Challenges

During the COVID-19 pandemic in Sierra Leone a decrease was experienced in patients/clients attending health facilities to access essential services, such as those for maternal and child health, immunization, family planning, etc. Clients often believe that if they go to health facilities, they will get infected with COVID; unfortunately, this means that more mothers and children could die from preventable deaths.

Sierra Leone was already grappling with the challenges of maternal, newborn and child mortality prior to the COVID-19 pandemic, and a concern arose that if mothers and children did not continue accessing essential services maternal, newborn and child health indicators could further deteriorate. COVID-19 is more than a health crisis; it is also an information and socio-economic crisis. Under these circumstances, there was an unprecedented need to elevate the role of risk communication and community engagement (RCCE) to break the chains of transmission of the virus and mitigate the pandemic’s impact on communities, including children. Gains in maternal and child health could be reversed if people did not receive accurate information, while appropriate and efficient dissemination of information gives people courage and confidence to continue positive health seeking behaviours even during the pandemic.

Toward a Solution

Civil society organizations (CSOs) can play a critical role in engaging communities, raising awareness and bringing desired changes to health behaviours. In Sierra Leone, UNICEF, in partnership with the government, collaborates with CSOs in various RCCE activities. Sierra Leone CSOs had been successful in creating awareness among communities during the Ebola outbreak in 2014-2015, which helped stop the outbreak in a timely manner. In collaboration with UNICEF, CSOs in Sierra Leone are now using their rich experiences and lessons learned during the Ebola outbreak to help communities learn about COVID. Similarly, China has been successful in responding to the COVID-19 crisis and Chinese CSOs played an important role supporting the government in this endeavour, including creating awareness in communities and engaging them effectively during the COVID crisis. 

With this backdrop, UNICEF, together with the China NGO Network for International Exchanges (CNIE), organized a virtual session to support CSOs in China and Sierra Leone to share knowledge and practical experiences in preventing and controlling COVID-19. More than 30 practitioners participated in the exchange, including representatives from CSOs in China and Sierra Leone and a Chinese medical team in Sierra Leone. 

The participants discussed the critical role of CSOs in RCCE, sharing examples of using digital, radio and interpersonal platforms and social media and engaging youth volunteers, traditional leaders and other influencers to raise public awareness for positive behaviour change in the context of COVID-19. The practitioners stressed the importance of evidence and data in shaping these approaches. The exchange facilitated knowledge sharing across CSOs and inspired all to explore more opportunities for in-depth South-South cooperation for emergency and development programmes in the best interests of children. For example, Sierra Leone’s innovative RCCE approaches and experiences that were shared included: 

• CSO engagement with a focus on interactive radio programmes (60 radio programmes at national and district level reached 3.2 million people);
• empowerment of community structures through training and capacity development led to better local governance and social accountability; and
• creation of the “Kombra Network,” a social group of inter-connected community-based actors that engage and support families and communities to provide care for children; the network comprises religious leaders, market women, traditional healers, youth representatives and media practitioners to facilitate action planning and advocacy.

Since 2020, the CSO engagement methodology in Sierra Leone has yielded impressive outcomes, including: 6,602 social and community mobilizers oriented and engaged across 16 districts; over 4 million people reached with life-saving COVID-19 related information and essential services through remote and direct engagement; and 1,115 communities supported for participatory response. As of July 2020, more than 96 percent of the target population knew at least three symptoms of COVID-19 compared to 88 percent in May and people were more willing to take prevention and control measures, like washing hands more often and going to health services if they have symptoms. 

Some lessons learned from CSO engagement in China and Sierra Leone include: 1) community engagement is critical to build and maintain trust and confidence in the delivery of health care services in health emergencies and for reduction of community transmission; 2) policy and guidelines for community engagement in health emergencies should be formulated to clarify roles and responsibilities and support coordination; and 3) use of community data and feedback should be strengthened for dissemination processes of data and participatory assessments. 

Building on the successful experience of the exchange between CSOs in China and Sierra Leone, UNICEF and CNIE will explore opportunities for additional knowledge sharing under the framework of South-South Cooperation and engagement with CSOs for the benefit of children in China and countries in Africa. Partnerships and interactions between international CSOs through South-South and Triangular Cooperation could be highly participatory. The CSO engagement approach has the potential to be transferred to other Southern countries, especially where there is a growing demand for more formalized and integrated interventions to facilitate communication and community engagement. CSOs, as active actors more than ever, can contribute their respective strengths towards COVID-19 prevention and control, as well as humanitarian and development programmes more broadly, for the benefit of children and communities.