Social Mobilization in Public Health Emergencies: Preparedness, Readiness and Response

"Lessons learned from dealing with past infectious disease outbreaks have shown that an outbreak is brought under control only when communities actively participate in control and prevention activities, and are ready to adopt and sustain preventive and mitigation behaviours."

This report describes the objectives and outcomes of a meeting held in Geneva, Switzerland, from December 10-11 2009 that explored social mobilisation/communication interventions as one of the core pillars for disease outbreak alert, readiness, response, and control. Social mobilisation/communication for behavioural impact (COMBI) interventions draw on participatory approaches, viewing affected communities as partners in finding solutions to control and contain the outbreak. The Global Alert and Response Department (GAR) provides technical and operational support to Member States through World Health Organization (WHO) country and regional offices. To help inform and guide the GAR's COMBI activities in the context of risk management, the meeting brought together a small group of experts in public health communication to review and discuss current opportunities and tools for addressing the cognitive, sociocultural, and organisational factors likely to influence the uptake of prevention and control measures in public health emergencies.

The meeting stressed that there is a general under-appreciation of the importance of human behaviour - which often drives epidemic emergence, transmission, and amplification - in responding to and managing public health emergencies. For instance, social-mobilisation interventions have been particularly important in disease outbreaks where medical interventions do not exist. In these circumstances, public health measures have concentrated on identifying local risk factors to minimise exposure and reduce infection, followed by vigorous health-information campaigns to raise awareness and educate people about the measures needed to protect individuals, families, and communities. According to meeting participants, human behaviour is critical to epidemic prevention, response, and management, and this imperative must be explicitly articulated. As such, public health communication interventions in emergencies should demonstrate an in-depth understanding of the needs of people, communities, and agencies, as well as a solid grounding in communication theories and planning frameworks encompassing multiple disciplines (behavioural study, anthropology, psychology, communications) and strategies.

One theme emphasised at the meeting was that public health communication should be a planned multilevel and multifaceted process and not view affected/at-risk groups and communities as ready sources of information and recipients of instruction and advice. Community understanding of diseases and their spread is complex, and yet there is still a tendency to produce generic communication messages and templates to respond to them. Recurrent infectious disease outbreaks may have more to do with underlying problems such as local infrastructure, health systems, access to resources, and existing beliefs, behaviours, and norms, which require longer-term sustainable inputs.

In order for communication to support effective behavioural adaptation by affected/at-risk populations, inform emergency response and event management, and ensure that risk assessment and verification include relevant sociocultural behavioural data, a GAR COMBI programme will, according to the meeting participants, need to: establish global, regional, and national operational networks; build links with forecasting readiness and preparedness; develop and field-test relevant tools and checklists; document existing evaluations and lessons learned and share best practices; and ensure links with the International Health Regulations (IHR) capacity-building programme.

Summary recommendations (see also Section 6 of the report):

1. "COMBI has a proven history of success and should be integrated as part of WHO's standard emergency alert and response, including integrating communications staff within rapid-response structures.
2. This could be applied and promoted within GAR-specific response and readiness programmes.
3. A recommendation should be made to Member States emphasizing the behavioural imperative in dealing with public health emergencies and the need for strategic communication planning, like the COMBI methodology, alongside medical and technical teams and interventions.
4. To strengthen the case, COMBI success stories and evaluations need to be collected to show 'proof of concept', while monitoring and evaluation systems need to be improved to ensure this is an essential step, built into all COMBI work going forward.
5. Appropriate terms must be developed to clearly differentiate COMBI approaches from 'social mobilization' and other terminology felt to be confusing or holding previous associations that do not accurately reflect the behavioural imperative."

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