OpenWHO.org 1 ©WHO2017

Joint Consultation

Health emergencies and social science

interventions: scope and needs.

10:00 – 10:45

Speakers:

Maria van Kerkhove (WHO)

Ketan Chitnis (UNICEF)

Juliet Bedford (Anthrologica)

Amrita Gill Bailey (JHU)

Rob Butler (WHO)

Facilitator:

Gaya Manori Gamhewage

MERS-CoV: Opportunities for Social Science

Maria Van Kerkhove, PhD MERS-CoV Technical Lead, Infectious Hazards Management,

World Health Organization Health, Emergencies Programme

June 2017

MERS-CoV: What we know

Since 2012, >1950 cases reported from 27 countries, >693 deaths

3

• Signs and Symptoms

– Symptoms are non-specific: range from no symptoms to severe pneumonia and death

– Typical signs/symptoms include headache, fever, fatigue, mild cough, Sore throat , Runny nose and shortness of breath; but may include gastrointestinal symptoms

• Severity: Approximately 35% of reported cases have died, but this may be an overestimate

– Many people with MERS have underlying chronic illnesses such as diabetes, renal failure, immune disorders

• The majority of cases have been reported in adults

• Males are currently more commonly affected (66%); median age of reported cases is 52 years

MERS Characteristics and diagnostic challenges

Limited surveillance/studies likely high seroprevalence of dromedaries = spill over risk

MERS-CoV Transmission Patterns

Opportunities

• Questions being addressed through engagement in non-emergencies

– Exposures resulting in infection

• In the community – from contact with dromedaries

• In health care settings

– Contact and cultural practices related to dromedaries, perceptions, fears, restrictions

– Health care seeking behaviors, concerns and barriers

– Potential use of (future) medical interventions

Reflections from the yellow

fever response in 2016 Immediate and long-term C4D/risk communication &

community engagement implications

Ketan Chitnis, PhD

UNICEF New York

UNICEF

Type your title in this FOOTER area and in CAPS

Complementary preventive

measures against Yellow Fever

Using insect repellent

Wearing protective clothing

Mosquito control esp. where vaccination coverage is low or

the vaccine is not available

• Integrated mosquito control - eliminating breeding sites; killing

adult mosquitoes and larvae by using insecticides and larvicides in areas with

high mosquito density.

• Community involvement critical

Angola and DRC

2016 YF Outbreak -

30 million vaccinated

Epi & Context • Angola –4,347

suspected cases, 377

deaths (884 confirmed)

• All 18 provinces,

autochthonous in 12

provinces

• Luanda province (epi-

center) – dense urban

and peri-urban population

• Most infected were males

(~70%)

• DRC - 2,987 suspected

cases all 26 provinces

• 78 confirmed cases,16

deaths (CFR: 21%);

• 57 acquired infection in

Angola, 13

autochthonous, 8 sylvatic

transmission.

• Cross-border issues,

• Urban & Rural context

• Widespread outbreak

UNICEF

An example of targeting

communication from Angola

Rapid KAP study conducted by CDC &Partners

• Describe practices and knowledge among men about yellow fever

vaccination in Luanda

• Identify demographic differences between vaccinated and

unvaccinated men

• Describe attitudes and barriers to vaccination of unvaccinated men

Recommendations to guide vaccination and social mobilization

efforts during the outbreak

UNICEF

1/3 of the men interviewed were not

vaccinated & reasons for that

UNICEF

Type your title in this FOOTER area and in CAPS 0% 5% 10% 15% 20% 25% 30%

Razões religiosas

Não pode beber álcool

Não sabe que tem vacina

Acha que tem que pagar

Não motivado

Não sabe onde se vacinar

Estava doente ou já estava

Estava viajando

Não quer esperar na fila

Acha que é perigosa

Não tem tempo

Key recommendations

Targeting men as key audience to reach out to

needed as medium to long term goal – men are part

of the target group in this response and in the future

Address rumors of fake vaccines and vaccines that

cause disease or death

Areas with low levels of understanding,

complement radio with community-based

approach

Diversify the forms of communication (music)

Supply - Simultaneous campaigns to avoid long

wait time & where to get vaccinated if missed UNICEF

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Implementation: social context

• Resistance towards vaccines in some places.

• Logistical challenges: megaphones, transport, internet to transfer daily

report etc

• Limited technical capacity of newly recruited mobilizers

• Low motivation of community health volunteers - they are not paid on

time

• Competing messages: Stop malaria, Voter Registration & National

Election Congress!!

UNICEF

Type your title in this FOOTER area and in CAPS

On-going response/future

considerations

• Vector control recommended as a medium to long-term response

• Continued vaccination as part of routine immunization

• Urbanization and climate change considerations

• Dual approach – urban/rural such as in DRC/ – cross-border

Angola/DRC

• 2017 campaign as an immediate response based on lessons from

2016

UNICEF

Type your title in this FOOTER area and in CAPS

.

Wellcome and WHO joint consultation

8-9 June 2017

julietbedford@anthrologica.com

Integrating social science interventions in epidemic, pandemic and health emergency

response

Juliet Bedford PhD

Value of social science

Well recognised

Advocacy

Operationally significant

Evaluation – resource mobilisation (effectiveness, efficiency, VfM)

Scope - preparedness

Pre-positioning – don’t work in a vacuum

Knowledge resources

Geographic

Thematic

Pathogen

Context

Human resources

Network (global, regional, country, sub-national)

Virtual / permanent

Deployable / surge

Tools

How to operationalise expertise / prioritise

Architecture of a response

Link with other technical expertise

Scope - emergency

Rapidly mobilise existing structures (network – knowledge and people)

Crowd source

What we know becomes backdrop for emerging issues on the ground

Methods and tools for identifying, tracking and reporting

Fit into operation

Transfer of knowledge

Digestable products, breifings

Timely

Internal / external perspective

Within / across a response

Scope of emergency / type of response

Need

Mechanisms for collegiate working

Sharing knowledge, data and analysis

Avoid duplication of effort

Knowledge, Attitudes and Practice surveys

Zika virus disease and potential complications

Resource pack

English

Spanish

Portuguese

Chinese

Arabic

Russian

http://www.who.int/csr/resources/publications/zi

ka/kap-surveys/en/

KAP resource pack

Guatemala

El Salvador

Honduras

Zika interactive map.

Dominican Republic

Scope and need

Integration of social science:

Design response to be more effective and efficient

Right information, conveyed at right time, in right way

Target resources

Most effective when built into strategy – contexts

Improving Public Health Emergency Response Programs through SBCC

Amrita Gill Bailey

June 8, 2017

Ebola Virus Disease in the Mano River Region

• Individual/community level challenges – Lack of awareness of methods of transmission of EVD – Lack of understanding and practice of EVD preventive behaviors including handwashing

and safe burial

• System level challenges – Low quality of care – Inadequate training in EVD response including preventive behaviors

• Supportive environment challenges – Lack of Coordinated Response – Lack of consistent and timely messages – Weak communication feedback

Social Science / SBCC Interventions

• Support the Liberian MOHSW in developing and coordinating harmonized messages and materials including community radio

• Strengthen capacity of and support MOHs in the Mano River Region on working groups in message and materials design and research and evaluation

• Coordinate the sharing of information and resources through the Ebola Communication Network

• Develop tools and resources to assist national governments to better respond to and mitigate a public health emergency.

The SBCC Emergency Helix

Foundational Concept Relationship Between Health Systems and Communities

Applications of the Helix during an Emergency: Liberia

• PREPARE – Strengthened the Social Mobilization Pillar within the National Incident Management System

(IMS)

– Established feedback loop with communities, with Red Cross volunteers, using the RapidPro SMS platform

• INQUIRE – Conducted rapid formative research- “Listening Exercises”, GeoPoll surveys, KAP surveys

• MOBILIZE – Developed materials to engage with communities and the media- training packages for

gCHVs, message guide, radio spots

• SUSTAIN – Monitor implementation, Refresh materials, continue “Dey Say”

• ADAPT – Revise message guide and materials to respond to new developments and results of rumor

monitoring

• REFLECT – Reviewed lessons learned and shared results in a wide variety of fora, participated in the

lessons learning process with other partners to share experiences across organizations

• EVOLVE – Developed a recovery strategy, to focus on re-building trust in the health system, based on

review of the landscape post Ebola, included mass media campaign, expanded community mobilization materials for gCHVs

Applications of the Helix before an emergency: Tanzania

• PREPARE – Establishment of a Social Mobilization Pillar within the National Emergency Operations

Center (EOC)

• INQUIRE – Reviewed literature in preparation of the Emergency Risk Communication (ERC) Strategy

• MOBILIZE – Developed ERC Strategy

– Developed training packages for ERC for Regional and District Health staff

• SUSTAIN

– Designed monitoring system, including rumor monitoring

• ADAPT – Plan to engage Social Mobilization pillar in the revision process

• REFLECT – Plan to conduct a lesson learning process

• EVOLVE – Will depend on strengthened coordination mechanisms to assess landscape post-

emergency and to develop the recovery activities

Step-by-step guidance, worksheets and examples to:

• Integrate SBCC into overall preparedness strategy

• Prepare to engage affected communities

• Prepare to detect rumors

• Prepare to address desired behaviors

http://sbccimplementationkits.org/sbcc-in-emergencies/

SBCC for Emergency

Preparedness Implementation

Kit

Recommendations

• SBC needs to be an integral part of the emergency response at the national, regional and community levels

• SBC interventions need to be coordinated, harmonized, timely and culturally appropriate.

• SBC interventions need to be linked to service delivery to better ensure uptake of individual/community preventive behaviors

• Engaged and involved communities are critical to a public health emergency response.

Ebola Preparedness Implementation Kit

Key considerations and a roadmap to: • To implement critical, timely

communication for responding to Ebola

http://sbccimplementationkits.org/ebola/

Additional Resources

Ebola Communication Network

Online collection 350+ Ebola resources to: • Access SBCC materials

• Access Demographic and Health Surveys

• Access Peer reviewed journal articles

http://ebolacommunicationnetwork.org/

Also in: French, Spanish, Portuguese

Zika communication Network

Growing collection of Zika prevention resources to access: • SBCC materials

• Vector control guidance

• MCH and FP information

• Research and development

http://www.zikacommunicationnetwork.org/

Also in: French, Spanish, Portuguese

Strategic Communication Framework for Zika Prevention

Strategic Communication Framework for Zika Prevention

Guidance and illustrative content to: • Understand the evidence

• Develop a conceptual model

• Adapt the framework

• Communicate accurately and effectively

Also in Spanish

https://healthcommcapacity.org/hc3resources/strategic-communication-zika-prevention-framework-local-adaptation/