Local capacity building: training health staff to communicate with communities

Caption 1: Group work on developing key messages.  Photo credit: WHO/Vanly Lorkuangming

“Keeping affected communities informed and involved is crucial when responding to an outbreak. It’s not enough just to “tell”: you need to listen and engage. That doesn’t always come naturally to health staff – but we can train them how to do it.” Dr Mark Jacobs, WHO Representative to Lao PDR.

People in an at-risk community can either be supportive or unsupportive of efforts to control a disease outbreak. Health staff are much more likely to succeed in controlling an outbreak when they can persuade the community to be supportive. This has been a hard-learned lesson for WHO and national health authorities over the years. Nonetheless, acting on this lesson can be a challenge. Winning over communities takes time, effort and skills. For example, an ability to actively listen and to see the outbreak through the eyes of the community. Not all health staff have these skills. But they can be taught.

In September, the Lao Ministry of Health’s Centre for Communication and Education on Health (CCEH) ran a series of workshops to teach risk communication skills. With the support of risk communicators from the WHO Country Office, they trained nearly a hundred provincial and district level staff. The workshops took place in the provinces of Bokeo, Luang Namtha and Oudomxay as part of a program funded by the USAID to strengthen Lao PDR’s preparedness for avian influenza outbreaks and human influenza pandemics. However, they also contribute to the wider goal of strengthening the country’s risk communication capacity for all types of health threats.

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“Is there anyone who knows about dengue?” - Kidsada asked a group of villagers. 

It is a peaceful morning in September, Kidsada and other health staff are talking with villagers at the village office. There are three groups: one group inside the office, the other two outside. Each group discusses a different health topic. One is discussing dengue, another diarrhea and the third discusses avian influenza.

“The focus group discussion is very interesting. I just realized that people are very interested to talk about their health problems like dengue.” – said Mr Kidsada, a local outbreak team member from Viengphukha District, Luang Namtha province.

Caption 2: The villagers sitting in a circle and participating in the discussion about diarrhea, Photo credit: WHO/Vanly Lorkuangming

The health staff play different roles during the focus group. Some are engaging the villagers and getting them to talk: about what they know about a particular disease; how they perceive the risks associated with it; and their attitudes to disease prevention measures. Other health staff are noting the suggestions the villagers make, so none of their advice is lost. The atmosphere is relaxed and full of chitchat and laughter.   

Caption 3: The note taker doing his job during a community discussion. Photo credit: WHO/Vanly Lorkuangming

Like Kidsada, all these district health staff have travelled to Luang Namtha Provincial Health Department to attend risk communication training.

Back in Vientiane WHO’s Representative to Lao PDR, Dr Mark Jacobs, explains why strengthening the country’s risk communication capacity is a high priority.  “The Ministry of Health has been working hard to strengthen its emergency response system. Strengthening its risk communication is a crucial part of that”. Dr Jacobs recalls that the Asia Pacific strategy for emerging diseases and public health emergencies (APSED III) calls on countries to maintain strong risk communication capacities.

Dr Jacobs feels the logic of all this is clear: “Keeping affected communities informed and involved is crucial when responding to outbreaks and emergencies.” He adds: “It’s not enough just to “tell”: you need to listen and engage. That doesn’t always come naturally to health staff – but we can help train them how to do it”

Speaking about the risk communication training in the provinces, Mr Visith Khamlusa, Director of the Centre for Communication and Education for Health in the national Ministry of Health explains: “District and provincial health staff are the people on the frontline when a health emergency happens. They are the first people to have contact with the communities at risk. They need to know how to communicate and engage with these communities in a timely and effective way”.

Reflecting on the focus group discussion in Luang Namtha, district outbreak team member Kidsada says:  

“This is my first time participating in risk communication training. I have learned a lot about communication skills for emergencies and outbreak response.”

Caption 4: Mr Kidsada talking with the villagers about dengue. Photo credit: WHO/Vanly Lorkuangming

Working as a junior staff member at Viengphukha District outbreak center for a couple of years, Kidsada knew that risk communication is an essential part of outbreak response. He is particularly excited to learn about the community engagement: “Through the discussion with the community, I learned about their concerns. For example, people in this village are concerned about dengue at the moment. But many are unsure of the symptoms or how they can protect themselves.”

Kidsada found it interesting to talk with people, which is quite different from what he often does: “It is a two-way communication. I think the discussion helps me understand more about the community. This can help me tailor our risk communication messages.”

Like Kidsada, Ms Vandee is a local health staff member. She is from Paktha District in Bokeo province. She has been working for the health education unit there for many years. She has participated in risk communication training several times. However, community engagement is quite new for her. She said: “mostly, we provide health education to the community, which is more like one-way communication.”

Caption 5: Representing her group, Ms Vandee presented the key messages on diarrhea. Photo credit: WHO/Vanly Lorkuangming

Speaking from her experience, Vandee said that she faces many barriers when providing health education to communities. These include lack of cooperation from some communities, cultural and language barriers vis-à-vis minority ethnic groups, low levels of literacy, lack of appropriate communication materials, limited time and budget…. and the list goes on. So, she found the community engagement training helpful as a method for identifying ways to overcome these barriers. 

Caption 6: Ms Vandee engaging with the villagers during the focus group discussion. Photo credit: WHO/Vanly Lorkuangming

“Community engagement is a very important and useful way to understand why people think and act in a certain way. When we understand our audience, we can think of key messages and a better way to deliver the messages and motivate behavior change among the community.” – She reflected. 

Caption 7: One of the participants sharing her thoughts. Photo credit: WHO/Vanly Lorkuangming

Caption 8: Group exercise on linking communication to a strategic goal. Photo credit: WHO/Vanly Lorkuangming

The core group of staff trained in the September 2019 workshops were district and provincial level health educators. However, given the importance of risk communication coordination across different organization during an emergency, district and provincial staff from mass organizations (Lao Youth Union, Lao Women’s Union), media, healthcare and agricultural sectors also participated. A total of nearly 100 district level staff were trained.

“This was a very valuable training,” reflected Mr Visith “But we have many hundreds more district and provincial staff who could benefit from risk communication training. I hope that, together with our partners in WHO we can train even more local staff in 2020.”

Caption 9: Plenty of laughter at focus group discussion with villagers in Oudomxay. Photo credit: WHO/Ben Duncan

Caption 10: Village leader opens a community meeting in Oudomxay Province. Photo credit: WHO/Ben Duncan

For more information about the Lao Ministry of Health’s Centre for Communication and Education for Health (CCEH) see: https://www.facebook.com/CIEH.MoH.Lao/?epa=SEARCH_BOX