The community engagement lessons being used to fight COVID-19

MANILA — In Tacurong, a city in the southern Philippines, individuals attacked and doused bleach on a hospital worker. In Kenya, some perceive the novel coronavirus as being “manufactured by [the] U.S. government to destabilize the Chinese economy,” while in the neighboring Democratic Republic of the Congo, rumor has it that China “created this virus to make money.”

Anti-Asian aggression is also on the rise around the world, with reports of people of Asian descent being physically attacked or refused boarding on public transportation.

“People are angry, and when you’re angry and afraid it’s easy to blame others,” said Rana Cassou, International Federation of the Red Cross and Red Crescent Societies head of communication for Middle East and North Africa.

As with other disease outbreaks, misinformation can be as “harmful as the disease itself,” said Michael Nyenhuis, UNICEF USA president and CEO.

“Within the context of this current pandemic, we're also seeing how anxiety is manifesting itself into fear and stigma, making a difficult situation worse — not only unfairly targeting healthy individuals, but also driving those who may have contracted the disease to avoid detection and treatment, and increasing the risk of further spread,” he said, adding, “we cannot allow this new virus to serve as a vehicle for racism or xenophobia.”

Aid organizations dealt with similar rumors and aggression during the Ebola outbreak in DRC, but now the challenge is on a much larger scale.

COVID-19 has to date been confirmed in 184 countries across all seven continents, with over 1.4 million confirmed COVID-19 cases globally, and more than 82,000 deaths, as of April 8. This poses an enormous task for organizations involved in risk communication and community engagement work. But the situation also reinforces the critical role of local organizations and volunteers.

Dealing with misconceptions

IFRC, UNICEF, and the World Health Organization have produced a stigma guide that local organizations can use as reference in preventing and addressing stigma associated with COVID-19.

The guide offers advice on appropriate language to use when talking about COVID-19, such as don’t call it the “Wuhan virus” and don’t say people are “transmitting,” “infecting” or “spreading” the virus, as it can imply that people are doing so intentionally.

It provides tips on how organizations can counter social stigma, such as engaging religious and community leaders, carrying out a campaign honoring frontline staff like health care workers, and ensuring the materials used portray different ethnic groups to show that anyone can acquire the disease.

UN Women and Translators without Borders also produced a guide on behalf of the Risk Communication and Community Engagement Working Group on COVID-19 Preparedness and Response in Asia and the Pacific. This guide covers how to include different segments of the population who often have limited access to information or have particular needs that can be overlooked in risk communication and engagement efforts.

IFRC also does webinars for national societies, community health workers, and volunteers to explain, for example, the difference between isolation and quarantine.

“Isolation is when you isolate a person who is confirmed to be affected by COVID-19, and quarantine is when you lock down a community of healthy people and stay at home to reduce the chain of transmission,” Cassou said.

This is important, she said, to get communities to understand and follow measures imposed by governments that restrict people’s movements.

“In some countries, they don’t trust the government. They think, ‘the government wants us to stay inside because they don’t want us to do demonstrations on the street.’ So volunteers need to explain,” she said, adding that communities are more likely to listen to neutral bearers of information.

Creating a mechanism that closes the feedback loop is one of the most important aspects to help address fear and misconceptions, showing communities that organizations are listening and acting on their questions, suggestions, and concerns, said Sharon Reader, senior adviser on community engagement and accountability for IFRC in Africa.

The organization does this in a number of ways, such as through its network of national societies and volunteers who are able to collect information on people’s perception or concerns about COVID-19. In Asia Pacific, IFRC, WHO, and UNICEF are rolling out a perception survey on COVID-19, in which they ask people what they’ve heard, where they got the information, and what questions they have.

“By being responsive, people realize that we're listening to them and they trust us. And if they trust us, they're obviously much more likely to listen to the kind of advice that we're sharing and work with us to fight the epidemic,” she said, adding that probably the biggest lesson from the Ebola outbreaks in DRC and West Africa was that “communities end an epidemic.”

Not acting on people’s concerns and suggestions could lead communities to “stop talking” and “destroy trust,” she said.

In the organization’s first community feedback report in Africa, one of the rumors that came up from Côte d’Ivoire is the use of salt water to prevent COVID-19 infection. Reader said that rumor was also rampant during the Ebola outbreak in West Africa.

In DRC, there were questions about the connection between COVID-19 and Ebola, such as, “can people affected by Ebola be targeted by corona or immunized, is there any ... link or not, [are] the ways to protect the same?” and “what is the difference between corona and Ebola?”

“We can provide health services, we can have clinical care, but stopping the transmission is led by the community. And if the communities don't buy into the process or don't accept or support mechanisms or practices that will stop the transmission, then you're never going to stop the transmission,” she said.

A different set-up

Community quarantines are putting constraints on doing this type of engagement. With almost every country in the world restricting movement of people, organizations such as IFRC and UNICEF are increasingly relying on mobile technology and social media, apart from the traditional forms of media such as radio, TV, billboards, and posters.

UNICEF, for example, works with governments, WHO, and digital platforms such as Facebook, Instagram, LinkedIn, and TikTok to make sure that accurate information and advice is available to populations across countries.

The U.N. program also deployed its U-Report chatbot in 24 countries to provide COVID-19 awareness and prevention activities. U-Report is a social messaging tool that UNICEF has used for years to provide vital information and engage citizens, often youth, on a range of health and social issues. In DRC, a toll-free nationwide hotline has been set up to address questions on COVID-19. UNICEF trained consultants to answer questions from 8 a.m. to 6 p.m.

While helpful, technology and digital platforms could exclude some groups of the population, such as people who are illiterate, people who don't speak a country’s standard language, and older people, warned Viviane Fluck, community engagement and accountability coordinator for IFRC in Asia Pacific

“And so that's really a challenge on how can we support communities when we actually cannot go and visit them in person,” she told Devex.

For instance in Myanmar, people in Yangon are most likely easier to reach with their access to mobile phones and the internet, compared to other more rural parts of the country.

It also raises a question on trust building.

“Normally, we have a lot of volunteers … and they go out into the community and they support the community and they're there. And that's also building up trust, right? If you see a person, if you go back regularly, that is how people trust us. And trust is a really big part of community engagement. Now we have to engage without having [to do] that very often,” Fluck said.

In some countries, IFRC’s network of volunteers are still able to go out in the communities. But in some places, it’s now impossible to do so, Fluck said.

But in places where they are still able to move or given permission by governments to visit communities, Reader said it’s important to continue but perhaps modify the way they conduct their activities. For instance, volunteers may have to speak with families through a window rather than entering people’s houses to maintain physical distance.

“It really is required, and not just as in the Red Cross, but all humanitarian agencies to really rethink how we work. And it's important as well that communities don't just think we've disappeared. So we don't just stop our presence in communities because then they'll be thinking, ‘where have you gone and why are you not here anymore?’” she said.

Similar to a number of organizations, IFRC is relying more on local chapters, host communities, and volunteers in reaching more people on the ground. This is happening in Bangladesh’s Cox’s Bazar, for example, as a number of organizations have repatriated or moved their foreign staff to Dhaka.

“There's [fewer] people going into the camps and the local host community, which kind of highlights, again, the importance of localization and making sure that we work together very closely with communities. They will be there [even when there are movement restrictions] and they will be the first responders,” she said.

Cassou said the pandemic has highlighted the importance of local actors, and the need to empower them as they are often the ones on the ground before, during, and long after a crisis is over.

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