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Stronger Together: Engaging Communities in the Zika Response Antigua, Guatemala April 24 - 26, 2018

On April 24th, 2018, USAID and the Knowledge for Health (K4Health) Project hosted a three-day share fair event in Antigua, Guatemala for USAID-funded community engagement partners in the Zika response in Latin America and the Caribbean.

Over 70 people attended from over 10 countries in the region, representing Ministries of Health and 16 partner organizations.

The event was designed to meet five specific objectives: 1) learn from one another; 2) share knowledge, tools, and resources; 3) brainstorm solutions to common challenges; 4) forge connections to strengthen the USAID Zika response; and 5) identify specific opportunities to strengthen country programs based on lessons learned and experiences shared. Specifically, the event focused on lessons learned and opportunities regarding community engagement for Zika prevention, including social and behavior change (SBC), vector control, and building local ownership and empowerment.

To kick off the event, community engagement partners MCDI, Save the Children, CARE, Global Communities, IFRC, SSI/AMOS, and UNICEF, each provided an overview of their current community engagement activities across the region including project successes and strategic approaches to address challenges.

Opening remarks by Dr. Roberto Molina from the Ministry of Public Health and Social Assistance in Guatemala

Next, participants discussed key strategies in community engagement through four engaging panel presentations on SBC, vector control, care and support, and local ownership and empowerment. The panels included discussions on challenges, solutions, and lessons learned and were followed by small group breakouts where participants shared and discussed country-level experiences including activities conducted, tools/resources used, and solutions to common challenges.

Small Group Discussions

During the SBC panel, panelists from IFRC, Save the Children, CARE, and CARPHA discussed the use of SBC messaging in various contexts including schools, home visits, and health facilities. The need for better monitoring and evaluation tools to determine the efficacy of SBC interventions emerged as a common challenge. During the subsequent breakout session, participants expanded on these topics and highlighted the need to conceptualize, design and evaluate SBC activities as ongoing processes rather than discrete, one-time interventions.

SBC Panel

The vector control panel included representatives from ZAP, MCDI, Save the Children, and the Dominican Republic MOH. Some common themes mentioned across countries and projects included inconsistent access to water in homes, security concerns during home visits, and the importance of coordination with MOHs. ZAP highlighted their work on capacity building, mapping, and developing standard protocols; Save the Children highlighted their work with home visits; MCDI highlighted their work on epidemiological surveys; and the Dominican Republic MOH discussed their use of epidemiological tools developed in conjunction with ZAP. During the accompanying breakout session, partners shared successful approaches to vector control that included community clean-ups, public awareness campaigns, and engaging youth as leaders.

Discussion Groups

The care and support panel featured representatives from UNICEF, Save the Children, IFRC, and ASCATED. Themes of the discussion included community awareness activities to reduce stigma and increase acceptance of people with disabilities, home visits to families affected by Congenital Zika Syndrome (CZS) to provide tools and resources on how and where to access services and support, and coordination efforts with MOHs and other partner organizations. Panelists highlighted community awareness as essential in ensuring support and acceptance among community members and shared their experiences addressing stigma and myths related to disabilities. They also agreed that institutionalization of services for disabilities in general, not just those related to the Zika virus, is necessary to ensure that all children are provided the same opportunities.

Care and Support Panel

During the local ownership and empowerment panel, representatives of SSI/AMOS, CARE, Save the Children, and the Guatemala MOH emphasized that community empowerment is not a single activity, but a collective process that requires constant adaptation to changing community needs. They noted that creating spaces for community participation lends credibility to projects and increases project success and sustainability. CARE discussed the implementation of community health fairs and how they have incorporated communities in the development of creative new resources. Save the Children and SSI/AMOS highlighted training models that include feedback loops to ensure that community member feedback is continuously incorporated into programming, and the Guatemala MOH discussed the development of their national communication strategy for the prevention of Zika. During the breakout session participants discussed the importance of conducting community diagnostics, listening to and understanding community needs, and strengthening existing systems to ensure community ownership.

Group Discussion

The event also included innovative project presentations from three partner organizations highlighting unique approaches to Zika vector control, care and support, and SBC. Save the Children presented on how they have used low-cost mobile technology platforms to simplify ovitrap monitoring within their community-based vector surveillance activities. Next, SSI/AMOS presented on their adaptation of the “Dengue Chat” mobile platform to deliver Zika vector control messages during house visits. Then, members of a local support group sponsored by UNICEF and ASCATED shared their experiences using WhatsApp to connect with other parents of children with CZS.

Two knowledge cafes designed to facilitate small group discussion and learning, that focused on key audiences and contexts within the Zika response were also conducted. The first knowledge café discussed strategies to engage communities in urban, peri-urban and rural contexts. One common theme that emerged was the risk of violence in urban settings, which has posed challenges for several Zika partners. The second knowledge café focused on strategies to engage various populations including male partners, women of reproductive age, youth, community groups and community leaders. Common themes included tactics to engage male partners who may not believe they have a role in antenatal care or related issues, as well as strategies to reach adolescents who often have competing interests and short attention spans.

Knowledge Cafe Discussions

In the afternoon, a “hands on” session provided participants the opportunity to share and interact with community engagement and education resources created by partner organizations including Zika games, water tank covers, ovitraps, educational flip charts and of course, a mosquito costume. The session promoted discussion and knowledge exchange through tactile learning and stressed the need for creative approaches.

The mosquito costume used by MCDI to engage communities in Zika prevention

On the final day of the Share Fair, participants were able to choose between two half-day workshops: one on SBC, led by Breakthrough ACTION, Breakthrough Research, and USAID; and the other on vector control, led by USAID.

During the half-day targeted workshop on SBC, the SBC matrix developed by Breakthrough ACTION, Breakthrough Research, and USAID was presented. The Zika Prevention Behavior Matrix presents seven priority behaviors that have the greatest potential to reduce Zika transmission and minimize negative pregnancy outcomes. The behaviors are grouped into three main categories: personal protection; vector control at the community and household level; and enabling behaviors. Participants discussed the various ways in which they intend to incorporate the key behaviors in their work. The group also discussed the creation of a tool to support community volunteers and health workers as they conduct Zika home visits, as well as improved indicators for monitoring and evaluation of behavior change within a community.

During the half-day vector control workshop, participants discussed the activities and tools they have developed for Zika vector control, including using georeference technologies to map vector control interventions alongside vector surveillance data, the use of social media to form vector control networks and share information, and mobile technologies to update surveillance data in real time. Participants highlighted that family member engagement with household vector control activities and surveillance, as well as MOH involvement in technologies used are essential to ensuring long-term sustainability.

Overall, several important themes emerged from the three-day share fair including the design of fun, engaging, and adaptable resources that have been implemented in community engagement activities; the importance of leveraging existing community structures; strategies for engaging community stakeholders; integrating continuous training/quality improvement for community volunteers, program implementers, and health workers; and adopting multi-sectoral approaches to include not only the health sector but also government, civil society, environment, and private sectors.

Participants distinguished between community involvement and community ownership, stressing that ownership will be necessary to ensure sustainability for Zika response activities beyond the end of the program. They highlighted early engagement in planning and execution as a successful strategy to achieve ownership and long term sustainability. Participants also emphasized the need for coordinated efforts among all organizations working in the Zika response in a given country, including MOHs, to ensure that communities recognize the credibility of projects, that projects reach all communities, and that activities are sustained by communities beyond the end of the project.

Sharing community engagement experiences and best practices is essential to ensuring that USAID’s Zika response efforts are as impactful as possible. “Stronger Together: Involving Communities in the Zika Response” aimed to spark these critical discussions and forge connections to strengthen the Zika response as it moves into its final year.

Credits:

Created with images by raissa - "3d grey map of south and north american countries"

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