Country and region: Sierra Leone, Moyamba and Freetown Western Area Districts

Organisation: Action Against Hunger (AAH)

Point person and Role: John Swaray, WASH Program Manager and COVID-19 Emergency Response Lead

Population served by the programme: 20,600

Unique characteristics of the setting: Crisis-affected (natural disasters and disease outbreaks) urban communities with a substantial part of the population living in informal settlements

Number of cases and deaths due to COVID-19 at time of publishing: 1,937 cases and 69 deaths

We have adopted a two-tiered risk communication approach that has been critical in improving knowledge about COVID-19 prevention measures and symptoms and has helped us to address misinformation. Our approach includes:

Mass-media campaigns: Our staff have worked with local radio stations to host discussions about COVID-19 and to develop jingles and public services announcements. We have complemented this with message sharing via public addresses. This involves broadcasting COVID-19 prevention messages from a vehicle in public places such as markets and bus stations.

Community outreach: This second component has built on our existing network of trusted local influencers and influential groups we have been working with since 2016. Local influences include a diverse group of people such as community leaders, religious leaders, health workers, traditional healers and community volunteers. Groups that we have engaged include women-led groups, support groups, and facility management committees. We are working with them to share information with others in their community about COVID-19. AAH have also been conducting Question and Answer Sessions (Q&A sessions) with communities. This involves engaging a group of 15 to 25 community members in a face-to-face (but physically distant) discussion and allowing them to ask any questions that they may have related to COVID-19. Three sessions are held each week in all of our 22 target communities by our Outreach Team, a group of 5 AHH staff members regularly trained on evolving COVID-19 evidence and guidance. These Q&A sessions allow our staff to provide tailored responses to communities in real-time, to identify the gaps or misconceptions that may be emerging so that we can take further action (programme adaptation, revision of our communication strategy), and to address the rapidly evolving context of the COVID-19 pandemic. To date, our team has answered a wide range of questions related to COVID-19 such as transmission, symptoms, risk perception, COVID-19 denialism and questions about the similarities and differences between Ebola and COVID-19. The Q&A sessions also provide us with an opportunity to remind the population about key preventive measures (such as handwashing with soap, physical distancing, mask-wearing) and encourage case reporting and health-seeking behaviours.

Our risk communication work complements the other components of our COVID-19 response including Infection Prevention and Control (IPC) measures within health care facilities, support for local surveillance systems and support for vulnerable households within communities (by distributing food and hygiene items and providing psychosocial support to 11,000 people).

AHH has designed our response in partnership with the Ministry of Health and Sanitation and with support from the AHH Headquarters. We have also involved staff from healthcare facilities and trusted community members in the design and delivery of many of our activities. We have set up coordination meetings between these key actors to enable coordination and adaptive programming.

The risk communication component of our programme has capitalized on our experience of working in this region previously on a sanitation and hygiene campaign. We complemented and adapted our approach based on the findings of a rapid Knowledge, Attitudes, and Practices (KAP) survey. One of the key insights from this survey was that there were widespread misunderstandings and misconceptions around COVID-19 and this prompted us to introduce the Q&A sessions as one mode of addressing this.

The Q&A sessions have proved to be particularly effective. Each session is delivered by our AHH Outreach Team of 5 members who are in charge of setting up a stall in a chosen public location and leading the discussion in conjunction with 2 trained local health facility staff members (2 staff members in each of our 22 target communities). Each session is an opportunity to have small-group discussions with diverse community groups (youths, women, etc.) and to engage with community members. We feel the Q&A process reduces the need for populations to independently search for COVID-19-related information. This minimises the risk of them encountering misinformation and instead allows them to access quality information in spaces where they feel comfortable asking questions and sharing opinions and feelings.

In Sierra Leone, there has been a lot of messaging and evolving recommendations around COVID-19 and communities are often confused about which advice or guidelines they should follow. We have faced similar issues in building our programme. For instance, we began by training 572 people within our trusted community groups on COVID-19. However, by the time the training was complete, new information had been released and communities were left with outstanding questions. The Q&A sessions have been a good platform to address this evolving context. To facilitate these sessions with quality we have provided more regular and up to date training to our outreach team which is comprised of our staff and 44 health facility staff. This helps to ensure questions are answered accurately and based on national guidance and evidence.

The initial KAP survey was used to inform the first Q&A session and to train our outreach team on questions they could expect to receive. To prepare for each subsequent session, we are getting our team to feedback summaries from each discussion so that we can identify new questions and issues raised by community members as well as new information or guidelines provided by the Ministry of Health and Sanitation. If a community member raises a question that our outreach team feels uncomfortable to answer, the question is discussed during our coordination meetings and an answer is brought back to the community in the following days.

Q&A sessions have, in themselves, been a feedback mechanism to engage the communities we are working with. They have given people space to share experiences, questions and comments regarding our activities.

These sessions have also become a key platform to adapt the other components of our programme to the needs of the communities. Through the Q&A sessions, we have been able to build up an understanding of the stress and trauma that is associated with COVID-19 pandemic. Now we are tailoring our mental health interventions to cover identified needs. We have also used feedback from the Q&A sessions to clarify our communication strategy promoting IPC measures and facility-based activities to our target communities.

We are planning to evaluate our risk communication programme, including the Q&A sessions, through a follow-up survey at the end of the year.

Image: Question and Answer session with community youths at Thompson Bay, Western Area Urban