Hyderabad: While there are fervent efforts to discover treatment and vaccines for COVID-19, community engagement is critical as a public health measure to effectively organise social and behavioural interventions.
Community engagement plays a significant role in public health emergencies. It is important to note in such circumstances, government and the health systems have to engage with communities, patients, their families and a range of other stakeholders, partners and sectors.
Community engagement has been effective in tackling two recent zoonotic infections of Ebola virus disease and Nipah virus that turned into diseases of public health importance.
Most recent Ebola outbreak was in 2018 in northeastern DR Congo in Africa that was declared as a public health emergency of international concern in July 2019. Whereas Nipah virus outbreak was reported in 2018 in Kerala, India and was identified by the WHO as emerging zoonotic disease of public health importance in the WHO South-East Asia Region.
What is community engagement?
The WHO has defined community engagement as “a process of developing relationships that enable stakeholders to work together to address health-related issues and promote well-being to achieve positive health impact and outcomes”.
Community here refers to ‘lay’ community as well as professionals such as academics, public health professionals, policy makers and institutions. The rationale for community engagement is grounded in the principle that health and illnesses are shaped by the social and ecological contexts of the people.
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Some of the established approaches and tactics related to the implementation of CE are social mobilisation, communication (outbreak, crisis, risk) and health promotion through health education.
How does it help?
Social mobilisation: Social mobilization seeks to facilitate change through a range of players engaged in interrelated and complementary. We have seen that the state is able to procure new resources (Relief fund for COVID-19), consolidate allies (private sector contribution of providing technological assistance in testing, surveillance and drug production, media campaigns etc)
In addition it is very important to co-opt the local communities in our efforts control the COVID-19 pandemic.
Identification of local community leaders and engaging them systematically is very essential. Mobilizing women is also particularly important as it is critical to changing behaviours and educating communities.
It’s very important the social, economic and political contexts of the society and its analysis are conducted to complement the epidemiological assessments to deal with such public health emergencies.
Working with communities in ways that build upon their culture, knowledge and experiences is important.
In case of Kerala, they successfully contained Nipah threat and community mobilisation played a key role.
Example: Well established village based panchayat system, urban local bodies played a role in contact tracking and supporting families, NGOs, opinion leaders, religious leaders everyone contributed to the government’s efforts. Lessons from this ‘Kerala model’ of tackling an outbreak helped them to confidently deal with COVID-19. Many other states are adapting the Kerala model of managing outbreaks in dealing with COVID-19.
Communication:
Effective communication of regarding the outbreak and risk is very important in dealing with pandemics such as COVID-19. It is essential that culturally appropriate messaging can reduce risk and motivate the affected individuals, families and communities to act in dealing with the threat.
In the time of unravelling pandemics, it’s critical that the messaging needs to be continuously updated so that the changing epidemiological situation is depicted clearly.
For an effective communication strategy, it’s important to contextualize the messaging to the communities’ cultural perception, norms, values, economic conditions, social structures, history and past experiences. Apart from the mainstream media, most people these days, people are forming virtual communities and are relying on social media to access information and make their decisions.
Proliferation of misinformation is also possible through social media. It is therefore very critical to co-opt these virtual communities as partners in circulating correct information to dealing with pandemics.
Information transparency is important in eliciting appropriate community response in crisis times. Kerala has maximized both the mainstream media and social media in tackling Nipah.
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They ensured that fake messages and wrong information was countered by providing regular and authenticated updates.
Health promotion through health education: Health promotion should be based on principles of social justice and empowerment. Such an approach along with effective community involvement, capacity building, social mobilisation and communication strategies ought to be complemented with political will and action. This will enable people make positive decisions to improve their health futuristically.
Benefits of community engagement: Involving communities and collaborating with them are vital to any efforts to improve public health. Community engagement will have a long term consequences in enhancing the community preparedness to deal with public health emergencies such as COVID-19.
Some of the tangible benefits of community engagement in the times of pandemics such as COVID-19 are:
1. It gives us an opportunity to build trust and confidence in the government efforts to control the pandemic
2. It increases communities belief in the public health workforce
3. It addresses stigma against the affected individuals and health care professionals.
4. Addresses community apprehensions and reluctance caused by misinformation.
5. Leads to better compliance to social and behavioural interventions such as physical distancing and hand hygiene.
