This piece was originally posted at Devex and is reposted here with their permission.
A French version of this piece is posted at Le Tribune.
Health workers explain social distancing as people wait in line to collect social grants in Cape Town, South Africa. Photo by: REUTERS / Mike Hutchings
Since the beginning of the COVID-19 outbreak, the majority of recommendations for preventing the spread — social distancing chief among them — have focused on middle- and high-income countries. It will be incommensurately more difficult to design and implement social distancing measures in low-income or under-resourced settings. In these contexts, crafting and implementing social distancing measures that work — before reaching 1,000 cases — can appear daunting. But these measures will be absolutely essential to save lives.
Most African governments have taken initial steps to encourage social distancing, focusing on border and travel restrictions, school closures, and bans on large gatherings. South Africa has begun a 21-day period of full lockdown. Other countries have instituted curfews and partial lockdowns or are discussing full lockdowns. Already, we are seeing that lockdowns can be problematic, causing unrest, violence, and high levels of contact between people — which can exacerbate the coronavirus’s spread.
Instead of full lockdowns, policymakers need to provide clear guidance on social distancing policies, especially for semiformal and informal businesses, communities, and households to protect the most vulnerable. Government officials should assess what factors will enable or impede these public health measures in their countries. Last, a solid communication strategy should be a key pillar of any prevention measures, rather than an afterthought.
A policy brief put together by IDinsight — research, data analytics, and advisory organization that works with nonprofits and governments to strengthen their social impact — offers high-level recommendations for African policymakers designing social distancing policies.
Here are five of our recommendations:
Restricting community activity can be the first port of call for decision-makers. Several countries have banned all religious gatherings and services, while others have prohibited large ones only. Religious services can be adapted — including by limiting attendance or moving gatherings outside. Family gatherings, weddings, and funerals can be suspended or limited. Sports and cultural events — even at the community level — can be suspended as well, which several countries have already done.
To guide the flow of people, communities can erect barriers and hand-washing stations at market entrances. Shoppers and merchants can be asked to wear cloth masks or scarves. Because overcrowded public transport systems can further the spread of COVID-19, some forms of transit can be banned, while the number of passengers can be capped for other transportation modes and new hygiene guidelines disseminated. Where possible, walking and cycling should be encouraged while social distancing.
Within households, social distancing measures should focus on three things: limiting contact with those outside the dwelling, context-specific hygiene recommendations, and protecting vulnerable household members. The standard World Health Organization guidelines should be further adapted for households across different regions, informed by local practices. Families can be encouraged to identify the most vulnerable within their household and isolate them as much as possible. With restrictions on mobility, rural-urban migrants may decide to return home and unintentionally spread the disease to rural areas. Governments could consider enacting specific quarantine rules for them upon their return.
Policymakers should consider which local practices might naturally support positive health outcomes and which might make social distancing or other measures more difficult. Such enablers of and barriers to public health might include a population’s awareness of the severity of COVID-19 or the risk of asymptomatic carriers. Expanding on preexisting religious or cultural practices worked well during the Ebola outbreak. But cultural practices may also hinder efforts, as was also the case with Ebola where burial practices facilitated the spread. Access to running water, soap, and other hygiene supplies as well as communication equipment — including radios and cellphones — can enable or hinder the uptake of safe public health behaviours.
Communication will be a key pillar of any prevention strategy. In addition to performing the behaviours, they expect from citizens — by social distancing during press conferences and other gatherings, for example — government officials should identify and partner with trusted leaders such as traditional chiefs, religious and public figures, and famous artists and athletes to disseminate key messages. If enforcement is done by police or security forces, public trust may erode. The main goal of enforcement should be educating the public, not repressing them. Repression destroys trust and can cause further damage. It will also hinder people from following guidelines in the future.
Messages should be clearly communicated, including to those who are illiterate or speak minority languages. Testing messages with a sample of respondents before scaling them up is essential. Insights from behavioural science tell us that messages should also be straightforward, emphasizing the consequences of noncompliance. Messages should also be consistent but reliant on multiple channels of communication.
To effectively disseminate messages, central governments will need to collaborate with entities that have reach and access to remote regions. These may include religious or youth groups, NGOs, the postal service, and utility companies. A coordination structure can ensure an entire territory is covered adequately.
As African countries continue to adapt their responses to COVID-19, it is important to enact strategic and nuanced social distancing measures now, even if it is unclear how COVID-19 will impact their communities.
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