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2 |
Module objective
By the end of this module, you will be able to:
● Describe why community engagement is essential for effective emergency risk communication
● Describe the links between health promotion, social mobilization and community engagement, and
● List actions for community engagement
Photo: WHO/A.Bhatiasevi
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Communities MUST BE at the heart of any public health intervention, especially in emergencies
Community engagement is central to any public health intervention.
Its importance is even more significant during public health emergencies.
Community engagement involves those affected in understanding the risks they face, and involves them in response actions that are acceptable.
Photo : WHO /A Bhatiasevi
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● Social Mobilization
● Communication for Development (C4D)
● Behaviour Change Communication
● Health Education
● Health Promotion
● Community Engagement
● Outbreak communication
● Crisis communication
● Risk Communication
● Communication for Behavioural Impact
Approaches and tactics linked to community engagement
Photo: WHO/A.Bhatiasevi
5 |
Health promotion – health education
A set of principles involving equity and empowerment, and practices encompassing of communication, capacity building and politically oriented activities, with the goal to enable others to gain more control over the influence of their lives and to improve their health.
● Health Education aims to provide information to influence their future decision-making on their health.
● Health Promotion aims at working on the needed social and political actions (e.g. legislation, movements, etc.)
- (Laverack, 2014)
Photo : WHO /A Bhatiasevi
6 |
Social mobilization
Social mobilization is a process that engages and motivates a wide range of partners and allies at national and local levels to raise awareness of and demand for a particular development objective through dialogue
Members of institutions, community networks, civic and religious groups and others work in a coordinated way to reach specific groups of people for dialogue with planned messages. Social mobilization seeks to facilitate change through a range of players engaged in interrelated and complementary. - UNICEF
Photo: http://unicef.in/CkEditor/ck_Uploaded_Images/img_1174.jpg
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● Community engagement is the process by which community
benefit organizations and individuals build a long term relationship
with collective vision for the benefit of the community
● It is primarily about the practice of moving communities towards a
better change through empowerment
Community engagement
Photo : WHO /A.Bhatiasevi
This presentation will focus on community engagement for risk
communication
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What we usually do for health promotion, social mobilization include…
Messages
Leaflets
Posters
T-shirts
Radio spots
TV adverts
Town criers
BUT community engagement requires much more than these
Photo : WHO /A.Bhatiasevi
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Why community engagement?
Graphic: http://www.dse.vic.gov.au/effective-engagement/introduction-to-
engagement/what-is-community-engagement
• Everyone has a right to know about risks to their health and well-being
• Culturally appropriate
information can help make informed decisions to reduce the health risks
• Action taken by individuals,
families and communities affected are key to controlling the public health threat/problem
10 |
Actions for community engagement
Community engagement covers a broad range of activities. Some activities undertaken by government practitioners include:
● Reaching out to / informing the community of policy directions of the government
● Consulting the community as part of a process to develop government policy, or build community awareness and understanding
● Involving the community through a range of mechanisms to ensure that issues and concerns are understood and considered as part of the decision-making process
● Collaborating with the community by developing partnerships to formulate options and provide recommendations.
● Shared leadership / empowering the community to make decisions and to implement and manage change.
Source: Victoria Government, Australia
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Community engagement
Modified from US Department of Health and Human Services and Victoria Government, Australia
INFORM CONSULT INVOLVE COLLABORATE SHARED
LEADERSHIP
Some community
Involvement
More community
involvement
Better community
involvement
Community
involvement
Strong relationship
Provides
community with
information
Gets information or
feedback from the
community
Involves more
participation with
community on
issues
Forms partnerships
with community on
each aspect of the
project – from
development to
solution
Strong partnership
structure is formed
Optimally
established
communication
channels and
channels for
outreach
Develops
connections
Visibility of
partnership
established with
increased
cooperation
Partnership
building, trust
building
Broader health
outcomes affecting
broader
community. Strong
bidirectional trust
built
http://www.dse.vic.gov.au/effective-engagement/introduction-to-engagement/what-is-community-engagement
http://www.atsdr.cdc.gov/communityengagement/pdf/PCE_Report_508_FINAL.pdf
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Principles of community engagement Planning phase
● Clarify purpose/goal
● Understand the community's culture, perception, economic condition, social networks, political and power structures, norms, values, demographic trends, history, past experience
● Establish relationships, build trust, work with formal and informal leaders, seek their commitment for mobilizing the community
● Map and leverage existing community engagement mechanisms, e.g. for polio, immunization campaigns, HIV work, red cross volunteers, etc.
Photo: http://www.unicef.org/cbsc/images/UNI102880-620x350.jpg
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Principles of community engagement Implementation phase
● Partner with community to create change and improve health.
● Recognize and respect diversity; and ensure that the most vulnerable are reached and engaged.
● Identify, mobilize assets and strengths in developing the community's capacity and resources to make decisions and take action.
● Be prepared to release control of actions and interventions to the community. Be flexible to meet the changing needs.
Photo: WHO/A.Bhatiasevi
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Challenges
● Maintaining community involvement over time
● Overcoming differences between responders, community and different influencers
● Working with unique, especially vulnerable, or hard to reach communities
● Communities and responders may not perceive risk in the same ways
● Communities have complex social dynamics and changing power relationships which influence how we engage them
Community engagement is complex, hard work requiring
expertise and dedicated resources
Image: http://blogs-images.forbes.com/steveolenski/files/2014/09/bigstock-Challenges-Road-Sign-3530978.jpg
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Know the community
● Community structure – Formal and informal
– Opinion leaders and influencers
● Community dynamics
● Power relationships
● Sources of information
● Beliefs and practices
● Available resources
● Others Photo: WHO/A Bhatiasevi
16 |
The perception trap - 2014 Ebola in West Africa
Trap 1- Fear: Ebola = death
● Everybody who has Ebola will die
● Ebola is a curse
Trap 3- Dismissal
● Don't want to know
● Don't want to believe
● Don't want to accept
Trap 2- Disbelief due to distrust
● The authorities can't handle the situation
● The foreigners are here to extract organs for scientific experiments
Photo : WHO /A.Bhatiasevi
17 |
Community engagement came late in Ebola outbreak in Liberia
Retrospective analysis of the Ebola response
Response Phase 1 Phase 2 Phase 3
Predominant risk communication strategy
Crisis communications Awareness-raising, social mobilization
Community engagement
Rationale Past experiences of Ebola outbreaks with 90% deaths, occurs in remote settings
Ebola spread in major cities. Increased survival rates, but unsafe burials and other dangerous practices continue
Community as part of the solution. Bring back trust
Key message Ebola kills. There is no cure. Bush meat consumption spreads the disease
Ebola is real. Signs & symptoms. Hotline
Avoid contact with dead bodies. Early treatment increases survival rates. De-stigmatize survivors
Intervention Mass media, posters, radio Campaign mode. Hotline. Mass media – print, broadcast, posters, radios, town criers, loud speakers on trucks & motorbikes, volunteers for social mobilization
Interpersonal communications. Community meetings, etc. Community awareness and training. Engage influencers including religious and tribal leaders
Outcomes Denial. Perception that Ebola spreads in remote areas, No bush meat = No Ebola risk. No cure = No treatment = stay at home, die at home
Demand exceeds response capacity. Lack of confidence in response, lack of trust in the existing structures
Community influencers are part of the response. More decentralized, localized communications. Mop-up campaigns in hotspots
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Applying sociological approaches in community engagement
● Lots of documented evidence from Ebola in West Africa (2014-2015), of where anthropology and other applied social sciences played a key role in understanding communities
● Insights on socio-cultural and political contexts of affected communities to build locally acceptable interventions. Some examples include:
– Understanding myths, beliefs
– Managing rumours, misinformation
– Decoding 'fear' 'resistance' 'risky health practices', etc.
– Working on community based interventions
– Adapted safe and dignified burial rites for Muslims and Christians
Photo : WHO /A.Bhatiasevi
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Tools for creating community discussion*
Community map Discussion groups Individual Interviews
Household and
facility observations Seasonal
calendar/event
Timeline
Community walk and
observations
Storytelling Causes and effects Emergency scenario
Bean ranking Communication
circles
Visions for action
* Source: Bringing the community together to plan for Disease Outbreaks and other Emergencies. http://www.globalhealthcommunication.org
20 |
Reminder
● Communities must be at the heart of any public health intervention, especially during an emergency
● It is critical to know and understand communities in order to effectively work with them in all phases – preparedness-response-recovery of a health emergency
● Multiple strategies and tactics should be used to engage communities
Photo: WHO/A. Zouiten