Ebola Outbreak, Sierra Leone: Communication Challenges and Good Practices

"Early messages designed to change the behaviour were counterproductive, as they failed to take into account deep rooted cultural practices and beliefs and context-specific difficulties. The most efficient messages were adaptable enough to be culturally and regionally appropriate, repetitious and available in relevant languages."

This is one of the key lessons learned outlined in this report discussing behaviour change communication and messages disseminated during the Ebola outbreak in Sierra Leone in 2014/2015. This report was produced by the Assessment Capacities Project (ACAPS) to identify lessons learned and good practice in community-led communication processes related to Ebola. The report focuses on: changing behaviours of the affected populations; developing channels for reaching communities; and identifying trusted actors for delivering information and adapting messages.

As part of the analysis, ACAPS identified messages that were disseminated during the crisis through a wide variety of materials, such as brochures, message guides, and strategic plans (a full list is provided in the publication). The report summarises the key findings as follows:

• "Increasing community-led communication and social mobilisation were instrumental in achieving behaviour change.
• Radio was the preferred means for receiving information for 85% of the population, followed by house-to-house visits, televisions and religious venues.
• The opinion of faith leaders was held in high regard. Mosques and churches became critical channels for the dissemination of Ebola messages.
• In a context of widespread quarantines and emergency measures that aimed to minimise large gatherings, mobile phones became a valuable tool to collect and share information with blocked off communities."

The report discusses behaviour change communication across the phases of the outbreak, highlighting aspects such as addressing early perceptions and fears, discouraging high-risk behaviours, and contributing to shifts in public opinion. According to the report, the period between October to December 2014 was characterised by increases in medical services, community mobilisers stepping in to support affected communities in taking action, and a series of wide-scale communication campaigns to inform the public, specifically designed to counter rumours and raise awareness of Ebola. As cases began to decrease, the focus shifted to community mobilisation and the empowerment of affected communities.

The report also outlines different kinds of communication channels used, such as radio, mobile phones, and face-to-face communication, comparing access and popularity before and during the outbreak. It goes on to discuss Ebola-related messaging, outlining guidance provided to stakeholders and how messages were communicated and adapted - particularly around the process for being treated when someone is sick and what to do if someone dies from Ebola. It was found that it was important for messages to be positive and engaging. "Early messages which were perceived as 'If you catch Ebola, you will die' became 'If you catch Ebola, you can survive'." Messages also needed to be developed to increase transparency and accountability, and counter false perceptions of corruption and misinformation. Similarly, later messages also incorporated the understanding that it was necessary to make messages more practical and credible, as well as more culturally appropriate.

The report identifies a number of lessons learned:

• Timing: Social mobilisation and the focus on "bottom-up" should have come sooner. "Some of the most successful initiatives were the ones that 'triggered' communities to assess the outbreak themselves, its effects and likely impacts, creating a sense of urgency to develop community action plans and change their behaviours."
• Telecommunication channels and media: In terms of channels, "mobile phones were a valuable channel to collect and share information with blocked off communities. As a result, practitioners should be trained to report effectively and responsibly through these channels and incorporate feedback mechanisms that encourage audience participation."
• Language: The research found that "information and messages about Ebola were first primarily available in English or French, leading to a gap in material which could be used as part of sensitization campaigns."
• Community leaders:: "Trusted members of communities serve as great role models for behaviour change. Significant improvements in community perceptions of key messages came when religious scholars were consulted to incorporate faith elements into public health messages, and provide examples from religious texts to support them."
• Gender:: "Preliminary data suggests that women died in greater numbers than men at the beginning and peak of the outbreak, in part due to their role as caregivers.. they were also less likely to access both telecommunication channels and traditional channels relaying information, and to be included in communication campaigns targeting community of faith leaders." More effort should be made to mainstream gender into health information campaigns.