I-Kit for Ebola Preparedness

Chapter 6. Key Considerations for Effective Ebola Communication

© 2014 Kevin Sieff/The Washington Post, Courtesy of Photoshare

© 2014 Kevin Sieff/The Washington Post, Courtesy of Photoshare

Chapter 6 includes many challenges that need to be addressed during an Ebola outbreak, offers recommendations for addressing those challenges, and offers a selection of tools for program design and implementation.  

For more detailed information about communication responses to specific communication challenges, see Appendix B. Ebola Communication Response Tables.

The first reports of Ebola will generate immediate, intense and sustained demand for information by the public. Systems should be in place to respond with one voice from designated and credible spokespersons, giving one consistent message through multiple media channels. Timely, transparent and regular dissemination of accurate information about Ebola, especially the means by which it is and is NOT transmitted, are key to establishing public trust and confidence at the beginning of the epidemic.  

Here are some ways to help manage fear and rumors:

Conduct research early (preferably even before an outbreak) to understand the current cultural context, burial practices, fears, rumors and understanding of Ebola and treatment centers.

Ensure that there is a system in place for quickly assessing and communicating research findings and recommendations with other Ebola implementing partners and relevant taskforces from the national to the community level.

Develop a messaging guide through a collaborative process with key stakeholders, including government, non-governmental organizations, faith communities and others. Pretest the messages with key audiences and ensure that the guide includes responses to existing and potential rumors.

Craft messages to allay fears and to instill confidence and non-discrimination, focusing on prevention- and treatment-seeking actions that are simple and actionable, in order to minimize potential risks.

Engage trusted persons to openly talk about and dispel myths and rumors.

Ensure that there are established mechanisms in place to convey these messages when needed, such as community volunteers, radio, mobile phone texts, community and religious leaders, and community activities.

Acknowledge what is not yet known and communicate uncertainty as required.

Communicate correct knowledge on transmission and risk and increase people’s sense of self-efficacy for prevention.

The first step in promoting safe and dignified burial practices is to understand the existing burial practices in the community. Only then can the team develop a plan to dealing with burial issues.

Provide care and compassion for children who have lost their caregivers (e.g., “we are all responsible for taking care of the community’s children”).

Review existing anthropological literature as well as rapid assessments.

Contact tracing, quarantine and SM efforts should be integrated into safe and dignified burial protocols. For example, social mobilizers can facilitate entry of a safe burial team into a community and family, and explain the roles of the safe burial team, the process of preparing the body, and the reason why this process is needed to protect other family members from getting Ebola.

Mobilizers and others refrain from wearing the full body PPE during the initial visit with the bereaved family.

Social mobilizers can explain what the family can do as the bodies are being prepared, such as pray for the family member with their community religious leaders, choose personal items that can be buried with the body, as well as select coffins or grave markers if they wish or are able to do so.

Stigma leads to individuals suffering, attempting to hide the disease from others, and in most instances, furthering transmission. If people are more afraid of the stigma resulting from getting a disease—becoming an outcast or being harmed or shunned by fellow community members—than the disease itself, they are less likely to report symptoms and seek care. From a communication perspective, program designers need to learn how to reduce stigma and help communities get beyond their fear to care for their own. Here are some suggestions:

Facilitate community discussions to help address concerns and celebrate Ebola survivors when they return home. Community members can plan and discuss how they want to celebrate and recognize returning survivors. Offer survivors the opportunity to serve as community mobilizers.

Communicate correct knowledge on transmission and risk and increase people’s sense of self-efficacy for prevention.

Provide care and compassion for children who have lost their caregivers (e.g., “we are all responsible for taking care of the community’s children”).

Mass media will be key for getting messages out to the general public quickly, consistently and in a coordinated manner using credible and trusted sources.

Coordination is key. Radio and TV announcements, press conferences, radio/TV spots and dramas, and other materials need to be coordinated at a central level to ensure consistency of information, addressing any rumors and reassuring the population that officials have the situation well in hand.

Media channels can reassure people that the government and health systems are trustworthy and credible, and are responding rapidly.

Mass media can also inform the public about all of the systems in place for reporting possible outbreaks and initiating immediate responses.

Messages on mass media need to link to messages and campaigns on social media, mobile phone messages, and group and interpersonal messages at the community level. These should be messages that a central Ebola communication coordinating mechanism has approved.

Use only the key and designated credible spokespersons identified in the planning stages. If there are trusted celebrities, performers or sports heroes who will speak out, use them as additional spokespersons for the campaign.

  For more information on how to set up a hotline, see the Hotline resources in the Ebola Communication Network. Hotlines and call centers can be crucial to providing correct and consistent information about Ebola, allying fears and dealing with rumors and misconceptions, and dispatching services such as case investigators, ambulances and burials teams where needed. Before informing the public about the hotlines, make sure that they are operating well and can handle the volume of calls. If not, people will become frustrated and trust will decline.

Hotlines need to be set up and publicized once there is certainty that they are operating well and staffed by well-trained staff who can provide consistent and accurate information.

The staff needs to be well trained in counseling techniques to manage the fear and uncertainty that callers who are sick themselves or dealing with a sick relative will express. (A sample training manual is available here). Hotlines can also provide a critical link to the dispatch of ambulance and burial team services, as well as serve as a point of entry for case investigations and contact tracing.

Hotlines present a unique opportunity to monitor incoming questions and to learn about current myths and misconceptions.

Providing information and services through a telephone hotline offers many advantages:

  It is accessible to mostly everyone

  It is available all hours of the day

  It allows for anonymity

  It costs less time and money than having to physically go somewhere to access these same services

There are also limitations and challenges to this approach.

Cell phone network coverage is not always reliable and the connection is not always clear in all areas of the country.

Because the interactions are over the phone, the call agent cannot read a caller’s body language or non-verbal communication.

The high volume of calls the centers receive, includes those from people abusing the toll-free number to place insincere or inappropriate calls.

Despite these challenges, the call center undoubtedly serves an important function. For some callers, the call center is the first point of contact in an emergency or when they are looking for help.

Health promotion messages and media need to evolve as the outbreak evolves and the community’s needs change. Messages first provide simple information about the signs and symptoms of the disease; but within a short period of time, messages must change in order to communicate more complex and detailed information. The more complex, practical information will answer questions such as: “How do I manage a family of children, infants and toddlers, while in quarantine?”; “How do I transport someone to a hospital or clinic without spreading the infection?”; “What does my community do with an exposed and infectious body when the healthy teams do not come to collect it?” An Ebola Communication Preparedness plan should consider mechanisms that not only share messages that promote awareness but also answer challenging questions and respond to rumors and information in real time. Here are general guidelines for messaging and materials during an Ebola response.

Ensure that SBCC materials are consistent with the messages approved by the MOH and central coordinating mechanism related to messaging.

Link SBCC materials to a full range of communication channels such as radio, social media, community theatre and dialogues.

Emphasize what communities can do to stay safe, and why they should make these choices.

Look for available evidence through recent studies and surveys. This will provide data from all pillars for data on community perceptions.

Ensure that mobilizers understand the local Ebola and health services context—such as data and issues related to number of cases and beds, availability of ambulances, medical and food supplies, and water and sanitation issues.

Note the literacy levels in the area and consider pictorial materials with minimal text for low-literate audiences.

Ensure that SBCC materials and messages are up to date, represent the current stage of the epidemic, and address current local barriers to adopting Ebola prevention practices. Engage local communities in re-shaping the messages as the epidemic and context shifts over time.

If materials are outdated or inappropriate, they should be removed from public places and replaced with newer materials that reflect the current situation, target audience, and culture.

Monitoring a program helps assess whether the program is reaching its goals. Monitoring answers the question: “Is the program achieving its goals?” Evaluating a program helps assess a its strengths and weaknesses. Evaluation answers the question: “What is the program doing?” Both monitoring and evaluation activities are most successful when they are integrated into program planning as early in the process as possible. Broadly, evaluation may fall into two categories.

  • Formative Evaluation assesses how to improve or strengthen a program (or other subject of interest). Needs assessments, implementation evaluation and process evaluation are examples of formative evaluation. Formative evaluation in general occurs prior to or during implementation of a program.
  • Summative Evaluation assesses the results of a program (or other subject of interest). Outcome evaluation or impact evaluation are examples of summative evaluation. Summative evaluation generally after implementation of a program.

Managers need to identify indicators that reflect your SBCC objectives and plan. As much as is feasible, indicators should be “SMART.” SMART is an acronym for:

S Specific: identifying a specific objective, behavior, etc., e.g., handwashing

M Measureable: something that can be measured, e.g., how many people do “X”

A Attainable: data which can be collected, e.g., via a SMS-based survey

R Relevant: data whose collection will help the program answer relevant questions

T Time-bound: identify the time-period of interest


Establish a central monitoring system that captures data from the primary organizations on the ground. This is important since designated communication and SM teams may consist of members from various organizations with their own M&E systems. This central system might be in the form of a weekly questionnaire that SM organizations submit to the local and central communication pillar(s) on a weekly basis. The central coordinating team can then analyze the data and communicate their findings to the national and local coordinating committees.

Monitoring results should be shared with spokespersons, technical experts and partners, and should be used to make regular adjustments in the communication messages.

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