Combatting Ebola
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Transcript of Combatting Ebola
The SBC Working GroupWelcomes You to a Learning Session
on
Combatting Ebola and Similar Outbreaks with Social and Behavior Change Strategies
Global Health Practitioner Conference, Spring 2015Alexandria, Virginia
April 16, 2015
Combatting Ebola and Similar Outbreaks with Social and Behavior Change Strategies
Presenters
• Mathias Pollock, Mercy Corps• Suzanne Van Hulle, Catholic Relief Services• Maya Bahoshy, International Medical Corps• Janine Schooley, Project Concern International
Moderator
• Paul Robinson, International Medical Corps
Emergence of Ebola:
1976-Yambuku, DRC
1976, 79—Nzara, S. Sudan
1977-Tandala, DRC
Group process – 15 minutes1. Jot down one idea of what you think is effective
as SBC initiative for addressing Ebola and similar outbreaks in the futurea) One idea only, please!b) Use one page from note pad on your table and c) Write legibly please
2. Discuss your one idea with your table mates
3. Refine/change your idea if you think necessary
4. Turn in your idea sheet to a volunteer nearby
Saving and improving lives in the world’s toughest places.Saving and improving lives in the world’s toughest places.
Obstacles to Case Reporting
A barrier analysis study of timely reporting of symptomatic family members by heads of households in Montserrado County, Liberia
Global Health Practitioners Conference
April 16th, 2015
Mathias Pollock, Technical Advisor
Saving and improving lives in the world’s toughest places.
E-CAP PROGRAM OVERVIEWObstacles to Case Reporting
Saving and improving lives in the world’s toughest places.
BARRIER ANALYSIS SUMMARY
- Rapid evaluation, mixed-method tool
- Identifies key determinants of behavior
- Perception-based
Obstacles to Case Reporting
Barrier Analysis: What is a determinant? (Food for the Hungry)
Saving and improving lives in the world’s toughest places.
STUDY PARAMETERSObstacles to Case Reporting
• Behavior: Timely case reporting
• 99 individual interviews
(44 Doers and 55 Non-doers)
• 5 Montserrado communities
(New Kru Town, West Point,
Gardenerville, Mount Barclay,
Brewerville)
• Data collection conducted Feb 16th – 18th
Rapid Research Team collecting data in Brewerville (photo: Mercy Corps)
Saving and improving lives in the world’s toughest places.
SELF-EFFICACYObstacles to Case Reporting
WHAT MAKES/WOULD MAKE IT EASY TO REPORT?
41
5
43
7 7
70
7
2520 25
53
11 11
89
713
0
20
40
60
80
100
Pe
rce
nt
resp
on
se
Doers %
NonDoer %
Saving and improving lives in the world’s toughest places.
POSITIVE CONSEQUENCESObstacles to Case Reporting
What are the good things that happen when you report?
52
34
43
20
47
3127
5
0
10
20
30
40
50
60
Patient will getearly Tx
Higher chance ofsurvival
Protectothers/community
Reduce spread ofEbola
% Doers
% Non-Doers
Saving and improving lives in the world’s toughest places.
SOCIAL NORMSObstacles to Case Reporting
WHO DISAPPROVES OF YOU REPORTING?
59
5
16
47
27
18
0
10
20
30
40
50
60
70
Nobody Friends & Neighbors Family members
% Doers
% Non-Doers
Saving and improving lives in the world’s toughest places.
11
25
64
2033
47
0
20
40
60
80
100
Verydifficult
Somewhatdifficult
Not difficult
Access
% Doers % Non-Doers
OTHER SIGNIFICANT DETERMINANTSObstacles to Case Reporting
511
82
1325
60
0
20
40
60
80
100
Very difficult Somewhatdifficult
Not difficult
Cues to Action
Saving and improving lives in the world’s toughest places.
RESULTS SUMMARYObstacles to Case Reporting
• Community leaders (CL) play a critical role but some people have problems accessing them
• Doers perceive “protecting others” and “avoiding the spread” as key motivators for reporting (preventive community altruism)
• Non Doers perceive “friends and neighbors” as disapproving of reporting to #4455 or CL
• Non Doers perceive difficulty in accessibility (lack phone/network)
• While messaging is working, some people are still forgetting to report
ECAP poster targeting holistic community action (photo: Mercy Corps )
Saving and improving lives in the world’s toughest places.
PROCESS LEARNINGObstacles to Case Reporting
Appropriate community entry
Power of stigma
Working w/ local leaders
We have as much to learn from the communities where
we work as we do to teach them!
“Listen, Learn, Act”
Learning to wash hands in Ebola-time (photo: Mercy Corps)
Saving and improving lives in the world’s toughest places.
LIMITATIONSObstacles to Case Reporting
• Limited geographic area
• Relaxed behavior statement
• Survey fatigue
• Time constraints
A survivor educating people about the harmful effects of discrimination. (photo: Mercy Corps)
Saving and improving lives in the world’s toughest places.
PROGRAM RECOMMENDATIONSObstacles to Case Reporting
• Establishing community selected volunteer committee to increase reporting to CL
• Host palava hut conversations with survivor testimonials to dissipate stigma among community members
• Create community maps to identify homes with functioning cell phones in case of emergency
Saving and improving lives in the world’s toughest places.
POLICY RECOMMENDATIONSObstacles to Case Reporting
• Focus on community mobilization from onset of emergencies
• Present messaging through holistic community lens
Community educators for the Center for Liberian Assistance mobilize for a community outreach activities. (photo: Mercy Corps)
Saving and improving lives in the world’s toughest places.
NEXT STEPS
E-CAP II
Follow up barrier analyses (stigma)
Photo voice survivor stories
Obstacles to Case Reporting
The Liberia Crusaders for Peace. (photo: Mercy Corps)
Saving and improving lives in the world’s toughest places.
Obstacles to Case Reporting
CONTACT
Technical [email protected]
Mathias Pollock, MPH
Thank you for your attentionQuestions?
Rapid Research Team: Marion, Prince, Eunice, Chris, Hermenia, and Marcus
CRS’ Social and Behaviour
Change tools for EVD
prevention
Suzanne Van Hulle & Annisha Vasutavan
Catholic Relief Services
Phases in the Sierra Leone Ebola Response
Phase 1: Learning
Phase 2: Alarm
Phase 3: Acceleration
Phase 1: Learning
Phase 2: Alarm
Phase 3: Acceleration
Comparing SBC activities and
Prochaska’s Stages of Change
Early
Response
Phase
SBC activities Prochaska’s Stage
of Change
1: Learning Public education using
mass media
(IEC materials – Posters,
Pamphlets, Banners, Radio
Discussions, Radio Jingles,
etc)
Pre- contemplation
Early
Response
Phase
SBC activities Prochaska’s Stages
of Change
2: Alarm 1. Community led activities of
positive reinforcement and
social support (district level
authorities working together
with traditional leaders).
2. Public education using mass
media (IEC materials – Posters,
Pamphlets, Banners, Radio
Discussions, Radio Jingles, etc)
1. Preparation/
Action for
initially affected
areas
2. Pre-
contemplation for
newly affected
areas
ER Phase SBC activities Prochaska’s Stages of
Change
3: Acceleration Focus of social mobilization is on
DIALOGUE, targeting influential
change agents .
Activities:
Stakeholder dialogue sessions
with community level change
agents
Training for religious leaders,
traditional leaders, societal
heads etc.
Community dialogue sessions
with representation for a variety
of community members.
Preparation/Action
Case study: Koinadugu District
CRS SBC activities to promote proactive measures to prevent
the EVD outbreak in Sierra Leone
What went well?
• Last district in Sierra Leone to record EVD cases
(mid-October 2014)
• To date, is the district with the 2nd lowest number of cases
in the outbreak (108 cases in total).
KAP Survey Findings – Knowledge of EVD
0102030405060708090
100
Koinadugu
Other districts(Avg %)
0
10
20
30
40
50
60
70
80
90
Handwashing(Soap &Water)
Avoidingphysical
contact withsick people
Participated ina funeral or
burialceremony inthe previous
month
Koinadugu
Other districts insampled in NorthernProvice(Avg %)
KAP Survey Findings –
Prevention behaviors/Behavior change
Challenges
One dimensional interaction
No forum for people to challenge beliefs and ideology
(27.7% of Koinadugu respondents believed that bathing in
salt and hot water can prevent Ebola, & 9.2% believed
that spiritual healers could successfully treat Ebola.)
Weaknesses in early
social mobilization strategies
Shift in CRS’ SBC strategy in the Acceleration phase
Sharing knowledge with communities
Engaging in dialogue
Understanding how various community groups communicate & share information
Understand barriers and motivating factors for certain key behaviors
CRS’ revised SBC strategy:Stream 1:
Community Level Social Mobilization through Influential
Community Change Agents
Identification and training
of community level change agents to be lead trainers
in their respective chiefdoms /districts
Each lead trainer to cascade
training to a further 30
community level change
agents
Community level change
agents to integrate behavior change
messaging in
community level
mobilization sessions
Conduct open
dialogue sessions at community
level to share
experiences
CRS’ revised SBC strategy:Stream 2:
Social Mobilization Rapid Response Teams (RRTs) to carry out SBC activities at
community level
CRS social mobilizers trained on community
engagement, social
mobilization tool kit,
deployment activities, etc
Standard Deployment
10 day blocks in the
field
Emergency Deployment
3-7 days deployment
based on size of
affected community
RRT conduct H2H
sensitization and
community structure
engagement using CRS
Soc. Mob
tool kit
RRTs to conduct regular
community follow ups to check on progress in behavior change
practices
CRS Rapid Response Teams
CRS Social Mobilization Toolkit
Features
Low literacy friendly
Images set in the local context and local languages
Prompts discussion with audience
Focuses on and reiterates (6) key messages through
out discussion
CRS Social Mobilization Toolkit
Rapid Response Team Field Protocol Guide
Video - “Ebola – A poem for the living”
Pictorial flipbook - “Ebola – A poem for the living”
Discussion guide for video and flipbook
Hotline cards – with district alert numbers
Poster
Flipbook
©2015 International Medical Corps
SBC and PSS:Hand in hand to address Ebola
From Relief to Self-Reliance
Maya BahoshyCORE Group GH Practitioner Conference, Spring 2015
All content in this document is the property of International Medical Corps UK and should not be reproduced without prior written consent. This material is protected by copyright. ©2015 International Medical Corps. Materials may not be reproduced without International Medical Corps’ prior written consent.
©2015 International Medical Corps
Our EVD Programming• Ebola Treatment Centers in Liberia (Bong and Margibi County) and
Sierra Leone (Lunsar, Makeni)• Screening and Referral Units in Liberia, Sierra Leone and Guinea• Multi-Agency Training Collaborative training center in Liberia for
healthcare staff from various agencies. Additional training centers in Sierra Leone and Mali.
• Rapid Response teams in Liberia, Sierra Leone and Guinea• EVD Preparedness and response expansion (Mali)• Donors: USAID/OFDA (main), DFID, CIFF, Gates, ECHO, Irish Aid,
Lumpking, Merck, Kaiser, BandAid,
©2015 International Medical Corps
Community Outreach Objectives
1. Address psychosocial needs
2. Support reintegration of survivors
3. Ensure local support and buy-in for ETC
4. Support rebuilding trust in health system
©2015 International Medical Corps
Key Findings/Barriers• To accessing ETC:
• To preventative behaviors:– Fear
– Denial
– Traditional beliefs
– Misconceptions about chlorine and sprayers
– Access to required materials
– Distance
– Perceived quality of treatment
– Mistrust
– Fear of death
– Low action efficacy
– Misconceptions about Ebola
– Poor communication with patients
©2015 International Medical Corps
Community Outreach strategy• Phase 2:
– Trained PSS/SBC dual outreach team
– Increased community engagement
– Key behavior change activities
• Phase 1:
– PSS team
– Needs assessment
– Reactive - pickups
©2015 International Medical Corps
Activities
• Program Launch
• Participatory Data Collection
– Mapping
– Seasonal Diagram
• ETC visits
©2015 International Medical Corps
Activities• Use of survivors for
increased access
• Radio programming
• Continual reflection
©2015 International Medical Corps
Lessons Learnt/Recommendations
• Invest in two way dialogue
• Involve the community and key stake holders from the start
• Ensure cultural appropriateness wherever possible
• Remain dynamic
©2015 International Medical Corps
Lessons Learnt/Recommendations
• Consider the psychological needs and abilities of the target population
• Strengthen the capacity of PSS staff on SBC approaches
• Further research
©2015 International Medical Corps
Thank you
Maya Bahoshy
Social & Behavior Change Officer
Janine Schooley
Senior VP Programs, PCI
CORE
Spring Meeting Apri l 2015
CARE GROUPS IN THE
CONTEXT OF EBOLA
In 2010, PCI and ACDI-VOCA (prime), received $40 millionfrom USAID for a 5 year, Title II DFAP for Liberia.
The Liberian Agricultural Upgrading Nutrition and Child Health (LAUNCH) program is designed to increase access to food, reduce chronic malnutrition, & increase access to improved livelihood & educational opportunities in Bong & Nimba counties.
BACKGROUND
PCI is responsible for 2 of 3
Strategic Objectives (SO):
SO2—Reduced Chronic
Malnutrition of Vulnerable
Women & Children
SO3—Increased Access to
Education Opportunities
Care Groups are the primary
platform through which PCI
works to achieve SO2.
There are a total of 158
Care Groups & about 1400
CGVs (i.e. Lead Mothers)
reaching a total of 402
communities.
CARE GROUPS IN LAUNCH
Initial outbreak of Ebola in Liberia with cases coming
from Lofa, a county bordering Sierra Leone & Guinea.
PCI began basic Ebola awareness with Care Groups, using
no additional materials, focused on :
1. Preparing dead bodies, a major risk for transmission
Traditionally Liberians bathe and plait the hair once someone
dies & then bury the dead in the yard with family.
2. Avoiding bush meat
3. No touching!
4. Hand washing
20-40 cases in Bong; 0 in Nimba.
TIMELINE OF EBOLA — MARCH 2014
PCI H&N staff served as “Promoters”, along with general Community Health Volunteers (gCHVs). At the time of the outbreak, staff received training from PCI’s Country Director.
Care Groups continued to meet normally, with CGVs conducting regular meetings and household visits, including basic messages about Ebola prevention as part of their regular meetings.
During this first wave LAUNCH became a member of the National Ebola Task Force &the Case Management sub-committee providing logistical and technical support to the initial training of health workers throughout the country.
CARE GROUPS — MARCH - MAY 2014
The second wave of the epidemic precipitated a consolidated response at the community, district, county & national levels which took precedence over all project health -related initiatives.
Monrovia was hit hard; Six counties exploded with cases including Bong & Nimba.
Nurses, Doctors & Health Care Workers began dying. People started to panic. Health clinics began closing.
In June, the Ministry of Health and Social Welfare ( MoHSW) suspended all non-Ebola related training & travel so that core MoHSW staff could focus solely on the Ebola response.
Care Group activities continued in the communities sharing the same basic Ebola information along with regular lesson plans.
TIMELINE OF EBOLA — JUNE/JULY 2014
The President declared a national State of Emergency in
August, prohibiting public meetings, closed central markets &
sealed international borders impacting food security &
instituted a national curfew.
LAUNCH program—all non-Ebola activities were put on hold;
food distributions ceased, no large gatherings were allowed.
PCI staff remained & by mid August activities were 100%
focused on the Ebola response.
TIMELINE OF EBOLA — AUG/SEPT 2014
PCI contributed to the
development of an Ebola
training guide for staff, based
on WHO & MoHSW training
guidelines.
Training materials were
produced by UNICEF & the
MoHSW for the gCHVs.
PCI printed and bound 4,000
copies as it was a perfect tool for
CGVs.
Tool included signs & symptoms,
how Ebola is spread, what to do
when a family member has Ebola,
etc.
CARE GROUPS — AUG/SEPT 2014
Care Groups in LAUNCH are 8-10 CGVs, a per fect size for continued trainings during Ebola.
CGVs were key in terms of educationto community members, distr ibutionof hand washing buckets, etc.
CGVs protected themselves from Ebola when making household visits.
Not touching anyone (including shaking hands, kissing, hugging), washing their hands with soap or disinfectant after each household, standing at a distance from others, avoiding contact with those who are sick, etc.
Care Groups al lowed us to be in the communit ies & stay connected, relevant & useful throughout when many projects & program activit ies couldn’t continue .
CARE GROUPS — AUG/SEPT 2014
PCI held community video shows on
Ebola. Special permission was
granted to show after curfew. CGVs,
along with gCHVs, led Q&A.
CGVs & gCHVs, supported families
who were quarantined & isolated.
Brought water & food
Helped with farming
By the end of Sept all LAUNCH
communities were mobilized &
educated. Everyone had hand
washing buckets & bleach &
everybody knew Ebola was real.
CARE GROUPS — AUG/SEPT 2014
CONTINUED
Stopped focusing fully on Ebola as staff realized Ebola education only wasn’t sufficient & other issues were also important.
CGVs reviewed old modules (ENA, Maternal Care, etc.)
CGVs focused on nutrition education including the preparation of a local CSB substitute.
PCI began working with the DHO to re-open clinics in Bong.
ANC services are now up & running in all health facil ities in Bong & Nimba. CGVs were key in reestablishing l inks between health facil ities & communities.
LAUNCH commodity distribution began again in October.
CARE GROUPS — SEPT/OCT 2014
The Care Group model is adaptable & flexible, able to be responsive to changing contexts & needs of communities.
PCI successfully used the Care Group approach in reaching & identifying the most vulnerable (both in terms of those at r isk for contracting Ebola, as well as pregnant & lactating women , elderly/disabled, those who lost their caregivers & others who struggled to access regular health services) during the emergency.
PCI has reached over 150,000 community members with Ebola education & prevention messages through the use of Care Groups .
The training of staff working with Care Groups lends itself to the successful use of Care Groups in Ebola as they are already trained in facilitation and outreach – critical in Ebola response.
Care Groups contributes to a full cycle approach, covering Ebola from the community awareness stage all the way to the Ebola Treatment Unit (ETU) level & then re-entering people back into the communities.
CONCLUSIONS
CGVs have been key to the Ebola response! To date, no PCI staff & CGVs
have contracted Ebola.
They are now taking up the task of helping communities adapt & meet the needs of the growing orphan population.
Helping with “re-entry”, minimizing stigma & discrimination of survivors.
Their messages/education & support on Ebola reached men, children, others in the community.
They have been the programming thread throughout!
THANK YOU!
feedthechildren.org
Hot off the press…• The Ebola Viral Disease Care Group Lesson Plans AND
Flipchart (draft for testing) is now available!
Questions & Answers – 10 minutes
• Keep your questions/comments REAL short and sweet
• This is important since we have only a very short time for the next activity – Group Process
Group process – 15 minutes
1. Jot down one idea of what you can do in your organization as SBC initiative to address Ebola and similar outbreaks in the futurea) One idea only, please!b) Use one page from note pad on your table
2. Discuss your one idea with your table mates
3. Refine/change your idea if you think necessary
4. Turn in your idea sheet to a volunteer nearby