One size does not fit all: adapt and localise for effective, proportionate and equitable responses to COVID-19 in Africa

MacGregor, Hayley; Leach, Melissa; Tshangela, Akhona; Hrynick, Tabitha; Lees, Shelley; Niederberger, Eva; Parker, Melissa; Lorenzo, Santiago Ripoll; Rohan, Hana; Schmidt‐Sane, Megan; Tulloch, Olivia

doi:10.1136/fmch-2020-000709

Cited by 9 publications

(8 citation statements)

References 10 publications

(13 reference statements)

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“…In Africa, with high rates of endemic and emerging diseases and its generally fragile health systems, the effect of the pandemic was expected to be devastating. Consequently, countries across Africa were also quick to call for the implementation of PHSMs early in the pandemic 4–6…”

Section: Introductionmentioning

confidence: 99%

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey

Murukutla

Gupta²,

Maharjan³

et al. 2022

BMJ Open

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ObjectiveThe objective of this study was to gain a better understanding of the psychosocial and sociodemographic factors that affected adherence to COVID-19 public health and social measures (PHSMs), and to identify the factors that most strongly related to whether citizens followed public health guidance.DesignCross-sectional study.Setting and participantsNationally representative telephone surveys were conducted from 4–17 August 2020 in 18 African Union Member States. A total of 21 600 adults (mean age=32.7 years, SD=11.4) were interviewed (1200 in each country).Outcome measuresInformation including sociodemographics, adherence to PHSMs and psychosocial variables was collected. Logistic regression models examined the association between PHSM adherence (eg, physical distancing, gathering restrictions) and sociodemographic and psychosocial characteristics (eg, risk perception, trust). Factors affecting adherence were ranked using the Shapley regression decomposition method.ResultsAdherence to PHSMs was high, with better adherence to personal than community PHSMs (65.5% vs 30.2%, p<0.05). Psychosocial measures were significantly associated with personal and community PHSMs (p<0.05). Women and older adults demonstrated better adherence to personal PHSMs (adjusted OR (aOR): women=1.43, age=1.01, p<0.05) and community PHSMs (aOR: women=1.57, age=1.01, p<0.05). Secondary education was associated with better adherence only to personal PHSMs (aOR=1.22, p<0.05). Rural residence and access to running water were associated with better adherence to community PHSMs (aOR=1.12 and 1.18, respectively, p<0.05). The factors that most affected adherence to personal PHSMs were: self-efficacy; trust in hospitals/health centres; knowledge about face masks; trust in the president; and gender. For community PHSMs they were: gender; trust in the president; access to running water; trust in hospitals/health centres; and risk perception.ConclusionsPsychosocial factors, particularly trust in authorities and institutions, played a critical role in PHSM adherence. Adherence to community PHSMs was lower than personal PHSMs since they can impose significant burdens, particularly on the socially vulnerable.

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Section: Introductionmentioning

confidence: 99%

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey

Murukutla

Gupta²,

Maharjan³

et al. 2022

BMJ Open

Self Cite

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“…In addition to scientific data, decision-makers may be unequally influenced by the often-competing narratives shared by different social actors, as well as political and economic concerns. The initial social and scientific uncertainty that surrounded the emerging new disease of COVID-19 may have further increased the tendency to pursue standardized “one size fits all” routes of response which favored disease containment through top-down, state-led interventions ( 27 ).…”

Section: Discussion: Lockdown Narratives and Public Policymentioning

confidence: 99%

Global narratives on unequal outcomes produced by lockdown in Africa: A social science perspective on the “one-size-fits all” COVID-19 response

Grant

Sams

2023

Front. Public Health

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IntroductionLockdown measures were introduced worldwide to prevent the spread of COVID-19, and several studies showed the positive impacts of these policies in places such as China and Europe. Many African governments also imposed lockdowns at the beginning of the pandemic. These lockdowns met with mixed reactions; some were positive, but others focused on concerns about the consequences of lockdowns.MethodsIn this article, we use social listening to examine social media narratives to investigate how people balanced concerns about preventing the spread of COVID-19 with other priorities. Analyzing social media conversations is one way of accessing different voices in real time, including those that often go unheard. As internet access grows and social media becomes more popular in Africa, it provides a different space for engagement, allowing people to connect with opinions outside of their own conceptual frameworks and disrupting hierarchies of how knowledge is shaped.ResultsThis article indicates which narratives were favored by different organizations, stakeholders, and the general public, and which of these narratives are most dominant in policy discourses. The range of narratives is found to be reflective of the blindness to inequality and social difference of much decision-making by policymakers.DiscussionThus, contrary to the “we are all in this together” narrative, diseases and public health responses to them clearly discriminate, accentuating long-standing structural inequalities locally, nationally, and globally, as well as interplaying with multiple, dynamic, and negotiated sources of marginalization. These and other insights from this article could play a useful role in understanding and interpreting how social media could be included in pandemic preparedness plans.

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“…Ultimately, a global narrative of crisis facilitates such vertical, top‐down approaches. As MacGregor et al ( 2021 , p. 4) argue, ‘response plans for epidemics that privilege top‐down action have been the norm, and governments have frequently echoed restrictive measures for COVID‐19 as implemented in other global regions’. In preparing for future pandemics, there is a need for deeper understanding of the complex lived experiences of ‘crisis’, which are shaped by, but also are in tension with, these narratives of global catastrophe.…”

Section: Discussionmentioning

confidence: 99%

Contesting the crisis narrative: epidemic accounts in Sierra Leone, Tanzania, and Democratic Republic of the Congo

2022

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In the early months of COVID-19 pandemic, scientists and global commentators watched African countries closely, predicting an impending disaster as the virus was projected to overwhelm already weak health systems. These expectations were informed by imaginaries of Africa as an inevitable site of epidemic disaster. This paper draws on accounts in Tanzania, Sierra Leone and Democratic Republic of Congo to contrast global catastrophe framings with everyday imaginations and experiences of crisis and crisis management. Drawing on ethnographic research, we explore how COVID-19 was understood in relation to previous epidemics, from HIV to Ebola, as well as political conflict. We then consider how global crisis narratives both inform and sit in tension with everyday collective and personal experiences. The paper brings these empirical reflections in conversation with theoretical debates around the discursive construction of crisis and its effects, and argues that these tensions matter because crisis framings have consequences.

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One size does not fit all: adapt and localise for effective, proportionate and equitable responses to COVID-19 in Africa

Cited by 9 publications

References 10 publications

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey

Global narratives on unequal outcomes produced by lockdown in Africa: A social science perspective on the “one-size-fits all” COVID-19 response

Contesting the crisis narrative: epidemic accounts in Sierra Leone, Tanzania, and Democratic Republic of the Congo

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