MAY SULE, IMPERIAL COLLEGE LONDON, 21/05/2018
A major outcome of the WISER project is to design guidelines and recommend appropriate, sustainable, affordable and equitable water infrastructure in partnership with the communities. Participation and ownership by the communities and individuals most affected by schistosomiasis, poverty and other developmental issues are very important. We cannot underestimate the power of adequate and robust stakeholder engagement by all parties – communities, Government, NGOs, schools etc. It is almost certain that risk and behavioural change communication will be crucial alongside other important factors: social and cultural beliefs, costs, maintenance requirements, local education and training needs, gender and class equity issues. Hence, the words we use with the community needs to be cautiously crafted in clear and understandable terms.
Two global conferences in particular over the past 20 years have helped create and shape the direction of Social and Behavioural Change Communication SBCC - the 1997 Bellagio Conference on Communication and Social Change and the 2006 World Congress on Communication for Development. The practice and systems of communications have the power to transform lives, and to influence the behaviour of institutions, communities and nations. Communities must therefore play an essential role in finding their own communication solutions and developing their own communication strategies. The images and stories that define and shape a group, a community or a people are primarily theirs alone to make. Successfully documented projects show how marginalized people, given the opportunity, can create solutions for complex problems, and often possess the energy and vision that will help ensure the best outcome.
The aim of Objective 3 of WISER is to engage communities through case studies in Ethiopia and Tanzania so as to consider the critical practical non-technical (e.g. socio-economic, cultural) challenges to address when applying the water treatment processes and biosensors for effective intervention. The WISER team visited one of the case study communities, Chole Isamilo near Mwanza, Tanzania on 26th of April 2018. The community, situated on the bank of Lake Victoria, was conducting their normal daily activities (occupational and domestic) without any apparent concern about the potential for the water to be contaminated with schistosome cercariae. Perhaps they have no choice, having no alternative water source, or maybe, they lack awareness regarding the disease burden of schistosomiasis. Perhaps their only source of income is occupational fishing. How do we communicate the risk to such communities? How do we fully engage them? One potential way is through role play. It is evident that “When you create a story with a community, and they see or hear people like themselves acting it out, the message resonates more deeply". Our community stakeholders generally want to lead happy and productive lives that improve themselves, their children and their communities.
During the First Dissemination and Stakeholder Engagement Workshop held on the 24th (Addis) and 27th (Mwanza) of April 2018, we had a session which specifically targeted community representatives from all the case study communities. Some local officials were also in attendance and we had well over 80 people in total for both sessions led by Acting for Health. Volunteers amongst the community members staged role plays, and some important themes began to emerge during the course of the session. These included: complexes and problems associated with schistosomiasis including stigma; obstacles including distance to accessing health services; moral and cultural/traditional beliefs causing parents to refuse medication for children; delaying treatment due to poverty; believing praziquantel to be responsible for lower sex drive/reproduction among men; alternative traditional medicine etc. At the end of the session, the representatives were asked how far in the future they thought schistosomiasis could be eliminated. Their general response was – “It is difficult to say in terms of years because of how our daily routine is so related with contact with the contaminated water body”. But on a positive note, they felt that proper and continued education on the relationship between schistosomiasis and water contact, provision of alternative water supplies, adequate sanitation, and availability of chemotherapy, as well as the willingness of parents to seek hospital medical help instead of traditional treatment, will all greatly help. Some also felt that the use of personal protective equipment for fishermen (e.g. boots and gloves to minimise occupational water contact), with the right messaging, could be helpful. All in all, it was an excellent session that gave us some initial insight into the huge but possible task of eliminating schistosomiasis.
A great example of WISER’s early positive impact through stakeholder engagement is the changes adopted by a local NGO - Cheka Sana Tanzania - that works on supporting Street Involved Children, Youth and their families in Mwanza. For a long time, during outreach work, children were taken to a place along Lake Victoria - known as Kigoto, to have a wash and improve their personal hygiene. By the time WISER started interacting with Cheka Sana, coupled with an increase in schistosomiasis cases amongst the children with whom they were involved with, Cheka Sana built an alternative washing facility in their Day centre which is now available for the children to use. They no longer take the children to the lake to wash. This is a great example of how adequate stakeholder engagement can influence policy and change behaviours positively. Although it has been difficult to stop some of the children who still go into the lake for leisure, we will look at how we can further liaise with the organisation to engage the kids and build their understanding of behavioural risks associated with water contact and schistosomiasis. Communicating the risk of exposure due to water contact with contaminated sources like Lake Victoria is very important for meaningful progress.
Now what next? We will work with the case study communities in assessing their knowledge of schistosomiasis and relationship to water (water contact), attitudes and perceptions towards the various strategies for controlling schistosomiasis, willingness to adopt potential interventions such as safe alternative water supplies or protective equipment, ownership and willingness to contribute to maintenance and sustainability of an alternative water supply, if applicable, as well as different approaches to behavioural change and attitudes.