CHOLERA RESPONSE AND PREVENTION COMMUNCATION PLAN
JANUARY 2013 – DECEMBER 2013
Background
Cholera has become endemic in many parts of the country especially due to poor basic
sanitation, high rates of open defecation (less than 10 per cent latrine coverage and use), and
lack of public awareness in many areas. Children are often the most vulnerable due to
exposure at school and play. There is an urgent need to address the situation before it
deteriorates. In addition, there is a general lack of preparedness and capacity for effective
response and lack of knowledge of the extent of the on-going epidemic by the general
population. In many instances, the pattern of spread has been rather erratic, due to the
general nature of the causative environmental issues. To that end, most high density urban
areas, and areas with high transient populations, such as major commercial centres in rural
areas are the most at risk. Delays in reporting of the early outbreak of cholera in the regions
have led to high case fatality rates and the continued spread of cholera to new districts and
across other borders – Ivory Coast and Burkina Faso have also increased the threat levels in
2012. Furthermore, the unexpectedly severe early outbreak of cholera across the West Africa
sub-region last year caused a level two emergency for which the Government of Ghana was
not prepared for in 2012.
Between 1 January and 23 December 2012 (Week 51), Ghana recorded a total of 9,542 cases of
cholera with 100 deaths (1.0 per cent case fatality rate). Several districts from nine regions
including Greater Accra, Eastern, Brong Ahafo, Western, Volta, Ashanti, Northern and Upper
East Regions were affected in 2012. Anecdotal reports since then indicate that most of the
affected districts have had regular re-occurring cholera outbreaks due to factors such as poor
supplies of potable water, poor household and environmental sanitation and floods leading
to contamination of water sources with the associated poor hygiene behaviours and practices
by the population. Affected communities therefore needed to be empowered with knowledge
and skills so they will be encouraged to take appropriate actions for themselves to help
prevent the regular outbreaks of cholera in their communities.
According to information received from Ghana Health Service (GHS) of the Ministry of
Health (MOH) the initial focal outbreaks of the disease which were reported in the Western
and Brong Ahafo Regions, as well as the epidemic in Northern Region were practically over
by September 2012. However, by October 2012, 62 new cases with one death wasagain
reported in Tarkwa and Takoradi Metro of the Western Region and 32 new cases from the
Northern Region. For this reason, the call to improve the overall risk perception and hygiene
practices of communities living in cholera-prone areas through long term communication
activities for sustained behavioural and social change using a mix of community based
1|P a g e
participatory methods has become very important to halt the recurring outbreaks of the
disease. This is due to the fact that social and cultural influences particularly amongst
individuals with low levels of education and access to resources are strong challenges, posing
a barrier to social and behavior change. In addition traditional beliefs, herbal remedies,
spiritual associations to health and illness, and practices, based on age-old beliefs are also
resistant to change. Again, illnesses such as diarrhea are perceived as common events that
one must simply endure rather than as a potential danger.
In response to the request from the Government of Ghana for support, and in close
consultation with all stakeholders and partners (such as Environmental Health and
Sanitation Division of the Ministry of Local Government, the Water Directorate of the
Ministry of Water Resources, Works and Housing, National Disaster Management
Organization (NADMO) Health Promotion Department of Ghana Health Service, Red Cross
Society of Ghana, GIZ Disease Surveillance and Disease Control Departments of Ghana
Health Service, Plan International, CHF International, WHO, UNDP, SHEP, AMA,
Chairperson of Parliamentary Select Committee on Water Resources) UNICEF developed a
communication plan to guide the implementation of targeted communication activities
aimed at changinghygiene behaviour and practices for the prevention and control of cholera
for the period of August 2012- end 2013.
During the implementation of the plan in 2012, it was identified that the following actions
would have to be taken in order to support the prevention and control activities being
undertaken. These included the following:
Advocate for nationally coordinated action to shift from the “fire fighting approach”
used in Ghana to respond to the cholera outbreak to a more long term sustainable
approach to achieve both social and behavior change using evidence based participatory
methods to ensure that individuals, communities, organizations and policy makers are
all active partners in achieving the change at the various levels.
Advocate for the creation of a more enabling environment for the achievement of
sustained changes in behaviours
Strengthen capacity and skills of agencies and institutions responsible for cholera
response and prevention
Support the frontline health workers including other frontline partners at the district and
regional levels with appropriate communication materials including audio visuals to
enable them carry out targeted activities for sustained change in behaviours of
individuals and communities.
In addition to the above, the re-occurring nature of the disease presents the need for
continued implementation of the targeted communication activities in order to achieve a
2|P a g e
sustained change in behaviours for complete prevention of subsequent outbreaks. This plan
was therefore developed to cover activities from January 2013 to December 2013. The plan
will be implemented with the support and in consultation with many partners including the
National Disaster Management Organization (NADMO), Health Promotion Department of
the Ghana Health Service (HP/GHS), the Environmental Health and Sanitation Directorate of
the Ministry of Local Government and Rural Development, School Health Education
Programme, National Food and Drugs Board as well as other government agencies,
development partners, NGOs/CSOs and the private sector.
Goal
The main goal of this plan is to reduce the threat of an outbreak of cholera in the regions
affected in 2012 by improving the hygiene behavior and practices of certainkey population
groups. The aim is to increase the level of knowledge on the causes, symptoms and modes of
prevention of the disease. Everybody in Ghana needs to be knowledgeable of the possible
reoccurrence of an outbreak of cholera in 2013 in the country, and as such the total
population in communities, are the crucial actors in responding to mitigate such an outbreak
in 2013.
The priority behaviours that would be promoted are:
Washing hands with soap and plenty of water at key times
 After defecating,
 After cleaning a child’s stools
 Before preparing food
 before eating food or feeding children
Practicing good food hygiene
 Washing fruit and vegetables thoroughly under running water
 Cooking food thoroughly and eating it hot,
 Covering left over food and protecting it from flies and dust
Maintaining good personal and environmental hygiene
Safe excreta disposal
 Use of latrines (stopopen defecation)
 Disposal of child’s faeces safely (in latrines)
Drinking safe water
 Drink boiled, cooled water which is stored safely
 Drink treated water particularly during an outbreak(Household water treatment
(HWT) by using chlorine tablets)

3|P a g e
Clean environment
 Safe rubbish disposal – Maintain a clean environment – home and community
Treatment of cholera during an outbreak
 Report to the nearest health facility when you have any signs of Acute Watery
Diarrhoea (AWD) – 3 or more watery stools in a day.
 Start rehydration immediately (and to be en route to health facility)
 Give ORS as routine practice for all cases of diarrhoea
 Continue to breastfeed babies (exclusively if under 6 months)
Good hygiene in schools/funerals / weddings /durbars by the use of appropriate hand
washing systems, serving only hot food and treated water.
The main actors to be targeted as agents of change are:
Households – All family members but particularly women and young people especially,
girls
Other contact/carers of cholera patients (who are normally left out of cholera education/
hygiene promotion activities) e.g. taxi drivers who transport the patients to the
hospitals/health centres –
Schools – pupils, Teachers, SHEP Coordinators and Circuit Supervisors
Food vendors, restaurants, hoteliers and chop bar operators/cafeterias
Market traders especially market women who sell food items both seaters and roamers
Community leaders /chiefs and queen mothers /religious leaders /assembly men
Community Based organisations
Organisers of Funerals /weddings /durbars/out doorings/naming ceremonies.
Public Toilet Operators
District Assemblies – health services /environmental heath
Water Vendors (where appropriate)
Journalists – Ghana Network of WATSAN Journalist
The Channels for the key messages are:
Institutional channels: including recognized public and private bodies such as the
Government Ministries with outreach workers (e.g. MLGRD/EHSD, Ghana Health
Service, Ministry of Education/GES, National Disaster Management Organisation etc),
networks of development workers, NGOs, etc., for the dissemination of correct and
timely information on cholera towards a coordinated response including enforcement of
regulations and by-laws.
Mass Media channels: such as television, radio, printed press, bill boards
Social media channels: such as the use of the Internet, SMS text messages etc.
4|P a g e
Socio-traditional and socio-cultural channels: Opinion leaders (customary chiefs,
queen mothers, religious leaders, notables, intellectuals, organized groups etc.) and
other informal networks through the various forms and opportunities of traditional
popular communication such as durbars, community/village meetings, collective work
in the fields, vigils and wakes, talks, baptisms, markets, marriages, funerals, naming
ceremonies, marriage ceremonies, journeys in public transports, churches and mosques
etc.
Commercial channels: The marketing circuits for common WASH related products
such as supermarkets, other retail shops, bookshops, kiosks, pharmacy shops, etc.
Inter personal communication (IPC) channels – through Community Based
Volunteers, CSOs e.g. Ghana Red Cross (GRC), Mothers Clubs and Assembly Agents in
workshops, Group discussions, Forum Theatre, Door to door outreach, Peer to Peer
outreach etc.
Proximity Media channels: such as Community Information Centres (CIC) - PA
systems, Mobile Vans – videos and community outreach, Community Radio (Talk
shows with phone-ins and Jingles, life presenter mentioning), Posters and wall paintings
depicting key desirable hygiene behaviours. In addition an animated short film called “The
Story of Cholera” was also used in IPC settings for the health workers to understand how
cholera spreads and what actions can be taken and was later used in affected communities and
places of gathering to increase awareness on cholera prevention mechanisms in 2012. However
this will be adopted in 2013 to use a similar story line but launch it using the ‘Sara
Communication Initiative’ as a platform for Entertainment Education.
Communication Materials to be used for the campaign include:
Flip Charts
Fliers
Posters
Bill Boards / wall paintings
Brochures (Q&A)
PromotionalMaterials/stickers
IPC Manual
Audio (recorded messages, audio drama series, radio magazine shows and jingles)
Videos (documentaries on cholera e.g. The Story of Cholera Video, audiovisual jingles,
drama series on cholera, Sara video etc)
5|P a g e
Monitoring of the activities
Quarterly monitoring visits will be carried out in the districts where implementation is
ongoing to assess the extent of progress of program implementation and whether
beneficiaries are practicing the desired and recommended behaviours. In addition, an
anthropological study to investigate human perception and behaviours in relation to cholera
will also be done in 2013.
6|P a g e
IMPLEMENTATION PLAN – COMMUNICATION FOR PREVENTION OF CHOLERA
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
Responsibility
Budget $
(USD)
Objective 1.: Advocate for a nationally coordinated action to shift from the “firefighting approach” used in Ghana to respond to the cholera outbreak to a more
long term sustainable approach to achieve both social and behavior change by creating the enabling environment and using evid ence based participatory
methods to ensure that individuals, communities, organizations and policy makers are all active partners in achieving the change at the various levels
 Hold separate meetings with
a) Parliamentary Sub-Committees for Water Resources Works and
Housing
b) Parliamentary Committee on Health
c) Parliamentary Committee on Education:
and present to them the trend of the cholera outbreaks in Ghana over a
period of 5 years, the risk factors and bottle necks, recommended
solutions and share the communication plan with them for their buyin as well as discuss government’s support for a more proactive and
sustained response to the cholera outbreaks to ensure total prevention
 Hold a second/follow up meeting to bring all the three sub-committees
together to develop an action plan on roles each committee will play to
ensure the sustained prevention of cholera outbreaks in Ghana (with
lessons from the Program for the Eradication of Guinea Worm)
 Hold meetings with the key stakeholders and partners in WASH (one
at the national level and two for each Regional every six months) for
the dissemination of activities being carried out by the various
stakeholders at the various levels to respond to and prevent cholera
outbreaks in Ghana
 Regularize the WASH Sector Emergency Committee by spelling out
exact mandate and roles of the committee, frequency of meetings etc
 Hold WASH Sector Emergency Response Committee meetings every
other month to discuss issues on emergency response especially issues
relating to cholera prevention
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
WHO and UNICEF
in collaboration
with the MWRWH,
MLGRD, MoE and
MOH
$15,000.00
WHO and UNICEF
in collaboration
with the MWRWH,
MLGRD, MoE and
MOH
UNICEF (C4D &
WASH), EHSD,
Water Directorate,
NADMO, GHS
Health Promotion
Dept. (HP), NGO/
UNICEF (WASH &
C4D), EHSD,
Water Directorate,
NADMO
UNICEF (WASH &
C4D), EHSD,
Water Directorate,
$5,000.00
7|P a g e
$45,000.00
$2,000.00
$12,000.00
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
Responsibility
Budget $
(USD)
NADMO
 Hold regular meetings for the Communication Sub-committee on
Emergencies to discuss progress in the implementation of the
communication plan, any lessons learnt during monitoring, what
needs to be improved or changed, participatory methods to be adopted
etc.
x
x
x
x
x
x
HPD/GHS,
NADMO, EHSD,
UNICEF (C4D)
Sub- total
$6,000.00
$85,000.00
Objective 2. Strengthen capacity and skills of agencies and institutions responsible for cholera response and prevention
 Extend the 3 days training workshop in participatory community
mobilization techniques for cholera response & prevention (– to include
IPC methodology and use of Pre-prepared communication materials –
e.g. UNICEF Cholera flipcharts, fliers, the Story of Cholera video etc) to
other regions that have not been captured in the first plan (i.e. Western,
Ashanti and Upper West regions i
 Identified potential ToT candidates from the frontline health workers in
these 3 regions to conduct step down orientations for community
volunteers and community groups to equip them with similar skills for
a coordinated response and prevention of cholera
 Conduct one day training for at least 20 school children and school
based SHEP coordinators and circuit supervisors selected from at least
10 schools from each of the affected districts of all the regions to act as
WASH ambassadors to promote key cholera and hygiene behaviours in
their schools and communities (20 school children x 10 schools per each
affected district x 8 regions)
 Conduct a two days orientation for selected journalists/press men to
improve their capacity on reporting on issues related to WASH
especially cholera
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
UNICEF (C4D &
WASH), EHSD/
GHS Health
Promotion Dept.
(HP), NADMO
$22,500.00
UNICEF (C4D &
WASH), EHSD/
GHS Health
Promotion Dept.
(HP), NADMO,
MMDAs
UNICEF (C4D &
WASH),
GHS/HPD,
NADMO,
MMDAs,
MoE/SHEP
UNICEF (C4D &
WASH), GHS/HPD
and identified
media houses
$15, 500.00
Sub-total
$103,000.00
$55,000.00
$10,000.00
8|P a g e
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
Responsibility
Budget $
(USD)
Objective 3: Support the frontline health workers at the district and regional levels with appropriate communication materials including a udio visuals to enable
them carry out targeted activities for sustained change in behaviours of individuals and communities

Re-print about 1000 more copies of the IPC manual to be distributed to
every frontline health worker who has been taken through the IPC
training in all the regions (50 participants x 10 regions = 500)
UNICEF (C4D for
$30,000.00
the printing),
x
x
HPD/GHS,
x
NADMO and
EHSD for the
distribution

Re-print more copies of the cholera Flip chart and distribute to be used
for group discussions in the communities in the Western, Ashanti and
Upper West Regions
UNICEF (C4D for
x
x
x
$15,000.00
the printing), GHS
x
and EHSD for the
distribution

Re-print 100,000 poster and 100,000 fliers on Cholera prevention and
the use of Chlorine Tablets for household water treatment and
distribute in the Western, Ashanti and Upper West Regions

Produce a video documentary on cholera (its causes, prevention and
treatment) using the concept of “The Story of Cholera” – for the
urban and rural settings in the different local languages

x
x
x
x
Make 5000 DVDs copies of the video documentary and distribute to all
district offices of EHSD, NADMO, HPD/GHS, Information Services
Department (ISD) CWSA, FDA etc to be used for group discussions in
the communities
x
x
x
x
x
x
x
UNICEF (C4D for
the printing), GHS
and EHSD for the
distribution
UNICEF (C4D and
Supply) ,
HPD/GHS, EHSD
and NADMO
UNICEF, EHSD,
NADMO,
HPD/GHS, ISD,
CWSA, FDA
Sub-total
$20,000.00
$30,000.00
$15,000.00
110,000.00
Objective 4: By the end of the one year period communities will be mobilized around cholera prevention and response through a coordinated team of
Community Agents equipped with IPC and community mobilization skills and materials as well as a common understanding of the symptoms of cholera and
the need for rapid re-hydration and treatment, the causes of cholera & key hygiene behaviours to prevent it

House to house visits by 10 trained community volunteers, CHNs and
x
x
x
x
x
x
x
x
x
x
x
x
UNICEF (C4D &
9|P a g e
$20,000.00
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
EHOs from each of the districts of the affected Regions to distribute
printed materials starting with cholera affected HHs and their
neighbours as a priority (to promote HWT – boiling or other methods
-distribute materials e.g. Aqua tabs & train in their use, promote
HWWS and key hygiene behaviours, promote ORS for routine
diarrhoea treatment, promote hygienic disposal of faecal and solid
waste throughout period of implementation)
Responsibility
Budget $
(USD)
WASH) GHS (HP),
EHSD, MMDAs
Subtotal
$20,000.00
Objective 5. : Regularly Engage the support of community leaders & Radio stations in community mobilization to fight cholera



Hold person to person meetings with metropolitan/municipal/district
authorities, the most influential community leaders, religious leaders
& Radio representatives in selected districts of the affected regions to
involve them in cholera prevention activities, through discussion
about the causes of cholera, and the roles they can play in mobilizing
the community to protect itself - including possible by-laws (e.g.
banning of flying toilets, compulsory provision of hand washing
stations at restaurants and toilets)
At least 4 Community leaders, other agents & invited ‘experts’
engaged as resource persons in 2 radio discussions per week for two
months in the affected Regions on cholera, its causes, treatment and
prevention and answer questions as well as discuss community based
solutions
Broadcast key messages on cholera prevention and hygiene promotion
BCC messages through radio spots/Live Presenter Mentioning and
jingles 2 prime times a day for 60 days on at least 2radio stations in
selected districts of the affected regions
x
x
x
x
x
x
x
x
x
x
x
x
UNICEF (C4D &
WASH) /CHF,
GHS/HP, CWSA,
NADMO, EHSD
and key trained
community agents
$16,000.00
UNICEF (C4D &
$16,000.00
WASH) /CHF,
x
x
x
x
x
x
x
x
x
x
x
x
EHSD/GHS/HP
UNICEF
x
x
x
x
x
x
x
x
x
x
x
x
$30,000.00
(C4D,WASH)
EHSD/ GHS/HP
Subtotal
$62,000.00
Objective 6.: Engage the support of CSOs, community groups & clubs etc in the fight against cholera and develop a collaborative relationship between them
and the EHOs

Mobilize and conduct at least a monthly small group meeting with
one Mothers' Club each in at least 4 districts each of the affected
x
x
x
x
x
x
x
x
x
x
x
x
CHN/CHV,
CWSA, City
$ 10, 000.00
10 | P a g e
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
Regions to involve them in cholera prevention activities for 6 months






Regularly hold small group meetings with food vendors, organized
groups and market women to involve them in cholera prevention
activities, through discussion about the causes of cholera, and train
them good food hygiene, importance of HWWS, protecting food from
flies etc
Regularly hold small group meetings with water vendors to involve
them in cholera prevention activities, through discussion about the
causes of cholera, and train them in improving the safety of drinking
water by water treatment and safe water handling and storage
Regularly hold at least a monthly small group meeting with the
public toilet operators, managers and staff in at least 4 district from
each of the affected regions to involve them in cholera prevention
activities through discussions about causes of cholera, their
responsibilities to the public as operators of public latrine facilities (for
which they charge) and find suitable ways of keeping toilets clean to
make them attractive to the public in order to prevent open defecation
as well as providing hand washing facilities
Regularly hold small group meetings with at least 10 Organizers of
Funeral and other public gathering to involve them in cholera
prevention activities, through discussion about the causes of cholera
& how it can be spread e.g. by handshaking, and the importance of
providing HWWS facilities and keeping good food and drinking water
hygiene at large gatherings (two meetings within the period of
implementation in at least 4 districts each of the affected Regions)
Intensify Inspections & visits to food vendors and market traders at
their stalls to involve them in cholera prevention activities, through
discussion about the causes of cholera, and the role that they have to
play to protect themselves and the community from cholera – e.g. by
using good food hygiene, HWWS & protecting food from flies
Intensify Inspections & visits to public latrines to ensure compliance of
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Responsibility
Budget $
(USD)
Authorities,
community WASH
teams and EHOs
CHN/CHV,
CWSA, City
Authorities,
community WASH
teams and EHOs
CHN/CHV,
CWSA, City
Authorities,
community WASH
teams and EHOs
CHN/CHV,
CWSA, City
Authorities,
community WASH
teams and EHOs
$ 10, 000.00
CHN/CHV,
CWSA, City
Authorities,
community WASH
teams and EHOs
x
x
x
x
x
x
x
x
x
x
x
x
City Authorities,
community WASH
teams and EHOs
x
x
x
x
x
x
x
x
x
x
x
x
City Authorities,
11 | P a g e
$10, 000.00
$ 10, 000.00
$10, 00000
-
-
When
Action/Activity
J
F
M
A
M
J
J
A
S
O
N
D
operators to by-laws e.i. provision of hand washing facilities, proper
disposal of feaces, clean environment etc
Responsibility
Budget $
(USD)
community WASH
teams and EHOs
Subtotal
$50,000.00
Objective 7.: By the one year period messages about symptoms and treatment of cholera, handwashing with soap, the use of Aqua tabs, ending open defecation
and proper disposal of refuse will be re-enforced




Use Multimedia Mobile information Vans and community information
Centres to educate the community about Cholera using the
Community Information Centres & in Mosques and Churches and
screen selected videos on Cholera and Hygiene e.g. ‘The Story of
Cholera’ & ‘Choose Soap’ in markets / taxi parks, community
parks/centres, funeral grounds, schools etc
Install wall paintings & posters with key Cholera and Hygiene
Promotion Images- taken from the Cholera Flip Chart on walls of
public places (e.g. 10 Public Toilets and 2 Markets each in at least 4
districts from each of the affected regions) using identified artists from
the communities
Carry out cholera awareness creation campaigns on at least 3 TV
stations of national coverage by playing the new TV documentary on
Cholera two times a day for 10 days every month
Engage experts from GHS, EHSD, NADMO and community resource
in TV discussions on cholera in an interactive manner (allowing
listeners to call in to ask questions) once a month for 3 consecutive
months from Feb – April and 3 consecutive months from August to
September
Information Service,
$5,500.00
City Authorities,
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
trained frontline
health workers
UNICEF (C4D &
WASH) and City /
District
Authorities,
UNICEF (C4D &
x
x
x
x
x
x
x
x
x
x
x
x
$6000.00
$30,000.00
WASH) EHDA/
GHS/HP
UNICEF (C4D &
$10,000.00
WASH) EHSD/
x
x
x
x
x
x
MMDA/ GHS/HP.
NADMO
Subtotal
51,500.00
Objective 8.: Monitor and evaluate the activities


Conduct quarterly monitoring
implementation is ongoing
visits
to
the
districts
where
Conduct two rapid assessments on people’s knowledge on cholera,
causes, symptoms, prevention and treatment in selected districts
x
x
x
x
x
x
UNICEF (C4D &
WASH) GHS/HP,
EHSD, NADMO
UNICEF (C4D &
WASH) GHS/HP,
12 | P a g e
UNICEF
1,500
When
Action/Activity

J
F
M
A
M
J
J
A
S
O
N
D
following year
Budget $
(USD)
EHSD, NADMO
UNICEF (C4D &
Evaluate the impact of the activities on reduction of cholera cases and
prevention of further outbreaks and make recommendations for the
Responsibility
x
WASH) GHS/HP,
EHSD, NADMO
Subtotal
1,500
GRAND TOTAL
$482,500.00
i
For more information please contact Surangani Abeyesekera, Communication for Development Specialist, UNCIEF Ghana.
Email: sabeyesekera@unicef.org Tel: +233(0)542117449
13 | P a g e