One Health National Emergency Risk Communication Strategic Plan

1 “Sierra Leone One Health National Strategic Plan 2019–2023”. One Health National Emergency Risk Communication Strategic Plan 3 Risk communication refers to the real-time exchange of information, advice, and opinions between experts, local officials, or political decision makers and the people who are at risk, as defined by WHO. Its goal is to enable people at risk to make informed and best possible decisions to mitigate the risks to their health and well-being. Timely and accurate communication with stakeholders and the public is paramount in any emergency situation. The general public must be regularly informed about the situation and given advice on prevention and protective actions to take. Clarifications are also necessary in order to offset false information that can generate more uncertainty and fear in the population. A strong and united voice coming from various sources at the community level can determine whether an emergency spirals out of control or is brought into check as soon as possible. Coordination across and between response sectors is key to how appropriate and positive behaviors, beliefs, and trust can affect the spread of a disease. As evidenced during the 2014–2016 EVD outbreak, an effective response can depend on changes to behavior and social norms. These changes require robust, trustworthy communication and commitment to community engagement to support those affected by a health emergency to: • Define the issue or problems affecting them. • Reflect on the causes of the issues, including how their behaviors affect them. • Identify their ability to improve the issue. • Organize themselves to address the issue. Risk communication should always make use of a range of social and behavior change communication and engagement tactics, including mass communication for public information; strategic partnerships, such as setting up working groups and committees with key stakeholders; and the leveraging of existing information platforms and information systems. The right message at the right time can save lives; however, risk communication is more than just delivering messages. Community engagement is a critical component of risk communication. Engaging communities prior to an event can foster trust and strengthen feedback loops between communities and health facilities. It can also accelerate the community-led action needed to create a demand-driven response in an emergency situation. Community engagement helps to ensure that communities recognize the benefits of adopting the behaviors emergency response advocates and willingly cooperating with response teams. Community engagement may sometimes be an afterthought. Systems that acknowledge the importance of community must be in place from the beginning. The primary goal of risk communication and social and behavior change communication should be to promote programs, campaigns, and messages that change the public’s behaviors in a positive direction—before an emergency or outbreak occurs. Such measures can prevent outbreaks from happening. Once an outbreak occurs, strong emergency risk communication involves a process with an outcome (e.g., ending an outbreak), thus promoting dialogue for everyone involved in the response, beginning with affected community members. Effective listening and two-way communication can strengthen relationships, build trust, and enhance transparency. During a public health crisis, early, One Health National Emergency Risk Communication Strategic Plan 4 coordinated, and effective delivery of life-saving messages through multiple channels that include community engagement activities can make a tremendous difference to the eventual magnitude of an outbreak or epidemic. Effective, integrated risk communication and social and behavior change communication can be major contributors to national health security and thus are critical to strengthening the government’s ability to safeguard the health of its people. The recently released Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries calls for a One Health multisectoral coordination mechanism (MCM) for zoonotic diseases. As the document states, “This may be construed as any formalized, standing group that acts to strengthen or develop collaboration, communication, and coordination across the sectors responsible for addressing zoonotic diseases and other health concerns at the human- animal-environment interface.” An MCM would have routine, ongoing functions and guide coordination, leadership, and governance of efforts among the relevant sectors to achieve jointly determined shared goals.2 The One Health National Emergency Risk Communication Strategic Plan proposes that a One Health risk communication MCM be formed. This MCM will comprise key persons with responsibility for risk communication from MOHS, MAF, EPA, and ONS. The following the mandates of these agencies: • MOHS has the mandate, according to the Public Health Ordinance 1960, to prevent and control infectious diseases within the country. • The Livestock and Veterinary Services Division, under MAF, has the responsibility to prevent transmission and control of diseases among animals. MAF, in collaboration with MOHS, works to prevent and control zoonotic diseases in the country. • EPA is mandated to protect the environment. As stipulated in the Environment Protection Agency Act of 2008, and as amended in 2010, EPA has the overall responsibility and mandates on the formulation of policies on all aspects of the environment, including its sustainable management and keeping the ecosystem safe and secure from all hazards. EPA acts as the focal point for all issues concerning the environment.3 • ONS is responsible for all issues related to the safety of the country and its people, and is directly under the office of the president of Sierra Leone. It is responsible for the military and the police and manages district and chiefdom security committees. Communication specialists from these four key agencies would be the core members of the proposed One Health risk communication MCM.

2 Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries, The Food and Agricultural Organization of the United Nations, The World Organization for Animal Health and the World Health Organization, 2019. http://www.fao.org/3/ca2942en/ca2942en.pdf

3 “Terms of Reference for the National One Health Coordination Committee in Sierra Leone”. One Health National Emergency Risk Communication Strategic Plan 5 Situation Analysis The following section outlines the key responsibilities and mandate of the four organizations (MOHS, MAF, EPA, and ONS) that will constitute the proposed One Health risk communication MCM. It includes other key development partners and an analysis of the media situation in the country. A timely and effective response requires an understanding of the mandates of each organization because numerous platforms/authorities/stakeholders/structures are involved in preparedness and response. The strength of communication systems and expertise geared to respond to an emergency from a risk communication and social and behavior change communication perspective and infrastructure varies from organization to organization. One Health Platform The following information is from the validated terms of reference (TOR) for the National One Health Coordination Committee in Sierra Leone. Some functions of the One Health committees are to: • Support training, research, education, and public awareness campaigns on risk reduction linked to human health, animal/wildlife health, and the health of the environment. • Take measures to improve community-based surveillance, ensuring that a One Health approach is implemented at the community level. • Facilitate and oversee multisectoral resource mobilization for prevention, detection, preparedness, and vulnerability reduction for priority public health events. The One Health Technical Committee • The One Health Technical Committee provides leadership to the technical working groups (TWGs) managing general concerns with prevention, detection, and response. The committee ensures attention to all issues of IHR, GHSA, and One Health and addresses any gaps it identifies. It is mainly composed of technical directors, program managers, and technical expertise from local and international bodies/partners. • One function is to identify and monitor IHR/GHSA, One Health issues, provide threat alerts/early warnings for public health threats, and propose solutions to the coordination committee. Protection Technical Working Group The Protection TWG is composed of experts/program leads from MOHS, MAF, EPA, academic institutions, and others. The team is enhanced by the expertise of development partners, civil society organizations (CSOs), and nongovernmental organizations (NGOs). Its key role is to ensure that preventive efforts in the following areas are strengthened: • Priority diseases under surveillance, including zoonotic diseases • Antimicrobial resistance in the country • Environment health situation One Health National Emergency Risk Communication Strategic Plan 6 • Public health situation across IHR-designated borders • Biosafety and biosecurity • Environment protection • Chemical events • Radiation • Medical countermeasures and personnel deployment Surveillance Technical Working Group • The Surveillance TWG will be composed of experts/program leads from MOHS, MAF, and EPA. The team will be enhanced by the expertise of development partners, CSOs, and NGOs. • This TWG will address all types of surveillance, including animal and human health and environment health, including monitoring of data. District-Level One Health Committees Each district will have its own One Health technical committee. Each district One Health technical committee is co-chaired by the district medical officer, the environment officer, and district agricultural officer. The committee meets at least monthly to analyze, make recommendations, and determine how to work together to address multisectoral issues in the district. The composition of the district committee varies according to the district’s key issues. • The existing district committees utilize chiefdom-level structures to coordinate activities at the village level. • The paramount chief has the mandate to coordinate activities within his chiefdom. • The village head is responsible for coordinating implementation of activities at the village level, utilizing existing village coordination structures. While each of these structures combines some aspect of monitoring and managing potential disease outbreaks, no coordinating body is tasked with risk communication in these TWGs and committees. One Health National Emergency Risk Communication Strategic Plan 7 One Health Key Partners’ Roles One Health partners with four key ministries and agencies, MOHS, MAF, EPA, and ONS, the core organizations tasked with dealing with any critical incidents, emergencies, or outbreaks across the sectors. Ministry of Health and Sanitation NATIONAL LEVEL Health Education Division As a division within the Directorate of Primary Health Care (DPHC), the Health Education Division (HED) serves as a national partner for health promotion and social and behavior change communication activities. • The HED oversees and manages the implementation of all health promotion activities in the country. • The HED is supported by numerous NGOs and CSOs. • Coordination mechanisms to share best practices include the Health NGO Forum, the International Health Forum, and the Health and Nutrition Civil Society. • Donors such as the United States Agency for International Development (USAID), the United Kingdom’s Department for International Development (DFID), Irish Aid, and others meet at regularly scheduled donor partner meetings to ensure efforts are coordinated. • United Nations (UN) country team (United Nations Children's Fund [UNICEF], WHO, United Nations Population Fund) are active partners as well. Public Health National Emergency Operations Center The Public Health National Emergency Operations Center (PHNEOC) is MOHS’s focal point for emergency planning and execution. In fulfilling these responsibilities, MOHS provides national leadership and coordination for the public health elements of the health sector’s emergency preparedness resilience response (EPRR) system. In addition, it provides risk analysis and assessment of emerging diseases, including evaluation and review of the public health effect of naturally occurring extreme events, chemical and radiological incidents, and deliberate release threats, including chemical, biological, radiological, or nuclear explosives, to inform ONS and other stakeholders. Rapid Response Teams A rapid response team (RRT) is a unit placed through WHO’s Integrated Disease Surveillance and Response system for the African region and is intended to ensure that outbreak response is prompt—from investigation, verification/confirmation, and management of cases through to reporting. The RRT is the proactive arm of the Emergency Operations Center and is expected to report back to the incident manager at all levels of operation. The Integrated Disease Surveillance and Response strategy adopted by WHO AFRO member states for improving public health surveillance and One Health National Emergency Risk Communication Strategic Plan 8 response provides for the establishment of RRTs at all levels of the health system. The function of an RRT is to capacitate, investigate, and provide technical leadership in the response to outbreaks and other public health events. The MOHS district and national levels, institutions (private and public), and other relevant sectors designate experienced technical personnel who can respond immediately when an outbreak is suspected. RRTs are established at national and district levels. RRTs are composed of scientists and specialists, including risk communication specialists and an EPA officer. The RRT has links with all the response pillars. The District Emergency Operations Center incident manager (IM) shares an operational plan with both the district and national RRTs in affected areas to enhance resources coordination.4 Incident Management All incident management decisions are led by an IM, appointed by MOHS, who is supported by relevant specialists and teams, as appropriate. These people constitute the Incident Management Team. The team will operate according to an agreed-upon daily schedule or battle rhythm (an operational tempo set by the IM) to coordinate the MOHS operational response and support other operational partners. The chief medical officer (CMO) is responsible for public health EPRR arrangements. The CMO focuses on responding to a national incident as set out in the Public Health Incident and Emergency Response TOR in collaboration with other government ministries, departments, and agencies (MDAs). (From Concept of Operations [ConOps] document) National Social Mobilization Pillar Throughout the EVD response, the national social mobilization (SM) pillar was the principal coordinating body for health promotion activities. It continues to serve in this capacity post EVD to ensure that SM and community engagement efforts harmonize at all levels. Supported by district SM pillars, the national SM pillar is the principal coordinating body for ensuring the harmonization of SM efforts, providing technical support on materials development and dissemination, review and approval of health promotion messages, evidence generation, and data usage for making decisions. The manager of the HED serves as the cochair of the SM pillar Secretariat with a designated UNICEF focal point as the other cochair. The HED participates in key pillar and hub meetings to ensure harmonization of activities. The pillar was reactivated during the EVD outbreak, but it has since evolved to include a variety of health areas, such as maternal and infant mortality, preparedness and response to disease outbreaks (e.g., malaria, measles, EVD, and cholera), and disaster management (e.g., flooding and famine).

4 “Operational Guidelines and Procedures for Rapid Response Teams in Public Health Emergencies, 2017”. One Health National Emergency Risk Communication Strategic Plan 9 A TOR document serves as a guide for the national SM pillar, which: • Sets the agenda and leads regular meetings. • Assigns and monitors tasks emanating from action points. • Reports to external parties and ensures minutes from all meetings are circulated to members. • Selects panelists for material design and reviews materials. • Maintains an active database of partners for broad-based information sharing and coordination. The MOHS HED and pillar must vet and approve all developed messages and materials before production, as stated in the MOHS health promotion policy. Communications Pillar As part of the PHNEOC, the communications pillar is designed to develop and implement emergency communication preparedness plans, with a focus on media and public information. A health promotion officer from the HED attached to the MOHS Directorate of Health Security and Emergencies serves as the communications pillar lead and chair, and a TOR document serves as a guide for the pillar. The communications lead works closely with the information technology team to ensure current/relevant information is posted in a timely manner. Representatives from the communications pillar and the SM pillar meet during scheduled meetings, and an HED health promotion officer attends pillar meetings to ensure harmonization. DISTRICT LEVEL District Health Management Team • Is responsible for operationalizing health policy, which includes liaising with respective local councils and central-level ministries for resource allocation and budget requests • Initiates quarterly community meetings with local stakeholders to identify gaps in the health system and propose solutions • Mobilizes resources for health promotion and other health services activities allocated by the district council • Coordinates activities of both local and international partners District Council • Mobilizes resources for health and other development activities • Distributes resources across the public sector district pillars; MDAs, and councils • Ensures that national-level priorities related to the community health worker (CHW) program are implemented at the district and local level • Participates in district SM meetings One Health National Emergency Risk Communication Strategic Plan 10 Each district has its own SM pillar linked to the national SM pillar that is responsible for implementing and overseeing district-level SM activities for health. Further, to aid in disease surveillance and coordination of health promotion activities, each district has a surveillance pillar; a district health coordinating committee; a district infection, prevention, and control committee; a district AIDS committee; a district health management team; a district RRT; and other related committees that work closely with the district CHW TWG, which includes a district CHW focal person. MOHS mandates that at least one CHW serves as the link between the health facility and the community they serve. COMMUNITY LEVEL Peripheral Health Units • Peripheral health units are delivery points for primary health care in the country. • CHWs are attached to the units to serve as social mobilizers. Health Management Committees/Facility Management Committees • Health management committees, also known as facility management committees, oversee the functioning and supply of the peripheral health units at the district level. • Each district has a health management committee or a facility management committee, which is composed of seven to 11 members appointed by the community. National CHW Hub Under the DPHC, health promotion is the key role for the nation’s CHWs. Under the DPHC, the National CHW Hub is responsible for the National CHW Program, which provides guidelines on policy, strategy, financing, and implementation as well as guidance related to CHWs. The National CHW Hub also facilitates the CHW steering committee and a CHW TWG. These national structures, which serve to ensure implementation of the CHW strategy and advise on coherence and complementarity, also link with district-level CHW TWGs and CHW focal persons. Membership includes all MOHS directors and program managers whose programs are implicated in the National CHW Program, including the HED. Village Development Committees • Oversees all development initiatives in communities, including health services and health promotion, environment, leadership, education, and other issues. CHWs are members of the village development committees (VDCs). • A TOR document serves as a guide for the VDCs. • CHWs and representatives from a variety of community groups are attached to the VDCs in each community and are regularly employed to promote health and sanitation issues. • This group must include, but should not be limited to, traditional leaders, ward councilors, societal heads, traditional healers, religious leaders, women’s secret societies, men’s secret societies, women’s leaders, youth groups, women’s clubs, market women, community health One Health National Emergency Risk Communication Strategic Plan 11 clubs, school health clubs, school management committees, and mother-to-mother groups. These representatives are instrumental to health promotion activities, and efforts to strengthen or, where necessary, revitalize them will be critical. Ministry of Agriculture and Forestry Extension Services in MAF Functions and Characteristics • Extension services have been an active feature of agricultural development in Sierra Leone since the early 1970s. Since independence, Sierra Leone has experimented with various approaches to agricultural extension under the cooperative movements, church-related development schemes, and a number of donor-assisted projects. Several scattered extension initiatives involve government organizations, international organizations, and NGOs. The major function of Agricultural Extension Services is to strengthen agricultural support services in terms of research and extension, marketing, and storing fertilizer and seed. • Approximately 250 extension officers operate at the district, chiefdom, and community levels under MAF in Sierra Leone. The extension officers are capable of providing handouts, bulletins, magazines, and so forth on animal and environment health issues to communities. They have the capacity to carry messages from top management to farmers and other environment resource users as well as to channel information to the national level. Such officers have the capacity to use periodic radio and TV slots, audiovisual equipment, agricultural shows, Farmer Awareness Days, study tours, and so forth. Environment Protection Agency Current Policy on the Environment Apart from the Council of Chiefs, all institutions have a policy on the environment. District and local councils have environment and social officers (ESOs) charged with monitoring and supervising activities that are likely to degrade the environment. They may also contribute to forming by-laws on the environment and issue notices and licenses for monitoring waste management in various councils. In 2011, the European Union, through the World Bank, determined that all councils should have an environmental unit. Each region has EPA regional head officers whose responsibilities include: • Assisting in planning, monitoring, and enforcement operations country-wide with an emphasis on the regions. • Preparing weekly status report of all licensed and nonlicensed environmental projects. • Developing the schedule for submission of quarterly environment and social management reports. • Assisting the assistant director in the preparation of the monitoring schedule. • Coordinating preliminary assessment of the monthly monitoring report. One Health National Emergency Risk Communication Strategic Plan 12 • Developing a database for all environmental projects submitted by proponents. • Investigating areas of environmental degradation and pollution, where necessary, in collaboration with other relevant departments. • Determining and reporting cases of environmental emergencies at the regional and district level. • Assisting the assistant director in the needs assessment process with provisional offices and district and local councils. • Assisting the local councils and ESOs in planning and implementing activities related to environmental and natural resource management. • Ensuring that logistical support is provided for the regional officers. • Fulfilling any other duties that may be assigned in accordance with the mandate of the agency. Local Councils’ Functions and Characteristics Local councils are the institutions closest to environmental problems because they are the custodians of local environment resources. These councils are mostly headed by elected and appointed representatives of communities who live with the people and experience the same problems. They are the highest political and administrative body in the district, and they coordinate several decentralized departments. They have extensive human resources and express official goodwill toward the environment. They include ESOs, ONS, police, army, and CSOs, among others, and maintain policies on the environment. EPA liaises with the Ministry of Information, Sierra Leone Broadcasting Corporation, Sierra Leone Association of Journalists, Mass Communication Department Fourah Bay College, Women in the Media Sierra Leone, Media Reform Coordination Group, Sierra Leone Environment Journalists Association, and other media production institutions in its programs. The media EPA works with can be divided into the following groups: a. Sierra Leone Broadcasting Corporation (Public Service Broadcaster) b. Private and commercial TV stations c. Radio stations and newspaper publication houses d. Community radio stations e. Commercial radio stations f. Print media—private newspapers, magazines, and so forth g. EPA websites and social media, including Facebook, YouTube, WhatsApp, and Twitter One Health National Emergency Risk Communication Strategic Plan 13 Institutions Involved EPA partners with the following institutions: MAF, Food and Agriculture Organization of the United Nations, International Fund for Agricultural Development, Sierra Leone Chamber for Agribusiness Development, and all other MDAs and UN partners. Office of National Security ONS reports directly to the president of Sierra Leone, who is the chair of the National Security Council. Under the NSC is the National Security Council Coordinating Group, consisting of permanent secretaries from concerned ministries chaired by the National Security Coordinator. Below the NSCCG is the Strategic Situation Group, a small think tank of key subject matter specialists drawn from the sector relevant to the nature of the emergency. The Joint Intelligence Committee (JIC), forms a “situation room” in the event of an emergency. It directs the day-to-day operations and provides daily situation reports during any emergency. The situation room consists of ONS plus relevant ministries and the communication and SM pillars. A network and committees under the aegis of JIC reach down to the village and chiefdom levels. One function of the JIC is to channel information and communication to officers at the local levels, including district and chiefdom security committees, on down to village level. JIC’s other function is intelligence overseeing individuals from the police and military at the district, chiefdom, and village levels. Other Partners and Institutions Traditional Rulers and Opinion Leaders This sector comprises chiefs, elders, household leaders, and opinion leaders. They mobilize the community to undertake communal labor, settle disputes among members of the community, impose sanctions on people whose behaviors they consider inimical to the development of the community, and in general monitor the activities of the people in the community. Institutions for traditional rulers and some opinion leaders include: • Ministry of Local Government and Rural Development • District and Local Councils • Council of Chiefs Sierra Leone Association of Journalists The Sierra Leone Association of Journalists is the umbrella organization overseeing the media houses and the independent radio networks, which themselves extend to the country’s credible local radio stations. As such, it is a key resource and partner in ensuring that approved messages are printed and broadcast in a timely manner to reach the largest number of people. Universities and Academia Communication and public health departments of higher education and universities may be sought for advice and input on message design and pretesting and disseminate messages throughout institutions of higher learning. One Health National Emergency Risk Communication Strategic Plan 14 NGOs and International Aid Agencies All local and international NGOs and development donors and agencies are part of both the support network and key channels for the dissemination of messages and policy decisions. Religious Organizations and Networks Religious groups and clergy and imams have ready-made audiences for preventive health and other messages in their weekly services. They have the advantage of being credible sources of information for members of their communities. Traditional Healers This cadre of providers often serves as the first source people consult for health information and treatment. Traditional healers are key partners for disseminating information about the best risk- prevention behaviors both before and during an emergency. Teachers Teachers are a key audience for information as well as a channel through which messages can be rapidly disseminated down to the grassroots level in all corners of the country. As respected persons in their communities, they also are credible sources of information. Youth Council Youth councils and their networks and branches, down to the grassroots level, are another key group to engage because they have the ability to rapidly mobilize their members in the event of an outbreak or emergency to spread messages and engage communities. Media Profile Geographic location and gender determine access to media. • A survey conducted by BBC Media Action indicates that radio remains the most widely accessed broadcast platform in Sierra Leone; 81% of Sierra Leoneans had access to radio, and 47% listened to it daily. By contrast, just under half of Sierra Leoneans (45%) could access TV or DVD content, and 13% could access newspapers. • The results of four surveys during the EVD outbreak revealed that over 90% of respondents received their information on EVD from radio. Further, respondents overwhelmingly rated radio as their preferred source for information about EVD. • Access to media varies greatly by rural and urban areas and by gender. Overall, 9% of people reported having access to no forms of media and, of this group, more than half (58%) was women. Women were also less likely to own a phone (44% of women versus 62% of men). Women listened to the radio slightly less frequently than men. • Access to mobile phones was high; 83% of people reported having access to a mobile phone through their household, and 53% owned a mobile phone, with 52% of owners having phones with basic features without Internet or app capacity. One Health National Emergency Risk Communication Strategic Plan 15 • Use of social media in Sierra Leone is a growing phenomenon but still small—only 13% of those with phones reported using them for social messaging. Social messaging use was also limited to specific demographic groups—notably, young people (those ages 15 to 24) and those in the western area. • Internet usage was 16% and dominated by young people.5 Strategic Objectives • Establish a risk communication MCM within One Health that ensures consistent, accurate, and clear message dissemination for increasing knowledge and prevention behaviors before, during, and after human, animal, zoonotic, and environmental emergencies across national and district levels. • Establish core coordination teams within MOHS, MAF, EPA, and ONS under One Health as the leading sources of emergency information in Sierra Leone. • Establish credible and trusted spokespersons in MOHS, MAF, EPA, and ONS under One Health at the national and district levels to share timely and accurate information using risk communication principles in the event of an emergency. • Provide clear and actionable communication on steps people can take to stay safe and healthy before, during, and after health emergencies. • Engage and coordinate key internal and external partners, providing leadership and guidance with risk communication and social and behavior change communication objectives, messages, and activities. • Encourage a timely end to health emergencies by using risk communication and social and behavior change communication methods to increase public confidence and community ownership of health protection strategies, including channels and mechanisms for feedback loops from the community. • Ensure consistency in government, partner, and private sector communication before, during, and after public health emergencies. • Ensure culturally appropriate and gender-sensitive risk communication messages and activities, employing communication channels that reach down to village and household level and ensure feedback loops to the national level.

5 “Communication in Sierra Leone: An Analysis of Media and Mobile Audiences, BBC Media Action, May 2016”. http://downloads.bbc.co.uk/rmhttp/mediaaction/pdf/research/mobile-media- landscape-sierra-leone-report.pdf One Health National Emergency Risk Communication Strategic Plan 16 Communication Objectives • Increase knowledge and awareness of protective health measures by sharing accurate information about infectious diseases, zoonotic diseases, and other public health threats and how to prevent their spread. • Increase self-efficacy and resilience at national and district levels by strengthening the ability of communities to respond to public health threats. Risk Communication Approaches 1. Employ the risk communication roles and responsibilities of One Health partners and other relevant partners and agencies, both at the national and district levels, and within the structure of the Public Health National Emergency Operations Center and the District Emergency Operations Center. Based upon the particular public health emergency, utilize the established pathways for communication flow (around emergency operations center [EOC] alert levels 1, 2, and 3, Appendix B) and steps to be taken in predetermined timeframes (i.e., 24 hours, 48 hours, 1 week, etc.). Establish in advance who the “lead” will be for each element of communication during public health emergencies, both at the national and district levels, and how partners at the national and district levels support the leads in their specific roles. Because communication pathways and channels in Sierra Leone involve multiple government MDAs and international partners, an established, written, and mutually approved plan is necessary. It is also necessary to develop a “notification” mechanism, whereby all communication partners can receive information on a new public health emergency. 2. Develop and maintain national and district-specific communication channels for prevention and preparedness that will enable early contact with appropriate leaders in the event of an outbreak. People are more likely to believe and act upon messages delivered by people they know and trust. Extensive experience in outbreak, epidemic, and development communication indicates that local leaders are pivotal in changing the course of events. Communication channels to paramount chiefs, religious leaders, societal heads, VDCs, and youth organizations and networks must be maintained at all times. 3. Develop risk communication plans to cover a range of scenarios for public health emergencies. Some public health emergencies can and should be anticipated due to the endemic and seasonal nature of disease cycles in West Africa. These might include the outbreak of cholera, Lassa fever, severe malaria seasons, yellow fever, novel or severe influenza, measles due to poor immunization coverage, and the resurgence of polio. 4. Establish and maintain relationships with external communication partners, and include them in the planning process. Radio, newspapers, mobile phones, posters, and flyers are all common tools for sharing messages within Sierra Leone. There is a need to have ongoing agreements relationships One Health National Emergency Risk Communication Strategic Plan 17 with radio stations, mobile phone providers, and printers to be available before emergencies and be responsive during national public health emergencies including establishing mechanisms for payment (if any) through an advance memorandum of understanding. 5. Prepare early communication material templates and established timelines for delivery. Advance preparation of some emergency communication materials is possible. Situation- specific information can be inserted into templates as the emergency unfolds and more information becomes known. Examples of products that should be prepared in advance include templates for press releases during the first 24 and 48 hours of the emergency as well as templates for “briefing reports” that can be used for daily or weekly briefings after the first week. Communication products geared toward specific audiences can be developed (e.g., women, children, workers). Slide sets on potential health issues (e.g., cholera, Lassa fever, severe malaria seasons, yellow fever, influenza, measles, and polio) can be created and maintained in advance. 6. Identify and train national and district spokespersons. A crisis is not the ideal time to introduce a new spokesperson or someone who has not been trained in risk communication. If they are not effective communicators, subject matter experts may not be the most credible spokespersons. For a public health emergency, the ideal spokesperson is someone the responsible partner ministry or agency has already established as a trusted and credible resource. This individual must be poised and comfortable with media as a result of their day-to-day activities and experiences. 7. Prepare district risk communication plans. While some districts will have specific needs (due to special populations, unique circumstances, etc.), in general, district plans should replicate and build upon the national communication strategy as much as possible so communication is standardized within and across districts. Identify mechanisms for two-way communication, from village and chiefdom levels to district to national levels, in order to enhance rapid response to confusion, rumors, and miscommunication. 8. Hold national and district partner meetings for ongoing planning and coordination of prevention and preparedness activities as well as to mobilize and test the system on a regular basis. Planning will do little to prepare the country for an effective response if the system is not tested and regularly evaluated. Once plans are established, a national communication strategy should include the capacity to hold an exercise to test response capabilities at 24 hours, 48 hours, and 1 week, and so forth, into a response. One Health National Emergency Risk Communication Strategic Plan 18 Communication Interventions Engaging Internal Audiences Consultative Meetings In addition to holding the regular One Health risk communication MCM meetings, regular intragovernmental meetings should occur among agencies affected by the public health emergency to share information; identify trends; harmonize messages; organize, track, and measure activities; and monitor results. Where feasible, chiefdom-, district-, or regional-level meetings should take place with leadership and outreach personnel to enable information gathering about local issues, identify message and communication needs, and have prompt awareness of issues or barriers. Debriefing Sessions It is important to convene debriefing sessions, provide briefs, and share regular reports with primary audiences to document actions completed and progress realized since the last report. Reports should include a section for cumulative information, which may be shown in the form of graphs, charts, or illustrations. The report should also include a description of progress against stated goals, acknowledgment of gaps or delays, and explanation of steps being taken to address communication issues. Engaging External Audiences Press Conferences and Press Releases Regular, proactive media updates, including press conferences and news releases, should describe actions the government has completed to address the public health threat. Public service announcements and other relevant promotional materials can present information from survivors, traditional leaders, government officials, health care workers, and others who serve as trusted communicators. Programming or public service announcements should fulfill the latest information needs as assessed by media tracking, call center input, and feedback from field personnel. Community Engagement Community engagement aims to connect with all sectors of the community to prompt individual, family, and community action. It uses a variety of approaches to raise awareness and empower individuals and groups toward those actions, creating an enabling environment and effecting positive change. Community engagement includes activities, such as door-to-door outreach, public meetings, health fairs, and participatory theater. Importantly, mobilization efforts are community driven, and community members are active participants in defining the problem, generating solutions, and evaluating the outcomes of those solutions. The use of person-to-person communication methods ensures message dissemination to the village and household levels. Community influencers (paramount chiefs, religious leaders, society heads, VDCs, facility management committees, etc.) should be invited to share feedback, including rumors, misconceptions, or barriers that community members are facing, and to assist in message and One Health National Emergency Risk Communication Strategic Plan 19 material development. Influencers may also be encouraged to share messages during meetings at district, chiefdom, and community levels and through house-to-house campaigns, social mobilizers, and so forth. Regular contact with and presence in communities is key, keeping leaders and community members regularly informed of new developments and encouraging them to share the messages from person-to-person. Information, Education, and Communication/Social and Behavior Change Communication Outlets Develop, share, and monitor information needs and adapt them to fit billboard and point-of-contact advertisements (e.g., posters in gathering places) to respond to messaging needs. Social Media Text messaging is a means of targeting information to population groups. Applicable social media (e.g., WhatsApp, Facebook, YouTube, Flickr, Twitter, Tango) can be used to create more personalized communication, including photos from different parts of the country and stories from workers, survivors, and leaders. Consider designating an administrator from more than one agency while ensuring consistency in social media posts. Internet It is in the TOR of One Health to establish a website under the One Health Secretariat to aggregate action information for the needs of citizens, domestic and international partners, media, the Government of Sierra Leone, and other governments. Audiences INTERNAL EXTERNAL Primary Governmental Nongovernmental and International Government of Sierra Leone International Partners • State House-Strategic Policy Unit • United Nations • Office of National Security • UNICEF • Republic of Sierra Leone Armed Forces • U.S. Agency for International Development • National Legislature • DFID • Ministry of Information and Communications • Médecins Sans Frontières (Doctors Without Borders) • Ministry of Social Welfare and Gender Affairs • IRC • Ministry of Education • Gesellschaft für Technische Zusammenarbeit (German Technical • Ministry of Agriculture Cooperation) • Environment Protection Agency • Irish Aid • Ministry of Water Resources One Health National Emergency Risk Communication Strategic Plan 20 INTERNAL EXTERNAL Primary Governmental Nongovernmental and International • Ministry of Internal Affairs • Ministry of Local Government and Rural development • Ministry of Finance • Ministry of Youth • Ministry of Foreign Affairs Ministry of Health and Sanitation International Public Health Partners • Directorate of MOHS • World Health Organization • District Health Management Team • U.S. Centers for Disease Control and Officials Prevention • Peripheral Health Units • China Centers for Disease Control • National Community Health Worker • Public Health England (CHW) Hub Community Leaders • Traditional leaders o Paramount chiefs o Section chiefs • Religious leaders o Imams o Christian leaders • Youth/women’s associations o Leadership associations • General public News Media • Sierra Leone Association of Journalists • BBC Media Action • Radio stations, including community radio • National newspapers • International broadcast One Health National Emergency Risk Communication Strategic Plan 21 INTERNAL EXTERNAL Primary Governmental Nongovernmental and International • Television International Public Health Nongovernmental Organizations • International Federation of Red Crescent • International Federation of Red Cross and Red Crescent Societies • Save the Children Private Sector • Telecom Companies Secondary • Ministry of Internal Affairs • International workers • Ministry of Foreign Affairs o Health care workers • Ministry of Finance • International business entities with interests in Sierra Leone • Ministry of Transportation o Airport and airlines • Ministry of Trade and Industry o Mining companies • Other government ministries o Import/export concerns o Contractors, infrastructure developers o Fuel distributors and shippers o Seaport and shipping agencies • Civil societies and volunteers One Health National Emergency Risk Communication Strategic Plan 22 Part B: One Health National Emergency Risk Communication Plan The One Health National Emergency Risk Communication Plan takes into account all stages of a possible health emergency or outbreak, starting with the period before any outbreak occurs and continuing through the outbreak to the recovery and postrecovery stages. Sound preparation, planning, risk communication, and social and behavior change communication around risks before an event or emergency happens can minimize or even prevent an outbreak from occurring in the first place. Having systems in place well before a crisis and having a clear chain of response with designated partners with specific roles is imperative to dealing with a health emergency or outbreak. Strategic Objectives Establish a risk communication MCM within One Health that ensures consistent, accurate, and clear message dissemination for increasing knowledge and prevention behaviors, before, during, and after human, animal, zoonotic, and environmental emergencies across national and district levels. Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries (published in February 2019) calls for the establishment of an MCM for communication within the One Health structure. This MCM should be made up of the four key organizations under One Health in Sierra Leone that have responsibility for risk communication before, during, and after any human, animal, zoonotic, or environmental emergency: MOHS, MAF, EPA, and ONS. The National One Health Coordinating Committee will be responsible for formally establishing the risk communication MCM, ensuring that the key persons from each organization are tasked with communication along with representatives from the Directorate of Health Security and Emergencies, Health Education Division, representatives from the Communication, SM, and Surveillance pillars. The One Health risk communication MCM will have the responsibility to: • Meet on a regular basis with all members to monitor, on an ongoing basis, the status of human, animal, and environmental health in the country. • Use existing messages and message guides, Knowledge Gateway materials, health message banks at the regional levels and, when needed, develop and share prevention messages on best practices in the human–animal–environment interface to prevent and respond to outbreaks. • Establish clear lines of communication down through their organizations in the event of an emergency and support multisectoral collaboration and coordination of communication. • In the event of an emergency, make the immediate decision as to which one of the four organizations will have the prime responsibility to manage public communication about the event, based on the nature of the emergency. One Health National Emergency Risk Communication Strategic Plan 23 • Support each other in all possible ways in message dissemination—regardless of which institution has the lead role—to ensure the broadest possible reach for the greatest impact. Establish core coordination teams within MOHS, MAF, EPA, and ONS under One Health as the leading sources of emergency information in Sierra Leone. The One Health risk communication MCM will be responsible for ensuring that each of its organizations has its own dedicated communication team within the organization from the national level, through the district to the village level, and that messages are consistent across all organizations and media. Establish credible and trusted spokespersons in MOHS, MAF, EPA, and ONS under One Health at the national and district levels to share timely and accurate information using risk communication principles in the event of an emergency. Well before any emergency occurs, it is necessary to identify and train the key person or persons at the national and district levels who will speak for that organization before, during, and after an emergency. They should be known and trusted persons whom the public will listen to for information about prevention and preparedness as well as find credible during an emergency. They should be trained to be articulate and presentable, be comfortable with broadcast media, and have solid working knowledge of the subject matter for which their agency is responsible. Provide clear and actionable communication on steps people can take to stay safe and healthy before, during, and after health emergencies. Messages and information provided before an emergency happens are the best means of prevention. Waiting until an outbreak is already underway is risky and irresponsible. Messages— before an emergency—promoting behaviors to prevent outbreaks are the most effective and time- and life-saving interventions. Developing and regularly updating message guides for various health emergencies (such as the Message Guide for Zoonotic Diseases and the Consolidated Message Guide for Ebola Communication in Sierra Leone) ensure the readiness of approved, ready-to-use messages for prevention and preparedness activities as well as for quick roll-out or adaptation in the event of an emergency. Messages before and during an outbreak must be direct, clear, and simple; include a call to action; and be feasible in the local context. Engage and coordinate key internal and external partners, providing leadership and guidance with risk communication and social and behavior change communication objectives, messages, and activities. Once messages are developed, they must be shared and widely disseminated to all ministries, international development partners, NGOs, media partners, schools, religious organizations, and the private sector to achieve the greatest reach and to ensure that everyone is on board and on one page with the same message and intended behaviors. Encourage a timely end to health emergencies by using risk communication and social and behavior change communication methods to increase public confidence and community One Health National Emergency Risk Communication Strategic Plan 24 ownership of health protection strategies, including channels and mechanisms for feedback loops from the community. Establishing feedback loops between and among communities up to the central level helps to identify and quell rumors and misinformation as well as aids in early detection of potential health emergencies. Feedback should be used to inform and modify communication to address communities’ needs on an ongoing basis before, during, and after an emergency, and enables the community to be a key, driving part of the process. Going to the community to gather more information and understand the social, economic, and cultural norms will help communication teams design credible messages and use appropriate and effective channels of communication that reach intended audiences. Ensure consistency in government, partner, and private sector communication before, during, and after health emergencies. The One Health risk communication MCM will be responsible for ensuring that all approved messages from any one of the organizations are timely, clear, and consistent. Consistency is key to improving recall and reducing misinformation and rumors before and during an emergency situation. Vague or conflicting messages can confuse and alienate the public and lead to a loss of credibility of the content and sources of messages. Build capacity in risk communication among key partners and establish relationships with external communication partners, and include them in the planning process. Ensure culturally appropriate and gender-sensitive risk communication messages and activities employing communication channels that extend to village and household levels and ensure feedback loops to the national level. Use existing message guides and, where gaps exist, develop other messages in advance for a range of scenarios while remaining sensitive to local cultural and gender norms. Gender-based and cultural barriers often limit women’s access to information, and media access may be a barrier for women. Women have less access to digital resources, and men may control their access to television and radio. Employ the appropriate and trusted channels and types of media that will reach the widest audience, including women, down to the most remote grassroots level, and ensure that messages are in the appropriate language or dialect for the intended communities. It is important to develop or strengthen capacity in local women’s and community groups to capture and share indigenous knowledge and to identify and support local women and men as community risk educators. One Health National Emergency Risk Communication Strategic Plan 25 Communication Objectives Increase knowledge and awareness of protective health measures by sharing accurate information about infectious diseases, zoonotic diseases, and other public health threats and how to prevent their spread. This objective is important both before an outbreak or emergency (to prevent it from happening) and during an emergency (to contain the spread of a disease and bring it to a swift end). • Prepare district communication plans. • Prepare early communication material templates and established timelines for delivery • Provide national and district health officers, local leaders, traditional leaders, and respected community resources (e.g., teachers) with health and progress information they can share with others. Keep them informed of new developments. • Identify key information and behaviors to develop health protection messages. • Engage key internal and external partners with communication objectives and messages. • Find the places people gather most frequently and place information there. • Reinforce communication through multiple channels. o Use these messages in radio broadcasts, news releases, speeches, public service announcements, posters, dramas, community education, text messaging, and social media. o Use social media (e.g., text messaging) and local/traditional leaders to microtarget messages. o Use radio to share consistent information widely, quickly, and regularly. Increase self-efficacy and resilience at national and district levels by strengthening the ability of communities to respond to public health threats. Fostering trust and belief in information and communication about risks requires prior work in communities to promote and engage their commitment. Establishing a community-based network of trusted intermediaries is an essential part of this work. • Engage with communities on the potential risks and the means of prevention. • Visit the communities to meet and exchange views on risks. • Leverage existing local structures and feedback loops to inform/guide prevention and preparedness activities. • Listen to communities to understand the context as well as their concerns and needs. • Identify the social practices through behavioral research and analyze their reasons. • Analyze and prepare the messages in line with the observations and conclusions drawn from the field. One Health National Emergency Risk Communication Strategic Plan 26 • Afford the opportunity to the communities to participate in the message development and testing process and take ownership of the evidence-based messages. • Define and test communication materials for behavior change. • Lead a community engagement effort by identifying the key people (influencers) and involve them on behalf of their communities. • Select and train trusted community spokespeople and social mobilizers. • Prepare people to take action when needed. Crisis Communication Lifecycle The following diagram highlights the stages involved in a health crisis event and the recommended actions at each stage. Crisis Communication Lifecycle Precrisis Initial Maintenance Resolution Evaluation § Prepare § Express § Further explain § Educate a primed § Capture lessons empathy risk by public for future learned § Foster alliances § Provide simple population crises § Develop an event § Develop risk groups § Examine SWOT consensus explanations § Provide more problems § Improve plan recommendations § Establish background § Gain support for § Return to precrisis § Test message credibility § Gain support for policy and planning § Evaluate plans resources § Recommend response actions § Empower § Promote your § Commit to risk/benefit organization’s stakeholders decisionmaking role § Capture feedback for analysis Emergency Risk Communication Interventions by Stage of Emergency Based on this graphic, the following information is a step-by-step recommendation and guide to the stages, the steps to follow, and the actions to be taken at each stage of the emergency. Precrisis In emergency risk communication, the best action for preventing an outbreak is to ensure that risk communication behavioral messages and campaigns as well as community engagement/dialogue/action planning occur throughout the year to remind the public to practice safe behaviors that will keep them and their families healthy. The One Health risk communication MCM will establish a chain of communication and an interagency system to coordinate communication to the public on an ongoing basis about the various risks in their sectors—such as animal bites, eating bush meat, killing and eating dead or sick animals, living in proximity to bats, foot and mouth disease, and so forth. All available communication channels and spokespersons following the actions listed under each of the communication objectives should be employed in this process—from mass media to One Health National Emergency Risk Communication Strategic Plan 27 interpersonal and community engagement—in order to raise awareness of risk and behaviors to prevent diseases that are preventable. Initial Immediate actions to take in the event of a public health emergency. First 12 hours • Pillar lead (or officer in charge) to share initial alert and call a meeting of the One Health risk communication MCM and pillar to discuss an initial press release and update key messages • Media monitoring to begin with information shared across the response pillars • Approved spokesperson to brief media on the event and the response • Beginning to engage community networks and feedback loops to gather real-time information from the field First 24 Hours 1. Activate and engage internal communication pathways at national and district levels. Within the first 24 hours of the response, the lead organization notifies the communication partners, sharing the information that will be provided to the public and activating the various previously established roles and responsibilities. Mechanisms of sharing information internally at the national and district levels might include: • Email distribution lists that can be quickly activated during an emergency (Appendix D) • Partner meetings • Short message service (SMS) text messages or phone trees • Other technology applications (e.g., Facebook posts, websites, WhatsApp groups set up within the ministries) 2. Establish credible and transparent initial information about the emergency. In the first 24 hours of a response, trust in leaders can be established or destroyed depending on how communication efforts are perceived. Principles of risk communication that are important to convey are (a) be first, (b) be right, (c) be credible, (d) express empathy, (e) promote action, and (f) show respect. Share what is known as soon as possible. The perception that information is being withheld erodes public confidence and can end up costing lives due to distrust of messages. Being open and transparent is key to winning trust. 3. Utilize trusted and trained spokespersons on the front lines of communications. Spokespersons should be individuals who were identified and trained during the planning and preparedness stage. One Health National Emergency Risk Communication Strategic Plan 28 4. Share initial information with the public quickly. • Press conference with spokesperson • Press release • Radio newscasts with spokesperson • SMS text messaging • Social media posts (WhatsApp, Facebook, Twitter) • Toll free hotline 117 • Contact with SM pillar to share information on activities and approved messages • Identify capacity within the pillar for communication activities • Circulate key messages on social media and websites of pillar partners and PHNEOC First 48 Hours 1. Continue to engage internal communication pathways. By 48 hours, an initial in-person meeting of the One Health risk communication MCM and all response partners should have occurred at the national and district levels, for purposes of information sharing and planning. Ensure district communication plans have been activated to impart information to village levels. 2. Continue to share emergency information with the public. • Press conference with spokesperson • Radio newscasts with spokesperson • Begin to establish rhythm of daily briefing in EOC • Continue to use SMS • Continue to use social media 3. Activate targeted communication to thought leaders and influencers. By 48 hours, the direct communication channel to community influencers (paramount chiefs, religious leaders, secret society leaders, VDCs, and extension workers in all relevant ministries) that was developed during the planning phase should be activated, and these individuals should receive messages, training, and guidance to pass on to their followers. 4. Develop top-level messages that will serve as a strong foundation during the ensuing public health emergency response. Short, clear messages are easier for both spokespersons and audiences to understand, recall, and repeat. Messages at the district level must reflect approved national messaging. Examples of top-level messages: • We know how to stop the spread of the outbreak. • Stopping this epidemic is our top priority. One Health National Emergency Risk Communication Strategic Plan 29 • When we work together, more people can survive the outbreak. • You can take steps now to protect yourself and your family. 5. Evaluate new data and revise messages according to risk communication principles. In the first 24 to 48 hours of a health crisis, new information will be coming in constantly. Initial messages may need to shift according to new data. It is important to make sure new information is credible and to have a plan (i.e., daily briefings) to deliver new information quickly. 6. Share initial messages for the public quickly. • A press conference to brief media with the CMO/IM/head of key partner agencies/ministries • After the press conference, there should be follow up with media houses to ensure intended messages are published and broadcast by media houses. • Press release • Radio newscasts with spokesperson • SMS text messaging • Social media posts (WhatsApp, Facebook, Twitter) First 72 hours • Develop communications materials on the response to highlight current situation and actions to be taken. • Identify key audiences. • Contact international media to facilitate interviews and visits. Early Stage and Maintenance Week One and Beyond 1. Continue to engage internal communication pathways at the national and district levels. Given the complexity of risk communication for public health emergencies, keeping internal government and nongovernment partners apprised of plans, next steps, and progress is critical for a harmonious response. By week one of the response, the One Health risk communication MCM should be meeting regularly to provide updates and plans. Daily meetings should include assessing effectiveness of district communication plans and social mobilizers to disseminate messages and discussing feedback regarding rumors, myths, and misconceptions that must be addressed through new messages, media coverage, and so on. 2. Continue to engage targeted communication to thought leaders and influencers. Community influencers (paramount chiefs, religious leaders, secret society leaders, VDCs) should be in communities sharing messages through meetings, door-to-door campaigns, town criers, and so forth, via the district communications plan. One Health National Emergency Risk Communication Strategic Plan 30 3. Design and deliver concise, consistent, actionable messages. Identify key behaviors and reinforce them through multiple channels. Modify messages as surveillance indicates changes may be needed. Ensure government and partner organizations are consistent in key messaging. 4. Use multiple channels and methods to layer consistent messages and information. • Radio (shows, newscasts, commercials, jingles) and print media (provide visuals, when possible, photos, drawings to accompany news articles) • Posters • SMS text messaging • Dramas • Social media • Daily situational briefings • Press conferences for new, critical information • Media statements for less urgent information • Community outreach and person-to-person message sharing 5. Via the district-level communication plans, work with the SM pillar and its networks to ensure messages reach the village and household level. A key lesson from the EVD outbreak is that village-level person-to-person conversations are urgently needed during public health emergencies. While this mechanism may not be easily organized in the first 24–48 hours of a health crisis, it should be utilized by week one and beyond. The SM pillar has established networks for the delivery of health information, including district social mobilization coordinators with connections to VDCs/facility management committees and other sector extension workers. The One Health risk communication MCM will have established communication networks in each of its organizations ready to be activated. 6. Emphasize person-to-person communication methods, and provide district media officers, local leaders, traditional leaders, and respected community resources (e.g., teachers) health and progress information they can share with others. Keep them informed of new developments. Where possible, arrange community meetings with national-level leaders to link government more closely to people. 7. Solicit feedback and use it to change messaging strategies. To know if the messages are working, it is critical to understand the questions, frustrations, and needs of those affected by a public health emergency. Use messaging channels to ensure a two-way dialogue. Collect reports and information from village-level communicators (VDCs) and share the feedback with communication partners through internal mechanisms, so that new plans and strategies to address needs can be created. 8. Provide regular updates (e.g., weekly) on actions taken to combat the disease. Use the Internet as a means of sharing progress information with international audiences. One Health National Emergency Risk Communication Strategic Plan 31 9. Celebrate and share victories. Create a series of stories from those whose actions saved lives, and share these stories through multiple channels—from worship services to text messages. Capture, record, and share stories and images of local innovations and successes in fighting the disease. Provide an easy method for community leaders and volunteer workers to share information and observations with county and national leaders. Report achievements widely through multiple channels. 10. Monitor messaging impact. Although it can be difficult to quantify the impact of messaging, monitoring key measures is important—as is doing so quickly, so that weaknesses and needs can be identified and addressed and messages modified, as needed based on feedback. Ways to assess “message penetration” and “audience understanding” might include: • Analyzing feedback received through SM channels (VDCs). • Examining text messages received by radio stations for content . • Utilizing SMS technology to deliver small “surveys” to cell phone users that they can respond to via phone. • Tracking questions and concerns received on the 117 hotline. • Media monitoring (radio, print) and summarizing content. • Actively monitoring social media (reach and response to official Facebook posts, etc.) and analyzing trends. • Investigate, collect, and analyze rumors, and develop new messages as needed to address them. • Plan for and respond to message fatigue. • Focus group discussions with key audiences and stakeholders. • Knowledge, attitudes, and practices surveys. • Rapid behavioral assessment surveys. Resolution (Postcrisis) Revisit the One Health National Emergency Risk Communication Strategic Plan and determine where improvements are needed. • Lessons learned should be used to revise the risk communication strategic plan and develop new communication systems if necessary. • Strengthen communication systems based on lessons learned. • Share findings with all stakeholders, including affected communities. One Health National Emergency Risk Communication Strategic Plan 32 Evaluation Evaluate problems and review lessons learned at both the national and district levels. In spite of advance planning, problems will arise. It is important to: • Take time after a crisis to review what worked, and review and document the lessons learned. • Assess the new landscape as a result of the emergency. • Ensure that all communication partners take part in a postemergency information-sharing evaluation meeting. Return to Pre–Public Health Emergency Planning and Testing • Test the system regularly • Ensure a continual feedback loop with communities, which will again feed into preparedness before an emergency Risk Communication Response Authority and Chain of Command by Organization One Health Risk Communication MCM The One Heath risk communication MCM will meet regularly, and its members will monitor the animal, human, and environment health situation in the country during their attendance at the weekly EPRR group meetings. The MCM consists of the key communication staff of MOHS, MAF, EPA, ONS, and the Communication and SM pillars. If an emergency is declared, the MCM will assess and determine, based on the nature of the emergency, which ministry or ministries are affected and make a decision as to which organization will take the communication lead to address the situation. They will determine, with the CMO of MOHS and the National Security Coordinator of ONS, the level of the response to the emergency according to the Emergency Preparedness, Resilience and Response Concept of Operations (ConOps) Public Health Emergency Incident Response Levels matrix (Appendix B). The chart below shows the makeup and representatives in the MCM. A description of each organization’s TOR and emergency communication-related structure, including a communication flow chart, follows. One Health National Emergency Risk Communication Strategic Plan 33 One Health Risk Communication Multisectoral Coordination Mechanism (MCM) MOHS ONS EPA MAF Communication and Communication Lead Public Relations Communication Lead Social Mobilization Officer/Head IEC Leads Ministry of Health and Sanitation The CMO has overall responsibility for the PHNEOC and is the approval authority for the stand-up and stand-down of the ConOps Public Health Emergency Incident Response Levels chart at Levels 2 and 3 (Appendix B). • The CMO represents MOHS at the Gold Level with respect to public health information when the ONS Situation Room and the National Strategic Security Group are activated. Initial Actions • Inform the PHNEOC and ensure it is aware of planned response and time to meet. • Notify external partners, including WHO under IHR, if applicable. • Convene and chair the first meetings of the One Health risk communication MCM and PHNEOC. • Collect as much information as possible o What has happened? o Who is affected? o Where is the incident located? o What time did it start? o What are the immediate consequences? o What is being done to mitigate the effect/impact? o Are any resources required, including mutual aid requests? • Review the risk assessment, undertaken by the technical team, providing clarity on the required incident response level. One Health National Emergency Risk Communication Strategic Plan 34 • Give directions on immediate lines of action. • Provide resources for initial response. • Identify resource needs and engage international partners for resourcing. • Ensure that a situation report is produced on a regular basis for incidents at Levels 2 and 3. • Ensure that all communications from MOHS regarding the event are disseminated to the general population. The nominated IM has delegated authority from CMO to act on their behalf. In such cases, the IM is the ultimate decision maker for actions to be taken by the EOC. The IM has the same responsibilities as those outlined above for the CMO in terms of managing the response.6 RRTs under the IM are deployed per the following guidelines: District-Level Deployment • All RRTs deployed shall be under the Unified Command of the IM, who shall be responsible for deployments • The RRT leader shall be in charge of dispatch of all teams at all levels. • Daily field mission findings shall be reported to the IM. • The RRT leader shall provide updates on daily investigations and proceedings to the IM. • The district RRT leader shall direct field operations. The process for rapid response to the affected areas must be coordinated to ensure the safety of the public and responders, protection of property, and effective response of the numerous organizations and jurisdictions involved. Partner support to all RRT-related interventions shall be coordinated through the PHNEOC IM. Social Mobilization Pillar • Establish community-based social engagement. • Help response team gain community entry trust. • Ensure and deepen extensive and intense community engagement. • Engage traditional and religious leaders. o Secret societies o Women groups and youth o Influential indigenes o People with special needs o Traditional healers

6 “Ministry of Health and Sanitation: Emergency Preparedness, Resilience and Response, Concept of Operations (ConOps)”. One Health National Emergency Risk Communication Strategic Plan 35 • Use surveillance data to inform messaging. • Ensure regular and coordinated home visits by social mobilisers. • Conduct monitoring and supportive supervisory visits. • Reinforce key messages in high-risk settings. • Identify gaps to intensify social engagement activities. • Monitor feedback on response to messaging and activities as well as rumors and misinformation from social engagement channels, including CHWs, VDCs, and traditional and community leaders. • Conduct follow up visits to ensure surrounding areas are aware of risks. Communications Pillar Disseminate decisions and actions from MOHS/PHNEOC to the public through the media. Ensure correct and agreed-upon messages from the MOHS/PHNEOC and partners on public health event are disseminated to the public in a coordinated manner through the media. Develop a holistic MOHS/PHNEOC communication and information dissemination strategy. Ensure targeted messages are disseminated in a coordinated manner in order to reach those targeted. Convey a transparent image of the MOHS/PHNEOC and its activities in the international and local media. Command and Control • Serves as the point group for all communication during the pandemic crisis • Manages the release of information to the public and the media • Knows incident-specific policy, science, and situation • Provides technical support to spokesperson(s) • Reports on a daily basis to the leadership team, or the highest authority in the respective municipality, during an emergency • Serves as a liaison to government agencies in the production of press releases with regard to public health event and scheduling of news conferences and meetings • Determines the operational hours and days, and reassesses these throughout the pandemic response • Ensures that communications resources are available (including human, technical, and mechanical supplies) Direct Media and Public Information • Manages inquiries and requests from the media and coordinates logistics for interviews and conferences with media representatives • Develops all internal and external crisis-related communications • Oversees media and public information monitoring systems and reports One Health National Emergency Risk Communication Strategic Plan 36 • Reviews and approves materials for release to the media and the public • Monitors local and national news media as well as the public response • Ensures that crisis communication principles to build trust and credibility are incorporated into all public messages delivered through the media • Organizes and manages a pandemic response website for the PHNEOC and maintains links Coordinate Communications Across Sectors • Organizes and facilitates regular meetings with all sectors to receive input about public response and communication messages • Arranges official briefings across all sectors of the government Develop Public Health Content and Material • Works with subject matter experts to create situation-specific fact sheets, questions and answers, and updates • Compiles information on possible public health emergency topics for release when needed • Tests messages and materials for cultural and language requirements of special populations • Uses analysis from media, public, and municipal sector monitoring systems and reports in order to adapt messages • Identifies additional content requirements and materials development needs One Health National Emergency Risk Communication Strategic Plan 37 Ministry of Agriculture and Forestry The livestock officers or animal health workers under the ministry include the following personnel working in the livestock division in the country. At the national level, the director and deputy director of the livestock division oversee the officers at the district, chiefdom, and community levels. District livestock officers are the focal point for gathering information from the chiefdom and community levels and transmitting it to headquarters at the national level. They are trained at university level in animal husbandry and supervise all livestock activities in the district. At the One Health National Emergency Risk Communication Strategic Plan 38 district level, there are also extension workers that cut across all areas of crops and livestock but are not yet merged into the reporting system. At the chiefdom level, the district livestock assistants and livestock inspectors report to the district livestock officer and treat animals for different ailments at the chiefdom level. The livestock assistants supervise the community animal health workers, who work at the community level. The community animal health workers are trained for a period of 3 weeks and are stationed at the community level. They work at the grassroots level with the livestock keepers and owners. Their responsibilities include: • Promoting animal welfare. • Supporting disease surveillance. • Collecting samples from animals. • Improving animal health production. • Conducting vaccinations and drenching campaigns. • Sensitizing communities on policy. At the district level, there are also district forest officers who protect the forests, and district agriculture officers who head the district agriculture offices. Agriculture extension workers are in charge of farmer education and serve as a liaison between the subject matter specialists and the farmers. Another group important to MAF are the traditional healers, who play a role in dealing with snake bites and many other health-related issues at the local level. Weekly paper reports are sent to by the district livestock assistants and the community animal health workers to the district livestock officers, who collate them into a weekly electronic report that is sent to headquarters. An official Google group shares information; a less formal, internal WhatsApp group also shares information. One Health National Emergency Risk Communication Strategic Plan 39 Ministry of Agriculture and Forestry One Health National Emergency Risk Communication Strategic Plan 40 Environment Protection Agency The flow of information for communication and social engagement begins at the EPA head office down to the regional heads. The environmental regional head officers pass that information on to the ESO, who then contact the CSOs. The CSOs then contact the local authorities and the general public. For the flow of any critical information regarding an emergency up to the national level the same flow would go through these channels in reverse order. If there is a security aspect to any situation, this would be communicated to the relevant ONS authorities. Environment Protection Agency One Health National Emergency Risk Communication Strategic Plan 41 Office of National Security The ONS is directly under the president of Sierra Leone, who is the chair of the National Security Council. The National Platform for Disaster Risk Reduction (NPDRR) The NPDRR is the highest level (Platinum) of disaster management in the country. It is chaired by the vice president, or in their absence, the national security coordinator. The NPDRR is responsible for the provision of policy direction and the creation of national policy. During emergencies, it brings together the highest national expertise to oversee the national response. In the event of a national emergency at Level 2 or 3 in the Emergency Preparedness, Resilience and Response ConOps Plan, ONS would be notified and the National Security Coordinating Group chaired by the national security coordinator would be activated, along with the National Strategic Situation Group (NSSG), the small think tank of key subject experts drawn from the relevant sector according to the nature of the emergency. The National Strategic Situation Group The NSSG is activated during a Level Two or Level Three emergency. It will meet as often as is necessary and fulfills the Gold responsibility for command, control, and coordination. It has an ONS core staff, but also brings together representatives from all involved MDAs, including the Republic of Sierra Leone Armed Forces, Sierra Leone Police, the Ministry of Finance and Economic Development, and MOHS. Representatives are the technical leaders from their respective organizations. The NSSG is supported by the national situation room (NSR). The JIC, consisting of ONS plus relevant ministries and the Communication and Social Mobilization pillars, would form the NSR. The National Situation Room • The NSR is activated during a Level Two and Level Three emergency. It will operate on a 24- hour basis and bring together working representatives from ONS and each MDA to develop the situational understanding and assessments that support the NSSG. • Key functional roles include linking to the primary operational (Silver) MDA to ensure that all necessary means are brought to support the response. The Operational MDA Lead (Silver) • When an emergency reaches Level Two or Level Three, the NPDRR will identify a lead MDA to take responsibility for the operational response to the emergency. This is called the Silver level. • The nominated lead MDA becomes the supported MDA, and the NSSG and NSR will be required to coordinate the support of all other required MDAs. One Health National Emergency Risk Communication Strategic Plan 42 • Key to the success of this arrangement is close coordination between the lead MDA and the NSSG and NSR. It is essential that the latter has a clear, common operational picture so that they can deliver the support and direction needed without interfering in the technical operation response, which is the SILVER MDA’s responsibility. • In a public health emergency, the PHNEOC will be the lead response center on behalf of the MOHS. The District Disaster Management Committee The District Disaster Management Committee is a multi-organizational grouping that operates within each district, bringing together district council leaders, security representatives, key local representatives, health organizations, and any active international partners within the area. It meets on a regular basis to support disaster management preparations and risk assessments, and will operate on a 24-hour basis during an emergency. During a public health emergency, it will link to PHNEOC. ONS provides the secretary to the committee. It is chaired by the district council chairperson. One Health National Emergency Risk Communication Strategic Plan 43 Office of National Security One Health National Emergency Risk Communication Strategic Plan 44 Appendix A: The National One Health Structure One Health National Emergency Risk Communication Strategic Plan 45 Appendix B: Ministry of Health and Sanitation Emergency Preparedness, Resilience, and Response Concept of Operations Public Health Emergency Incident Response Levels Level-Assessed Foreseeable Risk

1 Public health impact, including public interest or concern, is limited to the local population; however, it exceeds what is determined to be routine (steady state), and the district emergency operations center (DEOC)/district health management team (DHMT) can manage the response as determined by the initial rapid assessment. It is quite possible that external partners will provide support, which the DEOC/DHMT will also manage. The command, control, and coordination of the incident will be contained entirely within the DEOC/DHMT. Notification from a district medical officer of a Level 1 response will be provided to the PHNEOC immediately upon determination to activate the response by a situation report (initially within 2 hours) and every 24 hours thereafter. ONS and partners will be informed during the regular PHNEOC updates.

2 Public health impact, including public interest or concern, could expand beyond the local population and is greater than can be managed by one DHMT. It may require support and coordination from more than one district through the PHNEOC, as determined by the situational assessment. It may also require support from a MOHS internal program. The response may involve interagency working and larger external partner support. Command and control of the incident will be locally (district) focused; however, the coordination and overview focus (incident management) will be from the PHNEOC. The MOHS may issue briefing notes, in conjunction with the appropriate MOHS internal program, to be cascaded via the PHNEOC Daily Activity Report and/or briefing to ensure that all MDAs and partner organizations are aware of the incident and the arrangements for its management. The MOHS and its health development partners are able to respond and manage the public health event. For Ebola virus disease (EVD): a single EVD case with all contacts identified and evidence of only first-generation transmission to a very limited number of people will be considered a Level 2 event. In this scenario, the MOHS would most likely be able to cope and control the outbreak with existing resources in the affected district(s). Collaboration from ONS would be required at district(s) level only to ensure necessary security measures when enforcing a quarantine. When a Level 2 activation of the PHNEOC is triggered, MOHS will alert ONS via the liaison office.

3 The impact may or may not be limited but the incident has national implications and/or is significant across Sierra Leone, or the distribution of the cases/hazard is national and/or across borders. Central coordination, extended surveillance, and national or local incident control measures are required. A Level 3 response necessitates national direction and ensures national coordination while providing a more proportionate response to the threat to the public. Public health impact—including public interest or concern—upon the national population is severe. It requires national direction and coordination of the MOHS response and significant interaction with MDAs. The response will involve cross-agency work and will require significant MOHS resources. The PHNEMC will provide strategic guidance and direction as it relates to the public health response. One Health National Emergency Risk Communication Strategic Plan 46 Appendix C: Documents Consulted The following is a list of documents that informed the content and objectives of this strategy: • Communication in Sierra Leone: An Analysis of Media and Mobile Audiences, BBC Media Action, May 2016. http://downloads.bbc.co.uk/rmhttp/mediaaction/pdf/research/mobile- media-landscape-sierra-leone-report.pdf. • Emergency Preparedness, Resilience and Response, Concept of Operations. • EVD Lessons Learned. • Government of Sierra Leone MOHS HED National Health Promotion Strategy of Sierra Leone, 2017–2021. • Government of Sierra Leone Ministry of Health and Sanitation, Primary Health Care Programme, Emergency Preparedness Plan, Bombali District, April 2018–2022. • Health Education Division National Health Promotion Strategy Of Sierra Leone (2017– 2021), 2016. • Joint External Evaluation (JEE) of IHR Core Capacities of the Republic of Sierra Leone, 2016. • Ministry of Health and Sanitation Sierra Leone, Operational Guidelines and Procedures for Rapid Response Teams, 2016. • MOHS All Hazards Public Health Incident and Emergency Response Plan. • MOHS National Social Mobilization Pillar Terms of Reference. • National One Health Platform: Governance Manual, October 2018. • One Health TOR and Governance Manual. • PHNEOC Sierra Leone Media and Communications Standard Operating Procedures, 2016. • Republic of Sierra Leone National One Health Strategic Plan 2019–2023, September 2018. • Risk Communication in the Event of Disease Outbreaks and Epidemics in the ECOWAS Region Strategic Plan 2019–2023. (draft) • Situation Analysis of Health Risks Communication in the ECOWAS Region. (draft) • Social and Behavior Change Communication Emergency Helix, Johns Hopkins CCP. • Social and Behavior Change Communication Emergency Preparedness I-Kit, Johns Hopkins CCP. • Taking a Multisectoral, One Health Approach: A Tripartite Guide to Addressing Zoonotic Diseases in Countries, published by The Food and Agricultural Organization of the United Nations, The World Organization for Animal Health and the World Health Organization, 2019. http://www.fao.org/3/ca2942en/ca2942en.pdf One Health National Emergency Risk Communication Strategic Plan 47 • Terms of Reference for The National One Health Coordination Committee in Sierra Leone Social and Behavior Change Communication. • Terms of Reference for the PHNEOC Communications Pillar, Ministry of Health and Sanitation, Public Health National Emergency Operations Centre (SL). • West Africa Risk Communication Strategy Draft, Dec 2018. One Health National Emergency Risk Communication Strategic Plan 48 Appendix D: Contact Details for District Communications Focal Persons/Social Mobilization Officers No. District Email Mobile #

1 Kambia kambiahealthcomms01@gmail.com

2 Port Loko portlokohealthcomms01@gmail.com

3 Bombali bombalihealthcomms01@gmail.com

4 Koinadugu koinaduguhealthcomms01@gmail.com

5 Tonkolili tonkolilihealthcomms01@gmail.com

6 Kono konohealthcomms01@gmail.com

7 Kenema kenemahealthcomms01@gmail.com

8 Kailahun kailahunhealthcomms01@gmail.com

9 Bo bohealthcomms01@gmail.com

10 Pujehun pujehunhealthcomms01@gmail.com

11 Bonthe bonthehealthcomms01@gmail.com

12 Moyamba moyambahealthcomms01@gmail.com

13 Western Urban westernurbanhealthcomms01@gmail.com

14 Western Rural westernruralhealthcomms01@gmail.com Note: Need to maintain constant email and mobile number for district communications focal persons. One Health National Emergency Risk Communication Strategic Plan 49