02
DELIVERING RESULTS IN FIGHTING COVID-19 THROUGH STRENGTHENED RCCE IN
BANGLADESH
Deepak Gupta,1* Jai P. Narain2 and Mohammad Badrul Hassan3
1

Sr. Consulting Adviser (Programmes & Strategic Communication),
UN System in Asia & the Pacific, New Delhi, India
2
Formerly Director, World Health Organization, South East Asia (WHO/SEAR) & Global HealthInternational Advisers, Kullu, H.P., India
3
Development and Communication Expert, Several Countries in Asia & the Pacific Region,
Dhaka, Bangladesh
Corresponding Author Email: drguptad11@gmail.com

How to cite this paper:
Gupta, Deepak; Narain JaiP.; Hassan, Badrul (2023)
Delivering
Results
inFighting COVID-19 throughStrengthened
RCCE
inBangladesh: A UNICEF
Case, Journal of Global
Resources, Vol. 09 (01)DOI:
10.46587/JGR.2023.v09i01.002

Received: 31 Dec. 2022
Reviewed: 07 Jan. 2022
Final Accepted: 11 Jan. 2023

Abstract: The first COVID-19 (Disease caused due to
SARS-CoV-2) case was detected in Bangladesh on 8
March 2020. The country has already accounted for over
29,127 deaths and over 1.95 million laboratory tested
positive cases across the country as of 27th April, 2022.
The COVID-19 pandemic continues to pose a major publichealth challenge with equally serious health and economic
consequences. Not only has the health impact, the ongoingpandemic also demarcated clear lines between humanlives and livelihoods. Scientific community, with its
relentless efforts, developed multiple vaccines and‘repurposed’ clinical treatments for the COVID19; yet, thevaccination against this pathogen continues to throw ahuge challenge of low uptake in many regions across theworld, though Bangladesh has been relatively successful ingiving wide vaccine coverage through relentless Risk
Communication and Community Engagement (RCCE)
strategies. It is widely acknowledged that this pandemic isprimarily a ‘behavioural practices’ issue, both at individual
and at community levels. Although there will always be a
few hard-core ‘laggards’ who defy acceptance of any
positive change. The outrage of the ‘infodemic’ (spread of
misinformation during pandemic) is gaining currency
especially through social media and digital space.
Key words: Risk Communication and Community
Engagement (RCCE), Social & Behaviors
Change (SBC), Dev. Partners COVID-19.

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Bangladesh Response to the COVID-19 Pandemic
Public health practioners, political leaders, and communities alike, well acknowledge that the
COVID-19 pandemic is primarily about bringing a positive change in the ‘behaviouralpractices’ - both at individual and community levels. Although there still exist, like in mostother public health concerns, a few hard-core ‘laggards’ (and skeptics) who defy easy
acceptance of any change in a set behaviour practice, even if it is pointing to a positivechange. Needless to emphasize, such a group of people have their own reasoning based on
misinformation, rumours or incorrect beliefs. In addition, conspiracy theories and a vast
ocean of misinformation is thriving abound. Cyber space too is making things rather difficult
in more than many ways as the sustained ‘internet campaign’ as an ‘infodemic’ (spread of
misinformation during pandemic) is gaining currency.
An inherent and very critical dimension to such public health emergencies is also to
invoke and manage a tailor-made, locally contextual and research-driven risk communicationand community engagement strategy. However, it is noted that world across the highly
technical area of public health communication and the risk-communication, is being largely
managed by non-technical generalists or administrators in most cases, and in somecontexts, has even assumed a high-level of tilted ‘political communication’ in many countries.
Among these, Bangladesh can be considered as a notable exception.
As one of the most densely populated countries in the world (the current population
density of Bangladesh in 2022 is 1,134.54 people per square kilometer, a 0.95 percent
increase from 2021), Bangladesh too was hit hard like many other countries, and is stillfacing the COVID-19 pandemic with its limited resources and over-stretched health facilities.
Similar to other countries, within the region and beyond, COVID-19 pandemic has posedserious challenges to the system in Bangladesh, by adversely affecting economies,
healthcare systems and socio-cultural lives. It is indeed a struggle between human-lives andlivelihoods. Whereas the first COVID-19 case was detected in Bangladesh on 8 March 2020,
the country has already accounted for over 29,127 deaths and over 1.95 million laboratory
confirmed cases across the country as on 27th April, 2022.
In the early days of the pandemic, it was considered that Bangladesh had been
relatively successful in containing the spread and restricting mortality due to multiple
proactive actions that were initiated through the Bangladesh Preparedness and Response
Plan (BPRP). Out of the given ten BPRP pillars, Risk Communication and Community
Engagement (RCCE) was one such strategic pillar, which aimed to empower individuals andcommunities in helping to stop spread of SARS-CoV-2 and thus, expected to minimize thenegative impacts of the COVID-19 pandemic.
As a co-lead of the RCCE pillar, UNICEF Bangladesh, together with otherdevelopment partners, had been supporting Ministry of Health and Family Welfare indeveloping and organizing comprehensive campaign – advocating social-action,communicating pandemic prevention behaviours, and generating demand for COVID-19
vaccination. Furthermore, the campaign was so positioned in creating awareness on
possible Adverse Events Following Immunization (AEFI) wherein it encouraged common
people to report back through an appropriate mechanism. The RCCE strategy had also
embedded specific initiative to encounter and debunk infodemic in social media andelsewhere.

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Primary Purpose of the RCCE in Bangladesh
The BPRP - Bangladesh Preparedness and Response Plan - stipulated the need for risk
assessment and community engagement in order to ensure that individuals andcommunities internalized the life-saving information and thus, adapted to the set of ‘new
behaviors’ in the given emergency circumstances. The Plan also underlined the significanceof the obligation in ensuring enhanced participation of and engagement with relevant
communities, especially the vulnerable groups and populations, to mitigate barriers to
implementation and better uptake of public health measures such as social distancing anduse of masks for protecting self and others from infection. The approaches included
establishing effective feedback mechanisms to foster two-way communication between
health authorities and communities, the public and the stakeholders.
The overall objective of the community engagement strategy had been tomeaningfully engage with communities so as to enable them take responsibility of their own
wellbeing by participating and promoting the key recommended practices within thecommunity, consequently, reduce the risk of transmission and help controlling the COVID-19
pandemic, including its emerging variants.
The specific purpose of the risk-communication and community engagement
strategy, aligned with the BPRP, were –a)ensuring community engagement in a systematic, equitable and safe manner for
COVID-19 prevention, including promotion of the recommended behavioursb)fostering a two-way communication between the communities and other key field
actors, including regularly promoting feedback, to address stigma and discrimination; myths
and misconceptions; and rumors and misinformation with regard to the COVID-19 pandemic;c)creating a common communication framework suggesting the modes, channels andtools to engage with communities in promoting the use of face-masks and other appropriate
behaviours (prevention campaign); andd)engaging with communities in creating demand for essential services uptake,including appropriate COVID-19 vaccination, in the backdrop of the pandemic situation.
Precursor to RCCE: Ensuring Extensive Outreach & ‘Two-Way Dialogue’
The effective communication of risk forms a key component of public health measuresdesigned to improve the health of populations in countries. Public health professionals,
especially those working in the health communication space, frequently get to design
messages regarding the possibility of serious public health harm as the risk communication.
The management of public health emergencies, along with natural disasters, invariably
always includes a significant component of communication, which is in the form of warnings,
risk messages, evacuation notifications, messages regarding self-efficacy, information on
symptoms and medical treatment, and many other key messages. However, different kindsof crises manifest different forms of threat and thus, varied communication plans.
The primary objective of risk communication is to share correct, relevant, andaccurate information, in clear and easily understandable terms targeting a specific audience,
especially those ‘at-risk’. Such messages need not address and resolve all the differences
between information receiver and sender, but may surely lead to a better understanding of15

those missing gaps and differences. Therefore, it is construed as the exchange of real-time
information, prescriptions/advice and informed opinions between scientific experts andgeneral populations, especially those facing threats to their health, including economic orsocial well-being. The ultimate purpose of effective risk communication is to empower people
with knowledge resources enabling them to take informed decisions to protect themselves
and their loved ones.
Within the model of risk communication, the emphasis is always laid on the flow of
information/knowledge from the knowledgeable doctors/health providers to the less-informed
individuals/community/patients. However, communication is a two-way process, andincreasingly there is awareness of the active role of patients and the public, thus establishinga constructive dialogue in resolving all possible myths, misconceptions and informing about
doable preventive measures. In fact, there are various ways in which different individuals
and groups access and make use of risk information.
It is well noted that individuals, and collectively the communities whom they
represent, are not a mere passive recipient of information and do not always respond to risk
information ‘rationally’. Individuals actively engage in looking for and using information, butalso tend to make conscious decisions to avoid certain forms of information. Their response
to information is shaped by social context, their own needs for personal security and theextent to which they trust the source of specific items of information.
Treading the Technical Path
The RCCE has strived to design strategic interventions, through its Bangladesh network
partners, operating within the technical protocols of the time-tested frameworks. It is wellacknowledged that in order to address the inherent needs of addressing a public healthoutbreak or an emergency through apt and rapid health communication, ‘preparedness’ isthe key. Therefore, at the onset, key questions were flagged in seeking technical andoperational clarity on risk-communication. These included: Is this a ‘care communication’, a‘consensus communication’, or a ‘crisis communication’? Is the risk relatively new? What is
its visibility? What are the characteristics of this risk? What are the potential outrage factors?
Who are the audience?; What are the needs of these audiences?; Where are we on theladder of public involvement?; Where is the audience on the ladder of public involvement?;
What are the characteristics of the audience(s)? (Risk-factor analysis); Have we usedaudience analysis information to tailor the risk messages? How much do we presently know
about the virus and it’s transmissibility and virulence and who are the most credible sourcesof information? Have we presented technical information in a way that the public canunderstand?; Have we considered conveying the message by means other than written
words (eg. audio-visuals on social-media, pictorial and animated messages, publicbroadcast media).
Some relevant risk communication theories, over a period, have been potentiallyemployed in deciphering the challenges of wide spread disease control and pandemics.
When people are really concerned, stressed, or outrageously upset, they want to know thatyou care before they care what you know (Trust Determination Theory); When people
have difficulty in hearing, understanding, and remembering bulk of information and thus they
focus most on what they hear first (Mental Noise Theory); And again when people arehighly stressed, or upset, they often focus more on the negative than on the positive

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(Negative Dominance Theory); Similarly, the gaps between risk perceptions and reality
often become wider during such difficult times (Risk Perception Theory). At different stagesof a pandemic or an outbreak, these core communication frameworks serve as a common
denominator in planning and designing activities (Gupta, Narain & Yadav, JHM/SAGE 2021).
The structure of the RCCE pillar in Bangladesh was well positioned in adhering to therecommended technical premises of the time-tested frameworks under the riskcommunication.
What has been achieved so far?
In the last nearly two years, the RCCE has achieved notable campaign successes in using
mix-media approaches, including social media and by involving wide ranges of partners.
Specific campaign material and tools included specially designed newspaper
advertisements, social media posts and public discourse, posters/banners, public service
announcements (PSAs) and TV scrolls and engaging volunteers at community level throughdifferent field interventions.
The RCCE pillar also conducted an online rapid assessment from October 15 to 29,
2020 focusing on risk perception, which was administered through Facebook Messenger,
WhatsApp and SMS, and facilitated by the UNICEF supported U-Report mobile-based
messaging platform. The survey was conducted in the country’s eight divisions with theparticipation of 6,865 respondents, where 32 percent participants thought they had no risk ofgetting infected by COVID-19 and 26 percent thought they were at a medium risk. Similarly,
38 percent respondents informed they always wore mask when they went outside theirhomes whereas 19 percent said rarely and 8 percent said they never wore a face-mask.
Until 20 December 2020, 53,950,000 citizens reached with COVID-19 messages,
wherein 51,378,203 participated in COVID-19 engagement actions. Furthermore, 1,401,058
persons shared their concerns and asked questions through given help-lines (UNICEF,
Dashboard on RCCE, COVID19. 2021)
Figure 01: RCC Activities by Dissemination

Source: UNICEF & GoB COVID-19 Dashboard

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The UNICEF dashboard data shows that social media disseminated nearly 44.16 percent ofprimary messages and activities, while web pages, mosque announcements, mass media
were also widely used for different RCCE activities.
Figure 02: RCCE Activities by Issues

Source: UNICEF & GoB COVID-19 Dashboard

In terms of primary content of messages, 43.26 percent were on general COVID-19
awareness messages, while RCCE considered other types of messages too, which included
COVID-19 related stigma and discrimination, Ramadan preparedness during pandemic,
domestic violence, use of PPE, burial procedures etc.
Design elements of the RCCE kept into account the risk-factors that the communities
in Bangladesh were confronted with, including the community perceptions. With theenforcement of pandemic guidelines, the outreach strategies were accordingly shaped,
which largely included innovative mechanisms through digital space, social media, healthworkers’ extension activities and field-level mic announcements.
The RCCE had been implementing various activities and used different
communication tools and techniques. It generated evidences through observational studies
on mask wearing practices in Bangladesh, especially urban slums, and rural areas for two
rounds in July and October 2020. With the support of the RCCE, NGO network partners
observed mask wearing practices among 252,897 individuals in 7,308 hotspots for the study.
The study found a big drop in mask wearing practice from 71 percent in July to 31 percent in
October 2020. Surgical masks (54 percent) followed by cloth masks (29 percent) were foundmost popular across gender and area. There was a marked drop in the proper use of maskfrom 38 percent in July to 19 percent in October 2020. These findings were highly critical for
the SBC and RCCE experts in walking the path further ahead.

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Challenges Confronting the RCCE Pillar
With the onset of the SARS-CoV-2 pandemic, most people gradually acquired familiarity withthe concept of risk compensation. It denotes that in most circumstances which are perceived
as risky, individuals strive to modify their behaviours, thereby compensating to minimize a
specific risk. People who perceived the SARS-CoV-2 as a major threat to health, in mostcases, would wear appropriate masks, wash their hands regularly, and maintain physicaldistancing by avoiding large crowds. These pandemic appropriate practices become a moresustained ritual when cases began to surge. It is evidenced that the effects of risk
compensation tend to dilute over a period as the ‘fear and risk’ perceptions wear off.
In the recent months, the gradual rise in COVID-19 cases across the country, despitea fair number of people vaccinated, is attributed to the possible “pandemic fatigue”. It is also
observed that many communities have drastically reduced adherence to the highly
recommended risk reduction strategies. It is, therefore further heightening the complicationsin the ongoing public health efforts, thus newer challenger for the RCCE.
The innovative step taken in Bangladesh through creation of a dedicated RCCE pillar
network, that has highly dynamic web of member partners, is a giant leap forward inmanaging public health emergencies and any other natural disaster situations. It has proven,time and again, how cross-fertilization of comparative advantages of varied agencies thatare focused on human-centered development and health could help pulling out communities
from the scourge of health emergencies and such humanitarian situations.
Inferences
Bangladesh successfully reaped the positive outcomes of the RCCE activities, as is also
demonstrated through the COVID-19 vaccination coverage. To date, Bangladesh remains
the top recipient of COVID-19 vaccines under COVAX, the global initiative co-led by the
Coalition for Epidemic Preparedness Innovation, GAVI - the Vaccine Alliance, and the World
Health Organization, with UNICEF as a key delivery partner. In fact, COVAX accounts formore than 62 percent of Covid vaccine doses received by Bangladesh.
According to WHO Global Targets, Bangladesh was supposed to vaccinate 70
percent of its population accounting 119,221,953. The achievements so far are highly
encouraging as the 1st doses administered to 128,799,572 population which is 108.03(percent) against the target. The 2nd and 3rd doses administered to 117,831,591 (98.83
percent) and 16,770,810 (14.23 percent) respectively (Source: Government of Bangladesh,
COVID-19 Dashboard for Bangladesh, 2022).
Bangladesh is well recognized as a country that is gaining sustained momentum,
both in social and economic sectors. Herein, development actors, with UNICEF as thecentral force in the SBC and RCCE sectors, have been able to foster progressive policy
support and substantive programming in order to obtain positive results for children andadolescents and their mothers through new-generation social & behavior change andcommunity engagement strategies.
The current analysis suggests that the health behaviours related information,disseminated through the RCCE Pillar for COVID-19 and through the WHO, was largely welltrusted and acted upon by the public in Bangladesh. As is qualitatively captured through the19multiple social media sites, overall familiarity and compliance were reasonably high in mostareas of the country, though a few peri-urban and sub-urban areas did not particularly
adhere to the pandemic appropriate behaviors on a sustained basis (Hosen. Pakpour, Sakib,
Hussain, and Mamun. 2021); similarly, as was observed, by and large adherence was higher
for social distancing recommendations compared to hygiene measures. In addition, as
observed through regular print and electronic media stories, familiarity and adherence werehigher among adults, female, and highly educated persons. However, some observational
articles reflect that a fair number of heterogeneities were observed in the level of trust in
information disseminated by the health authorities, including the pandemic related
information directly beamed through the WHO.
The current analysis calls for further efforts from the health authorities, namely the
RCCE Pillar in Bangladesh, to get regular feedback from the public on their familiarity andadherence with the recommendations for preventive measures at all stages of the pandemic,
to further develop and adapt risk communication as the pandemic continues to evolve.
The continued threat to global health emanating from the COVID-19 poses a set ofcritical challenges to the respective governments, medical communities, healthorganizations, business corporations and the public at-large in responding to the everevolving pandemic. With forever growing misinformation on the pandemic and theassociated diseases, governments and health organizations surely need to be highly
meticulous in disseminating up-to-date and evidence-based information to the public, while
making sure that the most vulnerable and hard-to-reach populace too receives (understands,
processes, and believes in) the information/knowledge. The guidelines and recommended
preventive behaviors as put forward by WHO and the Ministry of Health in Bangladesh is ofimmense significance given the increasing prevalence of cases and emergence of newvariants. The WHO mainly recommends hygiene and physical contact precautions to the
public given that coronavirus is mainly transmitted through droplets and aerosols. As the
COVID-19 vaccination process in Bangladesh started January 2021, communities still havea long way to go before achieving the utopian goal of herd immunity. Needless to mention,
the importance of non-pharmaceutical interventions such as social distancing, use ofprotective equipment such as face masks and other hygiene behaviors in containing thecoronavirus needs to be highlighted all through the process of RCCE (WHO/Modes oftransmission/IPC).
It is also recommended that more systematic studies may be required, using bothquantitative and qualitative techniques, to substantially demonstrate the tangible impact of
RCCE in various developing countries, including Bangladesh. In nutshell in the long-run,countries need to strengthen systems and focus on three approaches, i.e., Mediated, Interpersonal, and social media. Within the given risk-factors, yet most importantly, the interpersonal approach with full engagement of the community and civil society/CBOs shall yield
gainful outcomes.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest
with respect to the research, authorship and/or publication of this article.

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