ABSTRACT
The 2014–2015 Ebola Virus Disease (EVD) outbreak in West Africa exposed the extent to which health system resilience depends on effective crisis and risk communication. While considerable scholarship has examined national and international response mechanisms, comparatively little attention has been paid to how faith-based health providers, which deliver an estimated 30–35% of health services in Ghana, organised their own communication response. This article draws on a mixed-methods study of the National Catholic Health Service (NCHS), Ghana’s largest faith-based health network, to appraise the communication strategies it deployed during the outbreak period. Using survey data from 100 health workers across two NCHS facilities and interviews with programme officers, the study finds that although the NCHS lacked a documented outbreak communication plan, it achieved wide message reach through Social Mobilisation and Information Education Communication (IEC) approaches anchored in staff durbars, congregational networks, and social media. Yet 56% of respondents identified persistent gaps, particularly around fear management and message translation. The article argues that faith-based providers require dedicated, pre-negotiated risk communication protocols integrated with national frameworks, rather than improvised adaptation during crisis, and proposes this integration as a concrete policy contribution to Ghana’s outbreak preparedness architecture.
Keywords: Ebola Virus Disease; health communication; faith-based health providers; crisis and risk communication; social mobilisation; Ghana
INTRODUCTION
When the Ebola Virus Disease (EVD) outbreak swept through Guinea, Liberia and Sierra Leone between 2014 and 2015, it infected more than 28,000 people and killed over 11,000, exposing profound weaknesses in West African health systems (World Health Organization [WHO], 2018). Ghana recorded no confirmed case, yet its proximity, porous borders and high population mobility placed it on continuous alert (Ghana Health Service, 2015). Government and donor attention concentrated on the Ghana Health Service’s (GHS) national preparedness architecture (Ghana Ebola National Plan, 2014), while assessments of WHO-led coordination proliferated internationally (Delamou et al., 2017). What received little scholarly attention was how Ghana’s substantial network of faith-based providers organised its own outbreak communication. The National Catholic Health Service (NCHS), which operates 38 hospitals, 81 clinics and 10 nursing colleges, and delivers roughly a third of Ghana’s health output through the Christian Health Association of Ghana (Adjei, 2011) represents an important but understudied case.
This article appraises the communication strategies the NCHS deployed during the 2014-2015 outbreak, addressing a specific gap in the health communication literature on faith-based crisis response, and offers a framework for how such providers might be integrated into national outbreak communication planning going forward. The question is not merely academic: with faith-based networks delivering close to a third of Ghana’s health output, their communication readiness or lack of it has direct bearing on how quickly and completely public health messaging reaches the communities such providers serve.
THEORETICAL CONTEXT
Effective outbreak communication is widely recognised as central to containment, yet studies consistently show that formal plans alone do not guarantee preparedness (Dickmann et al., 2016). This study is grounded in three complementary frameworks. The Health Belief Model (Rosenstock, 1974) explains why individuals adopt protective behaviour based on perceived susceptibility and severity — relevant given the acute uncertainty Ghanaians expressed despite the absence of confirmed cases (Adongo et al., 2016). Diffusion of Innovation theory explains how new health behaviours spread through population subgroups over time, and Communication for Behavioural Impact (COMBI), a structured social mobilisation methodology built around leveraging existing community and institutional networks rather than constructing new ones provided the practical scaffolding most closely mirrored in the NCHS’s own approach (WHO, 2012). Taken together, these frameworks suggest that faith-based providers, with their dense pre-existing congregational and staff networks, are theoretically well positioned for rapid social mobilisation, but not necessarily for the sustained reassurance that risk communication also demands (Schiavo, 2014).
METHODOLOGY
The study used a concurrent mixed-methods design (Creswell & Clark, 2007), combining a 100-respondent structured survey across two NCHS facilities: St. Luke Catholic Hospital, Apam, and St. Gregory Catholic Hospital, Gomoa-Budumburam with semi-structured interviews of two NCHS Directorate Health officers. Facilities were purposively selected from among those identified as high-risk under the NCHS’s Canadian High Commission-funded preparedness training. Respondents were predominantly female (79%) and drawn from nursing (65%), with 95% holding tertiary qualifications, a workforce well positioned to interpret technical health messaging. Quantitative data were analysed descriptively; qualitative interview data were coded thematically against three domains including strategy, effectiveness, and gaps matching the study’s three research objectives.
FINDINGS
Two strategies dominated the NCHS response. Information Education Communication (IEC) relied heavily on social media: 67% of respondents cited WhatsApp as an information source, alongside health outreach and flyers (each reported at 30%), interpersonal communication (27%), and public announcements (14%). Social Mobilisation activity centred on staff durbars, confirmed by 63% of respondents, followed by church and mosque engagement (41%), school sensitisation (21%), community durbars (18%), and outreach to market women and driver unions (12% and 8% respectively). This pattern reflects a provider that mobilised its existing institutional and congregational networks rather than building outbreak-specific channels from scratch consistent with COMBI’s emphasis on working through existing social infrastructure (WHO, 2012).
On effectiveness, respondents were broadly positive: 88% rated NCHS messaging as either extensive (45%) or very extensive (43%), with only 12% describing it as merely somewhat extensive. Interview data corroborated this: NCHS officers described using internal monitoring tools to verify sensitisation activity across facilities.
Yet 56% of respondents identified gaps, and the qualitative data clarify why. First, fear operated as a double-edged driver: it motivated engagement with sensitisation content but simultaneously undermined the reassurance that messaging was meant to provide, leaving staff and community members uncertain of their safety despite high message exposure. Second, respondents flagged the adequacy of local-language translation as a persistent weakness, echoing a broader tension in Ghana’s wider outbreak response: high awareness does not equate to full comprehension (Adongo et al., 2016). Third, and most significant for policy, neither survey respondents nor interviewees could point to a documented, NCHS-specific health emergency communication plan; the response instead relied on GHS protocols and improvised adaptation of existing institutional communication habits.
DISCUSSION
These findings extend the outbreak communication literature in two ways. First, they demonstrate that faith-based providers can achieve high message reach through pre-existing social capital congregational networks, staff durbars, community trust without a formal outbreak communication plan, partially validating COMBI’s premise that social mobilisation succeeds by working through existing structures rather than building parallel ones (WHO, 2012). Second, and more critically, the findings expose the limits of that approach: reach is not the same as reassurance. The persistence of fear and uncertainty despite extensive messaging suggests that faith-based providers need risk communication training specifically oriented toward psychological reassurance and rumour management, not simply message dissemination (Böl, 2015). This matters beyond Ghana: CHAG-affiliated and comparable faith-based networks across sub-Saharan Africa deliver a substantial share of frontline care in exactly the rural and peri-urban settings where outbreak risk communication is hardest to execute through government channels alone (Boateng, 2017). A network capable of assembling a durbar within days, or reaching congregants through an existing Sunday gathering, is also a network that public health authorities have historically under-resourced and under-consulted in formal emergency planning, a mismatch this study’s findings make difficult to ignore.
CONCLUSION AND CONTRIBUTION
The NCHS’s Ebola-period communication response was resourceful but reactive. Its reliance on Social Mobilisation and IEC materials achieved wide reach, yet the absence of a documented emergency communication protocol, and unresolved gaps around fear and translation, point to a structural vulnerability likely shared by many faith-based providers operating in similar contexts. The principal contribution of this study is empirical and specific: it is among the first appraisals of a faith-based provider’s outbreak communication strategy in Ghana, rather than of government or WHO-led coordination, and it demonstrates that institutional trust and network density are necessary but insufficient substitutes for a documented risk communication plan. Accordingly, this study recommends that national outbreak preparedness frameworks formally integrate faith-based networks such as CHAG and NCHS into pre-negotiated risk communication protocols, complete with translated message banks and fear-management guidance, rather than treating their contribution as an informal auxiliary to be assessed only after the fact. Doing so would convert an improvised strength into a planned, institutional capability ahead of the next health emergency, and would extend the reach of national risk communication into precisely the congregational and community networks that formal government channels most often struggle to penetrate.
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