Community Engagement in WASH Emergencies: Understanding Barriers and Enablers Based on Action Research from Bangladesh and the Democratic Republic of Congo (DRC)
Abstract
:1. Introduction
1.1. Context
1.2. Problem Statement
- Public health programming often adopts an instructive approach rather than building on the local expertise of affected communities;
- Teams use a variety of methods and communication channels to facilitate behavior change among diverse communities, but do not necessarily measure whether this results in meaningful participation;
- Despite global commitments to work in partnership with crisis-affected people and to strengthen accountability mechanisms, there is a persisting perception within both Oxfam’s public health team and the wider WASH sector that community participation is a mere “add-on”, a non-essential that is accordingly deprioritized when pressure on delivery is high;
- Community interaction does not necessarily factor in existing power dynamics and, as such, there is a tendency to focus on local elites rather than seeking to establish continuous interactions with the vulnerable or less accessible population groups.
1.3. How Do We as Oxfam WASH Address This?
- Implementation of the CE approach in varying emergency contexts—rapid-onset emergency, epidemic, and conflict—to capture lessons learnt and inform the new way of working.
- Measurement of community participation—critical to truly understand a project’s impact and how the response adjusts to community input.
- Orchestration of field trials—necessary to understand what effective CE in WASH emergencies means and how it contributes to the intended WASH outcomes. The aim here was to utilize the new CE model to inform both technical and strategic approaches.
- Identification of barriers and enablers that affect community-centered ways of working in WASH, across different contexts.
2. Materials and Methods
2.1. Macro Perspective
- Languages and communication channels used and the extent to which the information reaches all sections of the community using context-specific channels;
- How specific gendered needs of women and men, and boys and girls were taken into account in the design and location of the facilities (access, privacy, safety, menstrual hygiene management);
- The use of their feedback to make relevant changes in the program.
- Rohingya refugee crisis—Cox’s Bazar, Bangladesh;
- Ebola outbreak—North Kivu, DRC.
2.2. Micro Perspective—Bangladesh Example
- Establishing a measuring framework—this was done based on the participation and satisfaction indicators developed under the new CE approach, and entailed defining the following:
- clear outcomes in terms of WASH (i.e., increased acceptance and satisfaction with the design of water facilities by diverse age and gender groups, increased satisfaction with water supply in terms of quality and quantity);
- how the indicators were to be measured in terms of ongoing program activities;
- the relevant methodologies and tools (mostly participatory and qualitative).
- Defining with WASH response teams the critical components to enhance community-centered ways of working. In some areas, there may be a greater need to focus on closing the feedback loop, while, in others, the priority will be on establishing a good enough contextual understanding, or advocating for WASH infrastructure projects to be modified and improved through community involvement. Priorities will inevitably change according to the context and the phase of the humanitarian WASH response.
- Conducting learning reviews with technical teams and community volunteers/focal points of Oxfam’s WASH program to analyze what works well and what does not in terms of involving people in the response and increasing a community’s ownership over WASH-related processes.
3. Results
3.1. Case Studies—Summary
3.1.1. Barrier 1
3.1.2. Barrier 2
- Community participation: communities, including the more marginalized, influence the design of feedback and complaint mechanisms; diverse community members are included in identifying local priorities, problems, and their own solutions; community-based action plan with roles and responsibilities for all actors is agreed upon and monitored.
- Community satisfaction: communities report that specific gendered needs of women and men, and boys and girls are taken into account in the design and location of the facilities (access, privacy, safety, menstrual hygiene management); communities express satisfaction that Oxfam listened to their feedback and made changes to the program where possible.
3.1.3. Barrier 3
3.1.4. Barrier 4
3.2. Case Study 1: Water Network—Bangladesh
3.2.1. Background
3.2.2. Approach
3.2.3. Initial Findings
3.2.4. Outcomes
- Most of them prefer small group meetings, limited to the representatives of different water user groups, based on their suggestions. However, such representatives would have the assigned responsibility of ensuring that the outcomes of these meetings be shared among the user group members.
- The use of pictures/posters ranked as the second highest preferred communication method. Different groups suggested the printing of “dos and don’ts” in pictures on the tap stands, which they would use on a daily basis. Illiterate women expressed the need for colored images to facilitate understanding.
- The use of megaphones with pre-recorded messages was another critical communication channel identified, particularly among adolescent girls and elderly women.
- Information sharing on the project (technical details, roles and responsibilities in the process);
- Feedback mechanisms available for communities to share suggestions and concerns with Oxfam.
3.3. Case Study 2: Community-Based Alert System—DRC
3.3.1. Background
3.3.2. Persistent Issues and Corresponding Solutions to Enhance CE
- Issue: low trust in response teams and the politicization of the response, as well as continuous complaints about the lack of local actors involved in the Ebola response. This was closely associated with the visibly large resources, including financial ones, allocated to the Ebola response.
- Solution: as a result, the Oxfam team advocated to the Beni sub-coordination to ensure regular meetings with the local committee (focal points of the three hotspot areas where the CBAS was implemented). In addition, the team actively supported the design and implementation of the new CE strategy led by the United Nations Children’s Fund (UNICEF), strengthening local-level coordination mechanisms with regular platform meetings at the neighborhood level and improving the reporting systems.
- Issue: very low acceptance and partial rejection of the vaccination teams due to both a widespread perception of the vaccination being “only for elites” and the perceived discriminatory and disrespectful behavior of certain vaccination teams (see Table A1(xii), Appendix A).
- Solution: Oxfam took this issue seriously and shared this feedback with the focal point of UNICEF Communication for Development (C4D). Direct meetings with a representative of the vaccination team were then organized in two out of three sites where the complaints were raised, providing an opportunity to listen to the various concerns and explain the principles and eligibility criteria of the vaccination. These efforts were additionally supported by social-science researchers from the World Health Organization (WHO) and UNICEF, advocating for an orientation of the vaccination teams to improve their sensitivity to socio-cultural perceptions and behaviors.
3.3.3. Objective of the CBAS
3.3.4. Understanding the Risks
- Community actors of the CBAS becoming subject to violence and oppositions within their own community, and as such risking stigmatization;
- People’s high expectations toward incentives given, which would lead to disengagement over time;
- Confusions between different intervening actors and the inconsistency of the information shared with the local population.
3.3.5. Setting up the CBAS
3.3.6. CBAS Enablers
Support and Follow-Up
- Orientation from the safe and dignified burial team (SDB) on burial protocols and procedures.
- Protection training focused on how confidentiality could be ensured in the process, and to mitigate the risk of community actors becoming subject to threats and accusations by the wider population (whose fears would be around Ebola patients being sent to treatment centers that would “kill” the patient).
- Meetings with the vaccination team to understand the principles of vaccination, including eligibility criteria (i.e., those entitled to vaccination versus those who are not).
Planning for Action
Becoming More Strategic
- The analysis of the epidemiological situation, triangulating community alerts with data available from the surveillance commission.
- A detailed exploration of why the community remained at risk of the Ebola epidemic and the perceived barriers felt by the local population toward disease prevention and management.
- Barriers were then broken down and prioritized, and detailed actions discussed (including the resolution of roles and responsibilities for members of the alert system, other community actors, Oxfam, and the wider response system).
- A weekly evaluation of the action plans was established to understand challenges, progress made, and closing the feedback loop (by bringing information back from the wider coordination and activities carried out by Oxfam to support the community in the process).
- The community feedback was shared on a weekly basis within the wider Oxfam team, UNICEF C4D, and response commissions.
Barriers and Solutions
- reduce the fear of ETCs;
- promote formal health-seeking behavior.
How It Fostered Trust
The Value of Mobile Technology
4. Discussion
4.1. Measurement
4.2. CE Takes Time and Resources
4.3. CE Requires Extensive Collaboration and Coordination
4.4. Accountability and Program Quality
5. Conclusions
5.1. Key Outcomes—Bangladesh and the DRC
- Dedicated funding for a CE WASH advisory position, a role responsible for introducing the measuring framework on CE in WASH, developing a contextualized approach, and building the capacity of the team to design and implement a community-centered response.
- Allocated funding for CE-related innovation projects (such as collaborating with Translators without Borders to better understand communication needs and develop a WASH-specific glossary) [20].
- Documentation of lessons learned from the CE aspects of the water network design to inform the application of CE in other emergency settings and to better inform future global work with UNHCR—this will ultimately lead to WASH responses that are more community-centered than they were in the past.
- The response strategy evolved from a WASH Ebola program to a community-centered response, the aim of which is to increase community trust in the response system by providing a space to listen and foster community-led solutions.
- Additional deployment of CE and PHP experts across different project sites.
- Allocated funding for learning on CE and formative research on the ground.
- Replication of the bottom-up approach across new working sites (such as Butembo (see Table A1(xiv), Appendix A)), working with formal and informal community stakeholders to identify barriers and solutions.
- New support for Oxfam’s view on CE by the World Health Organization (WHO)—for example, in terms of developing a response-wide CE strategy that is owned by all commissions, as well as mapping at the local level (Katwa/Butembo) of key social influencers, barriers, and solutions to address the root causes of community distrust in the Ebola response system.
5.2. Overall Outcomes for Oxfam
5.3. Overall Outcomes for the Humanitarian Sector
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
Number | Note |
---|---|
i | In densely populated IDP and refugee camps, emergency water supply systems often consist of treatment systems, pumping stations, transmission and distribution lines, and standpipes. This system of infrastructure (assets) differs from rural water sources, which typically involve point sources (wells or boreholes) equipped with hand-pumps. |
ii | In the refugee camp context of Cox’s Bazar, Bangladesh, Oxfam’s WASH program included the installation of communal sanitation facilities (latrines) to ensure safe excreta disposal, the construction of deep tube wells to provide safe water, water treatment where required, the distribution of hygiene items (such as soap) to enable people to practice hand washing, as well as the training and support of a network of community-based volunteers (to discuss access, maintenance, and use issues with latrine and water point users), and the promotion of hygiene at household and community level. In the DRC, the response strategy initially followed a more “conventional” WASH approach to disease outbreaks. This involved (a) the construction/rehabilitation of WASH facilities at health centers; (b) the construction/rehabilitation of water sources at the community level; (c) WASH support for schools, including the provision of hardware facilities and training of teachers and students on Ebola prevention; and (d) public health promotion through the existing network of community health networkers, as well as the briefing of community leaders. |
iii | While it was critical to share vital information on the WASH situation in the camp, and promote both the use of the WASH facilities provided and any important hygiene measures, the team often adopted a rather instructive approach rather than tailoring the content and channels to the different population segments and their respective communication preferences. |
iv | The WASH sector was faced with a similar challenge in Jordan’s Za’atari camp during the Syrian refugee crisis, a camp that was established in 2012 for 10,000 people but swiftly grew to accommodate 79,000. Nobody could anticipate the scale and implications of the conflict in Syria and, as such, the probable lifespan of the camp was not considered from the outset. WASH programs were, therefore, poorly planned and did not take community voices into consideration. During the second year of the camp’s operations, the WASH sector constructed a piped water network, thereby investing in a longer-term governance model to ensure a fair water distribution. |
v | At the time of writing, the total number of refugees covered by Oxfam’s designated catchment area is 17,800. |
vi | A formal leadership system introduced by the Bangladesh government as a result of the refugee influx in 2017. All Mahjis are Rohingya and appointed by the Bangladeshi army to take on various responsibilities, including population counts and the identification of immediate survival needs. |
vii | Increased unemployment rates, loss in incomes, lower educational level, reduction in food consumption: World Bank, 2016 |
viii | Such as iron and gold: World Bank, 2016 |
ix | Community mobilization, as defined by Oxfam’s PHP guidelines, is a strategy for involving communities in taking action to achieve a particular goal. The emphasis of mobilization is on the action taken rather than the longer-term concept of behavior change and, thus, provides a more useful model for the emergency context. |
x | Broad term often referring to all different kinds of promotional approaches mostly focusing on “awareness-raising activities” aiming to inform a large number of people on a standard set of information. |
xi | These commissions include surveillance, contact tracing, case management, laboratory testing, communication, and CE, as well as prevention (WASH and infection, prevention, and control). |
xii | It was repeatedly noted that vaccination teams were prone to calling their friends (to ensure their protection) over the contact lists they were provided with, and wasting time on their smartphones rather than focusing on the urgent task at hand. |
xiii | Note that, since the start of 2019, the feedback system improved (largely due to response actors recognizing that CE plays a critical role in the reduction and control of the Ebola disease). |
xiv | Butembo is a city of nearly one million people, in North Kivu, DRC. Katwa health zone (located in Butembo city) is currently considered a main Ebola hotspot: 34% (33/97) of the new confirmed cases over the past 21 days were reported in this health zone” World Health Organization (WHO): “Ebola Virus Disease, Situation Report 34”. |
xv | A positive example on existing preparedness efforts is the work undertaken by the Global Task Force for Cholera Control (GTFCC), which, for example, invested in a standing commitment until 2030 to develop national cholera plans, mapping hotspot areas, planning for longer-term WASH investment, and detailing how CE across the acute and longer-term phase would look alike. |
WASH Outcomes | Community Participation | Community Satisfaction |
---|---|---|
There is no evidence of WASH-related disease outbreaks | Formal and informal community leaders, community organizations, and institutions are identified | Communities report that key information is clearly communicated in appropriate languages and reaches all sections of the community using context-specific channels |
Access to appropriate WASH facilities and resources is available to all in line with Sphere standards | A stakeholder map developed with communities is used to analyze power dynamics and for program planning | Communities report that specific gendered needs of women and men, and boys and girls are taken into account in the design and location of the facilities (access, privacy, safety, menstrual hygiene management) |
WASH facilities are consistently used, and users are involved in maintaining them | A diverse range of people selected by the community is involved in decisions on the planning, design, and maintenance of WASH infrastructure and services | Communities express satisfaction that their feedback was listened to and changes were made in the program where possible |
There is no evidence of open defecation | Communities, including more marginalized groups, influence the design of feedback and complaint mechanisms | Marginalized groups and individuals express satisfaction with consultation and program adaptations |
Safe water chain is maintained | There is evidence that cultural and religious beliefs are incorporated into program design | Communities report that they have the skills and support to manage WASH facilities and services |
Hand washing is effectively practiced | Diverse community members are included in identifying local priorities, problems, and their own solutions | |
Implementation plan with roles and responsibilities of all actors is agreed upon and monitored | ||
Community members are involved in monitoring program activities and in the feedback loop to their wider community | ||
Communities are supported to advocate on their behalf to Oxfam and to other stakeholders through coordination | ||
Capacity development and a timely exit/transition plan is agreed upon by communities and other key stakeholders |
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Area | Camp 3 | Camp 4 Extension | Camp 3 | Camp 4 Extension | Camp 3 | Overall |
---|---|---|---|---|---|---|
Group | Adolescent Girls | Women | Women | Men | Adolescent Boys | |
Information sharing | 3.8 | 4.4 | 3.2 | 4.9 | 3.25 | 3.91 |
Involvement in tap stand design | 5 | 5 | 4.4 | 5 | 4.75 | 4.8 |
Involvement in site selection of tap stands | 4.5 | 4.6 | 4.6 | 4.8 | 4 | 4.5 |
Involvement in construction | 4.2 | 4.8 | 4.8 | 4.9 | 4.5 | 4.6 |
Feedback from Oxfam on final design of tap stand | 4.9 | 4.8 | 4.2 | 5 | 4.91 | 4.7 |
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Niederberger, E.; Glanville-Wallis, T. Community Engagement in WASH Emergencies: Understanding Barriers and Enablers Based on Action Research from Bangladesh and the Democratic Republic of Congo (DRC). Water 2019, 11, 862. https://doi.org/10.3390/w11040862
Niederberger E, Glanville-Wallis T. Community Engagement in WASH Emergencies: Understanding Barriers and Enablers Based on Action Research from Bangladesh and the Democratic Republic of Congo (DRC). Water. 2019; 11(4):862. https://doi.org/10.3390/w11040862
Chicago/Turabian StyleNiederberger, Eva, and Tanya Glanville-Wallis. 2019. "Community Engagement in WASH Emergencies: Understanding Barriers and Enablers Based on Action Research from Bangladesh and the Democratic Republic of Congo (DRC)" Water 11, no. 4: 862. https://doi.org/10.3390/w11040862
APA StyleNiederberger, E., & Glanville-Wallis, T. (2019). Community Engagement in WASH Emergencies: Understanding Barriers and Enablers Based on Action Research from Bangladesh and the Democratic Republic of Congo (DRC). Water, 11(4), 862. https://doi.org/10.3390/w11040862