As COVID-19 cases rose dramatically in Fiji in June of 2021, health authorities noticed something strange: there was a less than expected increase in people coming to health facilities for treatment for COVID-19 or other ailments. But there were reports of people dying at home or arriving at the hospital too late to be treated.
To find out what was going on, Fiji’s Ministry of Health and Medical Services, in collaboration with the World Health Organization (WHO) and other partners, turned to the “social listening” system they had set up just a month earlier.
In public health, social listening is an important tool used to understand what the public is thinking and doing; during a health emergency for example. This informs adjustments to the response to better meet people’s needs. Thanks to financial support from the European Union, WHO has been supporting Pacific island countries to introduce and strengthen social listening throughout the pandemic.
Fiji’s social listening system had originally been established in May 2021 to identify and counter rumours and misinformation as the country prepared to roll out COVID-19 vaccines. But now the listening system was urgently needed to reverse the trend of people seeming to avoid healthcare.
In this particular case, risk communication and community engagement specialists in Fiji tuned in to the views people expressed on social media, on calls to emergency hotlines, in the news and in discussion with community-based volunteers and mobile medical teams.
This is an example of what the team heard:
“My Nana [grandmother] was sick with all the COVID-19 symptoms. We were too scared to take her to the hospital – she was so scared too. All her friends and family who went to … hospital died … No family, no loved ones, no one there with them!”
More than 600 comments, mostly on social media, expressed people’s fear of being trapped alone in hospital without care, or worse, dying there.
Ms Arishma Devi, a risk communication specialist hired by WHO to work with the Ministry of Health and Medical Services, said that listening to what people in Fiji were saying gave the team unique and important insights into what was driving their behaviour:
“Once we started hearing the experiences of everyday Fijians, we could see where some of the clear gaps were. We then very quickly passed along the complaints we were hearing to other parts of the COVID-19 response so that they could be addressed. For example, when we heard that there were no proper mattresses in some of the school-based isolation centres, we notified our partners who helped rectify the situation. Then we worked to restore people’s trust in the healthcare system as we knew that seeking care at the right place at the right time was essential to keeping people alive during this pandemic.”
To demystify and personalize healthcare, the Ministry of Health and Medical Services, with WHO’s support, launched a three-part campaign.
The first part highlighted the commitment of nurses, doctors and paramedics.
“We are part of the solution,” lead nurse Maria Bucago said tearfully in a video entitled Meet Our Frontliners posted on the Ministry’s Facebook page. Leaving her husband and five children in Serua province, she served at the Fiji Emergency Medical Assistance Team (FEMAT) hospital in the capital, Suva, during this extraordinary time.
“This is a national crisis and it’s a national calling for me and my colleagues. Never had I imagined that this is how it would be in my nursing career,” she said.
“There is just one thing I would like to plead with my fellow Fijians - please adhere to the advice from the Ministry of Health. We do not want things to get worse.”
The campaign also included the testimonies of patients treated at the height of the 2021 surge in cases who spoke about the professionalism, empathy and care they encountered.
A final part of the campaign involved responding to questions and concerns. A team in the Ministry answered questions on social media and hotlines, and directed people to healthcare resources.
The campaign was successful online, generating more than 200,000 views for Nurse Bucago’s video alone and hundreds of supportive comments such as, “Thank you, sister, for your hard work. This video made me so emotional. My prayers are with all frontline workers. Together we can do it.”
Importantly, in the real world, more people sought treatment for COVID-19 and other conditions.
Fiji’s social listening system has continued to inform the country’s COVID-19 response. When Fiji was ready to roll out COVID-19 vaccines, social listening helped to identify the fact that many people wanted to avoid further lockdowns. Guided by this insight, messages emphasized the importance of vaccination and COVID-safe behaviours in contributing to the easing of movement restrictions, as well as providing a safer environment for communities.
As a result, the team noticed much more positive conversations about vaccination online. As of 7 July 2022, almost 90% of the eligible population had been vaccinated. Thanks to the protection of vaccines and increased comfort with seeking healthcare, fewer people are dying during the current surge in COVID-19 transmission.
WHO Representative to the South Pacific and Director of Pacific Technical Support Dr Mark Jacobs said, “What happens with the COVID-19 pandemic depends to a large extent on how we behave as individuals and communities. Taking the time to listen to the public and to understand the drivers of their behaviour has given the government of Fiji, with WHO and partners, the opportunity to ensure that their communications and the broader emergency response are better tailored to people’s preferences, needs and expectations. As a result, lives have been saved. Given the excellent results and the capacity that has been built, we hope social listening will be used to address other health challenges in Fiji and elsewhere in the Pacific.”
In Fiji, other social listening partners include UNICEF, Australia’s Department of Foreign Affairs and Trade (DFAT), the International Federation of Red Cross and Red Crescent Societies (IFRC) and the Pacific Community (SPC).
Across the Western Pacific Region, WHO is scaling up its use of Communication for Health to tackle complex health challenges. Read more about Communication for Health (C4H)