By Nina Meghji
Messaging at the start of the 2014 Ebola epidemic in Sierra Leone was problematic. A lack of trust in the government and authorities, widespread misinformation, impracticable advice and culturally irrelevant and insensitive information were among the factors that contributed to the spread of the virus. Communicating the right messages through trusted channels was swiftly prioritized by government officials, health workers, and NGOs. The community-centered approach that followed became a cornerstone in the country’s Ebola response strategy. With the advent of Covid-19, past experience has informed both the content of Sierra Leone’s public health messages and those entrusted with their delivery. Sierra Leone’s Covid-19 communications response is an example of how a diverse and multifaceted approach can help ensure public health messages are heard and understood by entire communities.
Learning from Ebola
The Government of Sierra Leone’s One Health National Emergency Risk Communication Strategic Plan, developed post-Ebola, acknowledges lessons learned from the crisis. In particular. It identifies the role of community engagement, especially the fact that “People are more likely to believe and act upon messages delivered by people they know and trust. Extensive experience in outbreak, epidemic, and development communication indicates that local leaders are pivotal in changing the course of events.” These “community influencers” – paramount chiefs, heads of communities, religious leaders – and other trusted members of the community are integral to the planning and dissemination of public health emergency messages, it says. Alongside a person-centered approach, the Strategic Plan advocates early, effective coordination and delivery of messages – content has been developed in 12 languages, in addition to Krio, spoken widely in Sierra Leone – through diverse communication channels, including billboards and posters, social media, and text messages.
Getting the right messages out there
In an article for Sierra Leone’s Concord Times, Mohamed Massaquoi documents how the head of Sierra Leone’s traditional healers in Sierra Leone expressed commitment to combating the spread of Covid-19. He urged colleagues to adhere to government guidelines and to refer sick people to hospitals rather than treating them themselves. By deploying a “task-force” to educate people across the country on transmission of the virus, he hoped to avoid a situation similar to Ebola during “which every traditional healer was doing what he wanted.” Similar experience has informed international NGO Concern Worldwide’s work with traditional healers who, since Ebola, have emerged as “vocal health advocates in their communities, and are in the perfect position to convey the right messages about COVID-19.” Concern Worldwide attributes its success to trust, built over time, between its staff and traditional healers, and the longstanding trust between traditional healers and members of the community. For Concern, “the most valuable weapons in the fight against Ebola were information and trust” and “get[ting] the right messages out there.”
Information-sharing and communication is the foundation of the NGO Media Matters for Women’s (MMW) work. MMW harness the power of trusted communication networks through mobile technology and have been connecting women in rural areas with vital news and information about Covid-19 prevention since the outbreak. As well as podcasts, ‘town criers’ and ‘youth advocates’, delivering messages via megaphone, have enabled women without access to the internet, radio or telephones to hear life-saving information. Its Covid-19 outreach has included more than 115,000 women, children and men living in rural parts of the country. Similarly, Action for Advocacy and Development Sierra Leone (AAD-SL), in partnership with Irish NGO Trócaire, have reached marginalized and excluded communities across three districts, sharing information via radio, public address systems, posters and leaflets.
Migrants as Messengers
Sierra Leone is also one of seven West African countries participating in ‘Migrants as Messengers’ (MaM), a campaign by the International Organization for Migration (IOM) that empowers young people to make informed decisions about migration through returned migrant volunteers. As part of the scheme, volunteers have been broadcasting messages about protection from Covid-19 through radio and online videos, which include a recording by three aspiring musicians of a song entitled ‘Coronavirus is real’ in Krio and English, raising awareness of the virus. Public figures are also using their positions to education the wider community on Covid-19. Sierra Leonean author and UNICEF Ambassador Ishmael Beah features in an Covid-19 awareness-raising video on the agency’s Facebook page, and paralympian George Wyndham, is educating communities about the dangers of Covid-19, and preventative measures to mitigate them, in a full-time role with Sierra Leone’s Public Health National Emergency Operation Centre. A young graduate and artist has also been using his drawings to highlight the challenges associated with Covid-19. In an article by Sierra Leonean journalist Osman Benk Sankoh, Jusu, also known as Kontri Artist, explains the responsibility he feels as an artist to inform Sierra Leoneans of the issues affecting their lives. His sketches feature text in both English and Krio.
Community-based Organization
Operating from Sierra Leone’s informal settlements, the Federation of Urban and Rural Poor (FEDURP) and the Centre for Dialogue on Human Settlements and Poverty Alleviation (CODOHSAPA), are the embodiment of community-based organization. CODOHSAPA and FEDURP have customized Ministry of Health and Sanitation (MoHS) messaging materials for their communities, engaged in face-to-face and online advocacy – via social media – and radio broadcasts, and developed a Covid-19 monitoring app. FEDURP is also working with the Freetown City Council and with community chiefs within the settlements to help enforce compliance with state regulations. The Federation acknowledges “mixed messages [which] resulted in the emergence of myths and misconceptions in communities and the society generally about the Covid-19 virus” as one of the challenges it has faced. Mixed messaging has been a key challenge in the UK’s Covid-19 response. In an article published by British newspaper The Guardian, journalist Haroon Siddique argues that “public trust in the government’s ability to handle the coronavirus crisis has been tested by a summer of mixed messages.”
Political Messages undermine Public Health
Efforts to build trust and communicate life-saving information can also be compromised when the focus is shifted away from health. In an article for the International Growth Centre, Sierra Leone-based economist and researcher, Abou Bakarr Kamara expressed concern that “recent political tensions… ha[d] undermined the response effort” and that social media was “awash with inciting political messages, instead of COVID-19 prevention and awareness messages.”
In the UK, the British Prime Minister’s senior advisor, Dominic Cummings who broke lockdown rules and retained his job, set in motion what researchers in an article published by The Lancet, described as the “Cummings effect” – an event that “undermined confidence in the government to handle the pandemic.” Trust in the authorities, they believe, is crucial because it “underpins public attitudes and behaviours at a precarious time for public health.” Public health researchers, Samuel Boland, Gillian McKay, Benjamin Black, and Susannah H Mayhew lauded Sierra Leone’s Ebola response in a blog for BMJ Opinion, for its “massive community engagement effort.” Their message to Britain: “The UK should consider community level interventions as not only financially viable, but also epidemiologically effective—and invest in and validate them accordingly.”
Sierra Leone’s Covid-19 communications response demonstrates multiple and diverse approaches to public health messaging, with trust and communities at the forefront. If the focus on health, rather than politics, can be maintained, there are valuable lessons for countries like the UK struggling to engage with populations.