The ultimate control and prevention of the Covid-19 pandemic would rely largely on human behaviours. Therefore, people’s action or inaction is crucial in mitigating the spread of the virus. This common denominator often has a significant impact on outcome as displayed in Wuhan, China. As a result, it is imperative individuals and communities are actively engaged when making decisions that require a change in common-sense attitudes passed down from generation to generation.
A recent poll in sub-Saharan Africa indicates a high level of awareness of the Covid-19: 94% of 1350 respondents, in three countries Nigeria, Kenya and South Africa were aware of what it means (1). However, this knowledge is not fully translated into behavioural alteration. For instance, reports of violence following closure of mosques have been noted in Kastina state, North West Nigeria (2). However, due to popular opposition, these venues for worship have reopened for Friday congregational prayers in the state and other parts of the country (3). Given the exponential rise in number of cases in North West Nigeria (4) and the virulence of the pandemic, public health measures are only as effective as the proportion of the population that adheres to it.
Interestingly, some of these measures imposed across the continent were modelled based on developed countries. While these are evidence based, they may be not locally adaptable. As the number of cases and deaths increases, it is crucial to recognise communities as active participants in the response and management. Without this, operations may be extremely challenging, and the virus may continue to proliferate, thereby requiring more time and resources.
Because each outbreak is exclusive, community perception of its spread is multifaceted, culturally mediated and context dependent. A one-size-fit-all response would not be applicable. These responses must be adjusted to local realities, including culture, beliefs and socioeconomic conditions.
Among the average Northerner in Nigeria, Covid-19 is purported as a hoax deployed by the media and the government to further deprive the region (5), particularly as many of the earlier confirmed cases were among the political class (6). While the privilege of access to test facilities and international mobility is limited to the upper classes of society, the lingering Boko Haram crisis and widespread misappropriation of funds for victims of insurgency in the North East region further compound the issue (7). Thus, for many in this region, Covid-19 seems to be a fabrication and yet another deceitful scheme for its leaders to access federally allocated resources.
Thus, in order to understand and address this gap in high risk behaviours that reinforces resistance to public health measures across the continent, community engagement is vital.
Central to how an issue is understood or perceived publicly, is its framing, as people see or interpret the world differently. There are a number of scenarios described below where framing of the problem has proved to be either beneficial or detrimental.
In the UK today, in addition to disease burden, the SARS-Cov-2 virus is also perceived as a threat to the National Health Service (NHS), with a clear message being relayed to the public to “PROTECT THE NHS" (8). This 70-year old health institution is a symbol of pride and unity among the British people. More so, it was even celebrated in the London 2012 Olympics (9). Beyond mortality statistics of the pandemic, this disruption of the NHS has been a tool for social mobilisation among fellow English country men and women. This has instilled a sense of ownership in the response, incorporating a sense of awareness in their actions or inaction and not merely playing a passive role. Hence, how an issue is framed is of paramount importance.
Elsewhere in the United States, the rhetoric has been around China and lately the World Health Organisation. Thus, framing the pandemic as deception by Beijing or complicity by the WHO may have sown a seed of divide and disunity among fellow Americans (13, 14). Several protests have erupted from different groups, resistance to lockdown or stay at home directives (10). The plea comes amid rising mortality figures, with a few states such as Georgia relaxing lockdown directives.
On the African scene, Nigeria response to the 2014 Ebola outbreak was described as a “piece of world class epidemiological detective work” (11). As a result of the heroism of a Nigerian medical doctor who physically restrained patient zero from leaving the health facility despite pressure from the Liberian embassy (12). This tragedy helped in revitalising a sense of nationalism and patriotism among Nigerians, a catalyst for behavioural change during that event.
Image Credit: WHO Africa
Coming back to the topic of Covid-19, efforts to control the spread of the virus in Africa should be beyond public health measures. Response coordination should also be framed around symbols or figures that strengthen national unity in order to sustain community mobilisation. Hence, it is crucial African heads of state engage communities in ways that echo their shared beliefs and ideologies & should be reflected in planned behavioural change strategies. Nigeria is a non-secular state, with an equal proportion of both Christians and Muslims, 49% respectively (18). As Ramadan begins, convincing faithful Muslims to stay at home would be an uphill task (17). Thus, equivocal messages from religious leaders is crucial.
We also need to be mindful that about 87 million Nigerians live below the poverty line, on less than 1.90 USD per day (15). For many in this category, they rely on daily income for sustenance and survival. Although the government has created a social safety net: conditional cash transfer to cushion the financial fallout for the poor of the poorest, it is imperative the remote disbursement of such funds is marked with equity, transparency and accountability (16). People are far less likely to doubt a system that protects the lives and welfare of their families and communities. These palliatives will not only go a long way in protecting vulnerable citizens but in addition, may also potentially help in strengthening trust and regaining confidence in the system.
While there are clearly no easy answers to these issues, any measures adapted would not be free from difficulties. Community engagement guarantees a two-way communication and it would give a sense of responsibility during this period; feedback received from communities (i.e. current perceptions, rumours) would potentially increase the effectiveness of social mobilisation strategies. Africans should have a sense of ownership and participation, that they are playing a part in mitigating the outbreak of this deadly pandemic.
About the Author
Evaborhene Aghogho Nelson is a Nigerian Medical Doctor and Global Health Postgraduate Student at University College London. He can be reached at firstname.lastname@example.org.
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