Emergency and humanitarian action

In Nepal, risk communication supplements pre-existing health interventions

WHO/Joe Swan

Umesh Yadav is keenly aware of the post-quake health needs of his community. For the past 12 years, the 37-year-old has staffed the only health post in Bhimtar, a village of approximately 900 households perched above Sindhupalchok’s roaring Indrawati River. The mountainous district northeast of Kathmandu was one of the worst affected by Nepal’s 25 April and 12 May earthquakes.

“Before the earthquake we planned to declare Bhimtar as open defecation free,” he says. “Due to the disaster, however, many houses have collapsed and the open defecation free program has been postponed.”

Since 2011, Nepal has strived to eliminate open defecation in order to diminish the transmission of communicable diseases. In the immediate aftermath of the 25 April disaster, Nepal’s government and humanitarian partners have been prioritizing the restoration of water, sanitation and hygiene facilities to protect communities against a range of endemic diseases, including those associated with diarrhea, typhoid and hepatitis. The WHO and Ministry of Health and Population, meanwhile, implemented a rigorous disease surveillance system that involves daily reporting of case prevalence in the 14 most affected districts.

According to Yadav, who has been diligent in ensuring the provision of emergency latrines in his village, the risk of an outbreak is becoming increasingly acute as the emergency phase ends and new challenges present.

“Now, due to the monsoon, there is a greater chance of epidemics,” he explains.

As a means to supplement present water, sanitation and hygiene initiatives, WHO and Nepal Health Education, Information and Communication Centre (NHEICC) are disseminating a series of health messages among the communities that will amplify and reinforce safe water, sanitation and hygiene practices.

Joe Swan, a WHO risk communication specialist, says that engaging with communities directly is essential for promoting a ‘bottom-up’ approach to disease prevention.

“It’s important that communities be given the tools to defend themselves. Our primary focus is to reach each and every member of at-risk communities by disseminating messages via written, graphic and spoken mediums,” he says.

According to Swan, the range of messages being disseminated must, however, go beyond those related to water, sanitation and hygiene (WASH) and embrace the full spectrum of health-related challenges the country now faces.

“WASH is clearly an important part of what we’re doing, though it is integral that we provide material related to other health issues, such as vector-borne diseases, or how best to deal with animal carcasses, for example,” he says. “If we narrow our focus we may fail to adequately address other health risks.”

Flipcharts and flex banners being rolled out feature the aforementioned messages, along with those pertaining to snakebites, rabies, tetanus, flu and food safety among others. Nepal’s Female Community Health Volunteers (FCHV), who perform a vital role extending the health system’s reach in remote areas, are also being trained to impart the messages to their communities.

Nirmala Acharya, an FCHV in Kavrepalanchok, a district bordering Sindhupalchok, says that the WHO and NHEICC resources and training are of immense use in supplementing the post-quake work she has already performed.

“These will be very useful in communicating the messages to the community,” she affirms while thumbing through one of the flipcharts.

Acharya’s colleague Sita Bika, who works mostly with Dalit communities, agrees. “These messages are really going to be helpful. The images will make it easier to deliver the messages to the community. If we show the pictures along with the message hopefully people will be convinced,” she says.

Back in Bhimtar, as a result of his concerns regarding the change in weather, Umesh Yadav remains committed to ensuring there are no disease outbreaks during the rainy season.

“I love this place and want the community to be healthy,” he says.

Communicating risk and ensuring people have the knowledge and tools to diminish their vulnerability is a good place to start. To this end, WHO and NHEICC’s health communication strategy is vital.