7. Communicating for cholera preparedness
7.5. Mobilising for community action
7.5.1 Involving communities Communities are vital resources whose energy, knowledge and insights into ways to address cholera should not be ignored.
Ideally community groups should be facilitated to define the actions they can take to help prevent, prepare for or mitigate cholera. Attempts to impose pre-defined actions will often fail. (See Chapter 9 for further information).
The checklist below details key activities in relation to community mobilisation Section 9.1 lists the key community-focussed cholera response strategies as well as possible community actions.
A training package/module is available to train community workers/volunteers on interpersonal communication to advance safe household water treatment and storage, and safe health, hygiene and sanitation practices for cholera prevention. The training outlines key messages to deliver in the event of an outbreak, on preparing and using ORS, seeking treatment, handling of vomit/faeces of sick person, etc.).
Community workers have been trained or arrangements made to train community workers/volunteers on cholera prevention and response before the cholera season or as soon as possible into an outbreak.
Arrangements with NGOs, CBOs or other partners for community-based activities in communication for cholera prevention and response are signed/drafted. Activities include:
door-to-door activities, group discussions, identification of positive deviants and community dialogue and participatory activities to promote safe practices, mobilization of existing networks, or any other relevant intervention.
Agreements are signed with religious/traditional leaders and their associations to promote safe health, hygiene and sanitation practices for cholera prevention amongst communities.
7.5.2 Key audience / participant groups for community action Everybody in a community needs to know about how to prevent, prepare for and respond to cholera outbreaks, and, as many families as possible need to take action for an effective response. However, to be able to reach large numbers of families in a short timeframe it may be necessary to focus efforts on certain key groups or institutions such as:
Community leaders
•
Religious leaders, community volunteers and extension workers
•
“ Communities were not initially involved in the cholera
response. This later changed through the establishment
of community cholera management committees. ”
Source: CEpHI (2009) Zimbabwe Cholera Evaluation
7
Communicating for cholera preparedness and response1 2 3 4 5 6
8 9 10
TOC
Schools - refer to
• Annex 9E (Cholera response actions in institutions or public settings) and the UNICEF toolkit for teachers on water, sanitation and hygiene for schools in emergencies for further information
Existing groups such as workers unions and co-operatives, women’s
•
groups, youth groups.
Key resource people from these groups can be rapidly trained (or preferably identified and trained through preparedness) and can then meet with their affiliates or congregations. Community meetings can also be organised to communicate with large groups of people.
Where resources allow, home visiting by volunteers or extension workers can also help to convey important information and mobilise household and community action.
7.5.3 Human resources for community mobilisation
Extension workers from various disciplines, e.g. health or agriculture, community development workers or social workers may have relevant experience in mobilising communities and need briefing on the key messages and concepts for cholera response. The national Red Cross/
Red Crescent Societies and local and national NGOs may have worked closely with communities and possess the ability to initiate mobilisation efforts to mitigate cholera. It may be possible to work through the existing administrative structures (see box in Annex 7G). However, it will be
important to ensure that mobilisation efforts are coordinated and supported.
Assigning responsibility to key personnel and ensuring that regular sub-sector meetings are held will help maximise the potential benefits of community action.
If no outreach networks already exist, it may be useful to identify and train community volunteers, but this effort needs to be planned, supported and owned by both the government and communities.
Inexperienced hygiene promoters may need a lot of extra mentoring and supervising in field by experienced staff. Water, sanitation, and hygiene promotion is not a defined profession, and personnel normally come from a variety of backgrounds and may lack experience working in water and environmental health disciplines or responding to cholera. There is a lack of experienced hygiene promotion personnel worldwide, and cholera preparedness planning efforts need to consider how this issue can be addressed within each national context, including the provision of adequate training.
Supervision and support for outreach workers is also important and could be provided by the existing supervision structures, or new personnel may need to be recruited and trained.
More information about community actions can be found in Chapter 9 and about developing capacity in Section 6.4.
7.5.4 Community preparedness planning
Community engagement aims at strengthening the capacity of communities to identify their own issues and development needs, assess their options and take action, including the ability to assess the impact of their actions and to analyse their capacity gaps. A variety of community-based communication channels - including courtyard meetings, local level dialogues with service providers, social mappings and action plans, community-based entertainment programmes, community radios and other local media channels and religious groups - can be used to empower people for meaningful participation and to create demand for quality services.
Supporting communities in areas particularly vulnerable to cholera in the development of community action plans is a key preparedness priority.
Capable facilitation is required to raise awareness about the possible risks of cholera and to explain how action plans can be useful. An existing WASH or health-oriented community committee could develop a plan, or a community cholera co-ordination committee could be formed for the purpose of developing and supervising implementation of the plan.
Community action plans could detail:
How to improve water, sanitation and personal and food hygiene
• practices of various groups in the community, e.g., through the use of handwashing stations
How to make sure that all community members know how to prevent
•
cholera and what to do if someone in their family or neighbourhood gets cholera
How to support community members in visiting a health centre –
• especially those who have limited mobility or means to get there Where an ORS corner could be situated and who would manage it in
•
the event of an outbreak
7
Communicating for cholera preparedness and response1
What precautions could be taken at mass gatherings such as funerals
•
and weddings
What improvements could be made to markets or public institutions
•
such as schools
How to monitor and report on cases and trends
•
Who is available to help and what communication would be necessary in
•
the event of an outbreak, e.g., targeting authorities, health personnel, etc.
The following sections provide additional guidance for supporting communities with cholera preparedness:
Section 4 / Table
• 2 – The prevention of cholera (includes practical actions that can prevent cholera)
Annex 7
• D – Communication activities and channels for cholera response Annex 7
• E – Key messages, actions and behaviours Annex 7
• G – Working with communities & troubleshooting Section 5.
• 3 – Involvement of key stakeholders and sector responsibilities (includes a listing of stakeholders who may be involved in cholera
response efforts at community level) Chapter
• 9 and related annexes – Service delivery: community-focussed interventions (includes community-level actions in the household and in community- based institutional or public settings)
Country-specific examples of preparedness actions relating to community preparedness (most of which were undertaken after a cholera outbreak had started in neighbouring areas) are noted in the Key Resources section that follows.
KEy RESOURCES
Wateraid Australia, IWC, IRC; Promoting, good hygiene practices: Key elements and practical lessons.
WHO Outbreak communication planning guide, WHO: Geneva, Switzerland (2008)
UNICEF Writing a communication strategy for development UNICEF Specific tools and guidance. UNICEF Communication for development, cholera response intranet-site
AED-FHI360, Bringing the community together to plan for disease outbreaks and other emergencies
Training / awareness raising sessions run in Ethiopia for community leaders and key field extension workers in Oromia region, Ethiopia
CDC, Cholera communication resources
Example formative research question guide for investigating sanitation &
hygiene, extract from UNHCR hygiene promotion briefing pack
7
Communicating for cholera preparedness and response1 2 3 4 5 6
8 9 10
TOC