Recovery, Renewal, Resilience

TMB Issue 38 discussed the importance of community involvement in tackling disease outbreaks and presented the recommendations set out by the Independent Panel for Pandemic Preparedness and Response. This briefing offers examples of good practice in community participation during the COVID-19 pandemic. Consider:

• Tanzania: local government co-produced infection control measures with business leaders based in markets to integrate leaders’ understanding & knowledge of the challenges of implementing such measures
• Nigeria: the “community informer model” was employed by local authorities for COVID “surveillance, tracing and monitoring” – community informers are key trusted individuals in a community (e.g. faith leaders)
• Pakistan: community volunteers “set up quarantine wards, manufactured and provided free protective suits for medics”, and distributed food to vulnerable people
• India: Community volunteers came together to investigate and identify unknown (“hidden”) COVID-19 fatalities. The volunteer group comprised of expert physicians and data analysts who developed comparisons of official health data and other reports. This encouraged a review of the national death audit process and resulted in improvements in the process so that COVID-19 deaths were accurate and transparent
• USA: Volunteers built a public “Testing Site Locator” app which visualized the geographical location of testing centres to support collection of testing centre-related information and dissemination at the national level. This supported people to locate the nearest available testing centres and also the “health system to plan and distribute centres more effectively”

The pandemic, and previous disasters, have evidenced that communities play a crucial role when preparing for, responding to and recovering from, crisis. Communities and civil societies should be “partners early on in the design, planning, implementation, and assessment of preparedness and response efforts on all levels”, particularly at the local level. We have covered community participation and co-production with communities in various briefings, see TMB Issue 38; Issue 34; Issue 33.

There has recently been a new spotlight shone on the impact that communities have had on their local response. A key message from the UK’s Integrated Review was the need to build whole-of-society resilience through enhancing capabilities in local resilience (see a recent TMB case study). TMB has often highlighted the renewal of community resilience through building a Local Resilience Capability (TMB Issue 30, as well as Briefing A in this current issue). Communities are being seen in a new light in local resilience.

This has been further identified in a paper by the Independent Panel for Pandemic Preparedness and Response, titled ‘Centering communities in pandemic preparedness and response’. This paper emphasizes the importance of community involvement in tackling disease outbreaks and advises of the need to:

• Establish partnerships to work with communities to design, plan, implement and monitor local and national pandemic preparedness and response, for example:
  • In Sur, Oman, the city government developed an intervention of response in partnership with civil society (e.g. community sports clubs, the Omani Women Association, youth groups and voluntary organisations). These groups supported activities to “arrange, maintain, and supervise” pandemic response activities
• Improve community engagement through “clear structures and sustained funding”, recognising that continuous effort is needed (not just a one-off effort during crisis). This can help to develop trust between communities and official service providers
• Recognise that risk communication is key to community engagement, and one part of local resilience capabilities: two-way, bi-directional and co-produced communications are essential to understand needs, communicate responsibilities, and gain feedback (see TMB 37 ‘Risk communications as part of the Local Resilience Capability’)
• Community resilience requires a “sustainable framework for community empowerment and recovery”, including:
  • “Invest in civic mindedness” to establish a culture of social connectedness and empower communities to take responsibility through co-production to understand risk preparedness, response and recovery
  • Establish partnerships between governments and community-based groups/voluntary organisations/businesses to integrate communities into the planning and leadership of interventions that enhance their local resilience
  • “Invest in social and economic wellbeing, and in physical and psychological health” to ensure access to health services

Effective risk communication is central to public health risk management, so that people can make informed decisions and take the correct actions to "prevent, mitigate and recover from emergencies". It enables real-time access to, and exchange of, reliable information. However, the sheer scale and pace of COVID-19 led to an uncoordinated overload of sometimes inconsistent information, so people were unsure about the severity of risk, and therefore behaved according to their individual perception. There has also been a surge of misinformation throughout the pandemic, which has undermined national and local health responses globally.

Consider:

• A review of risk communication strategies employed during the pandemic, to identify what worked and what could be improved for future emergencies
• Build risk communication capacity by appointing dedicated risk communicators at national and local levels, to maintain consistency in communications and develop a sense of familiarity among the public, which can build trust
• Identify the stakeholders in disseminating risk information (e.g. media) and assess the strength of the relationships with stakeholders. Identify how collaboration and coordination can be enhanced so that the information disseminated is ‘timely, accurate and transparent’
• Tailor risk communications to the specific risk and needs of diverse communities
• Engage with the community to co-develop risk communication support structures and establish accountability of community members for required behavioural change
• Use social media to track (through data analytics) and counter misinformation, and develop a narrative of solidarity through crisis (UN Sri Lanka)
• Establish a central risk management coordination platform that consolidates risk information and forecasts other potential risks (e.g. concurrent emergencies such as severe flooding). This can enhance capacities and capabilities to provide strategic interventions, and minimize further social and economic impacts (Dominican Republic)
• Acknowledge and communicate uncertainty in clear and unambiguous language to avoid misinterpretation, e.g. use scientific evidence to estimate the likelihood of COVID-19 case resurgence as precisely as possible, and avoid language such as ‘probably/possibly’
• Regularly gauge and monitor the public perception of risk, through surveys and consultations with public bodies such as police, to inform timely action to prevent lax or panicked behaviour
• Evaluate and update risk communications regularly to account for developments (e.g. vaccination)

Consider:

• How digitization can facilitate capacity for longer-term economic recovery. For example, in Nigeria, Egypt, and South Africa, increased migration from cash to digital transactions has resulted in more account-to-account transfers and e-commerce sales which boosts economic activity and maintains social distancing
• The role of digital-payment platforms in increasing financial inclusion outside of traditional banking systems e.g. in Togo through cash transfers that disburse social welfare payments through mobiles
• Collaboration with banks and non-bank payments players to restructure transaction fees and limits to encourage digital payments
• Promoting easier access to digital-payment tools e.g. the Ghanaian government eased account-opening regulations

From many examples, internet and smart phone applications are playing a critical role for communication, awareness-raising, teleworking but also learning and skills development. Online platforms should test how good their systems are, collect feedback, and improve their products - because many of us will never leave these platforms after discovering their utility.

Local government should analyse their local communities by disaggregating all data collected by important characteristics (e.g. sex, age, and disability) to ensure that they can target those communities appropriately. Information should then be provided in a format and manner that makes it accessible to all, accounting for vulnerabilities in the community. Local government should consider IFRC Guidelines on this to support vulnerable people.

Local government should disseminate information in appropriate formats to ensure all communities receive information that is accurate and helpful to them. This will involve mapping community groups to understand their: individual characteristics; information needs; effective channels; appropriate languages and presentation.

Local government should help the public to access public health information and consider the effectiveness of different ways that public health information is disseminated. An 'information for all' approach is needed so that those with disabilities are included. This may include translation of information into brail, use of audio information, and signed videos for the deaf community.

Local government should provide additional psychosocial support for stigmatised or marginalised groups, those with underlying health conditions, and those that may be part of a marginalised group and have a health condition (i.e. those living with HIV).