020

(2)

The community-centered solution to a pandemic

Risk Communication and Community Engagement for co-production

of knowledge in health emergencies and infodemic context

Abstract

This research explores how community-centered solutions facilitate the success and ownership of the response actions to deal with a public health emergency, such as the Covid-19 pandemic.

When an outbreak or a hazard impacts a group of people, there is a strong need for communication in order to be able to access to the right information that takes people to make the correct decision and thus to take a protective action to be safe. This approach, known as Risk Communication and Community Engagement (RCCE)1, allows the

co-production of knowledge needed for a group of people to remain safe.

For this approach, social listening tools, such as media monitoring and community feedback collection are critical understand communities’ needs. Its analysis allows to tailor a RCCE strategy that is able to substantially reduce the threat that a public health emergency poses to human lives2.

Communities need solutions that are adapted to their needs in order to be able to deal with any emergency, including the Covid-19 pandemic. The RCCE approach empowers communities and provides them with the tools to amplify their voices. This

1World Health Organization (WHO) (2020). Risk communication and community engagement (RCCE)

readiness and response to the 2019 novel coronaviruses (2019-nCoV): interim guidance, 26 January 2020. Geneva: WHO.

(3)

participatory approach allows them to co-produce knowledge and get full ownership of the solutions.

Nevertheless, in an environment with excess of information, it may not be easy to discern the truth from the false. Unverified information and rumors are frequent and social media channels facilitate their rapid dissemination without borders. ‘Infodemic’ refers to an excessive amount of information concerning a problem such that the solution is made more difficult. (WHO, 2020)3

Some rumors may encourage people to take wrong decisions and perform actions that exacerbate risks during an emergency. The RCCE approach helps to promote real-time exchange of information to avoid that rumors and disinformation flourish. (WHO, 2018)4. It also allows to identify and implement community-centered solutions to

communities’ problems.

RCCE needs data to monitor and evaluate its activities and reach effectively populations in risk to encourage them to observe the health preventive measures. Lives at risk depends on the right information conveyed through the right channel at the right time. To be able to supply tailored and accurate information to those communities and engage them, evidence-based RCCE strategies are needed, respecting the socio-anthropological and cultural context of the community.

This research is based on the findings from five African countries -Cabo Verde, Cameroon, the Gambia, Mozambique and Niger-, all of them seriously affected by current Covid-19 pandemic. Its conclusions help to understand the critical role that RCCE plays in health emergencies resilient recovery.

Keywords: Risk Communication, Community Engagement, Co-production of

knowledge, Public health emergencies, Infodemic, Outbreak response, Disinformation, Misinformation, Rumor management, Covid-19, Development Communication.

3 World Health Organization (WHO) (2020). Infodemic management: a key component of the COVID-19

global response. Weekly Epidemiological Record 95 (16), 145 - 148. World Health Organization.

4 World Health Organization (WHO) (2018). Communicating Risk in Public Health Emergencies - A

(4)

Table of Contents

Abstract ... 1

Table of Contents ... 3

Index of figures and tables ... 4

Acronyms ... 5

Introduction ... 6

Rationale ... 8

Literature Review ... 10

Research design ... 15

Barrier gestures and preventive measures ... 17

Brief Covid-19 background ... 17

Conceptual Framework ... 19 Methodology... 24 Justification ... 25 Implementation ... 26 Ethical considerations ... 28 Analysis ... 30

Small Island Developing State: Cabo Verde ... 31

Central Africa: Cameroon ... 33

West Africa: The Gambia ... 37

Southern and Eastern Africa: Mozambique ... 40

The Sahel: Niger ... 42

Conclusions ... 45

References ... 48

Appendices ... 54

Research techniques distribution by country ... 54

(5)

Index of figures and tables

FIGURE 1:EVOLUTION OF THE MODERN RCCE APPROACH.SOURCE:WHO,2020 ... 12

FIGURE 2:POINTS OF INFLUENCE FOR CO-PRODUCTION OF KNOWLEDGE.SOURCE:TEMBO,2021 ... 13

FIGURE 3:COVID-19 EVOLUTION IN THE AFRICAN CONTINENT.SOURCE:SITREP 33,WHOAFRICAN REGION. ... 30

FIGURE 4:COVID-19 PROPAGATION BY ISLAND,CABO VERDE.SOURCE:SITREP 2-12-20,MINISTRY OF HEALTH OF CABO

VERDE... 31

FIGURE 5:COVID-19 DEATHS IN 2020 BY MONTH,CABO VERDE.SOURCE:SITREP 2-12-20,MINISTRY OF HEALTH OF CABO

VERDE ... 32

FIGURE 7:COVID-19 EPIDEMIOLOGICAL EVOLUTION IN THE GAMBIA.SOURCE:SITREP 267,MINISTRY OF HEALTH OF THE

GAMBIA ... 38

FIGURE 8:DAILY FIGURES OF THE OUTREACH OF RCCE ACTIVITIES ON FEBRUARY 2021, THE GAMBIA.SOURCE:SITREP 267,

MINISTRY OF HEALTH OF THE GAMBIA ... 39

FIGURE 9:COVID-19 EPIDEMIOLOGICAL EVOLUTION IN MOZAMBIQUE.SOURCE:SITREP 15-02-2021,NATIONAL INSTITUTE OF HEALTH OF MOZAMBIQUE ... 40

FIGURE 11:COVID-19 EPIDEMIOLOGICAL EVOLUTION IN NIGER.SOURCE:SITREP 11-01-2021,MINISTRY OF PUBLIC

HEALTH OF NIGER ... 43

TABLE 1:THE THREE APPROACHES OF THE MEDIA,COMMUNICATION AND DEVELOPMENT THEORY.SOURCE:MANYOZO,

2012:23 ... 11 TABLE 3:COVID-19 POSITIVE, DEATHS AND RECOVERED CASES IN 2020 BY REGION,CAMEROON.SOURCE:SITREP 61,

MINISTRY OF HEALTH OF CAMEROON. ... 34

TABLE 4:POPULATION REACHED BY RCCE ACTIVITIES,CAMEROON.SOURCE:SITREP 61,MINISTRY OF HEALTH OF

(6)

Acronyms

Africa CDC African Union Center for Disease Control CDC United States Center for Disease Control CHW Community Health Worker

ECDC European Center for Disease Control

EPI-WIN Epidemiological World Information Network EOC Emergency Operations Center

IASC Inter-Agency Standing Committee IFRC International Federation of Red Cross IGO Intergovernmental Organization IMS Incident Management System IPC Infection Prevention and Control MoH Ministry of Health

NGO Non-Governmental Organization SIDS Small Island Developing State SitRep Situational Report

RCCE Risk Communication and Community Engagement

UN United Nations

WHO World Health Organization UNICEF United Nations Children Fund

(7)

Introduction

The world is changing rapidly due to emerging threats to human security. Health is a major concern to assure that current and next generations will enjoy a healthy life and a healthy environment. Diseases and outbreaks challenge human development and are able to reverse economic and social growth all over the world.

This is the case of the Covid-19 pandemic that has paralyzed the world for over a year and it continues to devastate communities, reaching to over 111 million of people infected and nearly 2.5 million of deaths worldwide5. Numbers continue exponentially

raising up every day. Despite the vaccination campaigns hopes, the socio-economic impact of the pandemic continues to be serious all over the world.

Those figures take us to reflect that the way to deal with the pandemic could be improved. If more efforts had been made in prevention awareness, less people would have been affected by the disease. This is subject to discussion and it may vary depending on the country.

According to WHO, investing in health prevention saves lives and money. “The

evidence shows that prevention can be cost-effective, provide value for money and give returns on investment in both the short and longer terms” (WHO, 2014:2).

Indeed, once an individual is aware of a risk, preventive measures to be protected are taken instinctively. Nevertheless, when those protection methods involve a social change, including behaviors, attitudes or practices, challenges may arise. Hence, it takes more efforts and time to sensitize communities to adopt the recommended change. Even more difficult is when that change involves cultural, religious, traditional or social believes and practices shifts that communities could not accept or understand easily. This is the case of the several barrier gestures widely disseminated by ministries of health and public health stakeholders to prevent diseases.

The Covid-19 preventive measures involve a behavior change in each citizen of the world. This is the case of keeping social distance and avoiding mass gatherings. Traditional ways to greet each other become suddenly forbidden, including shaking hands, kisses and hugs. This implies a deep social and behavior change, particularly in societies that value the social contact and proximity.

(8)

Likewise, religious and social celebrations, leisure activities and parties, conferences and meetings and many other events have been cancelled or adapted to the new safety standards.

In order to achieve that those measures become accepted by most of the population, a big investment in sensitization, communication, information and education is needed. However, not all actors and countries can afford it.

An effective strategy with an optimized process of monitoring and evaluation is needed to be in place to achieve it. The strategy is Risk Communication and Community Engagement and the monitoring and evaluation process is the Community Feedback collection and analysis.

(9)

Rationale

When an outbreak or a hazard impacts a group of people, there is a strong need for communication in order to be able to access to the right information that takes people to make the correct decision and thus to take a protective action to be safe.

The RCCE approach helps to find community-centered solutions and promote ownership of the communication messages by the communities. Thus, the health preventive measures are accepted and put into practice by all members of the community.

The co-production of knowledge is based in the principle that communities have a practical know-how that is relevant for the response to an emergency situation. They are the first affected and, thus they have an interest to contribute with their experience to co-produce a solution to overcome the risk (Nelson, 2019).

To learn from communities is needed to develop social listening tools that help to collect the feedback from them. This reaction will allow to verify if they effectively understand the health messages and practice them. The analysis of the feedback allows to monitor and evaluate whether the awareness campaign has achieved its objectives or not. Indeed, it reveals if the citizens have adopted the recommended behaviors, attitudes or practices, and therefore, they take into action the protection measures.

Nonetheless, all this process can be disrupted by intended or unintended factors that can compromise the efforts to communicate and disengage communities, moving them to unfollow the health recommendations. This may include disinformation, misinformation or malinformation (Wardle & Derakhshan, 2017:5). Beyond being false, some of them can be harmful and have drastic consequences for those who trust them.

In an environment with excess of information, it may not be easy to discern the truth from the false. Unverified information and rumors are frequent in the context of epidemics and outbreaks. Internet and social media channels contribute to disseminate them even faster and without borders.

This phenomenon is known as ‘Infodemics’, which refers to an excessive amount of information available concerning a problem such that the solution is made more difficult (WHO, 2020).

Some rumors may encourage people to take wrong decisions and perform actions that may exacerbate the risk of the emergency. RCCE helps to promote real-time exchange of information6 to avoid that rumors and disinformation flourish. (WHO, 2018)

(10)

Likewise, RCCE needs data from the communities to monitor and evaluate the results of its implementation. That analyzed data allows to reshape and review the

implementation action lines in case it is needed. This improves the performance of the RCCE campaigns and facilitates reaching effectively to populations at risk to encourage them to observe the health preventive measures.

Indeed, lives at risk depends on the right information conveyed through the right channel. To be able to supply tailored and accurate information to those communities, community feedback data and analysis is critical for evidence-based RCCE strategies.

(11)

Literature Review

The Risk Communication and Community Engagement approach has become an

essential part of the Development Communication to assure that communities are placed at the center of the decision-making and knowledge co-production processes (WHO, 2020). This process of consolidation has taken few decades. During this period, diverse approaches has been put into place to promote the participation of the communities, evolving towards the most comprehensive and ambitious approach of RCCE.

According to Linje Manyozo (2012), three methodological and theoretical approaches have been distinguished traditionally in the Communication for Development field, each one placing the focus on the different component of the communication.

Firstly, the Media for Development approach, with emphasis on the content through media to promote and sell positive attitudes and behaviors. Theories such as social change, social marketing, health and population communication, educommunication, rural education broadcasting and farmcasting are related to this approach.

Secondly, Media Development approach, with focus on the development of media [infra]structures, policies and capacities to promote good governance. Freedom of speech, media and political pluralism and information society are key concepts related to this approach.

Thirdly, Participatory and Community Communication, stressing the engagement among development stakeholders within decentralized decision-making processes. Participatory action learning, collaborative decision-making, community engagement, participatory democracy and decentralization and community health development are fundamental to this approach.

Although there are interlinkages amid the three approaches, the evolution of the last one facilitated the consolidation of the RCCE approach, particularly in the health field and in outbreaks and diseases response. The participatory approach is at the core of the RCCE in order to engage communities and get their ownership.

In the development practice, community engagement literature starts in the 1970s and evolves progressively towards a decentralized approach for decision-making (Willis, 2005).

Kilpatrick (2009) presents two major approaches towards community engagement, depending if the focus is systems or in the empowerment that were conceptualized by conceptualized by Taylor, Wilkinson and Cheers (2008). The empowerment discourse, as community empowerment and developmental approaches, allow communities to

(12)

discourse, defined as the contributions and institutional approaches refers to an externally driven engagement in which participation is structured towards improving community health, services and well-being.

Table 1: The three approaches of the Media, Communication and Development theory. Source: Manyozo, 2012: 23

According to Manyozo, from the perspective of the development theory, participatory communication is an interpersonal communication mechanism that allows for

stakeholders to take center stage in the design and implementation of development plans It shows that “the media are just instruments aimed at facilitating the communicative practices surrounding the design, implementation and management of development interventions. In other cases, such media are not needed and the community engagement

(13)

approach provides that theoretical instrument for studying media, communication and development” (Manyozo, 2012: 195).

In 1996, the National Research Council published Understanding Risk: Informing Decisions in a Democratic Society. In this book, the theory of RCCE was developed to address public concerns about environmental hazards in the US. Few years later, several global outbreaks drove countries towards the approval in 2005 of a global health

emergency response framework, called the International Health Regulations. RCCE became an integrated component of the response to epidemics and pandemics, according to that new framework (IHR, 2005).

RCCE has now evolved considerably as well as social science evidence and new communication and media technologies and practices have evolved in the current century. Following Gaya M. Gamhewage, the three big shifts that have influenced the field for RCCE are:

- Experts and authorities are less trusted, and issue of real or perceived trust is now central to health and risk communications; 


- The way the public seek health advice has shifted to the public on-line sources and social media networks; 


- The way the media works has changed to embrace 24-hour journalism, the increase of citizenship journalism and social media, and the rise of opinion versus the well-sourced and referenced news stories of the past. 


Today, RCCE is recognized as a critical component in the response to public emergencies, contributing to build trust with the communities that facilitates the co-production of knowledge and the finding of adapted solutions centered in the communities.

(14)

The co-production of knowledge in the health sector has grown exponentially in recent years. Implementation of RCCE activities have definitely contributed to it, particularly in countries from the Global South. Co-production requires investment in time and resources and a commitment to building trust between researchers and communities (Tembo, 2021).

Within health emergency response, co-production can be achieved by setting up rapid response community panels, strengthening existing community relationships, and developing contingency plans for alternative methods of engagement during future outbreaks (Tembo, 2021). Those points of influence for co-production helps to find community-centered solutions. The RCCE approach stimulates this process.

The success of the RCCE strategies to the public in the event of emergencies relies heavily on public confidence in health actors and governments (Hance et al., 1988). The co-production of knowledge contributes to build trust. Hence, maintaining and nurturing mutual trust harness the potential of the RCCE to empower and protect communities (Covello, 2003).

(15)

This participatory process should be truthful, honest, frank, and open to ensure more effective outcomes (Shore, 2003). Trust plays a central role in decision-making processes and compliance rates among message recipients, as individuals are more likely to follow instructions given by someone they trust (Siegrist et Cvetkovich, 2000). When the public has low knowledge about the risk at hand, trust plays an important part in public perceptions about severity of that risk (Wray et al., 2006). This is the case of the current Covid-19 pandemic situation.

(16)

Research design

The research aims to strengthening evidence-based outbreak response management for risk communication and community engagement enhancement. It generates robust socio-anthropological evidence, which contributes to address in a more effective way the outbreak response. This finally enhances the awareness and protection of citizens across the country.

In particular, the research identifies social, cultural and anthropological drivers and analyzes their role to contribute to either spreading or controlling the disease. It examines why the people do not observe the preventive measures and it produces several recommendations to strengthening community engagement.

Likewise, it helps to understand the deep causes of this disengagement, including the analysis of attitudes, behaviors, beliefs, perceptions and practices that challenges people’s adoption of the barrier gestures. Indeed, the research characterizes people’s attitudes, behaviors, beliefs, perceptions and practices towards the disease and its impacts on their health, as well as in their social and cultural life.

Identifying key patterns that drives and sustain either adherence, indifference or rejection of preventive measures, the research enables to adjust RCCE strategies. Moreover, the research enables stakeholders working on behavioral change and impact to know in a more accurate way what is needed to transform individual and collective attitudes and practices in favor of an effective prevention.

The conclusions of the research are meaningful to health policies adaptation and RCCE campaigns review to motivate communities to shift from inappropriate to recommended behaviors and practices and stimulate the co-production of knowledge.

This research also explores how community feedback data and analysis are critical to co-produce knowledge that substantially reduce the threat that public health

emergencies poses to human lives (Tindana, 2007). It explains in detail the RCCE approach, as well as its origins and current practice, in the context of the current Covid-19 pandemic.

For scoping purposes, the research covers only a selection of representative countries in the African continent where RCCE campaigns have been or are currently being

implemented. It was selected this continent because of the large potential of harm that the Covid-19 pandemic could cause in Africa due to limited health facilities and services and the robust impact that RCCE actions can have to prevent it.

(17)

Likewise, the reduced number of scientific publications available from those countries bringing voices from the South gives special significance to this research and justifies the selection. In addition, the author’s acquaintance with the continent and the

accessibility to the sources of information was also taken into account for the selection. The five selected countries are Cabo Verde, Cameroon, the Gambia, Mozambique and Niger. These countries were selected because they represent diverse cultural, traditional and religious contexts, as well as geographical, developmental and linguistic.

Cabo Verde is a Small Island Developing State (SIDS) in the Atlantic coast of Africa with Portuguese as official language. Cameroon is located in Central Africa, on the Guinean Gulf coast and although it is predominantly French speaking, both English and French are the official languages. The Gambia is in West Africa and has English as official language. Mozambique is on the Southern and Eastern Africa Indian Ocean coast and Portuguese is also its official language. Finally, Niger is located in the Sahel region and it is a French speaking country. It was considered that such a diversity will enrich the findings of this research.

According to the WHO, diseases outbreaks and epidemics may become more frequent in next years. The probability of pandemics occurring in our lifetimes is significant (Gates, 2018). Thus, the global importance of the topic of this research.

The threats of public health emergencies continue relevant, particularly in a more globalized world, where goods and people travel more than ever, and thus diseases can be transmitted easily and quickly from one side of the world to the other (Lee and Dodgeson, 2000; Mondragon et al., 2017).

Therefore, findings and conclusions from this research will continue being relevant and precise. An avenue for more research is open, as the RCCE approach is becoming more important in disasters and health emergencies.

The World Health Organization considers RCCE as a central pillar in the fight against infectious diseases (WHO, 2018).

The relevance of RCCE is becoming increasingly evident in the theories of emergency health communications. The need for more participatory approaches to communication from a bottom-up perspective that are either incorporated alongside or substituting traditional top-down approaches has contributed to the raise of the RCCE (Waisbord, 2001).

From a theory of change perspective, the RCCE approach facilitates greater authentic representation of community voices that contribute to the co-production of knowledge and ultimately keep people better protected from diseases and outbreaks.

(18)

- How do Risk Communication and Community Engagement help to co-produce knowledge and solutions for a public health emergency?

Within that overall question, there is also the following sub-question:

o How do communicating risk and engaging communities contribute to avoid rumors and manage the infodemic?

The central question aims at examining how the RCCE approach in general may contribute to the co-production and co-creation of knowledge and solutions for health emergencies, while the sub-question aims at exploring how RCCE in particular may be relevant to manage rumors and infodemics.

Barrier gestures and preventive measures

In this research the terms preventive measures and barrier gestures are used thoroughly. As a way of clarification, they refer concretely to:

- Handwashing regularly with soap and water or hand sanitizer - Respiratory hygiene, particularly when sneezing or coughing

- Social distancing of a minimum of one meter and avoiding mass gatherings and close contacts

- Wearing a protective mask correctly

- Avoiding touching the mouth, nose and eyes

Those are the basic barrier measures for the Covid-19 infection prevention and control, according to WHO (2020) and widely accepted by countries.

Brief Covid-19 background

Following the guidance from the International Health Regulations (2005), China

notified to the World Health Organization (WHO) an outbreak of zoonotic origin in late 2019. As the outbreak was expanded rapidly to the surrounding countries, it was

declared by WHO a Public Health Emergency of International Concern (Mullen, 2020). When the state of international emergency was declared, many countries were not prepared to face such a long and devastating pandemic. Measures were taken by many

(19)

countries to control the virus and the expansion of the outbreak, including the lockdown of major cities and daily curfews.

This emergency situation created an extended sense of fear, particularly in vulnerable communities. However, some groups, particularly young people seemed not to be really aware of the danger and they continue their normal life.

In Africa, governments with the support of the development partners implemented national multisector response plan and launched RCCE awareness raising campaigns with focus on preventive measures and protective practices to be followed by every citizen.

This response plan was based in the ‘3-T Strategy' — tracking, testing and treating. (WHO, 2012). It included epidemiological surveillance, clinical and psychological case management, infection prevention and control, risk communication and community engagement, laboratory and logistics to booster the response.

Nevertheless, the implementation faced several challenges notably, lack of ownership by major stakeholders, weak engagement of opinion leaders, limited funding and people reluctance to observe control measures put in place to limit the spread of the pandemic. In this epidemic situation, authorities are trying to engage the population to follow the preventive measures using RCCE strategies. Nevertheless, the results until now are limited and communities across the continent feel disengaged with the governments and thus, they do not follow the barrier gestures encouraged by authorities and WHO.

(20)

Conceptual Framework

Risk Communication and Community Engagement places communities at the center. It empowers them to co-produce knowledge that can be useful for saving lives. It

contributes to the response to an emergency situation.

The co-production of messages that are framed within the cultural, historical, social, and political contexts, and owned by communities, contributes to develop credibility and trust in health emergency service delivery. In order to co-produce knowledge with communities is important to include experiential knowledge and participatory methodologies (Tembo, 2021).

Co-production is a core feature of RCCE, which is common to health research and implementation in both the global North and South, with a range of potential benefits. It helps to ensure that health research contributes to building knowledge and generating innovations that benefit users of research7. It makes implementation and the impact of

the research results more likely (Staley, 2015; Lignou et al., 2019).

RCCE is crucial for developing and disseminating accurate information and have been associated with more successful communication strategies in outbreaks (Walker et Adukwu, 2020). The RCCE approach was conceived within the context of Development Communication, with particular focus on Emergency situations.

“When the pathogen is not well known or understood, and if the effects are dramatic or disproportionally affect children or other vulnerable groups, risk communications address immediate concerns and evolve with the outbreak response as new information emerges” (WHO, 2020).

This is the case of the Covid-19 response. As it is a new disease, information and control measures evolves as more research and scientific data is available. Health authorities may not yet know all the facts (Reynolds et Seeger, 2012). As the science evolves, messages need to change too, which can spur further confusion, as people tries to separate accurate from non-accurate information (Balog-Way et McComas, 2020). RCCE helps to communicate and avoid noise when the messages needed to be adapted, based on the evolution of the outbreak. This avoids confusion and anxiety who may take people to wrong decisions. There are often deeper socio-anthropological and historical issues that can affect trust in health authorities and make communities less inclined to

(21)

listen, especially if they are not involved actively in their own community’s response (Ramsbottom et al., 2018).

RCCE implies the “real-time exchange of information, advice and opinions between experts, community leaders or officials and the people who are at risk, which is an integral part of any emergency response” (WHO, 2017). If messages are not properly adapted to the socio-cultural and historical context, communities may disengage and have low trust in the response (Richardson et al. 2019). This can lead to inability to influence positively behaviors, low uptake of health services and weak adherence to public health guidance (Gillespie et al., 2016).

When infodemics breeds in an environment steeped in distrust, aggravated by a poor public health communications response, the cost to public health systems can be colossal (Vicol et al, 2020).

In the midst of a health emergency, RCCE can quickly reach community influencers and members to facilitate a dialogue (Marston et al., 2020). Multidirectional

communication mechanisms are better suited for listening to and addressing concerns, especially in a public health emergency and infodemic context.

Different communities have different information needs. Framing information within a bio-medical and epidemiological lens is not always sufficient for clearing up

misperceptions or supplanting misinformation (Chandler et al., 2015).

The goals of RCCE are to share information vital for saving life, protecting health and minimizing harm to self and others; to change beliefs; and/or to change behavior (FDA, 2011). The perception of risk varies depending their sense of emotional engagement, including fear, anger and outrage. (Sandman, 1987).

For public health emergencies, RCCE includes “the range of communication capacities required through the preparedness, response and recovery phases of a serious public health event to encourage informed decision making, positive behavior change and the maintenance of trust” (Gamhewage, 2014).

In this case, Communication becomes not only an essential tool for development

(Enghel, 2013), but also a technical component within the Incident Management System (IMS). This is the standardized structure adopted internationally to manage the response to public health events and emergencies, included in the Humanitarian Programme Cycle defined by the Inter-Agency Standing Committee8 (IASC).

(22)

The IASC cluster structure, includes Risk Communication and Community Engagement as an essential sub-function, in relation to the Transformative Agenda Protocols9, and

the more recent Grand Bargain10 and New Way of Working11.

“This sub-function assesses the social and cultural context of populations at risk, engages stakeholders at national and local levels, develops tailored and targeted messages for dissemination, ensuring that they are technically sound and

socio-culturally appropriate, and conducts rapid surveys and other assessments to determine the barriers to adopting health advice. It delivers health messages using the most

effective means preferred by the target population in local languages and monitors their effectiveness. The sub-function also builds risk communications and community

engagement capacities in-country and coordinates key international and national partners.”

WHO Emergency Framework Response Handbook (p.48)

Thus, RCCE is understood as a critical component in the emergency response and it requires technical expertise that works interlinked with the main clusters of the IMS, such as Health, Shelter, Protection, Food Security and others.

Likewise, Risk Communication is one of the eight core functions of the International Health Regulations (2005). These regulations represent an international treaty adopted by countries, which are binding to all signatories. The IHR constitutes an essential step to prevent epidemics and pandemics, such as Covid-19.

Furthermore, a Guideline Development Group (GDG) comprised of external experts, both academic and practitioners, was constituted in 2015 to lead the development of the WHO guidance on emergency risk communication.

The work of the group included a full review of bibliography and grey literature, concluding with the production of the WHO Guidance and the publication of Communicating risk in public health emergencies12.

Some relevant actors in health emergencies, including the US CDC, Africa CDC, ECDC, Unicef, the Red Cross, the United Nations and several international NGOs have been involved in developing and applying the RCCE approach in scenarios all over the world.

9 Available at: https://interagencystandingcommittee.org/iasc-transformative-

agenda/documents-public/iasc-reference-module-implementation-humanitarian

10 Available at: http://www.agendaforhumanity.org/initiatives/3861 11 Available at:

https://interagencystandingcommittee.org/system/files/update_on_the_new_way_of_working.pdf

12 Available at: https://www.who.int/publications-detail/communicating-risk-in-public-health-emergencies

(23)

During an emergency crisis, access to the right information is not always easy. It is critical for stakeholders working in the response to provide safe and sustainable communication channels that will help affected communities to make quick decisions and work efficiently.

The RCCE approach helps to tackle infodemics, offering privileged multidirectional communication channels, where feedback and interaction is at the center. Infodemic has been defined by WHO as the over-abundance of accurate and non-accurate information that makes it harder for people to find trustworthy sources and reliable guidance when they need it.

Within the infodemic context, the false information can be intentional or

non-intentional. This is disinformation and misinformation, respectively. In addition, if the information aims to harm, then is called ‘malinformation’ (Wardle et Derakhshan, 2017). The spread of both types of false information compromise the response to a health threat, such as an outbreak, and affect adherence to public health guidance and health-seeking behavior (Karlova et Fisher, 2012).

In addition, false information can affect cognitive processes through its influence on cognitive schemas. “Cognitive schemas are thought patterns that organize information and relationships between objects and structures and assist with decision making. Schemas are dynamic and can be influenced by beliefs, norms, culture, emotions, identities, and ideologies. False information affects the integrity of cognitive schemas by introducing ambiguity, uncertainty, and doubt when presented with factual

information” (Cannan et Warren, 2018).

Internet and social media can be a powerful awareness tool that reinforces RCCE actions and contribute to democratize access to information and freedom of expression. Nevertheless, it can also facilitate the fast dissemination of rumors and biased or not fully verified information. There are concerns about whether the development created by the adoption of new technologies in emergency responses is positive (Maung et al., 2019).

Social media channels are currently one of the main sources of information about the outbreak in many countries. Verified news from credible sources compete with false information, posts that can become viral and influence decisions of a large number of people (ISOJ, 2020).

In this sense, the excessive amount of information concerning a problem may cause that the solution is more difficult to find. This is the case of Covid-19 pandemic. The over-abundance of information makes difficult to find responses. Moreover, some rumors may encourage people to take wrong decisions and perform actions that exacerbate the risk of the disease.

(24)

The Epi-Win13 portal by WHO is tracking rumors and presenting the debunking

information on the website, to facilitate the access to the right and scientific verified information.

(25)

Methodology

The methodology for this research encompasses both quantitative and qualitative approaches. It is based on the mixed methods research methodology that combines both approaches (Creswell, 2014).

This mixture of methodological approaches, including both descriptive and explanatory analysis, helps to provide evidence on how RCCE actions facilitate co-production of knowledge and influence people’s behaviors to adopt the pandemic preventive

measures. Responsible behaviors are critical to control the disease and break the chain of transmission of the virus (WHO, 2020).

Issues of perceptions, roles and behaviors that can influence people commitment and engagement in the fight against the outbreak were emphasized. This is embedded in a conceptual framework of research action that involves the participation of all relevant stakeholders (Mertens, 2003).

Community participation is essential for this kind of research. Participatory approach has gained increasing importance as a research strategy within qualitative social research (Bergold, 2007; Bergold & Thomas, 2012; Gruber, 2016). Subsequent data collection therefore measures changes in key patterns identified as great influencers of behaviors either for or against Covid-19 barrier gestures. Similar process has been used for data collection in other public health emergencies (WHO, 2018).

The quantitative method is based on the collection and analysis of the relevant figures included in the Covid-19 Situational Reports of the selected countries: Cabo Verde, Cameroon, Gambia, Mozambique and Niger. The data in these documents is represented numerically to build accurate and reliable measurements that allow statistical analysis (Matthews & Ross, 2010: 45).

These SitRep are published regularly by the national health authorities of each country with the support of the health stakeholders. Therefore, the data extracted from those official documents is expected to be accurate and in accordance with the MoH and WHO.

For this study, relevant information was collected from those published reports on the Covid-19 epidemiological evolution and RCCE actions outreach14. Then, the data

14 The RCCE data in the SitRep is being provided mainly by the sub-national health delegations and their

network of community health workers involved in community engagement activities. CHWs use printed forms and a mobile data collection tools to get the data for this purpose at community level. Then that

(26)

selected from a sample of SitRep was compared and analyzed. Thus, this method did not involve field research or surveys, since the data was collected indirectly from the SitRep.

The qualitative approach of this research was based in semi-structured interviews and direct observation of community health workers and local inhabitants reached by the health awareness campaigns. A representative sample was selected in each case, based on accessibility, relevance and availability criteria. Within the general population, special attention was given to vulnerable groups and community influencers. An informed selection of key people was done for sampling purposes. Based on the research goals, this kind of selection permitted to ensure representativeness of all important sub-population groups, in particular, few vulnerable groups targeted for interviews. This helped to incorporate greater diversity in the sample that permitted to observe the issues from as many different perspectives as possible (Given, 2012). Likewise, CHWs were involved in the semi-structured interviews implementation. This enabled interviewees to speak out about the impact of the outbreak in their professional and personal life with self-confidence in their local language when needed (Glesne, 2006).

The main quantitative research tool was:

- SitRep data collection and analysis (indirect technique). The main qualitative research tools used were:

- Semi-structured interviews for community actors.

- Onsite observation for individual attitudes, behaviors and practices.

Justification

The use of a combined methodology of both quantitative and qualitative was justified by the need to complement both kind of data to be able to produce a comprehensive study.

According to Creswell, a mixed methods research methodology is useful to combine different data and information types within one research study. In this methodology, both qualitative and quantitative approaches were used in a single study to collect and analyze data, integrate findings and draw conclusions. This approach has other

denominations depending on the purpose and author, such as Multi-Method, Hybrid Research or Triangulation (Creswell, 2014).

(27)

The mixed approach included a collection of both qualitative and quantitative data about historical and contextual factors. As defined by Mertens, this transformative-emancipatory approach15 is therefore an appropriate framework to lead to a quality

study from a comprehensive perspective, such as the case of this research.

Within this context, quantitative approach through SitRep analysis was justified due to the need to have indicators based on numeric data that can be compared and contrasted among regions and targets and represented visually in statistical graphics to facilitate proper understanding by decision-makers and development partners.

Likewise, a qualitative approach allowed to study in deep a phenomenon (Given, 2012). Semi-structured interviews for community actors allowed to interact directly with up to three participants, collecting accurate and sufficient detailed information on the specific perceptions of the target groups.

The observations facilitated the collection of data in a natural and spontaneous context, where community actors and health workers could discuss and exchange views to sensitize and promote indigenous practices towards the construction of a collective response to the disease.

Thus, the onsite observations allowed to identify more complex individual behaviors and attitudes towards the outbreak. It also facilitated to capture collective practices, beliefs and perceptions, complementing the discussions on semi-structured interviews. Likewise, it permitted to crosscheck and verify whether the discussed practices are observed on a real situation or not.

Qualitative data allowed to rebuild the overall mental and psychosocial logic and experience gathered since the start of the outbreak (Bergold, 2007). Facts were

unpacked and put in a structured order to understand what leads people to either accept or refuse the implementation of the protection and preventive measures.

Implementation

This research used a multi-sited data collection technique that was implemented over a period of eight months in 2020 and 2021. The literature review, desk research and quantitative data collection was done online, while the qualitative data collection was done in the field.

15 The transformative paradigm is explained as a framework for researchers who place a priority on social

(28)

Initially, due to the countries lockdown the interviews were planned to be conducted online. However, as the airports started reopening progressively and the quarantine measures were eased, it was possible for the author to visit the selected countries, as part of its routine professional duties. This also allowed to include observations to complement the interviews.

The semi-structured interviews were conducted with the support of local CHWs that were previously identified and briefed, as part of the preparation work. The selected CHWs had expertise in conducting awareness raising sessions and interviews and thus, they were capable to conduct the semi-structured interviews, following the guiding questions provided by the author, in a neutral and unbiased way.

The preparation of the interview was a key part of the process, allowing the author and the CHW to discuss in-deep the content and outreach of the questions. The interviews had an approximated duration of thirty to sixty minutes and were conducted normally in the official language of the country, although in some cases specific interactions and clarifications were done in the local language by the CHW.

At the beginning of the interview, introductions were done according to the local customs and etiquette, followed by an explanation of the research, the interview goals and the consent declaration. Then, the interaction took place as form of dialogue, facilitating a natural flow of the questions, based on the content discussed. At the end, the appreciation was expressed and the contacts were shared for follow-up purposes. After the interview, a debriefing was done with the CHW to get the feedback and capture additional details. Interviews were generally recorded on a mobile device and notes were taken.

In some cases, it was possible to contact again the interviewee after few weeks to learn about any eventual behavior, attitude or practice change. This was also relevant to document additional co-production of knowledge and examine the evolution of the ownership of the preventive measures within the community.

While the CWH was interviewing the community actor, the author was able to observe both the interview from a secondary position and the interviewee interaction in the community before and after the interview. Some awareness raising sessions in popular public spaces, such as markets, sports facilities, schools, public transportation stations and community centers were also observed. Observations did not exceed two hours by location. Those observations allowed to capture relevant information regarding the topics covered in the interviews. This was useful to contrast and complement the findings from the semi-structured interviews.

In each country, up to three venues were selected to implement interviews and

(29)

them, only one venue was possible due to Covid-19 related restrictions and time limitation. Nevertheless, this was compensated with in-deep desk review and quantitative analyses.

Analysis of both quantitative and qualitative methods were used to produce the research conclusions. While quantitative methods were useful to identify possible correlations and causalities, the techniques used for qualitative research helped to understand what were key patterns that lead people either to cope or not with control measures in their communities.

Ethical considerations

Since the purpose of this study is to identify and analyze community-centered solutions to the Covid-19 pandemic in developing countries from the African continent,

representativeness of the sample is important but is not critical.

Rather than examining key relations and correlations between information received, knowledge developed and subsequent practices, the study is more focused in

reconstructing the logic between people’s attitudes, behaviors and practices in relation the Covid-19 outbreak in their communities.

Freewill participation is the principle governing participants selection (Brinkmann and Kvale, 2005). None of the participants was forced to respond or received a

compensation. To ensure confidentiality, identity references were excluded from data fields extracted from the interviews and observations. The informed consent was mandatory and all responses were anonymous. Participants selected were informed previously of the purpose and length of the interview.

Covid-19 preventive measures were always kept as priority. No travel was required for the any interviewee. Interviews were scheduled out of business hours or during breaks previously consented by the interviewee to avoid interference with the working duties. Likewise, it was given preference to interviews within the community of the

interviewee or its surroundings.

The position of the author was all the time neutral, avoiding direct interaction when possible. In most cases, his role was limited to listening and observe from a secondary position. This allowed to collect unbiased information, while respecting and valuing the local habits.

(30)

A CHW speaking the local language accompanied all interviews and guaranteed the rigorous fulfilment of the IPC protocols stablished by the MoH of the country. Thus, the interviews posed no risk to the health of the participants. All interviews took place in open-air spaces, handwashing was encouraged at the beginning, social distance was always kept and the mask was provided in case the interviewee did not have one. The CHW conducted the interviews in most cases, with strict cultural sensitivity, following the guidelines instructed by the author previously. This facilitated the openness of the interviewees and allowed the author to carry the observation work in parallel.

To avoid any bias from the CHW, the author briefed them in advance and explained them the purpose and methodology of the semi-structured interviews. The familiarity of the author with the countries, allowed to have access to CHW capable to perform the job within the countries of the research. Their participation was in all cases volunteer and based in the freewill. At the end, the interviewee could pose any question and her/his time and responses were sincerely appreciated.

(31)

Analysis

During the research implementation quantitative and qualitative methods were

implemented in parallel, including field and desk research in the five selected countries in Africa: Cabo Verde, Cameroon, the Gambia, Mozambique and Niger.

The quantitative data was collected indirectly from several editions of the SitRep published in each one of the selected countries. This data was useful to reconstruct the trends of the outbreak in the country and to understand the sociodemographic and cultural impact of the pandemic. Moreover, quantitative date was used as explanatory variables to understand major fluctuations of the main variable that is people’s

commitment to protect themselves and relatives against the disease infection. (Goertzen, 2017).

Qualitative data from the interviews and observations allowed to understand people’s background and life experiences as well as how their readiness or reluctance to accept and observe preventive measures was influenced (Gubrium & Holstein, 2002). The first case of Covid-19 in Africa was in Egypt in February 2020. By March, most African countries were registering active cases of Covid-19 and the Incident

Management system was activated in most of them.

(32)

Small Island Developing State: Cabo Verde

In Cabo Verde, the first island to register a case of Covid-19 was Boa Vista. It was an imported case, registered from a tourist in one of the largest hotels of the island. Afterwards, the disease expanded progressively to the remaining eight islands of the country. However, most active cases were registered in Praia, the country capital, and the island of Santiago. In less than a week from the first detected case in Boa Vista, the first one in Santiago was identified.

In the less populated islands, the disease tended to be controlled faster. Due to the country insularity, the lockdowns of affected islands and the control of the flow of people were more effective than in the mainland African countries.

Figure 4: Covid-19 propagation by island, Cabo Verde. Source: SitRep 2-12-20, Ministry of Health of Cabo Verde.

The good coordination among the One Health structures in the country, including the animal, environmental and human health departments and stakeholders, within the Health Emergency Operations Center, contributed to a swift response to the outbreak. Likewise, country stability and good health indicators allowed government to fully focus on its efforts to respond to the pandemic in the nine islands.

The SitRep bulletins cover most relevant RCCE activities implemented in the country, including preventive messages dissemination in the media and social media channels, awareness raising campaigns in the communities, green line for phone counseling and information, communication and education materials distribution in communities and

(33)

schools, training sessions for community health workers and a website16 regularly

updated and fully dedicated to the Covid-19 pandemic in the country.

Those RCCE initiatives have had a general positive effect in the engagement of the population to follow the Covid-19 preventive measures.

During the first interview, in the neighborhood of Achada Santo Antonio, one of the most affected areas of Praia city, a community center worker explained about the cultural barriers to the social distancing measures. He explained how shaking hands is so much embedded in the traditions and the culture of the island. He added that people must greet each other before starting any conversation to show respect and cordiality. Then, he came across with the idea of using a less ‘exposed to the virus’ part of the body to be shaken, such as the elbow. In the following visit, three weeks later, it was verified that this new way to greet each other started to grow up in the community center area. This culturally adapted approach was considered a success, because a preventive measure was domesticated in a way that it was followed quickly and easily.

“I think we need to follow the preventive measures to protect ourselves. It is not worthy to take the risk. It is better to keep us safe respecting the barrier gestures. To avoid touching other people, I started to greet my friends using my elbow. At the beginning it was a bit weird, but after few weeks explaining it to my neighbors and colleagues, most people in my community joined this new trend to greet with the elbow.”

Figure 5: Covid-19 deaths in 2020 by month, Cabo Verde. Source: SitRep 2-12-20, Ministry of Health of Cabo Verde

(34)

Research interviewee, Praia While Santiago, the most populated island, is where the administrative and economic center of the country is located, Sal Island is the main tourism destination, with a very diverse population of nationals, foreign residents and tourists.

Sal Island was affected only in May 2020 and the cases were controlled smoothly, keeping the numbers low. Few months later, the island become free of Covid-19. Apart from some sporadic imported cases, the island has always been below the ten confirmed cases.

“The evolution of the pandemic in Sal Island is very positive and we can say that European tourists are safer here than in their home countries” The Mayor of Sal Island, in public declaration to the press

Nevertheless, restrictive measures were put into place in order keep this island with the lowest possible cases of Covid-19. The engagement of the municipal government, the health delegation and the community associations in the RCCE activities was critical to promote the local ownership of the preventive measures and boost the sense of

responsibility in each citizen.

“My boutique is my life. If I close it to the public, I will not earn anything to buy food and sustain my family. I need to keep it open at least during the weekdays. I have improvised a handwashing device at the entrance, using a trash bin with a tap. Now, I make sure every single client washes their hands before entering to my shop. This is the best way to protect clients and protect myself of the pandemic.” Research interviewee, Santa Maria Measures to tackle rumors and disinformation were also put into place in order to

quickly respond to questions and doubts that the population had about prevention, propagation and treatment of Covid-19. This was useful to avoid speculation and reduce the number of harmful information circulating in the country, thus to tackle infodemic.

(35)

In Cameroon, the first case of Covid-19 was also detected in March 2020. Since then, cases were rapidly growing all over the country. The most affected areas, the Central and Littoral regions, were those with larger concentration of population.

Immediately, a national IMS was stablished to respond to the pandemic and the first operational phase of the response was launched. About three months later, a second operational phase was put into place, involving the decentralization of the response and creating one sub-national IMS in each one of the ten regions of the country. Afterwards, the next operational phase involved to continue the decentralization process and

establishing IMS in the health districts with Covid-19 cases across the country. The main goal of this process was to make Covid-19 response activities become closer to the communities, involving lower levels of the public administration that could reach to the last mile.

Within the EOC structure, the Operations Section was in charge of the coordination of the RCCE activities in the communities, including the awareness messages production, health workers and community media training, and community feedback collection and analysis. The Planning Section was in charge of the RCCE activities related to media and social media monitoring, including the Green Line information center, rumors and disinformation tracking and management. The Public Information Office was in charge of RCCE activities linked to media relations, press conferences and information

dissemination through national media channels, such as broadcasting networks, newspapers and commercial radio stations.

This division of RCCE activities in three departments produced some fragmentation, but at the same time, it allowed the designated staff to fully focus in specific areas to achieve a larger impact. The numbers of people reached by the RCCE activities were high, but the level of engagement was low in many cases. This was evidenced by little

Table 2: Covid-19 positive, deaths and recovered cases in 2020 by region, Cameroon. Source: SitRep 61, Ministry of Health of Cameroon.

(36)

ownership of the barrier gestures among general population at the beginning of the pandemic.

Thus, a mechanism for community feedback collection and analysis was implemented with the support of an extensive network of community health workers all over the country. It was coordinated by the EOC Operations Unit with the support of WHO and other technical partners. The mechanism consisted in the use of a form for data

collection to be filled regularly by the CHW either in paper or in a mobile application on the smartphone. Then, the data is conveyed to the sub-national and national levels for analysis and conclusions elaboration. These results were communicated regularly to the EOC management team in order to be taken into account in the next review of the Covid-19 response activities.

In Kribi, a popular touristic seaside destination in the country, cases were raising, in the second semester of 2020. Thus, Covid-19 response stakeholders gradually increased their RCCE initiatives implemented in the area to sensitize the coastal communities. This included the involvement of the community radio station and its radio listeners’ club to disseminate prevention messages.

Markets in Kribi are a tourist attraction. Many rural farmers and fisherfolk from the surrounding villages go to downtown Kribi to sell their products. During the

observation exercise, it was noted that a lady was not wearing the mask while selling the fruits to her customers. When she was asked, she said that at the beginning, she had a vague idea of the Covid-19 disease, but as soon as the pandemic messages started to be disseminated in the community radio, she became aware and learn how to avoid Table 3: Population reached by RCCE activities, Cameroon. Source: SitRep 61, Ministry of Health of Cameroon.

Number of sensitized people Total of people sensitized Means of sensitization 24/12/2020 to 30/12/2020 06/03/2020 to 30/12/2020

Media (TV, Radio, Crawl, Social Media) Structures (Hotels, Health

Centers, Public Administration) Communities (Door-to-door,

Market, Supermarket, Transport Agency)

(37)

being contaminated. Nevertheless, in this case knowing about the disease did not imply to comply with the preventive measures.

“I listened in our radio the importance of protecting ourselves, but for me it is quite complicated to keep social distance and avoid touching. I need to touch the fruits to show them to the customers. Otherwise, nobody will buy from me. I tried to use hand sanitizer, but it is too expensive, so I prefer to use a locally made cleaning solution that my neighbor prepares at home.”

Research interviewee, Kribi Through the radio emissions, counselling sessions were broadcasted covering a

circumference of about sixty-five kilometers around Kribi. These sessions included explanations on techniques to produce affordable and basic protection equipment, such as cloth masks and hand sanitizing solution. The local community realized of the market opportunity around this and some local entrepreneurs started to produce and sell them. Although those products were attractive for the inhabitants, some caution was needed as there was no quality certification schemes applied to guarantee their real protection capacity.

In the Central region of Cameroon, the situation was quite similar. In this case, the observation focused on the activity of a local youth association that was implementing an awareness raising campaign on the correct use of masks in one of the largest markets of the city. The leaders of this association were trained by the National Youth Council, which played a very active role in mobilizing youth organizations across the country to promote the barrier gestures.

Due of the importance of the traditional chiefdoms in the country, the association involved the local traditional chief in the area, becoming a champion for the prevention of Covid-19. The results were positive after several weeks of intensive sensitization activities in the market.

“I have been sensitizing in this market area for nearly one month. Accompanied by the traditional chief and the market head, we have talked with most of the sellers based here to explain to them how to wear correctly the mask. Afterwards, we distributed two cloth masks to each one, based in their commitment to wear it in the market. At the beginning, there was almost no one wearing a mask. Now, I would say nearly one half of the sellers are using them. If we continue our volunteer work, we will manage to increase that number. Our goal is that all sellers wear the mask while they are working.”

Research interviewee, Yaounde The use of influencers to boost the awareness raising campaigns become more popular in the country, as Covid-19 cases were raising progressively. This included popular

(38)

dancers, sports champions and social media activists. This was the case of the football player Samuel Eto'o or the gospel singer Indira Baboke.

Besides the Covid-19 emergency situation, Cameroon was suffering of several other crisis and epidemic outbreaks. Thus, government efforts were divided to be able to respond to all emergencies simultaneously. Additional challenges, such as resources and equipment limitations accentuated the burden of diseases in the country.

Furthermore, rumors and false information circulated widely, particularly in the social media, compromising the effectivity of the pandemic response. All this created a substantial hostile environment to preventive actions, such as vaccination campaigns.

“The school has allowed health workers to vaccinate the pupils in previous campaigns. Because of the pandemic the situation has now changed. Parents are absolutely reluctant to vaccinate their children. I think it is because all rumors that circulate about experimenting vaccines with Africans. We cannot commit to take any action without prior approval of the parents. Therefore, the school bans any vaccination activity in our premises.”

Head of primary school (interviewee), Douala The government needed to implement several vaccination campaigns. The first one to contain a cholera outbreak. Then, the Polio vaccination campaign. Afterwards, the one against cervical cancer. Soon, it also expected to start to deliver the first Covid-19 vaccines. After visiting few schools in Douala, the aversion to vaccines was crystal clear. Social mobilization teams were deployed in all communities by the health district offices, accompanied by local authorities, influencers and celebrities to implement RCCE activities.

Four weeks later, back in the same school the unwillingness to vaccinate slightly decreased and the school allowed to discretely vaccinate some kids whose parents signed the consent letter. A timid change of attitude was observed, implying that still more awareness raising was needed.

The media and social media monitoring team at the sub-national EOC was involved in the RCCE campaign, quickly responding to false information and myths around

vaccination that were spread mainly in urban areas. The social listening mechanisms put into place allowed to identify those rumors that were harmful using a response

algorithm that allowed to debunk them rapidly and control the infodemic.

(39)

In the Gambia, the Covid-19 epidemiological evolution was examined to understand how the emergency response and the RCCE activities were planned and implemented. The first case of Covid-19 was imported in mid-March 2020. Immediately, the

international airport of Banjul was closed down and the situation was controlled. Nevertheless, the land border continued open and in late April few new cases were detected. Despite that fact, the disease was well controlled until the reduction of the restrictions and the progressive reopening of the airport. Then, cases raise up abruptly reaching the highest numbers around August 2020.

After the reactivation of restriction measures and the intensification of the RCCE activities in the communities, the numbers started to slow down. By the end of September, the situation was well controlled again.

RCCE activities continued over next months. However, after the end of the year celebrations, cases started to grow up again until nowadays. This showed the need to continuously implement and reinforce RCCE initiatives to promote preventive measures.

Since about 62% of confirmed Covid-19 cases were in population below the age of 40, many RCCE activities focused in engaging young people and youth organizations leaders to respect the preventive measures. The role of the National Youth Council was instrumental to mobilize young generations across the country to follow the barrier gestures.

Likewise, the Ministry of Health was involved in RCCE actions at national level, including a toll-free helpline for counselling and information on Covid-19, awareness messages dissemination through media channels, radio and TV phone programmes and Figure 6: Covid-19 epidemiological evolution in the Gambia. Source: SitRep 267, Ministry of Health of the Gambia

(40)

interaction with audiences through social media channels. All those actions allowed to directly exchange and respond to people concerns, as well as register their feedback, including their knowledge, attitudes and practices towards Covid-19, to be analyzed and incorporated in following RCCE actions.

In Serekunda, a large city in the West part of the country, next to Banjul, a young sportsman was met to talk about how he was dealing with the Covid-19, in a semi-structured interview. Although he recognized that at the beginning it was not easy to follow the preventive measures, he tried to avoid mass gatherings.

He explained that in the local culture, people has close contact and gather in large groups to watch matches and have fun. Indeed, he explained some cultural practices that are very extended, such as eating from the same dish with friends and family members. Thus, the challenges to change the way many people take the food and persuade them to start eating from individual dishes. From a socio-anthropological perspective, this change may take time and needs comprehensive RCCE actions to justify and explain the benefits of the recommended change.

He stressed that to change those routines he had practiced since he was a kid, required a great effort. After a community young volunteer visited him and explained in his mother tongue why the barrier gestures were so important, he changed his mind and started respecting them.

“I love football and every weekend I go to watch the match of the local league. However, since cases are raising up in my city, I changed my view. I prefer to watch it at home. I prevented my friends of going out to the stadium, too. We may not be contaminated by the virus, but the risk is always there.”

Research interviewee, Serekunda He also noted that rumors circulate in his community, but since their sources are not clear, he preferred to trust information from credible sources such as the government or Figure 7: Daily figures of the outreach of RCCE activities on February 2021, the Gambia. Source: SitRep 267, Ministry of Health of the Gambia

Figure

Table 1: The three approaches of the Media, Communication and Development theory. Source: Manyozo, 2012: 23
Figure 1: Evolution of the modern RCCE approach. Source: WHO, 2020
Figure 2: Points of influence for co-production of knowledge. Source: Tembo, 2021
Figure 3: Covid-19 evolution in the African continent. Source: SitRep 33, WHO African Region
+7

References

Related documents

The increasing availability of data and attention to services has increased the understanding of the contribution of services to innovation and productivity in

Generella styrmedel kan ha varit mindre verksamma än man har trott De generella styrmedlen, till skillnad från de specifika styrmedlen, har kommit att användas i större

Parallellmarknader innebär dock inte en drivkraft för en grön omställning Ökad andel direktförsäljning räddar många lokala producenter och kan tyckas utgöra en drivkraft

Närmare 90 procent av de statliga medlen (intäkter och utgifter) för näringslivets klimatomställning går till generella styrmedel, det vill säga styrmedel som påverkar

I dag uppgår denna del av befolkningen till knappt 4 200 personer och år 2030 beräknas det finnas drygt 4 800 personer i Gällivare kommun som är 65 år eller äldre i

Den förbättrade tillgängligheten berör framför allt boende i områden med en mycket hög eller hög tillgänglighet till tätorter, men även antalet personer med längre än

På många små orter i gles- och landsbygder, där varken några nya apotek eller försälj- ningsställen för receptfria läkemedel har tillkommit, är nätet av

Det har inte varit möjligt att skapa en tydlig överblick över hur FoI-verksamheten på Energimyndigheten bidrar till målet, det vill säga hur målen påverkar resursprioriteringar