Main text
Low -and middle-income countries face an additional challenge in
responding to the surging cases of COVID-19 globally. These countries
are already competing with the limited resources and triple burden of
diseases. The cases are soaring everyday as the testing services are
gradually expanded. The current pandemic have high rates of infection,
notable morbidity and mortality, inadequate protective or therapeutic
measures, and substantial increases in cases or case-fatality rates[1]. Most significant of these factors could be
the perception, communication and management of the risk presented by
COVID-19. It is vital to locate the analysis with respect to the risk
communication [1]. While few countries have
already reported successful containment of the cases, the situation in
South Asia is reverse with initial low rate of infection and a constant
rise in cases with expansion of testing services.
In most South Asian countries, the nationwide lock-down has been
gradually eased, not because the cases of COVID-19 have declined but out
of the compulsion and pressure from the socio-economic sectors. As
COVID-19 developed rapidly into a pandemic, people needed to acquire and
apply health information, and adapt into their behavior right away[2]. Health information offering simple and
practical solutions that include hand hygiene, physical distancing and
use of protective measures are widely available. There are global
initiatives that played a pivotal role in gradually controlling the
virus in many countries. These initiatives aimed at acting as myth
busters to enable fact-checking and providing credible sources relating
to COVID-19 [3]. However, there exists a global
epidemic of misinformation alongside this pandemic[4]. As no country is immune to misinformation,
people should be enabled to take informed decisions on mitigating the
effects of a disease outbreak and practice protective and preventive
actions [5]. This affirms the urgency and
importance of risk communication [6]. Risk
communication refers to the real-time exchange of information, advice
and opinions between health experts or officials and general people who
face a threat to their survival, health or socio-economic well-being[5]. Global evidence shows that effective risk
communication are helpful to avert new infections, management of the
existing infections, deal with the “Infodemics” and engage communities
in pandemic response [7–9]. In such pandemic,
where the situations tend to change promptly with rapid flow of
information, the role of risk communication is ever so important.
Therefore, along with the transmission of reliable and updated
information, risk communication should also appropriately enthuse change
in behavior [10]. The authors propose adoption of
risk communication framework emphasizing on 4Es, namely: Evidence,
Execute, Empower and Engage as depicted in Figure 1 .
Nationwide lockdown, physical distancing measures, different cues to
action have been brought into place across Nepal to reduce transmission
of SARS-Cov-2. Despite these efforts supplemented with expansion of
testing facilities across the nation, the number of infections is
increasing every day. Though the messages are simple, they are not
inevitably modest to implement for all. Even if everybody had reliable
and consistent information, behavior change would still be a challenge.
This will require communication to develop self-awareness that is
carelessly habitual to adjust to the new normal situation[11]. Several aspects of social and cultural
contexts affect the level and hustle of behavior change. Therefore,
there require significant shift in behavior during the pandemic while
the immense flow of health information and perspectives on the pandemic
is unparalleled and speckled [11]. There has been
debate in the role of the mass media in risk communication within health
and there should be one door system of information flow. The media
coverage during the outbreak of SARS in the beginning of 21st century
was excessive, sometimes inaccurate, and sensationalist[12]. Social media platforms albeit, a widely
available platform to disseminate health information, these platforms
are also the source of misinformation.
As of August 10, Nepal reported 23,310 positive cases (with 16,493 cases
recovered) and 79 deaths, with the majority of the cases returning from
abroad [13]. The Government of Nepal (GoN) in
collaboration with non-government counterparts is developing and
disseminating messages on prevention, testing, treatment and care of
COVID-19. Ministry of Health and Population (MoHP) has been coordinating
for messaging at designated stations of the air or ground routes,
responding with the frequently asked questions from the public, and
developing and disseminating information, education and communication
(IEC) materials. MoHP has also developed guidelines and mobilized
contact-tracing teams. Likewise, National Health Education Information
and Communication Centre (NHEICC) under the MoHP is the focal point for
social and behavioral change communication (SBCC) related activities.
Religious leaders are oriented to sensitize wide range of stakeholders.
The World Health Organization has been instrumental in developing and
promoting SBCC materials and sharing with concerned authorities for
wider circulation in both Nepali and English languages via websites.
COVID-19 related IEC, and training materials distributed in key
locations via stakeholders. Collaborative work with partner agencies and
mobile networks for pushing the COVID-19 awareness messages in
interactive voice response and short message service formats is being
undertaken along with messaging through mass media.
Further, MoHP organizes daily press releases and prepares daily
situation reports disseminated via various mass media, social media
platforms and websites aided with sign language targeting people with
hearing disorder. Some of the provincial ministries have also initiated
such practice. There are designated hotline numbers and mobile numbers
to provide information on COVID-19. However, consistency of the messages
delivered through these various platforms is still an issue. Some other
measures include orientation to media on COVID-19, crash course on risk
communication to MOHP officials, social media: COVID-19 web portal,Hamro Swasthya mobile application, MoHP official Facebook page
and Viber community.
Despite these various initiatives, people are disregarding the proven
cost-effective prevention strategies such as the use of masks or
physical distancing measures. In crowded cities of Nepal, maintaining
social distance is quite a challenge. (Figure 2: People
disregarding the use of mask and physical distancing while crowding to
buy fruits from a mobile vendor in Bhaktapur municipality of Nepal) Not
only the population density but also social structures often create a
hindrance in physical distancing. Public transportation being the main
mode of transport, people are compelled to travel in crowded vehicles.
Behavior change intervention should thus address such pragmatic
challenges and devise ways to work with interdisciplinary ministries
such as transport, labor, media, and environment in facilitating the
change in work culture while promoting health behavior. SBCC is a
gradual and continuous process. There is a need of balance between
fear/risk along with benefits of such an approach. SBCC entails
interactive and easy to comprehend messages along with edutainment
messages. To be effective, SBCC materials and messaging need to
incorporate ideas, images, and logic that will promote comprehension
among lay public. Small simple practical nudges such as the use of metal
bars in front of local shops can help maintain physical distancing.
Strict regulation on mask use, availability sanitizers or hand washing
facilities at the shopping malls, stores, food outlets, public vehicles,
social gatherings until they gradually develop as our habitual practice.
Other issue is the control of rumors, fear and stigma associated with
the disease. Wide spread of fake news and rumors from various social
media platforms creates unnecessary fear and stigmatization of infected
with COVID-19. There are challenges around handling media and
journalists and selecting channels of dissemination, although media
monitoring is being undertaken and addressed during experts’ sharing.
SBCC requires information sharing and establishing networks of working
relationships among individuals, groups similar to the socio-ecological
model. This is time to deal with epidemics rather than infodemics
through mobilization of the technical experts and media influencers and
strict media monitoring.
It is crucial to recognize the needs of specific groups such as children
and adults with disabilities, people who are illiterate while engaging
with larger populations within a community in the response to COVID-19.
They might experience barriers to retrieving information, care and
support or are at higher risk of exposure and secondary impacts. This
population make up an estimated nearly one sixth of the population and
are often unseen and excluded. The needs of the vulnerable population
should be central while designing such an intervention. Nepal’s
population is varied with diverse characteristics along with large
topographical differences. There need to be tailored messages that
enhance the public’s perception with a clear “menu of options”. Health
Sector Emergency Response Plan developed by GoN calls NHEICC for the
development of standardized messages that is to be delivered through
coordinated channels and with consideration of the local needs. While
the government is struggling to mitigate the effects of this global
pandemic, an urgent need exists on forming a dedicated risk
communication team in the country to design and deliver risk
communication packages with the SBCC approach addressing the need of
sub-populations dwelling at all levels. These communication
interventions must display accountability by keeping the public updated
on the situation, on actions carried out, and the impact of those
actions in containing the spread of disease.