Somalia - COVID-19 Risk Communication and Community Engagement Assessment

Somalia's 2.6 million internally displaced persons (IDPs) living in 2,143 IDP sites throughout the nation experience conditions that are favourable for the transmission of COVID-19, including congestion and lack of adequate sanitation. This report presents the findings of an assessment on COVID-19 risk perception and preferred communication channels conducted by Camp Coordination and Camp Management Cluster (CCCM) partners and International Organization for Migration (IOM)'s Displacement Tracking Matrix (DTM) in IDP sites across Somalia. Its purpose is to enhance risk communication and community engagement (RCCE) effectiveness by providing evidence-based recommendations.

As explained here, CCCM Cluster partners have teamed up with stakeholders such as local health ministers to circulate key COVID-19 messages approved by the Ministry of Health and the World Health Organization (WHO). As of May 6 2020, CCCM partners had delivered RCCE sessions in 852 IDP sites spanning 16 districts. Moreover, government offices and humanitarian and development partners have rolled out comprehensive messaging campaigns geared at improving behavioural change related to COVID-19 and equipping communities with the resources needed to both prevent the spread of the virus and to respond appropriately during times of community transmission.

The assessment, which was conducted between April 21 and May 4 2020, used a mixed methods approach: (i) quantitative data were collected through 346 interviews in IDP sites in 6 districts (Hargeisa, Doolow, Baidoa, Kismayo, Banadir - Deynile, and Banadir - Khada). The interviews were conducted remotely through the use of mobile devices, whose owners are typically male heads of household; partners sought to ensure sufficient participation from women and youth, which meant that some interviews were conducted face to face. (ii) 6 qualitative key informant interviews (KII) were conducted per location with camp management committee (CMC) leaders, for a total of 36 KIIs.

The findings are organised according to 3 thematic areas:

Community knowledge of COVID-19:

• 98% of IDPs interviewed acknowledged the importance of preventing virus transmission within targeted communities. However, 35% of respondents in Kahda and 29% of respondents in Deynile said they did not know anything about the disease.
• 35% of participants did not recognise that sneezes and coughs transmit the virus, while 49% did not know that touching contaminated objects may spread COVID-19.
• 49% of respondents accurately reported that elderly persons are at a heightened risk of becoming sick. However, only 10% of Hargeisa participants were able to correctly identify this demographic as being at increased risk.
• COVID-19 misinformation appears highest in Kismayo and Hargeisa, as the majority of participants believe COVID-19 is transmitted through mosquito bites or blood transfusion.
• Most participants were able to describe the main symptoms of COVID-19, with 90% mentioning fever and 72% mentioning cough.

Preferred and most utilised channels for receiving COVID-19 messages:

• Radio (48%), humanitarian aid workers (46%), and phone calls (34%) are the main channels through which IDPs have received COVID-19 information. Facebook, SMS, and TV appear to be infrequent sources for obtaining COVID-19 information among IDPs.
• Religious leaders (45%), humanitarian aid workers (42%), and radio (38%) are perceived as the 3 most trusted sources of COVID-19 information. Despite religious leaders being viewed as the most trusted source to receive COVID-19 updates, they stand as the fourth most popular channel for receiving information about the virus (30%). This triggers questions on whether religious leaders have been sufficiently engaged in RCCE efforts. In addition, it is important to note that there are significant variances among districts when it comes to both preferred means of receiving information and most popular channels. This calls for RCCE actors to improve their understanding on the particularities of each district and adapting their strategies accordingly.
• Community leaders from Deynile and Doolow mentioned the Ministry of Health and local authorities as the most trusted sources for receiving COVID-19 updates.
• Community leaders such as gatekeepers, CMC members, and influential individuals within IDP sites tend to elicit mixed levels of trust (ranging from 38% in Doolow to only 2% in Hargeisa). The same is also true for phone calls or voice messages sent to beneficiaries. In additionally, other than respondents from Kismayo, participants have a low level of trust of Facebook as a source for COVID-19 information.
• Participants said they wanted to learn more about how to protect both their communities and themselves from COVID-19.

Attitudes and practices related to COVID-19:

• Most respondents expressed that COVID-19 is very dangerous for themselves (95%), their families (94%), and their communities (95%); however only 83% said that it is important to take steps to prevent the spread of COVID-19 in their communities. Meanwhile, one respondent said: "COVID-19 is important, but we are dying of hunger and you are only talking about the virus".
• 53% of respondents think that specific groups of people are more likely to carry the virus; of these, Somali nationals returning from abroad (41%) and foreign nationals (39%) were identified as the groups most likely to carry COVID-19. And CMC leaders in Hargeisa stated they "believe that this disease will not affect Muslims, specifically, Somalis". This statement highlights elements of misinformation that have also been identified in other assessments.
• In order to prevent the spread of the virus, respondents stated their families have washed their hands regularly (77%), avoided social gatherings and maintained social distancing (57%), and covered their mouth and nose when sneezing/coughing (48%). Only 33% expressed having avoided close contact with people presenting symptoms.
• When asked what an informant would do if he/she or a family member develops COVID-19 symptoms, 53% said they would go to the local hospital or clinic while 36% said they would stay in quarantine at their homes.

Key recommendations:

• Information consumption habits differ greatly among districts, requiring partners to diversify the methods employed at circulating COVID-19 messaging in IDP sites and to tailor approaches around favoured information channels.
• Continued emphasis on including religious leaders within awareness activities is paramount due to their trusted status within IDP communities - e.g., religious leaders from Doolow and Kahda have been vocalising a need to follow social distancing measures, even when it comes to religious gatherings.
• Comprehensive knowledge of the fundamentals of COVID-19 and what communities can do to mitigate transmission are statistically higher in districts that are receiving COVID-19 messages through radio and in-person RCCE sessions.
• There are indications that certain groups may be stigmatised in the context of the current pandemic. This situation requires close monitoring, especially in areas near international borders or in significant migration corridors.
• There is a continued need to survey communities' perception of COVID-19 and analyse a community's ability to prevent and respond to the threat of this virus. Future assessments that aim to highlight RCCE impact should utilise a methodology that allows for streamlined inclusion of these groups.

This research was supported by the Somalia Humanitarian Fund; UNHCR, the UN Refugee Agency; and the United States Agency for International Development (USAID).