COVID-19 Risk Communication

& Community Engagement

Implementing Social and Behavior Change for COVID-19

Home Based Isolation & Care
Learning Objectives
 By the end of the training session the learners [HCWs & CHVs] will be
able to:

1. Discuss the rationale behind RC&CE for COVID-19 cases under HBIC

2. Discuss and practice their role as a key agent with direct influence
over the support and care for COVID-19 cases under HBIC

3. Understand and be able to mobilize the community to support HBIC

4. Understand advocacy in the context of COVID-19 HBIC

Introduction

 What is COVID-19 https://youtu.be/i0ZabxXmH4Y

 In Kenya since the 1st case was reported on 13/3/2020, the cases have been
increasing [as at 24/8/2020]
 32,557 positive cases from 425, 364 tests
 554 lives lost

 All the 47 counties in Kenya have reported a case

 Majority of the cases [78 per cent] are asymptomatic or presenting with
mild conditions

 As the cases increase, it is exerting pressure on the health system.

Guidelines for HBIC

 WHO issued guidelines that recommends “Patients who are asymptomatic

or those with mild or moderate disease without risk factors for poor
outcome may not require emergency interventions or hospitalization,
and could be suitable for home isolation and care”, June 2020 [revised in
August 2020]

 MoH, Kenya – June 2020 adopted this guidelines that also require 3 key
steps:
1. COVID-19 client testing positive meet the criteria for HBIC
2. An assessment of the HBIC space [an assessment form is available]
3. System for follow up & referral is in place.
Rationale of HBIC RC&CE?
 The ‘home is now a hospital’ hence:
 The client testing positive needs to self care and manage themself.
 The client will require support & care from a caregiver, family, relatives
and the community while in isolation.

 It is hence important they recognize:

 WHAT COVID-19 self care and management entails?
 WHEN they require such support & care?
 WHERE & WHO can access the support & care?
Aim of HBIC Social & Behavior Change

1. Empower COVID-19 clients under HBIC with the correct KNOWLEDGE &
SKILLS on the necessary care and support package.
• When they are empowered it then CREATES a demand for support
and care services.

2. Empower the family members of the COVID-19 clients under HBIC with
the correct KNOWLEDGE & SKILLS on the necessary care and support
to offer .

3. Achieve community engagement for the support and care for COVID-19
clients under HBIC
• Hence contribute to reducing community stigma associated with
COVID-19
Socio-Ecological Model for Positive COVID-19 clients

 Primary audience – Positive COVID-19

client under HBIC.

 Secondary audience
 Family members, caregiver and
relatives.
 CHVs & HCWs

 Tertiary
 SCHMT/CHMT and the County
Government
 Partners
COVID-19 SBC strategies

 Communication: using a variety of channels to reach the key targeted

audiences with targeted messages for action.

 Social mobilization: engaging diverse stakeholders [Organized

community groups, CBOs, women or youth groups, associations] to
provide support and care for persons testing positive for COVID-19
under HBIC.

 Advocacy: for high level participation, involvement of the political,

social, administrative leadership for support and resource mobilization
for HBIC.
 Communication for COVID-19 client on HBIC
[Primary Audience]
 Desired change
 Know and PRACTICE self care and management.
 Know WHERE to access and WHO can provide care and support when
necessary.

 Key barriers
 Lack of knowledge and skills on self-care
 Lack of the basic self-care kits
 Inadequate environment for self-care

 Communication objectives
 80 percent of the clients testing positive for COVID-19 on HBIC will have
knowledge on self-care and management while at home.
 80 percent of those with the knowledge on COVID-19 self-care and
management will practice self-care and management while at home.
  Scope:
 Infection prevention & control
 Self Clinical Care
Content for  Self Referral
Primary  Self Nursing Care
Audience  Self Nutrition
 Self Psychosocial Care
 Self Community Based Rehabilitation
Infection Prevention & Control

 Aimed at preventing and minimizing transmission of

infections to other household members, caregiver or
community

 It entails managing the body excretions [especially fluids

such as droplets] and ensure safe disposal of used items.

 Visit: https://youtu.be/1APwq1df6Mw on basic IPC

  Ensure they stay in a well-ventilated room by keeping
windows open.

 Ensure they wear facemasks at all times in isolation to

prevent droplets especially when coughing or sneezing.
[Visit: https://youtu.be/adB8RW4I3o4 ]
Key IPC
action  Practice good coughing etiquettes by coughing within a
flexed elbow.

 Practice proper personal hygiene through regular hand

washing with soap and running water and where possible
use alcohol based hand sanitizers to wash off viruses and
other disease causing agents.
  Practice environmental hygiene by:
 Cleaning of surfaces that a frequently touched like - tables,
floor, chair, cell phone and door knobs with a recommended
disinfectant.
 Regular cleaning of linen and clothing’s
 Ensure use of separate cutlery that is maintained clean.

 Proper disposal of use waste especially hand gloves and

Key IPC facemasks
action
 Stay indoors as much as possible and not going out

 Limiting the number of persons visiting while in isolation.

 Recommended disinfectant: Diluted 0.5% Sodium

Hypochlorite solution
Self Clinical Care
 It is important to note that asymptomatic or mild COVID-19 conditions can progress to a
moderate and severe conditions.

 Moderate and severe conditions should be managed at a health facility under care and
equipment’s.

 Self Clinical Care is how the COVID-19 feels & examines him/her self for signs &
symptoms. If the client on HBIC recognizes a progression from asymptomatic or mild to
moderate / severe condition.
1. They should IMMEDIATELY contact their CHV or HCW for referral to be initiated.
2. Such is when they recognize the danger signs for COVID-19 that include – high
temperature, difficulty in breathing, chest pain. In children dehydration, fast/shallow, blue
lips or face.

 Know when to undertake a repeat sample for lab test [after 10 days] by reminding their
CHV to contact the surveillance team.
  Self-nursing care ensures a continuity of care: restore
functionality and prevent complications.

 COVID-19 clients on HBIC should practice self-care nursing

by:
 Daily and routine temperature check and recording it on the
daily monitoring chart.
Self Nursing  Undertake breathing exercises
Care https://youtu.be/sQwheE7wJZY
 Have adequate rest
 Taking medical prescription as and when required.

 Know that they can consult a CHV or HCW for advice on

self-nursing care.
Self Nutrition Care
 Good nutrition promotes recovery and builds the bodies immunity against other
infections too. It also reduces lifestyle diseases like cancer and Cardio-Vascular
Diseases.

 COVID-19 clients under HBIC should:

 Take a variety of foods including energy rich foods like milk, legumes and pulses,
fruits and vegetables
 Consider supplementation with Vitamin C, Vitamin A, B6, D, E, Iron, Foliate and
Fibre.
 Besides good nutrition they should also
 Ensure they have adequate sleep, physical exercises, avoid intake of alcohol and
tobacco products
 Take adequate fluids – at least 2 litres of water per day or more in case they have
fever
 Note that
 Coughs can be relieved by the use of honey, pineapples and chicken soup
 Sore throat can be relieved by taking tea, honey, ginger, turmeric and sage.
  Self-psychosocial aims at minimizing an imbalanced state of
mind of arising from isolation and possible stigmatization

 COVID-19 clients on HBICU should:

 Understand and explain why they are in isolation by getting
the correct and accurate information on COVID-19
transmission and prevention.
 Appreciate that they are in isolation to prevent infecting
Self- others.
Psychosocial
Care  Know how to cope with isolation by:
 Maintaining external contact with their social networks –
relatives, friend, religious leaders & be able to explain why they
will remain in isolation

 Remain active by remaining updated with the world through

listening to the radio, watching TV, reading, engaging with
social media
  To help them with psychosocial support, let them think
through?

 If I am working – have I informed my colleagues that I will be

in away in isolation? Do I want them to know? Y/N

Self-  If I am a member of a church – have I informed my religious

leader? Do I need to inform them? Y/N
Psychosocial
Care  Have I informed my relatives and friends? Do I want them to
know? Y/N

 Am I a member of a welfare group? Have I informed other

members that I will be in isolation? Do I want them to know?
Y/N
Community  Positive COVID-19 clients on HBIC and living with
disability need to inform their CHVs and HCWs that
Based they have special needs so that they are catered
Rehabilitatio for.
n
Primary Audience: Channels, Materials &
Activities
 Counseling and education: Eligible COVID-19 clients testing positive and initiated on
HBIC should be counseled and educated immediately their test results are
communicated. In case they are many – group counseling can be considered.

 Information kit: upon counseling and education, it will be desirable that they are issued
with self-care information kit as hey are being discharged for HBIC, this they can make
reference while in isolation.

 Inter Personal Communication: while at HH level a trained CHVs will conduct HH visit
to educate the COVID-19 client on HBIC

 Audio-visual materials: while in isolation they can also be provided with audio-visual
materials on the thematic area that demonstrate self-nursing care, physical exercises

 Audio messages: it is also expected that they would be listening to a radio hence target
audio messages
Communication for the Secondary Audience

 These include:
 Family members, caregiver and relatives
 CHVs & HCWs
 Relatives and friends

 Desired changes
 Caregiver and family members: they need to identify the isolation
space and to provide support and care for persons on HBIC.
 CHVs & HCWs they need to provide support and care for persons on
HBIC including the dispensing the relevant medications – antipyretics
for fever & pain relieve or antibiotics for mild symptoms
 Relatives and friends – they need to offer psychosocial support to the
positive CIVID-19 client on HBIC
Communication for the Secondary Audience

 Key barriers:
 Caregivers and family members may be stigmatized with the
isolation of one of their own
 CHVs may be overwhelmed by the increased number of positive
COVID-19 clients
 HCWs may not have time to follow up COVID-19 clients;
 Health care facilities may also be overwhelmed with many patients
and not able to receive those who get worse while on HBIC
 Fear of contracting the virus while providing support and care.

 Communication objectives:
 80 percent of CHVs, family, caregivers, friends and relatives will be
aware of COVID-19 HBIC care and support package.
 80 per cent of CHVs, family, caregivers, friends and relatives will
provide support and care required by the COVID-19 on HBIC.
Content, Channel, Materials & Activities
 Content:
 HCWs have formal training on IPC, Clinical, Nursing, Nutrition &
Psychosocial Care.
 They may need re-orientation within the context of COVID-19
 CHWs have basic knowledge on IPC, Clinical, Nursing, Nutrition &
Psychosocial Care.
 They will need re-orientation within the context of COVID-19 HBIC
 Caregivers, Family, Friends & Relatives – they need to understand the
HBIC support and care package for COVID-19 clients on HBIC

 Channels & materials

 Re-orientation curriculum for training HCWs and CHVs on HBIC
 Job aides – Flip charts for CHVs to use in training caregivers at HH level.
 Information kit – brochure on HBIC support & care package.
 Support supervision
Strategic Social
Mobilization
Social mobilization aims at engaging as many stakeholders
[Organized community groups, CBOs, women or youth groups,
association] within the community so that the provide support and
care for persons testing positive for COVID-19 on HBIC.
  Target audience
 Organized community groups, Community
Based Organizations, Women / Youth groups,
welfare groups, places of worship, Chama’s,
Nyumba Kumi and any existing associations
Plan for within the community
Social
Mobilization  Desired changes
 They should provide support and care for
persons testing positive for COVID-19 under
HBIC as they may be members of their
association, close friends or relatives.
  Key barriers
 Stigma associated with persons testing positive for COVID-19
 Inadequate knowledge and skills on COVID-19
 Non-disclosure to the friends and relatives by the COVID-19
client.

 They should appreciate why HBIC is an important approach

Plan for to COVID-19 management
Social
Mobilization  Communication objectives
 They should know that within their community some of their
members have tested positive for COVID-19 and are under
HBIC.
 They should reach out and support one of their own while in
isolation.
 See video link on tips of what we can do to reduce stigma
https://youtu.be/vinh0lIG1p0
Planning for COVID-19 Social Mobilization

 Materials
 Develop a community engagement guide

 Channels and activities

 Organize and hold Focus Group Discussions FGDs for the engagement
of the various community groups, community based organizations,
Women / Youth groups, welfare groups, places of worship, Chama’s,
Nyumba Kumi and any existing associations.
Implementing Social Mobilization for COVID-19
 The Government has initiated a HBIC program for clients testing positive for COVID-19.

 Under the program clients testing positive for COVID-19 who are asymptomatic or
having mild conditions can be self-managed at home with positive outcomes

 Pose questions
 Do they know of anyone who has tested positive for COVID-19?
 Allow them to share their experiences
 Do they know what HBIC entails?

 Let the know what HBIC entails

 Emphasize that community members under HBIC need psychosocial support and
encourage them to reach out if they know anyone under HBIC

 Everyone is susceptible and majority (>90%) of those who become infected recover.
Strategic Advocacy
Advocacy targets the local political, social and
administrative leadership for high level participation,
involvement and resource mobilization
  Target audience
 County & Sub County Health Management Teams
 County Government
 Partners and the private sector

 Desired change
Planning  County & Sub County Health Management Teams:
need to roll out and implement the HBIC guidelines.
Advocacy  County Government: putting in systems and
structures for successful implementation of HBIC,
training of the health care workers and CHVs on HBIC
and ensuring that there is adequate resource
allocation for HBIC.
 Partners: this includes development partners, NGOs,
CBOs and the private sector so that they can support
county governments with resources for HBIC.
  Barriers
 Long bureaucracies & slow process
 Competing resources, activities and priorities
that require resourcing.

Planning  Communication objectives

 County Governments will understand the
Advocacy COVID-19 HBIC is resource intensive and that
they will allocate adequate resources for the
implementation of COVID-19 HBIC
 Partners including the private sector will
understand that COVID-19 HBIC is resource
intensive and they will allocate resources in
support of HBIC.
Implementing Strategic COVID-19 Advocacy

 Channels, materials & activities

 Organize County HBIC stakeholders meetings
where the budgeted County HBIC plan is
disseminated to partners for resource
mobilization.

 Key contents
 Existence of a budgeted County HBIC plan
 Power point presentation