In 2020, Ghana Health Service and UNICEF partnered with Amplio on an emergency public health campaign. The work will continue for ongoing health education in rural districts.
In March 2020, the Amplio Ghana team sprang into action, partnering with Ghana Health Service to launch an emergency COVID-19 awareness campaign in the Upper West Region. UNICEF Ghana provided the loan of their Talking Book devices. Our Ghana team worked closely with district health directors and staff to produce audio content about COVID-19 symptoms, treatment, and safety. Messages were recorded in local languages and loaded onto Talking Books, which the team distributed to 207 CHPS compounds and five community health volunteers (CHVs) per district.
Community health nurses used Talking Books to share consistent and accurate COVID-19 messages during antenatal care and child wellness clinics. CHVs played messages during household visits. Normally, the Talking Book's built-in speaker works for families and groups of about 20 people. To adhere to social distancing guidelines and reach even more people, the team also connected Talking Books to battery-powered outdoor speakers and broadcasted messages at the markets and lorry stations.
From April to December, the campaign reached over 200,000 people.
Messages to address COVID-19
Over the course of the campaign, Amplio Ghana deployed three sets of messages, recorded in four local dialects. The first deployment covered coronavirus symptoms, treatment, and prevention, as well as meningitis information due to an outbreak in the region. Content included district endorsements from health directors and traditional and religious leaders. For the second and third deployments, the team added messages to address emerging issues identified by the local monitoring and evaluation (M&E) assistants. The Talking Book content updates included songs, dramas, and interviews about COVID-19 stigmatization, mental health, and domestic violence.
Usage data and survey findings
To promote action learning, the team reviewed Talking Book usage statistics. They also worked with M&E staff to lead community dialogues and conducted a household survey at the project midway point (July-August). Activities took place over the phone and in-person with adherence to social distancing guidelines.
Talking Book usage data showed that district endorsement messages were the most played. Community health workers explained that people were scared and unsure about what to do or believe, so messages from local leaders helped to build trust and combat misinformation. Other popular messages included audios dramas on how to talk to children about COVID-19 and welcome a COVID-19 survivor back into a community.
The graph above shows the number of times messages were played to completion.
In a midline survey, community members cited their top sources of COVID-19 information as radio (89%) and Talking Books (44.3%). However, not everyone has a radio. Addressing this reality, respondents reflected that Talking Books helped the most vulnerable community members gain access to critical information. The survey also found evidence of COVID-19 stigma. Most community members were fearful of those who had recovered from COVID-19. People also were afraid to go to the hospital for treatment. These findings informed the development of new messages.
Through monitoring, the team recognized a strain on Ghana Health Service. Under normal circumstances, GHS rural districts see a high turnover rate of community health nurses. However, the turnover was even higher due to COVID-19. To build capacity for health education, the team ran Talking Book refresher training for GHS staff.
Watch a short video about using Talking Books during a public health crisis
District endorsements and program expansion
When the campaign came to an end in December, GHS had positive feedback. Nurses reported that Talking Books helped them deliver COVID-19 messages, allowing more time for direct services. CHVs said the device gave them greater authority within their communities. District health directors emphasized the value of being able to deliver consistent and accurate information. They also saw a use for Talking Books to support other health education priorities, including non-communicable diseases, family planning, immunizations, and adolescent sexual and reproductive health.
”The Talking Book delivers our health advice at the time of day when most people are home — with the radio, one may miss out. Also, the Talking Book plays the same message consistently, and I believe this consistency is an advantage,” said Dr. Bernard Ziem, Lawra Municipal Health Director, GHS.
Phoebe Balagumyetime, Nadowli/Kaleo District Regional Health Directorate, agreed.
"The Talking Book is context-specific. It is made to suit the communities. It is a language that the community members can understand,” said Balagumyetime. She said that GHS wants to continue using Talking Book to deliver health education, including maternal and child health, immunization, and disease prevention messages.
"We're looking at issues of malaria. People still do not believe that malaria can cause a lot of deaths, and children die every minute. We're talking about tuberculosis, polio. I mean, we thought we were done with polio."
The Ghana COVID-19 Awareness Campaign was supported by Arm and VoLo Foundation. Amplio's partnership with UNICEF and Ghana Health Service will continue and expand to new districts. Community health workers are currently using Talking Books at 27 CHPS compounds and 20 mobile clinics in Jirapa District.