The document describes how Care Groups were utilized to combat the Ebola outbreak in Liberia. It provides background on the Liberian Agricultural Upgrading Nutrition and Child Health (LAUNCH) program and how Care Groups were the primary platform used to achieve reduced chronic malnutrition objectives. Initially, Care Groups conducted basic Ebola awareness focusing on preparing dead bodies, avoiding bush meat, no touching, and hand washing. As the outbreak grew, Care Groups continued meeting normally and discussing Ebola prevention messages. LAUNCH became involved in the national Ebola task force, providing support to health worker training.

1. The SBC Working Group
Welcomes You to a Learning Session
on
Combatting Ebola and Similar Outbreaks with
Social and Behavior Change Strategies
Global Health Practitioner Conference, Spring 2015
Alexandria, Virginia
April 16, 2015

2. Combatting Ebola and Similar Outbreaks with
Social and Behavior Change Strategies
Presenters
• Mathias Pollock, Mercy Corps
• Suzanne Van Hulle, Catholic Relief Services
• Maya Bahoshy, International Medical Corps
• Janine Schooley, Project Concern International
Moderator
• Paul Robinson, International Medical Corps

3. Emergence of
Ebola:
1976-Yambuku,
DRC
1976, 79—
Nzara, S. Sudan
1977-Tandala,
DRC

4. Group process – 15 minutes
1. Jot down one idea of what you think is effective
as SBC initiative for addressing Ebola and similar
outbreaks in the future
a) One idea only, please!
b) Use one page from note pad on your table and
c) Write legibly please
2. Discuss your one idea with your table mates
3. Refine/change your idea if you think necessary
4. Turn in your idea sheet to a volunteer nearby

5. Saving and improving lives in the world’s toughest places.Saving and improving lives in the world’s toughest places.
Obstacles to Case Reporting
A barrier analysis study of timely reporting of symptomatic family
members by heads of households in Montserrado County, Liberia
Global Health Practitioners Conference
April 16th, 2015
Mathias Pollock, Technical Advisor

6. Saving and improving lives in the world’s toughest places.
E-CAP PROGRAM OVERVIEW
Obstacles to Case Reporting

7. Saving and improving lives in the world’s toughest places.
BARRIER ANALYSIS SUMMARY
- Rapid evaluation,
mixed-method
tool
- Identifies key
determinants of
behavior
- Perception-based
Obstacles to Case Reporting
Barrier Analysis: What is a determinant? (Food for the Hungry)

8. Saving and improving lives in the world’s toughest places.
STUDY PARAMETERS
Obstacles to Case Reporting
• Behavior: Timely case reporting
• 99 individual interviews
(44 Doers and 55 Non-doers)
• 5 Montserrado communities
(New Kru Town, West Point,
Gardenerville, Mount Barclay,
Brewerville)
• Data collection conducted Feb 16th – 18th
Rapid Research Team collecting data in
Brewerville (photo: Mercy Corps)

9. Saving and improving lives in the world’s toughest places.
SELF-EFFICACY
Obstacles to Case Reporting
WHAT MAKES/WOULD MAKE IT EASY TO REPORT?
41
5
43
7 7
70
7
2520 25
53
11 11
89
7
13
0
20
40
60
80
100
Percentresponse
Doers %
NonDoer %

10. Saving and improving lives in the world’s toughest places.
POSITIVE CONSEQUENCES
Obstacles to Case Reporting
What are the good things that happen when you report?
52
34
43
20
47
31
27
5
0
10
20
30
40
50
60
Patient will get
early Tx
Higher chance of
survival
Protect
others/community
Reduce spread of
Ebola
% Doers
% Non-Doers

11. Saving and improving lives in the world’s toughest places.
SOCIAL NORMS
Obstacles to Case Reporting
WHO DISAPPROVES OF YOU REPORTING?
59
5
16
47
27
18
0
10
20
30
40
50
60
70
Nobody Friends & Neighbors Family members
% Doers
% Non-Doers

12. Saving and improving lives in the world’s toughest places.
11
25
64
20
33
47
0
20
40
60
80
100
Very
difficult
Somewhat
difficult
Not difficult
Access
% Doers % Non-Doers
OTHER SIGNIFICANT DETERMINANTS
Obstacles to Case Reporting
5
11
82
13
25
60
0
20
40
60
80
100
Very difficult Somewhat
difficult
Not difficult
Cues to Action

13. Saving and improving lives in the world’s toughest places.
RESULTS SUMMARY
Obstacles to Case Reporting
• Community leaders (CL) play a critical role
but some people have problems accessing
them
• Doers perceive “protecting others” and
“avoiding the spread” as key motivators for
reporting (preventive community altruism)
• Non Doers perceive “friends and neighbors”
as disapproving of reporting to #4455 or CL
• Non Doers perceive difficulty in accessibility
(lack phone/network)
• While messaging is working, some people
are still forgetting to report
ECAP poster targeting holistic community action
(photo: Mercy Corps )

14. Saving and improving lives in the world’s toughest places.
PROCESS LEARNING
Obstacles to Case Reporting
Appropriate community entry
Power of stigma
Working w/ local leaders
We have as much to learn
from the communities where
we work as we do to teach
them!
“Listen, Learn, Act”
Learning to wash hands in Ebola-time (photo: Mercy Corps)

15. Saving and improving lives in the world’s toughest places.
LIMITATIONS
Obstacles to Case Reporting
• Limited geographic area
• Relaxed behavior statement
• Survey fatigue
• Time constraints
A survivor educating people about the harmful
effects of discrimination. (photo: Mercy Corps)

16. Saving and improving lives in the world’s toughest places.
PROGRAM RECOMMENDATIONS
Obstacles to Case Reporting
• Establishing community selected volunteer committee to
increase reporting to CL
• Host palava hut conversations with survivor testimonials to
dissipate stigma among community members
• Create community maps to identify homes with functioning
cell phones in case of emergency

17. Saving and improving lives in the world’s toughest places.
POLICY RECOMMENDATIONS
Obstacles to Case Reporting
• Focus on community
mobilization from
onset of emergencies
• Present messaging
through holistic
community lens
Community educators for the Center for Liberian Assistance mobilize
for a community outreach activities. (photo: Mercy Corps)

18. Saving and improving lives in the world’s toughest places.
NEXT STEPS
E-CAP II
Follow up barrier
analyses (stigma)
Photo voice
survivor stories
Obstacles to Case Reporting
The Liberia Crusaders for Peace. (photo: Mercy Corps)

19. Saving and improving lives in the world’s toughest places.
Obstacles to Case Reporting
CONTACT
Technical Advisor
mpollock@dc.mercycorps.org
Mathias Pollock, MPH
Thank you for your attention
Questions?
Rapid Research Team: Marion, Prince, Eunice, Chris, Hermenia, and Marcus

20. CRS’Social and Behaviour
Change tools for EVD
prevention
Suzanne Van Hulle & Annisha Vasutavan
Catholic Relief Services

21. Phases in the Sierra Leone Ebola Response
Phase 1:
Learning
Phase 2:
Alarm
Phase 3:
Acceleration

22. Phase1:Learning

23. Phase 2:Alarm

24. Phase 3:Acceleration

25. Comparing SBC activities and
Prochaska’s Stages of Change
Early
Response
Phase
SBC activities Prochaska’s Stage
of Change
1: Learning Public education using
mass media
(IEC materials – Posters,
Pamphlets, Banners, Radio
Discussions, Radio Jingles,
etc)
Pre- contemplation

26. Early
Response
Phase
SBC activities Prochaska’s Stages
of Change
2: Alarm 1. Community led activities of
positive reinforcement and
social support (district level
authorities working together
with traditional leaders).
2. Public education using mass
media (IEC materials – Posters,
Pamphlets, Banners, Radio
Discussions, Radio Jingles, etc)
1. Preparation/
Action for
initially affected
areas
2. Pre-
contemplation for
newly affected
areas

27. ER Phase SBC activities Prochaska’s Stages of
Change
3: Acceleration Focus of social mobilization is on
DIALOGUE, targeting influential
change agents .
Activities:
 Stakeholder dialogue sessions
with community level change
agents
 Training for religious leaders,
traditional leaders, societal
heads etc.
 Community dialogue sessions
with representation for a variety
of community members.
Preparation/Action

28. Case study: Koinadugu District
CRS SBC activities to promote proactivemeasures to prevent
the EVD outbreak in Sierra Leone

30. What went well?

31. • Last district in Sierra Leone to record EVD cases
(mid-October 2014)
• To date, is the district with the 2nd lowest number of cases
in the outbreak (108 cases in total).

32. KAPSurvey Findings – Knowledge of EVD
0
10
20
30
40
50
60
70
80
90
100
Koinadugu
Other districts
(Avg %)

33. 0
10
20
30
40
50
60
70
80
90
Handwashing
(Soap &Water)
Avoiding
physical
contact with
sick people
Participated in
a funeral or
burial
ceremony in
the previous
month
Koinadugu
Other districts in
sampled in Northern
Provice(Avg %)
KAPSurvey Findings –
Prevention behaviors/Behavior change

34. Challenges

35. One dimensional interaction

36.  No forum for people to challenge beliefs and ideology
(27.7% of Koinadugu respondents believed that bathing in
salt and hot water can prevent Ebola, & 9.2% believed
that spiritual healers could successfully treat Ebola.)
Weaknesses in early
social mobilization strategies

37. Shift in CRS’SBC strategy in theAcceleration phase
 Sharing knowledge with communities
 Engaging in dialogue
 Understanding how various community groups communicate & share information
 Understand barriers and motivating factors for certain key behaviors

38. CRS’revised SBC strategy:
Stream1:
CommunityLevelSocialMobilizationthroughInfluential
Community ChangeAgents
Identification
and training
of community
level change
agents to be
lead trainers
in their
respective
chiefdoms
/districts
Each lead
trainer to
cascade
training to a
further 30
community
level change
agents
Community
level change
agents to
integrate
behavior
change
messaging
in
community
level
mobilization
sessions
Conduct
open
dialogue
sessions at
community
level to
share
experiences

39. CRS’revised SBC strategy:
Stream2:
SocialMobilizationRapidResponseTeams(RRTs)to carry outSBCactivitiesat
community level
CRS social
mobilizers
trained on
community
engagement,
social
mobilization
tool kit,
deployment
activities, etc
Standard
Deployment
10 day
blocks in the
field
Emergency
Deployment
3-7 days
deployment
based on
size of
affected
community
RRT conduct
H2H
sensitization
and
community
structure
engagement
using
CRS
Soc. Mob
tool kit
RRTs to
conduct
regular
community
follow ups
to check on
progress in
behavior
change
practices

40. CRS Rapid ResponseTeams

41. CRS Social Mobilization Toolkit
Features
 Low literacy friendly
 Images set in the local context and local languages
 Prompts discussion with audience
 Focuses on and reiterates (6) key messages through
out discussion

42. CRS Social Mobilization Toolkit
 Rapid Response Team Field Protocol Guide
 Video - “Ebola – A poem for the living”
 Pictorial flipbook - “Ebola – A poem for the living”
 Discussion guide for video and flipbook
 Hotline cards – with district alert numbers
 Poster

43. Flipbook

45. ©2015 International Medical Corps
SBC and PSS:
Hand in hand to address Ebola
From Relief to Self-Reliance
Maya Bahoshy
CORE Group GH Practitioner Conference, Spring 2015
All content in this document is the property of International Medical Corps UK and should not be reproduced without prior written consent. This material is
protected by copyright. ©2015 International Medical Corps. Materials may not be reproduced without International Medical Corps’ prior written consent.

46. ©2015 International Medical Corps
Our EVD Programming
• Ebola Treatment Centers in Liberia (Bong and Margibi County) and
Sierra Leone (Lunsar, Makeni)
• Screening and Referral Units in Liberia, Sierra Leone and Guinea
• Multi-Agency Training Collaborative training center in Liberia for
healthcare staff from various agencies. Additional training centers in
Sierra Leone and Mali.
• Rapid Response teams in Liberia, Sierra Leone and Guinea
• EVD Preparedness and response expansion (Mali)
• Donors: USAID/OFDA (main), DFID, CIFF, Gates, ECHO, Irish Aid,
Lumpking, Merck, Kaiser, BandAid,

47. ©2015 International Medical Corps
Community Outreach Objectives
1. Address psychosocial needs
2. Support reintegration of
survivors
3. Ensure local support and buy-in
for ETC
4. Support rebuilding trust in
health system

48. ©2015 International Medical Corps
Key Findings/Barriers
• To accessing ETC:
• To preventative behaviors:
– Fear
– Denial
– Traditional beliefs
– Misconceptions about chlorine and sprayers
– Access to required materials
– Distance
– Perceived quality of
treatment
– Mistrust
– Fear of death
– Low action efficacy
– Misconceptions about
Ebola
– Poor communication with
patients

49. ©2015 International Medical Corps
Community Outreach strategy
• Phase 2:
– Trained PSS/SBC dual outreach
team
– Increased community
engagement
– Key behavior change activities
• Phase 1:
– PSS team
– Needs assessment
– Reactive - pickups

50. ©2015 International Medical Corps
Activities
• Program Launch
• Participatory Data
Collection
– Mapping
– Seasonal Diagram
• ETC visits

51. ©2015 International Medical Corps
Activities
• Use of survivors for
increased access
• Radio programming
• Continual reflection

52. ©2015 International Medical Corps
Lessons Learnt/Recommendations
• Invest in two way dialogue
• Involve the community and key
stake holders from the start
• Ensure cultural appropriateness
wherever possible
• Remain dynamic

53. ©2015 International Medical Corps
Lessons Learnt/Recommendations
• Consider the
psychological needs
and abilities of the
target population
• Strengthen the
capacity of PSS staff
on SBC approaches
• Further research

54. ©2015 International Medical Corps
Thank you
Maya Bahoshy
Social & Behavior Change Officer
mbahoshy@internationalmedicalcorps.org

55. Janine Schooley
Senior VP
Programs, PCI
CORE
Spring Meeting
April 2015
CARE GROUPS IN THE
CONTEXT OF EBOLA

56.  In 2010, PCI and ACDI-VOCA
(prime), received $40 million
from USAID for a 5 year, Title
II DFAP for Liberia.
 The Liberian Agricultural
Upgrading Nutrition and Child
Health (LAUNCH) program is
designed to increase access
to food, reduce chronic
malnutrition, & increase
access to improved livelihood
& educational opportunities
in Bong & Nimba counties.
BACKGROUND

57.  PCI is responsible for 2 of 3
Strategic Objectives (SO):
 SO2—Reduced Chronic
Malnutrition of Vulnerable
Women & Children
 SO3—Increased Access to
Education Opportunities
 Care Groups are the primary
platform through which PCI
works to achieve SO2.
 There are a total of 158
Care Groups & about 1400
CGVs (i.e. Lead Mothers)
reaching a total of 402
communities.
CARE GROUPS IN LAUNCH

58.  Initial outbreak of Ebola in Liberia with cases coming
from Lofa, a county bordering Sierra Leone & Guinea.
 PCI began basic Ebola awareness with Care Groups, using
no additional materials, focused on:
1. Preparing dead bodies, a major risk for transmission
 Traditionally Liberians bathe and plait the hair once someone
dies & then bury the dead in the yard with family.
2. Avoiding bush meat
3. No touching!
4. Hand washing
 20-40 cases in Bong; 0 in Nimba.
TIMELINE OF EBOLA — MARCH 2014

59.  PCI H&N staff served as “Promoters”, along
with general Community Health Volunteers
(gCHVs). At the time of the outbreak, staff
received training from PCI’s Country
Director.
 Care Groups continued to meet normally,
with CGVs conducting regular meetings and
household visits, including basic messages
about Ebola prevention as part of their
regular meetings.
 During this first wave LAUNCH became a
member of the National Ebola Task Force &
the Case Management sub-committee
providing logistical and technical support
to the initial training of health workers
throughout the country.
CARE GROUPS — MARCH - MAY 2014

60.  The second wave of the epidemic precipitated a consolidated
response at the community, district, county & national levels
which took precedence over all project health-related
initiatives.
 Monrovia was hit hard; Six counties exploded with cases
including Bong & Nimba.
 Nurses, Doctors & Health Care Workers began dying. People
started to panic. Health clinics began closing.
 In June, the Ministry of Health and Social Welfare (MoHSW)
suspended all non-Ebola related training & travel so that core
MoHSW staff could focus solely on the Ebola response.
 Care Group activities continued in the communities sharing the
same basic Ebola information along with regular lesson plans.
TIMELINE OF EBOLA — JUNE/JULY 2014

61.  The President declared a national State of Emergency in
August, prohibiting public meetings, closed central markets &
sealed international borders impacting food security &
instituted a national curfew.
 LAUNCH program—all non-Ebola activities were put on hold;
food distributions ceased, no large gatherings were allowed.
 PCI staff remained & by mid August activities were 100%
focused on the Ebola response.
TIMELINE OF EBOLA — AUG/SEPT 2014

62.  PCI contributed to the
development of an Ebola
training guide for staff, based
on WHO & MoHSW training
guidelines.
 Training materials were
produced by UNICEF & the
MoHSW for the gCHVs.
 PCI printed and bound 4,000
copies as it was a perfect tool for
CGVs.
 Tool included signs & symptoms,
how Ebola is spread, what to do
when a family member has Ebola,
etc.
CARE GROUPS — AUG/SEPT 2014

63.  Care Groups in LAUNCH are 8-10
CGVs, a perfect size for continued
trainings during Ebola.
 CGVs were key in terms of education
to community members, distribution
of hand washing buckets, etc.
 CGVs protected themselves from
Ebola when making household visits.
 Not touching anyone (including shaking
hands, kissing, hugging), washing their
hands with soap or disinfectant after
each household, standing at a distance
from others, avoiding contact with those
who are sick, etc.
 Care Groups allowed us to be in the
communities & stay connected,
relevant & useful throughout when
many projects & program activities
couldn’t continue.
CARE GROUPS — AUG/SEPT 2014

64.  PCI held community video shows on
Ebola. Special permission was
granted to show after curfew. CGVs,
along with gCHVs, led Q&A.
 CGVs & gCHVs, supported families
who were quarantined & isolated.
 Brought water & food
 Helped with farming
 By the end of Sept all LAUNCH
communities were mobilized &
educated. Everyone had hand
washing buckets & bleach &
everybody knew Ebola was real.
CARE GROUPS — AUG/SEPT 2014
CONTINUED

65.  Stopped focusing fully on Ebola as staff
realized Ebola education only wasn’t
sufficient & other issues were also
important.
 CGVs reviewed old modules (ENA, Maternal
Care, etc.)
 CGVs focused on nutrition education
including the preparation of a local CSB
substitute.
 PCI began working with the DHO to re-
open clinics in Bong.
 ANC services are now up & running in
all health facilities in Bong & Nimba.
CGVs were key in reestablishing links
between health facilities &
communities.
 LAUNCH commodity distribution began
again in October.
CARE GROUPS — SEPT/OCT 2014

66.  The Care Group model is adaptable & flexible, able to be responsive
to changing contexts & needs of communities.
 PCI successfully used the Care Group approach in reaching &
identifying the most vulnerable (both in terms of those at risk for
contracting Ebola, as well as pregnant & lactating women,
elderly/disabled, those who lost their caregivers & others who
struggled to access regular health services) during the emergency.
 PCI has reached over 150,000 community members with Ebola
education & prevention messages through the use of Care Groups.
 The training of staff working with Care Groups lends itself to the
successful use of Care Groups in Ebola as they are already trained in
facilitation and outreach – critical in Ebola response.
 Care Groups contributes to a full cycle approach, covering Ebola from
the community awareness stage all the way to the Ebola Treatment
Unit (ETU) level & then re-entering people back into the communities.
CONCLUSIONS

67.  CGVs have been key to the
Ebola response!
 To date, no PCI staff & CGVs
have contracted Ebola.
 They are now taking up the task
of helping communities adapt &
meet the needs of the growing
orphan population.
 Helping with “re-entry”,
minimizing stigma &
discrimination of survivors.
 Their messages/education &
support on Ebola reached men,
children, others in the
community.
 They have been the
programming thread
throughout!
THANK YOU!
JSCHOOLEY@PCIGLOBAL.ORG

68. feedthechildren.org
Hot off the press…
• The Ebola Viral Disease Care Group Lesson Plans AND
Flipchart (draft for testing) is now available!

69. Questions & Answers – 10 minutes
• Keep your questions/comments
REAL short and sweet 
• This is important since we have only
a very short time for the next activity
– Group Process

70. Group process – 15 minutes
1. Jot down one idea of what you can do in your
organization as SBC initiative to address Ebola
and similar outbreaks in the future
a) One idea only, please!
b) Use one page from note pad on your table
2. Discuss your one idea with your table mates
3. Refine/change your idea if you think necessary
4. Turn in your idea sheet to a volunteer nearby