Community Health Education: Lessons from Ethiopia to Build Decisive Strategies for Outbreak Control
By Eleleta Surafel Abay, Liya Sisay Getachew, Jenerit Hadush Araya, Beza Seleshi Ketsela, and Liya Elias Loha
As a civilization, we have lived through various outbreaks that have subsequently molded the basic principles of modern public health practice. In many instances, public health has helped generate evidence and access to scientific information to serve as a public resource for infection prevention and control. The variations in country responses to outbreaks emphasize the role of public health in contextualizing responses to local needs and generating locally tailored educational tools. While the expansion of infrastructure and skilled workforce play important roles in achieving optimal population health, providing health education to the community remains critical in improving disease prevention and health promotion. For concerted effort towards better outbreak control and fast return to normalcy, community education on disease prevention and health promotion is key.
The COVID-19 pandemic has and still is, challenging even the most advanced and modernized healthcare systems. The pandemic has been a clear indication that addressing such health crises requires not only scientific approaches but also the utilization of broader public health strategies with a fundamental focus on health education for the community. If the COVID-19 pandemic has taught us anything, it is that health systems and policies may be revised, resources prioritized and allocated, approaches digitized and modernized, practitioners trained and deployed in mass, and all effort would be negated by the mere lack of community support.
Ethiopia’s journey helps contextualize the complexity of COVID-19 responses and community uptake, particularly in low- and middle-income countries within Sub-Saharan Africa. While some of Ethiopia’s challenges are unique to the country, the lessons learned can be applied globally.
Lessons from Ethiopia’s COVID-19 Response
Ethiopia is currently navigating the third wave of the COVID-19 pandemic. As it stands, the country lacks the infrastructure, medical supplies, and optimal health care provider-to-population ratio to fight the outbreak. Such substandard pandemic response efforts need the support of health awareness and promotion for rapid control. For preventive public health measures to be effectively implemented, appropriate risk perception by the public through education is necessary; as education directly predicts protective behaviors.
The Ethiopian society still carries elements of a vision of public health with limited understanding of health promotion, with most “knowledge” regarding disease entities derived from cultural beliefs and/or religious teachings, and uncensored, non-scientific social media posts. A recent study in the country found that only 40.1% knew the main clinical symptoms of COVID-19, with 49.2% believing that COVID-19 cannot affect young people, and 79.2% having an optimistic view of viral control. This is rooted in the misguided, continental belief that Africans are resistant to the disease. Such belief has further seeded its way into leniency in adherence to public health measures, as evident in mask usage that has plummeted to 59% in the capital, and 20% in rural areas as compared to the initial stages of the pandemic.
Furthermore, it has been shown that illiterate persons are 5.12 times more likely to be less compliant with public health measures. This figure is a serious cause for concern given the country’s adult illiteracy rate of 48.23%. Beyond the lack of adherence to public health measures, this limited knowledge is currently impacting vaccine hesitancy as well. A recent study found that one out of five adults in the country is not willing to get vaccinated.
Ethiopia is not a lone case study. Many countries are battling misinformation, lack of interest within the public in understanding the challenges associated with COVID-19 and willful ignorance of COVID-19 regulations despite awareness. With increasing challenges related to antimicrobial resistance, COVID-19 will certainly not be the last pandemic. As such, health promotion and disease prevention need to be crucial aspects of addressing global health security challenges. Additionally, in countries such as Ethiopia where hospital care remains unaffordable to a vast majority of the public community education can also be a significant cost reduction factor as well.
Integrating community health education is the way forward
If effective health promotion and disease prevention can be prioritized in the community through educational outreach efforts in primary care facilities, among health extension workers and schools, it would drive the society toward increased consensus on taking on an active role in minimizing risk factors in public health emergencies based on available scientific evidence.
Community adherence challenges and disease trajectory in low- and middle-income countries show that increased investments for health education and promotion are crucial for disease prevention. These investments should prioritize:
Educational methods that are based in social community service centers, primary health care facilities, and health extension visits.
Better multi-sectoral health education efforts among local and international scholars and medical entities.
Integration of comprehensive disease prevention and health promotion curricula in-school programs, as schools provide settings where health promotion can be instilled during impressionable years.
Clear communication of health measures through messages that reconcile religious and cultural beliefs with onboarding of leaders and elders in public health message dissemination.
Social media posts that are linked to scientific pieces and peer-reviewed articles, with strict regulation of misinformation.
In order to manage the urgent need for health services when faced with rising cases, it makes sense to put more focus and effort into acute healthcare during outbreaks. However, hospital care is only the surface in the hierarchy of holistic care. The actions of the community in following public health measures can have a larger impact on disease prevention. Such impact can be evidenced through community education efforts that have helped in the response against Guinea worm. Investments towards health education can help reduce disease incidence and the burden on the healthcare system minimizing service delivery costs and potential long-term effects of some diseases. Thus, regardless of the income level of the country, prioritizing a community-focused action plan with health education at its center is vital for a sustainable approach to minimize the impact of current and future outbreaks.
About the Authors
Eleleta Surafel Abay, M.D., COVID-19 Response Task Force, Kadisco General Hospital. Eleleta is a physician with a specialty in epidemiological surveillance. Her work further includes advocacy roles in organizations like the World Medical Association-Junior Doctors Network in the areas of equitable and sustainable primary health care access. She tweets @eleleta_s.
Liya Sisay Getachew, M.D., Associate Researcher, Armauer Hansen Research Institute. Liya serves as a clinical coordinator in the national WHO SOLIDARITY Clinical Trial against COVID-19. She additionally serves as a medical consultant in numerous digital women’s health initiatives.
Jenerit Hadush Araya, M.D., Medical Advisor, Star Metropolis Clinical Laboratories. Jenerit serves as a focal person for medical advice and consultation for several clinical and diagnostic laboratories. Through local and continental engagement, she advocates for increased access to laboratory tests and imaging in rural settings.
Beza Seleshi Ketsela, M.D., Graduate Assistant, San Diego State University. Beza is a general practitioner currently pursuing a masters in bioengineering with specialty in neurophysics. Her work is motivated by community engagement and pre-hospital care for Traumatic Brain Injury.
Liya Elias Loha, M.D., COVID-19 Response Task Force, Washington Medical Center. Liya serves as an advisor for project implementation teams in several maternal health and sexual and reproductive health initiatives. In this capacity, she coordinates teams of experts in field studies for male engagement in maternal and newborn care, family planning and sex education.