Community Engagement during COVID-19 in Bangladesh: Leave no one behind!
by Zarin Tasnim
The COVID-19 pandemic and its aftermath disproportionately affected vulnerable social groups like people living in poverty, persons with disabilities (PWDs), homeless people, sexual and ethnic minority groups, and other marginalised groups with catastrophic consequences. For an effective and inclusive pandemic response and mitigation, community-centred intervention involving the underprivileged population is a must.
The Centre of Excellence for Health Systems and Universal Health Coverage (CoE-HS & UHC), BRAC James P Grant School of Public Health (JPGSPH), BRAC University has conducted a study to explore the Community Engagement (CE) initiatives that have been practised during COVID-19 in Bangladesh. Besides, it explored the challenges associated with such engagement and made recommendations on how to effectively involve the community to combat future epidemics/pandemics. The study conducted four Community Engagement Stakeholder Dialogue (CESD) meetings and ten Focused Group Discussions (FGDs) in five purposively selected districts based on COVID-19 hotspots. Participants included physicians, representatives from Non-Governmental Organisations (NGOs) and the community representatives such as the religious leaders, local well-off and rich individuals such as businessmen, landlords, vulnerable groups e.g., transgender people, sex workers, persons with disabilities, day labourers, maids, beggars etc.
Let’s begin with how they learnt about COVID-19. Television and newspapers were the most frequently reported sources of information by the participants to access information. However, quite a few of them could not rely on any of the sources since they perceived that these sources failed to deliver accurate data on COVID-19. For the young respondents, that social media appeared to be an easily accessible source of information on COVID-19.
From the data, it is apparent that different social groups in the community, e.g., religious leaders, students, volunteers, NGOs, clubs, and the City Corporation authorities played a significant role in the dissemination of COVID-19 information including motivation to follow preventive measures. Discussing in religious congregations, crowded spots like local markets, courtyard meetings, and door-to-door visits by the CHWs, distributing leaflets, miking etc. were some of the tools employed by them. In addition, the students listed down the common misconceptions regarding COVID-19, and health messages related to COVID-19, and conveyed these to their family/community members. The students of the ethnic communities translated the health messages into their native languages and presented to their respective communities.
The widespread circulation of COVID-19-related messages encouraged the community to participate in pandemic response, prevention, and mitigation activities. Local wealthy and well-off people including business owners, landlords, teachers, young volunteers particularly students, as well as local clubs and committees participated actively in prevention activities at the individual level or in cooperation with the government and NGOs. They established hand washing stations, distributed protective equipment such as masks and soap, prepared hand sanitisers in labs and distributed those free of cost, restricted public and transport movement and discouraged social gatherings, registered people for vaccination, arranged the burial of dead bodies of COVID-19 patients, and prepared and sprayed bleaching powder mixed solution on the roads and markets. The landlords’ association encouraged maids to get vaccinated by offering them one week of leave. In addition, the students in schools donated the surplus cash saved from transport costs during the lockdown to the underprivileged kids and their families.
Physicians, NGOs, and the other community groups took part in treatment-related activities to improve the accessibility of the required services during COVID-19. Performing COVID-19 tests during home visits, encouraging the community to avail of telemedicine services and sharing the hotline numbers, transporting COVID-19 patients from hard-to-reach areas, setting up dedicated facilities and delivering services free of cost to the COVID-19 patients, arranging oxygen cylinders and ambulances, and financial support by the physicians for the patients from personal initiative etc. were some of the measures taken by different groups of the community. However, the patients were not willing to do the test due to fear of social isolation.
Although there have been some attempts to involve the community in COVID-19 prevention, control, and mitigation activities, the participants felt that these efforts fell short, indicated some challenges, and offered suggestions for their better involvement. Miking was found to be challenging to motivate and influence the community to adopt preventive measures since it was a one-way communication medium to share messages. The backyard meetings were interrupted due to COVID-19 as well. The young volunteers and students faced challenges to communicate and convince the elderly in following preventive precautions. In addition, the community members struggled to understand complex terms as the delivered messages were not locally adapted. Various misinformation from different media served as barriers to involving the community in performing COVID-19 tests and receiving vaccinations. Furthermore, the fear of COVID-19 was greatly reduced due to the drop in COVID-19 cases as the pandemic progressed. Therefore, the COVID-19 preventive practices declined, and the participation of the community was interrupted. Interestingly, the community only consistently followed the preventive measures when the death rate spiked. Extreme poverty hindered adherence to containment and prevention measures of COVID-19. Without any assistance or relief materials, it was difficult to engage the poor and needy in awareness activities. On the other hand, there was mistrust in the government because of corruption in numerous sectors, e.g., the distribution of relief materials or cash advancement. Additionally, the vulnerable groups, for example, sex workers, transgenders, and persons with disabilities (PWDs) were not included in the mainstream organisations. The movement and participation of persons with disabilities was itself a challenge.
The respondents recommended various measures to address the aforementioned challenges. The community members recommended a context and age-specific risk communication approach during the pandemic, such as using social media for the young and engaging religious leaders to motivate the elderly. Additionally, they strongly suggested delivering COVID-19 related information messages in places where crowds gather, such as markets and tea stalls, using local television channels and cable operators. Since the informal health care providers and Community Health Workers (CHWs) are considered trusted, respected and usually the first contact to manage any patients, they can also be trained on how to properly communicate health information about COVID-19 to the community. Courtyard meetings and initiatives from the local clubs can be another effective mode for this kind of health communication. The health messages should include the vaccination registration process, dates, and venues for the vaccination, where and whom to report if any symptoms of COVID-19 appear, etc. apart from the other health messages. To ensure that the marginalised population groups are not overlooked during crises like a pandemic, they should always be included in CE activities. A public-private partnership was strongly recommended to overcome the impacts of pandemics like COVID-19.
The detailed analysis and solid evidence from the findings above underscore the critical need to establish locally adapted, inclusive, and context-specific interventions for CE in Bangladesh to fight against pandemics like COVID-19.
Zarin Tasnim is a Research Associate at BRAC James P Grant School of Public Health (JPGSPH), BRAC University