A TOT lecture to NYSC Officials and Corps members from across Nigeria at a national training, Abuja, 2014

1. HEALTH PROMOTION AND THE PREVENTION
OF EBOLA VIRUS DISEASE (EVD)
Dr. Abraham Idokoko
Alternate Team Lead/Operations Manager,
Social Mobilization, Communications & Health
Promotion,
Ebola EOC, Lagos.

2. Welcome!
…Let’s have
some theories

3. What is Health Promotion?

4. It’s been confused with a number of related terms
• Health Education
• Information Education and Communication (IEC)
• Behavior Change Communication (BCC)
• Strategic Behavioral Change Communication (SBC)
• Health Communication
• Strategic health communication (SHC)
• These are overlapping terms with blurred distinctions, drawing from
the same body of theories and concepts.
4

5. Some key Theories and models of health Promotion
• Almost all health promotion education interventions are design
based on the theories and models such as:
» The Health Belief Model (HBM)
» The Theory of Reasoned Action (TRA)
» The Stages of Change Theory
» Diffusion of Innovations
5

6. The Birth of Health Promotion
• With rising criticism that traditional health education was too
narrow, focused on individual’s lifestyle and could become “victim
blaming”, more work was done about wider issues e.g. social
policy, environmental safety measures
( EMERGENCE of HEALTH PROMOTION )
6

7. Definition of Health Promotion
• A process of enabling people to increase control over
their health and its determinants, and thereby improve
their health (WHO, 1986).
• It is a core function of public health effective to the overall
work of control of communicable and non communicable
diseases and other threats to health
• HP activities are aimed at either reinforcing healthy behaviors
or encouraging change in risky behaviors

8. Elements of Health Promotion
 Development of healthy public policies
 Health education to individuals and communities
 Reorientation of health services to improve the accessibility,
acceptability and appropriateness
 Advocacy to influence policy makers to adopt healthy policies and
enact/enforce laws that promote health and consumers rights
 Strengthening of Community Action & creating supportive
environment for health

9. What then is health education?

10. “Health Education is the primary and
dominant measure in Health
Promotion”
10

11. Health Education is defined as:
Planned learning activities that enable individuals, groups
and communities to voluntarily adopt behaviors that:
– Promote and maintain health
– Prevent specific diseases
– Facilitates recovery from illness

12. Key Principles of HE
1. Participation_ right & duty
2. Voluntary action_ long lasting
3. Informed consent_ service and research
4. Confidentiality_ basis of trust
5. Client-centred_ felt not perceived needs

13. The Emphasis is on Behaviour Change
 Behaviors are what “people do” or “what they fail to do”
 Behavior is a critical component in the relationship between health, disease
and quality of life.
 Behavior can ADD or DECREASE a person’s years of potential life (Green &
Kreuter, 1991)
 Behaviors can be changed or modified forcefully or voluntarily
 Voluntary change is long lasting
 So, you don’t just inform, u need to educate

14. A Quick Difference between Information & Education
 An individual is informed when he/she has acquired facts, ideas, or
messages about health
 An individual is educated when he/she receives a piece of health information and put
it into practice
 The exposure to health information is sometimes the first step in the adoption of a
behavior or practice.
 Correct information about health is a major requirement for education, but this is not
sufficient in of itself to bring about change in the behavior of many persons

15. Useful Health education methods
• A method is a special or specific way for facilitating a behavior change for
health
• Examples:
- Demonstration and return-demonstration
- Role-play
- Discussion
- Brainstorming
- Story telling
- Lecture
- Health talk
15

16. Now,
…Let’s go back to
the EVD task

17. Challenges of this Outbreak
 First complex mix transmission pattern : Rural, Urban,
Cross-border outbreaks
 Unusual number of health care workers among the cases
and deaths [health facilities serving as amplifier of the
EVD]
 Community resistance to key messages, strong traditional
beliefs and cultural practices fuelling the outbreak

18. To intervene,
..a few things we should remember….

19. Understanding if not the same as
rememberingWe are wired to forget!

20. 20 |
The Psychology of memory
 30% Hear
 20% Read
 40% See
 50% Say
 60% Do
 90% Multisensory
combination

21. 21 |
1. Experts and authorities are less trusted
 Doctors, experts and authorities are
less trusted and respected as the
source of all medical and health
advice
 Our patients and the public took our
advice
 No one complained about our
communications

22. 22 |
2. How the public get health advice has changed
 35% of the world´s population uses
internet,
 Mobile broadband - 41.6 per 100
people
 1 in 5 minutes on internet spent on
social networks, mostly Facebook
(50%), and twitter (7-9% but influential)

23. 23 |
3. Know and segment audiences
1. Primary audiences: these are the groups who
you are targetting for attitude or behaviour
change
2. Secondary audiences: those who influence the
primary audience
- The general public, governments, member
states, partners, “blockers and opponents”
3. Gatekeepers: groups that can amplify, diminish,
distort or otherwise influence our messages and
peoples’ perception and understanding of what
we say
- The media, community-based groups,
lobbies, on-line communities, community-
based organizations and civil society Indystar, 5 August

24. 24 |
The audience is always thinking…
Why is this important for me?
Why should I care?

25. 25 |
4. TRUST is key
Trust in individuals
and organizations
is by far the
greatest factor in
communicating
risk.

26. 26 |
5. Perception is everything
 Experts and patients perceive risk differently.
 Patient’s beliefs, experiences, values and opinions play a major
role in their perception of risk – about the health danger and
about the potential risk from an intervention
 Organized lobbies that go against what you advise, distort
perception even further
 Patients’ perceptions must be acknowledged, validated before
we start advising them
 The media, and social media play an important role in public
risk perception

27. 27 |
1. Trust
2. Announcing early
3. Transparency
4. Listening (Communications Surveillance)
5. Planning
WHO Outbreak communication
principles

28. 28 |
Risk and crisis communication building blocks:
Credibility
Expression
Of Caring
Values
Technical
Information
Trust
in individuals and
organizations is by far the
greatest factor

29. Nigeria is now
Ebola Free!!
Hurray!!

30. BUT, BEFORE YOU GO TO SLEEP:
…LET’S SEE THIS:

31. There are a few more things we MUST do?
• Maintain Public Alertness, Awareness and re-enforce key messages among
the general public
• Sustain Enhanced Surveillance of EVD in all our communities
• Strengthen Port health Capacity at all POE
• Strengthen the Infection Control and prevention practices of Health care
workers
• Research.! Research.!! Research..!!!
31

32. The Focus of Social Mobilization at this stage is:
1. Sustain Public Alertness and Awareness about Ebola Transmission
2. Re-enforce the key Message of Personal and Environmental
Hygiene Standards
3. Support Enhanced-Surveillance efforts of the health system
4. Empower the communities to actively participate in the
surveillance of their domains

33. Monitor EVD SitRep e.g. WHO October 25th, 2014
Country
TOTAL
Cases Deaths CFR (%)
Guinea 1553 926 59.6
Liberia 4665 2705 58.0
Sierra Leone 3896 1281 32.9
Nigeria 20 8 40.0
Senegal 1 0 0
Congo DR (last updated September 25th
) 68 41 60.2
USA 4 1 25.0
Spain 1 0 0
Mali 1 1 100
Total (Minus Congo DR) 10141 4922 48.5

34. Who is an Ebola Contact?
A person without any symptoms who has had physical contact with
a case or the body fluids of a case within the last three weeks.
The notion of physical contact may be proven or highly suspected
such as having shared the same room/bed, cared for a patient,
touched body fluids, or closely participated in a burial (physical
contact with the corpse).

35. A Suspected Ebola Case Definition
 Any person, alive or dead, who has (or had) sudden onset of high fever and had contact
with a suspected, probable or confirmed Ebola case, or a dead or sick animal OR
 Any person with sudden onset of high fever and at least three of the following
symptoms: headache, vomiting, anorexia / loss of appetite, diarhoea, lethargy, stomach
pain, aching muscles or joints, difficulty swallowing, breating difficulties, or hiccups; OR
 Any person with unexplained bleeding OR
 Any sudden, unexplained death
The distinction between a suspected case and a probable case in practice relatively unimportant as far as outbreak control is concerned.

36. A Probable Ebola Case Definition
Any suspected case evaluated by a clinician OR
Any person who died from ‘suspected’ Ebola and had an
epidemiological link to confirmed case but was not tested and did
not have laboratory confirmation of the disease
The distinction between a suspected case and a probable case in practice relatively
unimportant as far as outbreak control is concerned.

37. A Confirmed Ebola Case Definition
A probable or suspected case is classified as confirmed when a
sample from that person test positive for Ebola Virus in the
Laboratory
The distinction between a suspected case and a probable case in practice is relatively unimportant as far as
outbreak control is concerned.

38. Community Case Definition
• “any person who has unexplained illness with fever, diarrhoea,
vomiting with or without bleeding which does not respond to
antimalarial or who died after an unexplained severe illness
with fever and bleeding”.
– Communities should be vigilant and should immediately notify any clusters of an unusual
illnesses or deaths occurring in their communities either through the Ebola Help line, or
directly to LGA DSNO officer.

39. JUST BEFORE WE CONCLUDE:

40. EEOC Social Mobilization, Communication and
Health Promotion –in brief
• Risk Assessment and Target Population Analysis
• Focal community entry, engagement, advocacy and partnership
• IEC material development and Circulation
• Dedicated Helpline, website and social media interventions
• Mass Media (Electronic and Print) Health Education and
Sensitization
• House to House Sensitization and Hygiene Skill Transfer
• Special Mass Gathering Interventions
• Training and Local Capacity building

41. What worked at the EEOC?
• Passionate Expertise
• Phenomenal Team Spirit
• Zero protocol
• Effective Community participation

42. The Question is:
What will you do?

43. Please, Identify Your Partners/Hidden Resources:
• LGA Health Department
• Political and Traditional Leaders
• Religious Leaders
• NGO/CBO, Volunteers
• WHO Local Office, UNICEF Local Office, etc

44. What did I do as a Corp Member?

45. For further information and supportive collaboration,
please reach out to:
0800 EBOLA HELP
0800 32652 4357
ebola.mobilizers@gmail.com
www.ebolaalert.org

46. In Conclusion
• Public Awareness and Community Engagement is a
central component of the EVD Preparedness and
Response checklist by the WHO
• It reduces anxiety, supports behavioural change and
mobilize communities to report suspicious cases or
death
• Hence, health promotion remain the most effective
guard to preventing another EVD outbreak on our oil

47. Acknowledgements
• Department of Communications, WHO, Geneva
• Department of Health Promotion and Education, Faculty of
Public Health, University of Ibadan
• Social Mobilization and Communications Team, Ebola
Emergency Operations Centre (EEOC), Lagos

48. QUESTIONS?
CONTRIBUTIONS?

49. Thank You
Email: abrahamidokoko@gmail.com