Community-based education bridges the gap between institutional guidelines and local realities. It is an effective way to spread important health information as it more directly engages end learners.
Formally, governments play a leading role in spreading public health information. However, accessibility barriers and cultural mistrust in many marginalized communities prevent important messages from being received. This communication gap is one factor that amplifies health inequities, especially during an emergency like the COVID-19 pandemic.
This is where nongovernmental organizations (NGOs) and community-based education come in. NGOs are powerful facilitators of community-based education, and help ensure that information coming from groups with a broader focus, such as the World Health Organization and government agencies, reach and resonate in the communities they serve.
When COVID-19 began spreading around the world, we heard from our NGO collaborators in sub-Saharan Africa about their successes and challenges in reaching communities with critical health information. We quickly responded with our adaptable COVID-19 toolkit, designed to share evidence-based information in customizable, visual formats.
Along the way, we discovered a lack of research on the role local organizations play in disseminating health information during a global public health crisis, and how organizations like Digital Medic can support them.
Our evaluation team launched a qualitative study from May to June 2020, conducting semi-structured interviews with the leaders of 19 NGOs in Zambia and South Africa. Our goal was to better understand how these organizations were responding to the pandemic and to understand their needs in educating and supporting their communities.
Here are five themes we discovered in our interviews with NGO leaders:
1. NGOs intimately understand community needs during the pandemic
The organizations in our study serve a range of vulnerable populations and demonstrated a deep understanding of their needs during the pandemic. In addition to having extensive experience working in their communities, NGOs also have access to these populations for rapid needs assessments during times of crisis. This unique proximity allows NGOs to understand the concerns of their populations beyond immediate health risks, including economic impact, school shutdowns, and resource and infrastructure limitations.
“What we did in the early days of the lockdown is we developed a survey, and we actually contacted a lot of the familiar individuals we knew within the learning site to better understand their experiences of COVID.” – Interview participant and NGO leader
2. NGOs adapt to pandemic constraints to continue supporting vulnerable populations
In the wake of the pandemic, NGOs adapted their existing programs to operate remotely or with physical distancing. Since these organizations were already intimately connected with their constituents, they did their best to respond to immediate needs in new ways. For example, one organization responded to the food insecurity experienced in their community by starting a food bank initiative. Another organization supporting people living with HIV/AIDS acted quickly to ensure that they had adequate supplies of antiviral medication during lockdown.
“Women still need to go to their ANC [antenatal care] appointments. Kids still need to get immunized… And if that gets disrupted and if other organizations and institutions are solely just focused on COVID, COVID, COVID there’s going to be [many] gaps…and it will be difficult to regain that territory.” – Interview participant and NGO leader
3. NGOs play a unique role in educating the public about COVID-19 due to established access and trust within communities
Because of their established presence within communities, NGOs are well positioned to quickly provide health information to vulnerable and harder-to-reach groups. The NGOs in our study used combinations of social media, phone calls, text messages, posters, pamphlets, and radio announcements to reach their constituents.
Several organizations trained employees to conduct home visits when necessary. For example, one organization trained community health workers to conduct COVID-19 screening and education during home visits for people with disabilities. Another organization doing door-to-door visits found that many families had not heard of COVID-19.
Nearly all participants emphasized that in addition to tapping into appropriate distribution channels, they needed to account for local norms to increase the likelihood that information would be embraced. Organization leaders shared that among more vulnerable populations, including rural and migrant communities, there can be substantial mistrust in government and international sources. They emphasized the importance of leveraging trusted sources of information within communities, such as religious and traditional leaders.
Additionally, NGOs need strategies to combat misinformation. The majority of NGO leaders reported misinformation about COVID-19, either spread through word of mouth or through social media. Since local organizations are consistently connected with communities, they are aware of prevalent myths and motivated to dispel them.
“Making use of the tribal authorities – we’ve definitely found that it’s been a very powerful way of spreading messages. We started asking if we could have a say in some of the traditional meetings that happen and sharing stuff with the headman, and then they’ve shared it on with the community, and the [incidence] has gone [down] dramatically since those messages.” – Interview participant and NGO leader
4. NGOs are able to customize health education and information to address nuanced needs of local communities served
Few of the organizations we spoke with created their own COVID-19 education materials. Instead, a strength of local NGOs is their ability to adapt information from government or international sources, such as the World Health Organization, to fit the local language, culture, and needs.
To increase the likelihood that information would be embraced, NGO leaders described the need to customize information, not just through translations and simplification of language, but also in contextual ways.
Rural communities, migrant and refugee communities, low literacy populations, and people living with HIV and NCDs were groups described as often overlooked in educational content. People have unique needs, resources, and histories, and tailoring evidence-based guidance to their realities is critical for any desired health behavior change.
“None of it [COVID-19 education content] was really looking at COVID-19 in context. So, COVID-19 if you’re HIV positive, COVID-19 if you have an NCD, COVID-19 if you have mental health issues. I think you can’t really just talk about COVID-19 in our country without the broader context.” – Interview participant and NGO leader
5. NGOs need external support to effectively respond to the pandemic
Despite their ability to quickly adapt to emerging constraints, the participating NGOs described three needs: funding, technology support, and health expertise.
Organizations have experienced crippling economic circumstances, with many now operating on reduced revenue streams. Losses in funding have not only limited organizations’ ability to respond to the pandemic, but have also reduced their capacity to continue pre-pandemic activities.
“People can’t afford the mask. People can’t afford small things that are needed that we are telling them about. We’re preaching to people about the mask, but we’re not providing those things to the people. So it’s always good that what we are preaching, we should be in a position of providing people with that.” – Interview participant and NGO leader
The shift to remote communication increases the need for technology support, both in terms of greater access to the technology itself and support for using the technology. Participants expressed concern that the shift to digital communication brought on by the pandemic may exclude certain portions of the population. Even for those with mobile devices, data costs remain high.
Lastly, organizations cited a need for health expertise and guidance in deciphering and distilling what one participant described as an “information overload”, subsequently noting a desire for “just [the] relevant information appropriate to you and to your constituency”. Organization leaders also expressed concerns about the changing nature of health recommendations, and noted the need for education materials that can be easily updated as new information becomes available.
“[We are] basically drowning in information. There’s just too much. I guess [we would like] help around pointing us to those sources that are not your obvious ones that we have covered and… helping us as a find how we can add value in that deluge of information.” – Interview participant and NGO leader
While the COVID-19 pandemic is unique in the breadth and severity of its impact, these findings highlight the role local organizations can play in meeting the needs of the most vulnerable members of society during a health crisis, who are otherwise unreached by mainstream channels of health education. What has been emphasized is that without adequate support, many of these programs are at risk. External support in the form of funding and expertise is needed to sustain organizations’ impact within the communities they serve.