The Ebola crisis in West Africa was quickly recognized as being driven as much by misinformation and rumors as by weaknesses in the health care system.
International response agencies invested significant resources in rolling out the Social Mobilization and Community Engagement drive, a wide-scale intensive social behavior change communication campaign. The result was a massive and rather poorly coordinated blast of messaging shared on billboards, in print, on radio and TV, through health outreach workers and community organizations, via SMS and call-in hotlines.
A preliminary assessment done by Internews in November found more than 300 types of social mobilization and messaging systems in the three worst-affected countries: Liberia, Guinea and Sierra Leone. This chaotic information landscape consisted mainly of information “out,” with little opportunity for community dialogue.
While the immediate impact of the messaging campaign has helped slow the epidemic, the imperative to “get to zero” has shown how superficial the uptake of information has been. Even in communities that were initially persuaded to adopt prevention methods, in places where Ebola has abated, people believe these methods are no longer necessary. Their understanding of the nature of the virus is often not sophisticated enough to grasp the importance of extended vigilance in every village.
Public service messaging alone cannot address these challenges.
A more robust approach is needed to ensure that citizens can access not only a wide range of information from trusted sources, but also channels for questioning and discussing that information.
Here are five takeaways that the international development community should take to heart.
1. Form genuine partnerships with local media.
Many international agencies claimed to be “partnering” with local media while using them mainly as paid platforms to disseminate messages, with little to no investment in their potential to actively provide a range of “news you can use” — accurate, timely and actionable information that can help people interpret public health messaging, understand the evolving situation around them and make informed decisions that give them greater agency in their own survival.
The “media working group” established in Monrovia, Liberia, for example, included no representatives from local media. The reasons that senior international health personnel gave for not including local media as equal partners were familiar: that they would not understand the issues confronting the international agencies, and would do poor reporting if given a seat at the table.
2. Build capacity rather than paying to disseminate prepared messages.
Most agencies went the traditional route of bypassing capacity building in favor of paying media outlets to disseminate prepared messages. By late 2014, radio stations in all three countries were generating comfortable revenue from this service, while their journalists remained largely in the dark about how to report the catastrophic public health crisis.
This approach promotes complacency and underdevelopment in local media, creates a perception of the international development community as a cash cow and, most importantly, undermines the potential of local media to develop their potential as a conduit for citizens’ voices and a platform for accountability.
3. Deliver consistent messages and don’t oversimplify.
Much has been made of the “bizarre myths” that persist in “resistant communities” despite saturation messaging, which have been attributed largely to local beliefs and cultural anomalies. That communities have found it necessary to create their own narratives around the virus (and the response) points to their need to receive and discuss more nuanced information than “Ebola Kills” and “Wash Your Hands.”
Rather than focusing on the capacity of the affected population to understand complicated information, we should consider that oversimplifying the messages themselves may have created the misunderstandings and mistrust.
The difference between the messages “Wash your hands” and “Are you able to wash your hands?” speaks to missed opportunities to connect with, consult and better understand the information needs of affected communities.
4. Encourage two-way communication with community audiences.
The above approach also bypassed the potential for local media to establish two-way communication with their community audiences, responding to their daily information needs and facilitating citizen feedback through radio call-ins and SMS traffic.
International responders often do not trust local media as interlocutors in crisis situations, while local media (like local communities) are often bewildered by and distrust the intense, overwhelming dynamics of an international humanitarian response.
5. Help local media realize their full potential as a platform for accountability.
Much like local health workers, local media can be poorly trained and resourced and can lack expertise in the issues at hand. In the thick of an evolving humanitarian crisis, it is as hard to quickly ramp up local media capacity as it is to ramp up local health capacity — but that’s no reason to go around it.
Intensive mentoring and technical support for media has had proven impact in emergency situations, along with the simplest kind of capacity building: sending local staff to sit in the radio studio to answer questions from listeners in their local language, inviting local media to meetings, and having them ask questions that help their audiences more fully understand the messages they are receiving.
The road to recovery, stability and preparedness
Local information ecosystems are by nature dynamic, idiosyncratic and easily subject to corruption and disruption. This is especially true in remote, traditional communities where trusted sources are not necessarily well-informed and where mass media practices are weak and unable to deliver consistent information in ways that can gain public trust. In these environments, bad information can travel faster than good information simply by traveling on trusted local grapevines.
As the situation across the three Ebola-affected countries moves cautiously into the recovery phase, attention is turning to two key sets of challenges. The first is strengthening the historically weak health systems that were so vulnerable to the epidemic in the first place. The second is addressing the extensive raft of Ebola-related regional impacts and issues involved in “building back better”: education, security, trade and, underpinning them all, governance.
It would be shocking if local health workers emerged from the epidemic with barely any more knowledge, skills or prospects for sustainable contribution to their health systems than they had a year earlier. It would be equally shocking if local reporters find themselves in that same position due to a failure to recognize the importance of a robust national and regional public health reporting capacity in strengthening health systems more broadly.
Consistent investment in local media capacity must go hand in hand with all other efforts on the road to recovery, stability and preparedness in the region.
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