Ward 356 social mobilizer Zainab Rogers (left) advises Hassan Bangura, 20, what he should do if one of his loved ones begins showing signs of Ebola

Social mobilizers empower ‘hotspot’ communities to fight Ebola in Sierra Leone

“Communities are at the forefront of the response.” – UNICEF Global Ebola Emergency Coordinator Dr. Peter Salama

Ward 356 social mobilizer Zainab Rogers (left) advises Hassan Bangura, 20, what he should do if one of his loved ones begins showing signs of Ebola

FREETOWN, Sierra Leone, 28 January 2015 – On a bright, hot day, Andrew Koroma and Mohamed Conteh walk through Freetown’s congested Rokupa community, armed with a megaphone, posters and flyers. This small team of social mobilizers is here because one particular community is currently under its second 21-day quarantine after recording an Ebola death.

“This community is one of the worst cases,” says Mr. Koroma. “We have around 28 quarantined homes, 30 survivors, 20 deaths and 5 who are in treatment centres.

“Of the 60 people here who were infected, around 50 tested positive so far. They will start their quarantine again because someone died this morning. We also have three new fresh cases here, so we have to work hard.”

Hotspot busters

Mr. Koroma and Mr. Conteh are among 788 ‘hotspot busters’ in Sierra Leone. Hotspot busters deploy rapidly to communities that are considered hotspots of the epidemic, as part of an immediate response to an outbreak. Members of the community themselves, hotspot busters are trained to intensify social mobilization activities and increase engagement of communities to stop the spread of Ebola. They conduct one-on-one sensitization sessions, house-to-house visits and public awareness-raising.

To ensure that the hotspot is covered, the social mobilizers activate youth, women and volunteer networks in each community and reach approximately 9,000 households every week. They are involved in active community surveillance and are approached by community members to call the 117 Ebola hotline to refer sick loved ones to hospital.

“The only way to ‘bust the hotspot’ is to make sure that community members are empowered, engaged and active,” explains UNICEF Sierra Leone Chief of Communication for Development Kshitij Joshi. “We ensure that the social mobilizers are from the community and know the context so that tailor-fit strategies are able to respond to what the particular community needs.”

Since the initiative began, hotspot busters have carried out social mobilization in more than 344 hotspot communities nationwide. Some 275,103 households have been reached on their house-to-house visits.

Awareness and change

The Hotspot Busters initiative is a key element of UNICEF’s response to the Ebola outbreak in Sierra Leone. As co-chair of the National Social Mobilization Pillar, the organization works closely with the Health Education Division of Sierra Leone’s Ministry of Health and Sanitation. It provides technical support for evidence-based programme planning and management and coordinates social mobilization partnerships at national and district levels.

Among the activities UNICEF supports are mapping and engagement of traditional and religious leaders, key community influencers, women and youth groups; partnership with 97 per cent of radio channels for Ebola education; use of SMS technology for real-time monitoring; and leading the community engagement process and social mobilization activities in and around community care centres.

Evidence-based outreach

A Knowledge, Attitude and Behaviour survey conducted in October reveals that social mobilization is working. Compared to results from the first such study, in August, there has been a marked positive change in people’s knowledge, attitude and intention to modify behaviour, in the context of Ebola.

More than 90 per cent of respondents accepted three key means of preventing Ebola, compared to 79 per cent in the previous study. The proportion of people who also accepted that Ebola can be prevented by avoiding contact with blood and other body fluids increased from 87 to 92 per cent. Ninety-four per cent of respondents accepted that Ebola can be prevented by avoiding funeral or other burial rituals for someone who has died from Ebola, up from 85 per cent. The proportion of respondents who hold any form of discriminatory attitude towards Ebola survivors decreased significantly – from 94 to 46 per cent.

United against Ebola

That cases are still appearing in some communities indicates that more can be done. That’s where the Hotspot Busters initiative comes into play. In partnership with the Health for All Coalition, UNICEF is pioneering the project in the hope that greater social participation will lead to heightened awareness and accountability for one’s own community. The efforts are bearing fruit: In Ward 355 in Portee, Western Area Urban, community spirit is paving the way for better coordination, reporting and trust of social mobilizers, contact tracers and other Ebola workers in the community.

Christopher Jones is Chief Coordinator of the Portee Ebola Response Alliance Volunteers (PERAV). This 35-member organization was created to assist Ebola workers sent to Ward 355 to help eradicate Ebola. Mr. Jones and his volunteers help their neighbours understand why Ebola workers such as the Hotspot Busters are coming into their community. They work in close partnership with the social mobilizers when families resist the efforts.

“We try and make them understand the nature of what Ebola workers are trying to do,” says Mr. Jones. “We help the people understand the essence of driving this Ebola out from our community.

“We have been successful in making people accept that Ebola is real, to allow people from NGOs to talk to them.” Community leaders also consider the social mobilizers integral to their overall Ebola response. Councillor Alusine Conteh is from the community in which PERAV is active. “More than a hundred per cent the social mobilizers have been helpful to us,” he says. “They work around the clock as a member of the community, always with us and always involved. They investigate the issues, go to the homes to educate people and report if there are sick persons to make sure they are taken to the hospital.

“They are very important to us.”

By Marge Francia, UNICEF Sierra Leone