- Report -

Ukraine

Making every school a health-promoting school: global standards and indicators

Credits

author

Outcome

Supportive and empowering societies through addressing health risk factors

[COUNTRY STORY]

Investing in Risk Communication and Community Engagement to battle Crimean-Congo haemorrhagic fever in Iraq

Iraq

Photo: WHO Iraq Information about preventive measures was disseminated to people at highest risk through individual and small group sessions

Risk Communication and Community Engagement to stop disease

Crimean-Congo haemorrhagic fever (CCHF) is a viral haemorrhagic fever caused by a tick-borne virus, mainly spread to people from livestock. It has a high fatality rate ranging between 10 and 40 percent. The first outbreak was reported in Iraq in 1979, after which a few cases have been reported every year. In 2020-2021, due to the COVID-19 pandemic and climate change, the largest CCHF outbreak ever in Iraq occurred, with over 300 confirmed cases by early 2022. As there is no vaccine, the only way to reduce infections is to raise awareness of the risks and educate people on preventive measures. To combat the outbreak, WHO Iraq, Iraqi Ministry of Health (MoH) and Ministry of Agriculture launched Risk Communication and Community Engagement (RCCE) activities, reaching 15 million people through social media and 1 million high-risk individuals through other outreach mechanisms. This led to a decrease in cases, morbidity, and mortality, with the epidemic curve plateauing 22 weeks after the first case was reported.

Key WHO Contributions

Initiation of multi-disciplinary response teams for greater contextual understanding
Development of bespoke communication material for different audiences
Conduct of trainings for different populations groups for tailored outreach
Supportive supervision to ensure adherence to training practices
Conduct of monitoring to evaluate numbers of population reached.

How did Iraq, with the support of WHO Secretariat, achieve this?

As soon as WHO knew about the CCHF outbreak, WHO Iraq and the MoH worked together to develop a multi-faceted RCCE programme. Response teams from WHO Iraq, the MoH, the Ministry of Agriculture, and Iraqi Red Crescent Society (IRCS) visited affected areas in the southern governates to engage with and improve understanding of various groups and stakeholders. Those most likely to be affected were those working with livestock and pilgrims because Arbaeen, the world's largest annual pilgrimage, was taking place in the southern governates of Iraq which were most affected by CCHF. Interviews with farmers and livestock traders and focus group discussions with women were conducted to tailor messages to those at highest risk. Dozens of high-quality videos, motion graphics, animations, cartoons, infographics, and radio dramas were then created from scratch by RCCE and communication teams in WHO Iraq office, with content tailored to different audiences in different languages (e.g., Arabic and Kurdish), Iraqi dialects, and comprehension levels.

^{To maximize reach, messages about Crimean-Congo haemorrhagic fever were spread through social media platforms.}Photo credit: WHO Iraq.

The RCCE strategy aimed to reach communities by meeting them and transmitting messages to empower them to become actors in their own health. WHO Iraq, the MoH and the IRCS collaborated to disseminate information about preventive measures, with WHO training 252 volunteers who conducted around 18 500 individual and small group sessions in 572 high-risk areas in 11 governates. These efforts, despite the challenging weather conditions, reached a total of 139 000 people [1, 2] at high risk, in often remote areas, to help prevent the spread of disease. Roughly 40 000 hours were dedicated to lowering the health risks of mass gathering events. To maximize impact, messages were also spread through social media platforms such as Instagram, YouTube and TikTok. People in positions of social and cultural authority were recruited and celebrities and community influencers involved to increase awareness. To ensure the messages were effective in reaching and motivating people, training workshops were held by WHO Iraq, extending to around 4 500 faith and tribal leaders and more than 9 000 frontline responders, including health workers, health educators and community volunteers. These training workshops built the capacity of these groups to effectively convey health messages on preventive measures against different diseases.

WHO Iraq then supported the efforts of the MoH to combat and control the disease through conducting supervisory visits, holding dialogue, providing coordination across various departments, and procuring supplies.

"RCCE hasn't only helped in building trust among communities across Iraq, but also in increasing their sense of ownership and accountability to take action to address health hazards"

- Dr Ahmed Zouiten, WHO Representative in Iraq

The COVID-19 pandemic highlighted the importance of RCCE for emergency response in Iraq. In both rural (44%) and urban (56%) areas people were empowered, and communities mobilized. Gender balance was ensured, with 46% of RCCE recipients being female. This new approach to RCCE, which harnesses current communications channels such as social media in addition to in-person communications, enabled WHO to reach many more Iraqis with accurate health messages about outbreaks and diseases. The success of the RCCE over the past two years is a significant achievement, and the scope of RCCE will be extended to cover other Non-Communicable Diseases (NCDs) and communicable disease control in Iraq in the future.