FIELD REPORT Dec 2020. Christian Journal for Global Health 7(5) Utilizing social media technology during the COVID-19 pandemic to assist highly vulnerable populations in the Philippines Daryn Joy Go a, Natalee Hung a, Hannah Ferrolino a, Kendall Wilson a, Mia Choi a, Daniel Mayhugh a, Lincoln Lau b a, International Care Ministries, Manilla, Philippines b PhD, Director of Research, International Care Ministries, Manilla, PH; Assistant Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Adjunct Assistant Professor, School of Public Health & Health Systems, University of Waterloo, Waterloo, Canada Abstract: National lockdowns and social distancing measures enforced in response to COVID-19 have forced many non-governmental organizations (NGOs) serving in low- and middle- income countries to suspend their operations. While low-income families continue to suffer from hunger and poverty, community quarantine restrictions additionally isolated them from town centers where healthcare, education, food, supplies, and livelihood opportunities are usually accessed. International Care Ministries (ICM) is a Philippine-based NGO that runs a poverty-alleviation program targeted towards extreme low-income households. As we re-evaluated how we may continue to effectively minister and serve our communities despite lockdown measures, we identified two priorities: (1) to serve people’s physical needs by providing food and access to healthcare and (2) to serve people’s spiritual needs through spiritual nourishment and community. In this field report, we describe how ICM was able to identify and use social network platforms as an alternative to continue both service delivery and spiritual feeding remotely. We hope this example may encourage other development NGOs to persevere as we all continue to seek ways to adapt to these extraordinary and seemingly ever-changing circumstances. Key words: COVID-19, pandemic, low- and middle- income countries, social networks, technology Introduction When it first emerged, few could have imagined the novel coronavirus disease 2019 (COVID-19) developing into a global crisis sending shock waves around the world. That governments often do not have sufficient resources to address needs caused by acute outbreaks of disease has become strikingly apparent. Many public health and 95 Go, Hung, Ferrolino, Wilson, Choi, Mayhung & Lau Dec 2020. Christian Journal for Global Health 7(5) socioeconomic systems have been crippled as a result. These strains are exaggerated in low- and middle- income countries where healthcare infrastructures are undeveloped and financial resources are limited.1 In such contexts, non- governmental organizations (NGOs) play a crucial role in supporting government efforts to serve vulnerable communities that lack access to information, healthcare, and social safety nets.2 However, national lockdowns and social distancing measures enforced by governments in response to the COVID-19 pandemic have forced many organizations to suspend their ongoing operations. These were the circumstances facing International Care Ministries (ICM). We are a Philippine-based NGO that runs a poverty- alleviation program targeting extreme low-income households. When the pandemic led the Philippines to implement strict lockdowns and community quarantines in March 2020, ICM had to suspend all its programs across the country. Although it was clear that the need would be greater than ever, we could not travel to the communities to provide food and health services to the families we serve. With households unable to undertake economic activities due to lockdown measures, the rise in hunger and poverty would be acute and exponential. In this paper, we detail how ICM was able to use social network alternatives to continue both service provision and spiritual feeding within the communities. We hope this example may encourage other development NGOs, as we all continue to seek ways to adapt to these extraordinary circumstances. The Need In early attempts to contain the transmission of COVID-19 within the Philippines, the government enforced enhanced community quarantine (ECQ) measures in many regions which involved imposing strict home quarantine, implementing lockdowns in places with positive COVID-19 cases, and suspending public transportation systems.3 The ECQ restricted ICM from continuing its face-to-face programs, which meant that we were also barred from meeting with our partner pastors, all of whom play crucial roles in our poverty alleviation program. Every year, ICM partners with local pastors to provide support to 45,000 families, forming a network of pastors we call Thrive. These pastors act as both shepherds and champions, providing spiritual guidance while also advocating for the physical and socio-economic needs of their communities. Currently, ICM equips and engages over 15,000 pastors in its Thrive network by (1) providing guidance and resources for pastors to serve their communities and (2) holding monthly gatherings where pastors can come together and support each other in ministry. With ICM’s normal operations paralyzed, our resources, networks, and approach all had to be repositioned in order to effectively meet the changing needs of our communities. The development of alternative service delivery platforms was guided by the primary objectives as follows. Fill Public and Private Health Care Gaps The Philippines’ total expenditure on health only accounted for 4.6% of gross domestic product (GDP) in 2018,4 and the surge in hospitalizations due to the COVID-19 pandemic is placing severe demands on already over-stretched resources. Public and private hospitals alike have faced shortages in healthcare workers, personal protective equipment, intensive care beds, and ventilators.5 Especially in the context of existing inequities in the accessibility and affordability of healthcare between the rich and the poor, there is a pressing need to fill the gaps of the overburdened system and reach underserved communities. Create an Alternate Avenue to Connect with Partner Pastors With ICM unable to provide services and their communities’ needs growing, our partner pastors have been left feeling helpless, unable to minister to 96 Go, Hung, Ferrolino, Wilson, Choi, Mayhung & Lau Dec 2020. Christian Journal for Global Health 7(5) or provide for their own families or community members. Reports we received from another survey conducted by ICM from October 19 to October 27, 2020 indicated that each pastor was aware of a mean of 56 families in need of immediate food supplies (N = 226). Besides addressing the needs of others, pastors themselves also need to be spiritually, emotionally, and physically supported during the pandemic. There is a need to provide ongoing support to our partner pastors who play pivotal roles in their communities, especially in times of crises. Identify and Help Those Who Are Most in Need Quarantine restrictions, coupled with rising fear and uncertainty toward the virus, has brought the local economy to a standstill, leaving many workers jobless. With the majority of the population living hand-to-mouth, hunger and poverty is an acute and ever-growing threat. In order to facilitate the coordination of efficient relief responses to vulnerable communities where food security is threatened, there is a need to obtain real time information and timely data. ICM’s Response With the widespread and growing use of technology and the internet in the Philippines,6,7 ICM sought to leverage the accessibility and convenience of social media channels to overcome the barriers of physical distancing and community movement restrictions. This led to the development of an online platform that would allow us to obtain informative data and form efficient responses to the communities. The Thrive Network Chatbot, hosted on Facebook, was launched on April 21, 2020 with the purpose of connecting with our partner pastors as bridges to the communities. As of October 2020, there were currently 2,108 pastors registered to the Chatbot. This parent messenger bot consists of three parts: (1) the COVID-19 Assessment Chatbot, (2) the Lay Leader Leadership Devotional Chatbot, and (3) the Rapid Emergencies and Disasters Intervention (REDI) Chatbot. COVID-19 Assessment Chatbot To fill health care gaps, the COVID-19 Assessment Chatbot was developed in collaboration with the Department of Health to provide easily accessible COVID-19 health information. This Chatbot is an online health assessment tool that evaluates the health of pastors through a series of questions and subsequently suggests any follow-up actions, if necessary. Video and text information on COVID-19 are also provided with the objective of decreasing fear of COVID-19 among communities attributable to misinformation. After the health assessment, pastors are posed questions on food security to provide ICM with information on regional food scarcity. The COVID-19 Assessment Chatbot has been translated into 5 dialects so that it is accessible to the full range of communities in which ICM serves. Lay Leader Leadership Devotional Chatbot The Lay Leader Leadership Devotional Chatbot was created to support pastors as they face ministry challenges during the pandemic by providing an avenue for continuous spiritual support. Within the Chatbot, the Lay Leader Learning Hub provides church leaders with 2-minute, daily devotionals, equips potential pastors and lay leaders in the development of leadership and ministry skills, and connects them to a wider network of pastors in the ICM Pastors’ Facebook group. There are now 599 pastors registered to receive the daily devotionals. Rapid Emergencies and Disasters Intervention (REDI) Chatbot To provide an avenue for pastors to share the immediate needs of the community, the Thrive Network Chatbot also includes a function where pastors can register for ICM’s REDI Network, a web-based application to report incidents and 97 Go, Hung, Ferrolino, Wilson, Choi, Mayhung & Lau Dec 2020. Christian Journal for Global Health 7(5) coordinate relief efforts to deliver food packs to the communities. In addition to the REDI Chatbot, pastors can also text or call a REDI phone number to report emergencies and disasters to ICM. In the midst of COVID-19, this REDI Network has allowed ICM to call and pray for 5,372 community leaders and has helped 1,004,349 families receive food packs. Discussion The COVID-19 pandemic has left communities more vulnerable than ever. While extreme low-income families continue to suffer from hunger and poverty, quarantine restrictions have additionally isolated them from town centers where healthcare, education, food, supplies, and livelihood opportunities are usually accessed. When the lockdowns were enforced, ICM was also forced to suspend all of its programs across the country, challenging us to re-evaluate how we may continue to effectively minister and serve our communities remotely. To guide our efforts, we identified two priorities: (1) to serve people’s physical needs by providing food and access to healthcare and (2) to serve people’s spiritual needs through spiritual nourishment and community. As we shifted our focus as an NGO from development to emergency response, it was important that we used resources that could be readily leveraged and that had a wide reach. We came to identify two that met these criteria: (1) the widespread use of technology and social media across the Philippines and (2) the wide network of pastors living among all the communities ICM was serving. The use of social media has become instrumental in responding to a range of disaster and crisis situations.8 With its ability to disseminate real- time information to victims, emergency responders, and the public, it is recognized as an effective tool to identify and meet immediate needs. However, its use in fostering social support between people bearing similar burdens has tended to be overlooked. The development of the Thrive Network Chatbot has helped us connect with partner pastors, not only providing them with an immediate platform that they can use to communicate the gaps in their communities’ healthcare and food needs, but also with spiritual nourishment and opportunities for them to connect with other pastors facing similar challenges. From initial feedback discussions, users also indicated that the information and guidance they received from the Chatbot was helpful in decreasing stress and anxiety when navigating uncertainties surrounding the virus. Experiencing unprecedented and crippling disruptions on the scale of COVID-19 can, at times, leave us feeling helpless, but we must not lose heart. Our hope is for other development NGOs to persevere in preparations to adapt to changing circumstances, knowing that ultimately, we serve a God who meets people in their unique circumstances but remains unchanging in His goodness and provisions. References 1. Lau LL, Hung N, Wilson K. COVID-19 response strategies: considering inequalities between and within countries. Int J Equity Health. 2020;19(1):137. https://doi.org/10.1186/s12939-020-01254-9 2. Kandel N, Chungong S, Omaar A, Xing J. Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries. Lancet. 2020;395(10229):1047-53. https://doi.org/10.1016/S0140-6736(20)30553-5 3. Office of the President of the Philippines. Memorandum from the Executive Secretary: guidelines for the management of the 2019 Novel Coronavirus Acute Respiratory Disease situation [Internet]. 2020 [cited 2020 Aug 26]. Available from: https://www.doh.gov.ph/sites/de- fault/files/health_advisory/memorandum_from_the_e xecutive_secretary.pdf 4. Philippine Statistics Authority. Philippine National Health Accounts [Internet]. 2019 [cited 2020 Oct 14]. Available from: https://psa.gov.ph/pnha-press- release/node/144466 5. World Health Organization Representative Office for the Philippines. WHO Philippines CORONAVIRUS about:blank about:blank about:blank about:blank about:blank about:blank about:blank 98 Go, Hung, Ferrolino, Wilson, Choi, Mayhung & Lau Dec 2020. Christian Journal for Global Health 7(5) DISEASE (COVID-19) situation report 35. Geneva: WHO; 2020. 6. Mander J, Buckle C, Moran S. Social flagship report 2020. London: GlobalWebIndex, 2020. 7. World Bank Group. Individuals using the internet (% of population) – Philippines [Internet]. 2020 [cited 2020 Aug 27]. Available from: https://data.worldbank.org/indicator/IT.NET.USER.Z S?locations=PH 8. Simon T, Goldberg A, Adini B. Socializing in emergencies—a review of the use of social media in emergency situations. Int J Inf Manag Sci. 2015;35(5):609-19. https://doi.org/10.1016/j.ijinfomgt.2015.07.001 Peer Reviewed: Submitted 9 Nov 2020, accepted 30 Nov 2020, published 21 Dec 2020 Competing Interests: None declared. Correspondence: Lincoln Lau, PhD lincoln.lau@caremin.com. For further information and to access the Thrive Network Chatbot, please see https://m.me/covid19assessment?ref=Thrive Cite this article as: Go DJ, Hung N, Ferrolino H, Wilson K, Choi M, Mayhung D, Lau L. Utilizing social media technology during the COVID-19 pandemic to assist highly vulnerable populations in the Philippines. Christ J Global Health. December 2020; 7(5):94-98. https://doi.org/10.15566/cjgh.v7i5.479 © Authors. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/ cjgh.org about:blank about:blank about:blank about:blank about:blank about:blank about:blank Introduction References