The engagement of the community affected is an integral part of all control and elimination activities. Why it is critical to consider the community perspective in VL control? How does it contribute to strengthening a VL programme?
Understanding perception of VL in affected communities
Studies on knowledge, acceptability and practice (KAP studies) of control tools are hugely beneficial. They inform health practitioners about what the community believes about the disease symptoms, transmission and about control measures. Importantly, they can expose areas of misconception that can be tackled by health education.
For example, a study approaching community members in highly endemic areas in the Bihar state of North-east India, exposed, amongst other findings, that even though almost 95% of participants had heard about VL, only 4.3% of participants associated the disease with a bite of a sand fly (Siddiqui et al., 2010). The majority (62.8%) associated VL with mosquitoes and the remaining participants (32.9%) did not know. Furthermore, 72% of participants in the same study were not able to recognise a sand fly. This information was later then used for the development of health education campaigns that target these knowledge gaps around transmission of the sand fly.
Similarly, a study conducted in South Gondar, in Northwest Ethiopia (Alemu et al., 2013), showed that people had a good level of knowledge about VL and had a positive opinion about community engagement, cre and treatment of the disease. However, it was also apparent that there was a gap between knowledge of vector control measures and the implementation of them.
For more KAP studies, do have a look in the See Also links at the bottom of this Step.
Health education – a form of intervention
Health education is a form of intervention. As a method, it supplements diagnosis and treatment and vector control activities in the community, and is critical during outbreaks, especially in remote areas.
In practice, health education consists of activities collectively known as Information Education Communication/Behaviour Change Communication (IEC/BCC) and operates within the context of a control and/or elimination national outreach strategy. IEC/BCC involves the development of educational materials targeted to the specific community affected. Topics covered can include the recognition of symptoms, understanding risks and mode of transmission of VL, the importance of early diagnosis and treatment compliance and acceptance and correct use of vector control methods.
Education tools might have various formats; display posters, banners and wall stickers placed at various noticeable places; multimedia formats of radio or TV spots and films; paper books, or FAQ (frequently asked questions) booklets. Other innovative approaches have also been used, including street theatre, involvement of traditional healers (e.g. in Afghanistan for the control of leishmaniases (NMLCP, 2012) or engaging children, school teachers and former patients (e.g. part of the current approach in Sudan).
IEC/BCC are delivered via a communication outreach team and in different types of sessions and target areas. Behaviour change communication facilitators (BCCFs) might deliver IEC/BCC in interpersonal or in group communication sessions in affected areas. IEC/BCC can be rolled out per district and be managed regionally. There should be a country-level strategic guideline from which the region, state or district can develop their tools and plan, taking in to account local culture and tradition. This ensures that the most marginalised and hard-to-reach communities are served.
Monitoring and evaluating health education is also important.
Why educate the community?
Health education is the improvement of health seeking behaviour which is central to VL control and case management. Health education can help dispel social barriers that prevent access to care by removing potential stigma/ misconceptions associated with the disease. Moreover, the more communities are aware of how to recognise relevant symptoms and know how to seek treatment, the more likely they are to report to health facilities and more cases can be treated. At the same time, health education can also contribute to the acceptance of vector control interventions.
The major benefit of educating and engaging closely with the community affected is that it builds capacity and partnership across members of the communities and builds resilience against emerging threats. Social engagement and mobilisation against VL can aid the sustainability of control efforts, while also helping to break the link of the poverty and disability associated with VL (Bardosh et al, 2017).
© London School of Hygiene & Tropical Medicine 2018