A trip from DC to Dar es Salaam takes less than a day--about 21 hours. This unprecedented speed of transportation means an outbreak can quickly turn into an emergency of international concern.
In response to this concern, the World Health Organization (WHO) updated the International Health Regulations (IHR), a legal framework to enhance national and global health security in 2005. When WHO released the Joint External Evaluation (JEE) Tool, a new instrument to measure country progress, Tanzania was the first country to use it.
At the end of the country’s JEE assessment in February 2016, results were presented to the Tanzania Ministry of Health. One of the weak areas identified in the country's national capacity was risk communication:
Risk communication capacities and capabilities at subnational level are very limited. Capacity building measures, such as regular training and supervision for subnational communicators is needed. This includes training of health care workers in social mobilization at “house-to-house” level. -JEE of the United Republic of Tanzania
Meanwhile, the country was struggling to control a cholera outbreak. By April 20, 2016, a total of 24,108 cases, including 378 deaths had been reported nationwide.
Health care workers need to be equipped to inform and engage communities, and the ongoing cholera outbreak was additional motivation to prioritize a risk communication training program. Seeking to improve national capacity for risk communication and social mobilization, the Ministry of Health reached out to the Tanzania Capacity and Communication Project (TCCP) in June 2016.
Elizabeth Serlemitsos, Advisor for Capacity Building at TCCP, knows health emergencies well. During the 2014 West Africa Ebola outbreak, Serlemitsos was the Mano River Regional Director for the Health Communication Capacity Collaborative (HC3), based at Johns Hopkins Center for Communication Programs. She witnessed, first-hand, the swift, strategic communication needed for quickly moving outbreaks. When asked to provide support for a training curriculum, she agreed, and began researching strategic communication resources to adapt for Tanzania's risk communication training.
HC3 was about to pilot a resource, the SBCC for Emergency Preparedness Implementation Kit (I-Kit) with components that would be easily adapted for the training in Tanzania. This I-Kit walks through key steps and considerations for developing an emergency preparedness communication plan and is designed to strengthen health system capacity for social and behavior change communication (SBCC). Each of the nine units in this training tool also provides worksheets and examples.
The I-Kit was a perfect starting point for the training that Tanzania's JEE assessment revealed was needed. The WHO risk communication essentials course was used to complement the I-Kit.
Another valuable part of the training wasn't fully recognized until the curriculum was pretested. As a capacity and communication expert, Serlimitsos knew training tools are most effective when participants have a scenario to test their knowledge. She assigned half of the participants to a cholera outbreak scenario and the other half to a fictional disease outbreak: the Wongi virus.
On day one, participants were given a news headline of a sudden outbreak and asked, "What is the right risk communication response?" As each day of the five-day training progressed, participants were provided with realistic developments and it became clear the simulation was a critical piece to improving risk communication capacity.
According to the Ministry of Health, this curriculum adapted from the I-Kit will be a training of trainers program to be rolled out regionally for improving health systems throughout the country. With this curriculum in the toolbox, Tanzania is already on the way to achieving IHR standards and better risk communication preparedness and response.
“We found the I-Kit so useful when we were developing our guidelines and strategy as well as the curriculum. Each of the steps helped to guide our thinking, and it is the core part of our curriculum, since it is logical and easy to use.” -Peter Mabwe, Health Communication Officer, Health Promotion Section, Ministry of Health, Community Development, Gender, Elderly and Children, Tanzania