(DrumBeatnet] COVID-19 - Communication Response?

Good Advocates, good day. 

I understand that the C-19 is none discriminatory, it has no race, no colour, nor creed and has no bounderies of behind urban or rural dweller etc.  But, messaging has drawn me back and pointed to me as C-19 is for Urbanites.  All IEC material produced is about urban residents, photos or pictures, even language used eg access, use and disposal of face masks and gloves including saniteizers neglects the 75% rural based populations. 

Social distancing (household to household) is almost natural but strategic communal water points force people to meet in the mornings and evenings and it has proved difficult to sanitizer buckets or borehole rod used to draw water or to disinfect all water drawers' hands.  

In some areas (lack of info) some politicians and traditional leaders have gathered people to give information on prevention methods and referrals when one suspect of being infected.  This again works against the concept of social distancing though gathering people at a go is considered the quickest way of information dissemination, than a health /social worker doing door to door campaigns. 

Is it safe to be in Rural areas when C-19 strikes? What are the advantages and disadvantages of being in Rural setup in our different countries or regions?

Your problem is my job

Nudges are physical cues that influence people to behave in a certain way, without particular messaging or promotion of any behavior. Nudges avoid direct instruction, mandates or enforcement. The term "nudge" became popularized starting in 2008, after publication of Thaler and Sunstein's book by that name. Nudges engage audiences at a subliminal level and work 'reflexively', rather than providing information to audiences to 'reflect' upon and then act. Nudges are reflexive not reflective.

Nudge theory operates by designing elements or 'architecture' in the environment which encourage positive or improved behaviors....

Ed - this has also been submitted as a full blog that can be read at this link

In many countries, authorities are releasing large numbers of prisoners because it's impossible to keep them safe from COVID19 even in the "best" prison conditions.

Social distancing and self-isolation are unthinkable where people are kept in cages.

So I had this thought... and I don't have satisfactory answers.

When we target our COVID19 messages at people living in poor and marginalized communities where people live crowded in small shacks with poor ventilation and no running water, we would do well to ponder the situation of prisoners that authorities are now being forced to release...

The bars behind which society cages the poor are invisible. How can our efforts to promote health and safety help throw open the jail cells of poverty and discrimination?

To many of the people we serve, our very sound and very scientific advice could seem like a cruel joke.

I know these are structural issues beyond the immediate scope of our SBCC work, but in this existential crisis for humanity we must think outside the box, connecting the dots to systematic and collective solutions that go beyond individual behaviors that are next to impossible to practice under current conditions.

What do you think, dear friends?

My friend and former UNICEF colleague, Alan Brody, shared this excellent article from the Guardian that seems very pertinent to our discussion. It's realistic about the limited feasibility of social distancing and self-isolation in crowded settings of extreme poverty, and emphasizes the science of face masks as the next-best solution for flattening the pandemic curve.  Lessons for SBCC are obvious. 

I'm taking the liberty of sharing the note Alan sent to his family: 

"The link to a Guardian piece about masks is worth reading, and is perhaps the first thing I've read that gives me hope that Africa could come up with strategies to deal effectively with the Covid-19 pandemic."

It is becoming clear that the major transmission route of the virus is airborne droplets. It has also now been established that infected but non-symptomatic persons with covid-19 produce and distribute those droplets, even via talking (or singing!)

Like the common cold, the novel corona virus 2019 can initially begin to replicate in the nasal and throat passages, where the viral load can quickly increase (and be shed into the environment). As with many viruses (such as measles), the period following the initial infection, before the immune system can respond and before symptoms appear, quickly becomes the time of highest viral load and infectiousness.

The article suggests that if persons recently infected, with or without symptoms, wore simple cloth masks (even bandanna or balaclava style), this would block spreading of about 99% of the virus-laden droplets from them to others. Let me quote (from the Guardian article by Jeremy Howard):

In a paper published in Nature on Friday, a five-year study from the University of Hong Kong and the University of Maryland has found that a simple non-fitted mask blocked 100% of coronavirus droplets and aerosol. There's a vast chasm between what the science is showing and what many countries are doing. Masks may be the most important weapon in our war on the virus. But we're not even using it.

With 6-18 months to go before we have a vaccine (if then), this knowledge about masks is the "miracle" we have been looking for. The article suggests that if 50% of the public started wearing masks, we could cut in half the number of Covid-19 cases; but if over 80% of the public wore masks, we would largely stop transmission (similar to vaccines, where achieving 80% coverage of a vaccine creates "herd immunity.")

The only trouble is, I can't fully protect "me" by wearing such a mask; only "you" (and everyone else) can protect "me." And you need "me" to help protect "you." "

To us working in rural communities where the vast majority is illiterate and lack access to information, we have no option other than door to door sensitization. We refuse all forms of community educative talks and focus on interpersonal communication and home visits. During these home visits our trained team wear face masks, gloves and carry each 50ml hand sanitizer.

Our greatest challenge now is finding funding to provide face masks to our rural population. We strongly believe if everyone wears a facemask it will reduce the potential spread of the virus in places such as streams and boreholes.

The COVID-19 Communication and Community Engagement HUB - Shared Knowledge and Active Dialogue in Support of Effective COVID-19 Action

SBCC practitioners facing the challenge of promoting "social distancing" in poor communities will appreciate this NYT frontpage article highlighting the "perils of proximity".

Although it focusses on the US, it certainly applies ten-fold to developing countries and marginalized communities around the world, where physical and structural barriers are so much worse.

What the article does NOT cover are the coping mechanisms and innovative solutions that can be found even under conditions of crowding and extreme disadvantage. It would be great to share here what some of these practices are and how you are translating them into messages and SBCC programs.

This thread is so great as the need for sharing experiences and supporting one another has never been greater. Thank you all!

COVID-19, like all health emergencies, is not gender-neutral, and neither should the global health response be. Many of the official strategies and guidelines tackling the current novel coronavirus crisis are uninformed by gender analysis, despite existing evidence of the impact of gender norms, roles and relations on health emergencies. Gender-informed approaches in COVID-19 –related communications are also largely missing.

COVID-19 exposes women, men and people with non-binary identities to different vulnerabilities. Gender-based violence (GBV) is increasing, women and girls' access to essential sexual and reproductive health services [PDF] is dwindling, and women continue to shoulder the burden of care work - at homes and in hospitals - while men largely lead natonal and global health structures. The long-term economic and social impacts of the crisis are likely to hit women the hardest. Men may have ... For the full contribution please click here: Why gender-responsive communication interventions are critical in the battle against COVID-19

The COVID-19 Communication and Community Engagement HUB

Dear Felico, (re Rural Communities)

Please be reassured that face masks are a vital prevention measure for COVID-19 prevention. Unfortunately the World Health Organisation (WHO) guidance on face masks is not in line with global understanding on this matter. Many countries have adopted their own policies in this regard.

The guidance advanced by WHO urgently needs to be revised. For example, from the WHO guidance of 19 March, also reiterated on 6 April, 2020, the following claims are made:

1) WHO state: A medical mask is not required for people who are not sick as there is no evidence of its usefulness in protecting them. Response: This is incorrect. COVID-19 is a respiratory disease transmitted through respiratory droplets and viral particles emitted when a person speaks, shouts, sings, coughs and sneezes. A person who has COVID-19 is able to transmit the infection during a pre-symptomatic or asymptomatic phase when they feel healthy. When a person feels healthy, they move around freely and are unaware that they may transmit the disease to others. Their ability to transmit is the same as if they were symptomatic. Modelling studies suggest that around 44% of infections are the result of pre-symptomatic/asymptomatic transmission.

2) WHO state: Wearing medical masks when not indicated may result in unnecessary costs and procurement burdens. Response: This concern is readily overcome by using cloth masks, which are effective when used in conjunction with physical distancing of around 1.5m. Cloth masks can be made at home at little or no cost. They do not need to be procured. The means that this vital barrier method for COVID-19 prevention is in everyone's hands. Currently all countries that advocate use of cloth masks emphasize that medical masks must be preserved for health care settings. 

3) WHO state: Masks create a false sense of security. Response: I have yet to see the evidence that results in this conclusion that can be inferred from research related to respiratory virus transmission in epidemic circumstances. This is a global pandemic. People are concerned about their health. One has to ask, where is the research that shows that people are risk averse in such circumstances? More to the point, countries advocate combining prevention approaches to improve protection. For example, promoting face masks with physical distancing and hand washing.

4) WHO state: Wearing a face mask would lead to the neglect of other essential measures, such as hand hygiene practices. Response: Why would this be so in the context of an epidemic/pandemic? Where is the evidence? Again, prevention in all countries focuses on combining methods, and people are well aware this is a serious disease. It cannot be inferred up-front that prevention of infection is not 'top of mind'.

5) WHO state: Using a mask incorrectly may hamper its effectiveness in reducing the risk of transmission. Response: Obviously this is a general statement. The very same point could be made hand washing to prevent COVID-19 or using condoms to prevent HIV. This concern does not invalidate promoting masks. Rather, it suggests that all behavioral measures, including those currently advocated, require consistent and correct use. But there are challenges too. For example, hand washing for 20 seconds is not feasible in many settings. At least a cloth face mask can be made at home by anyone, irrespective of their economic circumstances. 

To sum up, wearing cloth face mask is now widely considered to be an effective prevention measure when combined with physical distancing of 1.5m. Hand washing at key moments provides protection from transmission through touch contact with surfaces that may carry the virus.

As noted, a number of countries have used face masks at as part of their prevention mix from the outset. In East Asia, the use of surgical face masks was integral to bringing epidemics close to zero new infections in most countries. For example in China, Hong Kong; South Korea, Singapore, Taiwan and Japan, where face masks are mandatory in high density areas, on public transport, and when shopping or conducting other outdoor activities.

The following countries have introduced cloth face masks into their mix of prevention measures. Most include mandatory wearing of fabric face masks or cloth face coverings in close-contact settings or generally outdoors.

South Asia: India

Europe: Czech Republic; Slovakia; Bosnia-Herzegovina; Poland; Turkey Austria; Germany; Italy; Scotland

Latin America & The Caribbean: Mexico, Chile, Ecuador, Jamaica

North America: United States

Africa: Morocco, Kenya, South Africa;

In many countries, factories have been repurposed to produce cloth face masks. This is over and above homemade production.

There is an active global movement of homemade face mask production. Many of these initiatives fall under the masks4all banner which has the slogan 'I protect you, you protect me'. This highlights the importance of wearing a face mask to protect others from the possibility of infection in a situtaion where you may be unknowingly be infected with COVID-19.

All the best for your work on COVID-19 prevention

Interactive Radio Drama Online Training from Theatre for a Change

Interactive Radio Drama is a unique approach that allows audiences to call in and replace the main character in the story, to show what they could do differently to change the story for the better. It enables behaviour change and advocacy to happen on a large scale. In Malawi, we reach over 550,000 listeners through interactive broadcasts each week.

Theatre for a Change is currently working with the Malawi Government as part of their national response to Covid-19, using Interactive Radio Drama to disseminate key Covid-19 messages in participatory ways.

We are now offering online training in this approach to other organisations who are interested in using it as part of their comprehensive response to Covid-19.

Course structure

A. Condensed version – three half days of live interactive online sessions, plus group work between the sessions.

B. Full version – six half days of live interactive online sessions, plus group work between the sessions.

ED - For the full network submission with further details on this opportunity please access this link

The COVID-19 Communication and Community Engagement HUB
The Network for Shared Knowledge and Active Dialogue in Support of Effective COVID-19 Action

UNICEF with support from UKAid is influencing children in Malawi to practice 5 key actions to prevent COVID-19: frequent handwashing with soap, physical distancing, use of the flexed elbow when coughing and sneezing, avoiding touching the face (mouth, nose and eyes) and staying at home. Watch and enjoy: https://www.youtube.com/watch?v=CecQuh1nGM0 

For more information: cmauluka@unicef.org 

The COVID-19 Communication and Community Engagement HUB
The Network for Shared Knowledge and Active Dialogue in Support of Effective COVID-19 Action

Turning the ship around – adapting a long-term SBCC initiative to respond quickly to Covid-19.

PCI Media’s Ouro Negro programme in Mozambique

Covid-19 is forcing many communications organizations to adjust their Entertainment Education programs to address issues around the virus. Like many of you, PCI Media has been considering how to make best use of the assets we have, and the popular programming we already create with our partners.

In 2014, UNICEF Mozambique and PCI Media Impact began our collaboration to produce a radio-drama in Portuguese, an edutainment product to promote children’s and adolescents’ rights and well-being in the country. In 2015, broadcasting started on Radio Mozambique and community radio stations, with stories that address issues related to health, education, child protection and nutrition, among others. Since then Ouro Negro has become a very popular trans-media campaign based around the radio drama, re-purposing content in different formats (drama, live radio shows, theatre plays, etc.) and platforms (radio, television, social media, community theatre etc.), reaching different audiences, from young people to older, both rural and urban. The radio drama is now played on 116 stations every week, and 36 of the stations co-produce their own live call-in shows in 20 different local languages.

As with most complex drama series with many strands of messaging and levels of approval – Ouro Negro is written months in advance of broadcast – so when COVID-19 arose we wondered how we could respond. Fortunately, the many other formats are more flexible, so in discussion with UNICEF we came up with the following:

Special Covid-19 mini-drama series

A series of scenes were written and produced based on the popular characters from Ouro Negro, but focus on social distancing, prevention, hygiene, lockdown and more. We faced two big challenges. The first was getting rapid approval of the scripts and messages – which we did thanks to the long-standing partnerships and trust developed over many seasons. The second was producing the radio pieces while respecting the health and safety of the producers and actors. This involved recording voices one by one and disinfecting the various parts of the studio between each actor. Links to these audio pieces, uploaded to YouTube, can be found at the bottom.

Adapting the radio live show – the new Q&A programme

Ouro Negro ao Vivo – the live, local language call-in shows – have continued throughout the pandemic and usually focus on key issues within the drama episodes. In order not to break that flow, we essentially split the show into two parts – one where a health professional focuses on COVID-19 messaging and the other continues to address the long-running storylines and week’s issues. For the COVID-19 section we connected radio producers with local health personnel who answer listeners’ questions and concerns on air by phone. Our usual in-studio guests are also now taking part by phone.

Adapting the theatre – from community to radio

For some time, we have been adapting scenes from the Ouro Negro drama to highlight specific issues, and creating local language community theatre pieces from them. However, the middle of a pandemic is no time to bring together hundreds of people crowded around a village square to watch and enjoy a theatre show! While in lockdown, we have instead recorded the written theatre pieces for broadcast by our various radio partners. The pieces are produced in enough languages to reach large populations in the North, Centre and South of the country. Though there is no direct, live interaction with audiences which normally give the theatre shows their energy, audience feedback his achieved through calls and SMS to the radio partners, who can then respond live or by text.

Adapting the social media – balancing planned and emergency information

The programme’s popular Facebook page, with over 100,000 followers, has been beefed up with additional Ministry of Health-approved COVID messaging. We have emphasized the connection between existing drama stories and the pandemic, and have added links to all the audio pieces mentioned above. To keep the audiences informed about Covid-19 and entertained, we’ve adopted a strategy of separating our weekly posts between some dedicated to existing storylines from Ouro Negro, others dedicated to COVID issues, messages and questions. So far this mix of products seems to be reaching a large audience, which is accepting and understanding the COVID messaging well. Radio partner reports and Social Media response show that Ouro Negro is contributing to Mozambique’s very strong pandemic response so far – with a population of 31 million people there are currently only 115 confirmed cases and zero deaths.

For more information about PCI Media’s Ouro Negro programme in Mozambique, check the website or email Elena Colonna, Research and Messaging Manager 

Elena Colonna, PCI Media Mozambique