Country and region: Somaliland and Puntland, Somalia
Population served by the programme: More than 1.2 million people since mid-April 2020
Unique characteristics of the setting: In a country with a predominantly oral tradition and high levels of illiteracy such as Somalia, it is critical to ensure access to reliable information on COVID-19 to avoid potentially harmful misinformation. Over the last few years, both Somaliland and Puntland regions have been heavily affected by recurring natural disasters such as droughts and floods as well as waves of locust invasions since late 2019, threatening already fragile food security and WASH situations. Somalia only has 15 intensive care unit beds ranking 194th of 195 in the Global Health Security Index. Over one third of Somalis do not have enough clean water to meet their daily needs, let alone for more frequent preventive handwashing. Less than 44% have access to soap.
Number of cases and deaths due to COVID-19 at time of publishing (15 August 2020): 3,745 deaths and 99 deaths.
Briefly describe the key components of your COVID-19 response programme.
Since mid-April 2020, with the support of Oxfam, we have set up two COVID-19 hotlines hosted in call centres in the Ministries of Health of Somaliland and Puntland, Somalia. Our hotlines use an Interactive Voice Response system that we have specifically developed for the COVID-19 response. Our Interactive Voice Response system allows users to interact with our host system via their cell phone keypad and to be directed to the service of their choice.
People across Somaliland and Puntland can call the hotline, and can receive WHO-approved pre-recorded preventive messages on COVID-19, leave a message, or be connected to a health officer or a call centre agent, to be screened for symptoms by these professionals if necessary. If the person calling is identified as a suspected case, health officers and agents directly refer them to Ministry of Health medical staff.
Layout of the four main services proposed by our COVID-19 Interactive Voice Response system
With support from Somalia's largest telecommunication companies, we were able to make our calls toll-free for all consumers. To date, this has allowed our NGO to save around 60,000 USD. Around 1.3 million people out of the 2 million we are expecting to reach have called our two hotlines since we launched our programme in mid-April.
What process did you use when designing your COVID-19 response programme?
Early on into the COVID-19 pandemic, we were approached by the Somaliland Ministry of Health to support information campaigns on COVID-19. Shaqodoon is a local NGO founded in 2011 to create innovative and long-lasting solutions to youth employment challenges in Somalia and Somaliland. We run an innovation hub for young entrepreneurs and are also well-known locally for our work on digital feedback systems, employing innovative solutions such as Interactive Voice Response systems.
Myths and misconceptions related to COVID-19 were widespread in communities. For instance, people believed that outsiders and strangers were the cause of COVID-19 transmission in communities or that the disease results from the wrath of God falling only on wrong-doers in the society. Additionally, the disease burden was overlooked due to low numbers of confirmed cases, mostly due to lack of testing.
Alongside Oxfam, we proposed that the Somaliland and Puntland Ministries of Health set up in-house call centres and toll-free numbers. We favoured this option considering that cellular network coverage is wide, reaching even the most remote areas in Somalia, and that feedback hotlines are the most common and preferred feedback mechanism by communities.
Initially, we created COVID-19 messages covering both basic knowledge about the virus and the disease and tackling misconceptions. Our messages included COVID-19 transmission, preventive measures, symptoms and appropriate health-seeking behaviours. We then designed the Interactive Voice Record system used by the call centres.
What is one thing that has been working really well so far and is there something other programmes could learn from this?
The set-up and organisation of our call centres has been one key factor for success. Our hotline is a 24-hour a day, 7-day a week service where callers can have direct over-the-phone contacts with health professionals who have been specially recruited for the programme. It allows both rural and urban populations, regardless of their literacy level or internet access, to benefit from accurate information and tailored answers to their questions. For instance, using our hotline, a 70-year woman was able to report her difficulties breathing overnight. She was immediately referred to the nearest health centre by an agent and was able to receive appropriate care until recovery from COVID-19.
By supporting the set-up of the call centres in the Ministries of Health and training their staff, we have also ensured the Government remains the primary focal point of all COVID-19 programmes, thereby promoting social accountability. The Ministries receive daily suspect case lists (for testing and assistance) as well as daily or weekly reports about call centre statistics. We have also set up an online, individual password-protected dashboard that is only accessible to selected Ministries’ staff and call centre agents, to ensure the protection of callers’ personal data.
To date, more than 1.3 million people have called our hotlines, confirming the huge demand for trustworthy information on COVID-19 and widespread concerns related to the virus and its health and societal implications.
What is one challenge that you have encountered and how are you trying to overcome this?
Our NGO, call centre agents and Ministries of Health have access to callers’ personal information and messages. This is sensitive data we are obliged to protect. To ensure adequate protection of this data, Oxfam has developed risk analysis frameworks and has trained the Ministries and call centres on safe programming and responsible data management.
We are also facing the challenge of COVID-19 complacency. While most COVID-19 restrictions have been lifted in Somalia and the number of confirmed cases has decreased significantly, many people feel that the virus has vanished from Somalia. We have decided to adapt our pre-recorded messages and further raise awareness via our hotlines to maintain people’s vigilance and promote continuous practice of preventive measures.
How have you been engaging communities throughout your programme and what feedback have you received?
We use our hotlines to gather feedback from our users. For instance, callers who cannot be connected to a health officer or an agent, are encouraged to leave a message and ask their questions, so we can call them back with tailored answers meeting their needs. Feedback we have received has allowed us to refine our COVID-19 messages and communication strategy, especially around tackling misconceptions and misbeliefs.
Detailed layout of the different pathways and services a user can access when calling our hotline.