Key Considerations: COVID-19 RCCE Strategies for Cross-Border Movement in Eastern and Southern Africa

"Previous research on cross-border dynamics during Ebola outbreaks has highlighted the importance of engaging with trusted local authorities, particularly those with a role in cross-border governance..."

Developed for the Social Science in Humanitarian Action Platform (SSHAP), this brief focuses on cross-border movement in Eastern and Southern Africa (ESA) and its implications for development of risk communication and community engagement (RCCE) strategies aimed at preventing transmission of COVID-19 in the ESA region. SSHAP explains that people on both sides of borders in this region often share culture, familial ties, and economic activity, and fluid movement across the borders, regardless of formal closures, means that cross-border transmission of COVID-19 is an increasing concern. Yet, historically, few governments have invested in public health capacity at border crossings, and efforts to control cross-border COVID-19 transmission may be impeded by political and economic factors.

As reported here, the World Health Organization (WHO) Regional Office for Africa, the East African Community (EAC), and ESA COVID-19 regional technical working groups have developed a range of strategic recommendations and guidance on issues related to cross-border travel in the context of COVID-19, such as testing and contact tracing. However, these efforts can be influenced by the fact that, for example, in some border populations, low levels of knowledge of the disease, low risk perception, and negative attitudes toward movement restrictions may compromise COVID-19 control. To cite another example: Groups at high risk of stigma (e.g., truck and boda-boda (motorcycle taxi) drivers, sex workers, migrants, returnees, or displaced persons) may hesitate to seek treatment for COVID-19 and other health concerns due to fear of discrimination or further marginalisation. There are also structural (e.g., lack of infrastructure) and political/economic factors (e.g., community noncompliance) to consider.

To address such issues, a variety of communication initiatives have been designed to reach cross-border traffic in the region. The International Organization for Migration (IOM) is working to raise awareness of COVID-19 among truck drivers, cross-border traders, and host communities through a variety of means, including in-person communication at the border, radio programmes, and billboards at 5 points of entry (POEs) in Zimbabwe and 2 POEs in Mozambique. They use tailored messaging on risk and prevention measures and provide information, education, and communication (IEC) materials for migrants during quarantine and on arrival in the host community. Throughout the region, a variety of informational campaigns on COVID-19 prevention and services, meant to reach the population more generally, are running on radio, TV, and the internet. In South Sudan, a systematic approach to rumour collection and countering has been incorporated into RCCE strategies.

Some RCCE-related recommendations:

• A key first step in the development of RCCE should be to closely analyse the specific cross-border context to allow a tailored approach. RCCE efforts for COVID-19 prevention should aim to reach key/vulnerable populations at a variety of locations, including formal and informal POEs and along transport routes. For example, many women are cross-border traders and informal and domestic workers in neighbouring countries, and they make up a disproportionate number of caregivers and health workers. Yet they often lack access to information and services. Other vulnerable populations on whom specially tailored efforts should be concentrated are children, people with disabilities, refugees and migrants, and the elderly.
• Development and sharing of RCCE information should involve trusted community members, including religious and cultural leaders, trusted authorities, leaders of relevant trade associations, and representatives of vulnerable and marginalised population groups.
• Due to the diversity of individuals at the border and along transport routes, a variety of online and offline communication channels should be used in line with key populations' preferences and with the aim of sharing accurate and timely information about COVID-19 and how to minimise infection risks. Technology-based messaging may be suitable for some populations but are not uniformly accessible or trusted; other communication methods, like radio, public address, print materials, and personal/peer-to-peer communication should also be used.
• Two-way community engagement should cover public health recommendations using common terminology. Considering that literacy varies greatly throughout the region and that 157 different languages are spoken in 5 ESA countries alone, an emphasis on pictorial, audio, and video dissemination of COVID-19 information may be most effective, with translation of materials into accessible formats and languages. Posters in high-traffic areas may be preferable to leaflets and pamphlets, which may contribute to transmission as they are passed from hand to hand. Where possible, captions or sign language should be included on videos and TV productions, and IEC materials should be translated into braille. Child-friendly message formats will also be needed. Communication should allow for information sharing from the community, which can then be incorporated into revised RCCE.
• Experience with past epidemics, including Ebola, demonstrates the importance of regional cooperation and cross-border coordination. For example, RCCE implementers should collaborate across borders, and cross-border population groups should be actively involved in joint risk analysis and developing actions to minimise infection risks.