Country and region: Ethiopia – Oromia, SNNPR, Dire Dawa and Benishangul Gumuz regions

Organisation: International Organisation for Migration Ethiopia (IOM Ethiopia)

Point person and Role: Nadia Kevlin, Hygiene Promotion and Community Engagement Officer

Population served by the programme: Between January and August 2020, IOM reached 707,472 adults and children with hygiene promotion messaging.

Unique characteristics of the setting: IOM’s intervention is focused on internally displaced persons (IDPs) and returnees who were previously displaced and have now returned to their home communities, in most cases in rural areas. The majority of people are integrated into the host communities, but in Dire Dawa and East Hararghe IDPs and returnees live in camp-like settings.

Number of cases and deaths due to COVID-19 at time of publishing: 68,820 cases and 1,096 deaths

Briefly describe the key components of your COVID-19 response programme.

Since the start of the COVID-19 pandemic in Ethiopia, we have aimed to develop and deliver a demand-driven integrated COVID-19 response for IDPs and returnees, by ensuring a strong collaboration between the different departments of our organisation. We have, for instance, supported the decongestion of IDPs’ sites, the management of returning migrants during their quarantine period in collaboration with the government, and healthcare facilities.

Our COVID-19 response focuses on four main activities:

1) Hygiene promotion delivered by around 150 community workers in different regions of the country

2) Rehabilitation of institutional latrines: currently, five institutional latrine rehabilitations are in process

3) Distribution of soap and handwashing facilities: to date, more than 25,000 people have received soap, and more than 1,500 handwashing facilities have been distributed

4) Creation and distribution of Information, Education and Communication (IEC) materials, notably targeting children

Our hygiene promotion activity is based on group discussions with religious leaders and water committees’ representatives and we have also engaged hygiene promoters to visit households to discuss hand hygiene with IDPs and returnees. Using the resources developed by WASH’Em, hygiene promoters demonstrate different handwashing options, for instance using laundry powder mixed with water, and encourage people to build their own handwashing devices.

We have developed our activities to focus on specific tools and approaches to target children. Since the nation-wide closure of schools in Ethiopia in April 2020, educational activities have been done at the community level rather than at schools. We have developed two sub-activities to support communities in delivering appropriate COVID-19 educational content.

First, our hygiene promotion team has been using puppets – depicting a child and the SARS-CoV-2 virus – to teach about transmission and preventive behaviours in a “child-friendly” approach, for example, giving practical tips on how to refuse to shake someone’s hand politely. This activity has been delivered in physically-distant small group settings.

Children assist to puppet-shows about COVID-19: puppet represents the SARS-CoV-2

Second, our Mental Health and Psychosocial Support (MHPSS) team created a children’s colouring book providing messages about COVID-19 both from both mental health and hygiene perspectives. This colouring book was designed by a local artist with support from both the Hygiene Promotion and the Site Management Services Teams, demonstrating the effectiveness of integrated approaches to programming. Both these IOM teams have also been involved in the distribution process to several thousands of children.

What process did you use when designing your COVID-19 response programme?

Our programme started in areas in which IOM was already doing WASH programming for the past two to three years, as well as newly identified areas. One of the main challenges we faced was to adequately assess the on-the-ground situation while movement of people was limited to essential services to limit the risk of exposure to COVID-19. We therefore used our existing knowledge about the communities as well as previously conducted Knowledge, Attitudes and Practices (KAP) surveys to initially suggest activities, but we also sought out opinions of religious leaders, water committees, and vulnerable groups of people such as people with disabilities. This preliminary assessment was key in understanding the challenges faced by people with disability in the COVID-19 pandemic, and led us to design activities tailored to their needs. To help us inform our Hygiene Promotion response, the MHPSS Team conducted a survey with parents about their children’s fears about COVID-19. Other “mini-assessments” were also conducted, including questions about COVID-19 associated myths circulating in communities.

Our programme was also designed to reflect and integrate our day-to-day learnings from the community. Our staff check in with all the community workers on a regular basis, either in person or on the phone, and communicate any feedback, as well as specific questions or misconceptions collated from the community. Based on their experience talking with community members, all promoters and fieldworkers were also encouraged to provide ideas to improve our programmes, and we continue to adapt and add new activities and messages in response to this feedback.

What is one thing that has been working really well so far and is there something other programmes could learn from this?

Approaching children using puppets and games has worked really well. Our hygiene promoters have reported that children seemed much more engaged and interested by the topic and could retain information better compared to when messages are given in a more formal way, for instance through household visits.

For our hygiene promotion activity, we moved from our previous approach (group discussions with all community members) to focus on discussions with religious leaders and water committees’ representatives. This decision was motivated by the need to avoid large gatherings, and evidence that community leaders are key drivers of change within their community and can influence others’ beliefs and behaviours. Engaging with water committees has proven to be highly effective, and has allowed us to have an overview of the specific needs of each community and to coordinate our different activities on the ground to have the most impact. For example, in conjunction with the water committees, we organised behavioural observations and hygiene promotion messaging directly at water points to propose tailored advice to each individual.

Finally, our strong collaboration with other teams inside IOM Ethiopia has greatly contributed to our capacity to address cross-cutting issues, to provide a coordinated and integrated COVID-19 response, and to reach a wider audience with our messages.

What is one challenge that you have encountered and how are you trying to overcome this?

In most communities, IDPs and returnees declared that some of the COVID-19 mitigation measures they were asked to observe were not possible to follow due to their current living conditions or resources. Our hygiene promotion team reported that many people therefore felt defeated or unable to participate in the discussion due to this.

We have tried to address this challenge by helping each household or group of people to define a “step-by-step” doable course of action. For example, most returnees and IDPs reported not being able to keep a physical distance with their family members or neighbours due to their living conditions. We advised them to try maintaining physical distancing with people living in other areas of the community or the settlement. We suggested they use scarves they already have to cover their mouse and nose if they are not able to afford to buy facemasks.

In addition, COVID-19 denialism and doubts about the severity of the disease are widespread among these communities, diminishing people’s commitment to observe mitigation measures. IDPs and returnees are also expressing their fear about being put into isolation centres if they show symptoms, impeding the work we are also doing in quarantine centres. Our Risk Communication and Community Engagement (RCCE) and hygiene promotion work has tried to address these misconceptions and fears, but it is difficult to measure independently the direct impact of our messaging on people’s beliefs and compliance with preventive measures.

How have you been engaging communities throughout your programme and what feedback have you received?

Our hygiene promotion team has focused on engaging with community and religious leaders, as well as community members on a regular basis. In addition, we have worked closely with local authorities to gather feedback at all levels, from the community members to the local authorities.

Feedback we have received following delivery of our activities has been mostly positive. Regarding our child-focused sessions with puppeting and games, parents reported being happy for their children to take part. They also reported their children to be extremely excited about the colouring book, as most have not previously owned items such as crayons and leaflets. Our household visits and messages around building handwashing devices were also positively received. In West Guji and Gedeo Zones in southern Ethiopia, the community workers and field staff observed that a large proportion of returnees and host communities had built their own handwashing facilities using either oil containers (tippy-tap design) or empty plastic water bottles.