Empowering Communities During the COVID-19 Pandemic Through Mothers' Support Groups: Evidence From a Community Engagement Initiative in Sri Lanka

"The MSGs have employed many successful community-level methods in overcoming the COVID-19 pandemic in Sri Lanka."

Well-implemented community engagement strategies can support health systems in overcoming pandemics. An empowered community can be mobilised during a health crisis to help disseminate information, identify and help vulnerable people, and improve public compliance to preventive actions. From the beginning of the COVID-19 pandemic until the present, the Health Promotion Bureau (HPB) of Sri Lanka used mothers' support groups (MSGs) to empower communities in preventing the spread of the disease.

The global history of MSGs began in the 1950s with the idea of the "experienced mother helping the new mother". However, presently, in Sri Lanka, MSGs aim to promote health, well-being, and nutrition practices in the community through community engagement. Each MSG comprises 5-20 participants from families with children aged younger than 5 years. The HPB initially linked MSGs and other platforms at the village and district levels, such as community support organisations and religious leaders. The MSGs chose the best activities for their communities based on problem tree analysis methodology; all MSG members received training. Religious leaders and government officials of the area also helped with some of the activities. The MSG members themselves generated funds for these activities. In some regions, donors also helped the members of MSGs by providing essential goods for quarantined people.

Examples of MSG activities during the pandemic included:

• Establishment of communication networks: Meeting with the community in person was limited, and new modalities of communicating with community members and MSG members had to be established. The majority of them selected the WhatsApp platform for sharing information, education, and communication (IEC) materials and other related documents on COVID-19. In addition, some MSG members used a public address system to raise awareness and distribute relevant messages. Others used existing notice boards in public places to paste notices and announcements related to COVID-19 prevention.
• Creation of a supportive environment for infection prevention and control practices, such as by marking 1-metre footsteps for social distancing in supermarkets and at automated teller machines.
• Work to increase COVID-19 vaccine acceptance, such as by helping to alleviate people's fears regarding vaccination and using their communication networks to inform people in their community of the dates of vaccination clinics and the importance of vaccination.
• Distribution of essential food items and medicines to people in need.
• Organisation of recreational and social support activities.
• Monitoring of community-level COVID-19 prevention and control activities.

As the article outlines, a key strength of using MSGs was the well-established, high-quality relationships within communities they had cultivated over time, as well as their direct access to communities who trusted them. "The success of the MSGs at the community level can be explained by notions of social capital, such as the overall improvement in access to financial and social resources and reliable social relationships leading to better health outcomes....In addition, it can be explained in the form of 'bonding social capital,' which refers to social connections between socially similar individuals (e.g., MSG members and other mothers in the communities that were affected), and in the form of 'bridging social capital,' which refers to connections between socially dissimilar individuals (e.g., MSG members and other hierarchical health and non-health stakeholders)..." Other, related facilitating factors were the support received from existing community partnerships and training and capacity-building from district health education officer networks.

Key barriers to conducting these activities included reluctance of public health workers to work together with MSGs, competing stakeholder agendas, and lack of support for appreciation of MSG activities from local health authorities.

In conclusion, the "review showed that adaptation to the sociocultural context of the particular community is important to improve efficiency and overall success in community engagement. Furthermore, it revealed the importance of the continuous development of the knowledge and skills of MSG members, appreciation of MSG activities by the health authorities, and promotion of power-sharing among partners for successful community engagement."