The prolonged outbreak of the Ebola Virus Disease (EVD) in the Democratic Republic of the Congo has had consequences for the countries neighbouring the affected provinces of North Kivu and Ituri. Over the past 18 months, UNICEF has supported four countries categorized as priority one (Burundi, Rwanda, South Sudan and Uganda), as well as Tanzania, in enhancing their readiness to respond to the imminent risk of cross-border EVD transmission.
Many lessons have been learnt, challenges tackled, and progress made during the longest-known preparedness effort for a public health emergency globally – some of which could be applied during other outbreaks, including the current coronavirus disease (COVID-19) pandemic.
This report explores the Risk Communication and Community Engagement (RCCE) undertaken for EVD preparedness in the priority countries and the main takeaways from these initiatives, based on a regional review and stocktaking meeting that UNICEF hosted in Nairobi, Kenya on 28–29 January 2020.
The following are key lessons learnt in the different countries:
The prolonged period of community awareness regarding Ebola prevention resulted in message fatigue (a state of being exhaustion resulting from extended exposure to similarly themed messages). This calls for innovative strategies around messages, format and delivery platforms to keep audiences engaged while maintaining a high perception of risk during preparedness.
Social science evidence reviews on cross-border dynamics between the Democratic Republic of the Congo and each of the neighbouring countries were crucial in informing the development of interventions addressing specific community issues in border locations.
Strong coordination mechanisms for RCCE ensured optimization of resources, harmonization of public messages and clear division of labour among partners.
The secondment of consultants to local government to provide direct support and mentoring counterparts in high-risk districts enabled skills transfer, contributing to systems strengthening and enhancing efforts for sustaining preparedness activities.
The pairing of key community influencers with district technical officers during radio talk shows and call-in programmes ensured audience engagement, fostered trust and provided good opportunities to respond to rumours and provide feedback to the communities.
The creation of the RCCE pillar of EVD preparedness and response ensured that due attention was given to its work, while the integration of RCCE into all pillars of EVD public health emergency preparedness/response ensured clear understanding of community perspectives, cross pillar technical support, while also allowing for feedback to other pillars from community interactions.
Too much community feedback without corresponding mechanisms to respond leads to a “feedback blot.” Participants at the meeting also discussed recommendations for sustaining current preparedness activities and informing future ones. They include:
Community feedback should be systematically collated, analysed and presented to/fed into the national task forces to ensure that concerns implicating other pillars can be responded to and acted upon.
RCCE preparedness plans should be scenario-based to provide clear guidance for a nuanced transition of activities between preparedness and response.
Cross-border collaboration and coordination between neighbouring countries should be strengthened to ensure the harmonization of messages and community engagement interventions. The free movement of people and the unique geographical and sociocultural dynamics of border communities calls for specific cross-border RCCE strategies, initially, these can piggy back on already strong surveillance cross border engagements.
Community engagement interventions for EVD and other public health emergencies should consider health workers and support staff as priority audiences for engagement. Surveys from different countries showed limited knowledge and awareness of prevention measures among these groups.
Social science research/anthropology should be incorporated into RCCE preparedness efforts to understand the unique contextual and social dynamics (beyond knowledge), in order to inform strategy and message design as well as inform response efforts through other pillars.
Specific strategies should be developed for urban communities. Rural communities were more likely to be aware of EVD prevention measures than their urban counterparts.
RCCE should be integrated into and a core part of the global health security agenda. There should be a review of RCCE aspects of the Joint External Evaluation tools to ensure that they are more comprehensive. Further,
RCCE key partners should be deliberately included in all International Health Regulations (2005) processes – such as Joint External Evaluations, joint monitoring missions, joint assessment missions, after-action reviews.
Establish/strengthen a regional coordination mechanism for RCCE, with systematic inclusion of international nongovernmental organizations (NGOs) as key collaborative partners.
Develop a toolkit for community feedback that can be adapted to different country contexts during outbreak preparedness and response.