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African countries can fight coronavirus better when citizens encourage one another

A recent survey offers public health insights from Nigeria, Uganda and Kenya

By early September, Africa had recorded more than 1.25 million covid-19 cases. The actual count is probably significantly higher, given low testing volumes in a number of countries. One recent news report details a covid-19 “blind spot” in sub-Saharan Africa, where little data are available, echoing other concerns Africa could become the new epicenter of the pandemic.

When the pandemic spread to the continent, public health officials in Africa drew on their expertise in containing previous outbreaks such as Ebola. Many moved quickly to impose restrictions to contain and mitigate the disease’s spread. But by early May, leaders began lifting the curfews and lockdowns. This means governments rely on citizens to comply with health directives like social distancing and sanitation measures.

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Counting on individuals to follow pandemic directives is tricky. Our April online survey in Uganda, Kenya and Nigeria investigated how individual beliefs and behaviors relate to social norms and expectations of others’ behavior in the pandemic. How willing are individuals to comply with physical distancing? Why do people who can afford to comply with health directives not do so?

Social media users are familiar with best practices

Our online study captures a sample of 2,814 social media users. Similar to other studies of social media users, our sample is more male, more educated and more urban than the general population in these countries. While not nationally representative, our sample provides insights about individuals who can afford smartphones and Internet access, which means they are more likely to have greater access to information. Compared to lower-income individuals, this group would be more likely to be able to afford masks and food delivery and have space to socially distance from their neighbors.

These three countries varied in the number of covid-19 cases and in their governments’ response to the pandemic, as the figure shows.

Cumulative number of confirmed covid-19 cases, through Sept. 6. The shaded areas indicate the time period during which lockdown measures were in place nationwide in Uganda, and statewide in Nigeria. Kenya did not institute lockdowns.
Cumulative number of confirmed covid-19 cases, through Sept. 6. The shaded areas indicate the time period during which lockdown measures were in place nationwide in Uganda, and statewide in Nigeria. Kenya did not institute lockdowns.

Our survey revealed participants are generally well-informed about both the recommended health guidelines and the status of the epidemic within their country’s borders. When asked to report the total number of domestic covid-19 cases, 90 percent of respondents in Uganda and Kenya and 75 percent in Nigeria provided an answer within 10 percent of the official case count at the time.

More than 80 percent of respondents across all three countries report maintaining a distance of 1 to 2 meters (about 3 to 6 feet) from others is a way to reduce the spread of the virus. Respondents also demonstrated widespread awareness of other mitigation strategies such as frequent handwashing and wearing a mask. At the time of the survey, few believed rumors about false ways to avoid transmission, including eating garlic and sleeping under a mosquito net.

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Many did not practice social distancing

Despite awareness of health guidelines, a substantial share of respondents were unable or unwilling to practice social distancing, even during lockdowns. In Uganda, which was under a nationwide lockdown at the time of the survey, 43 percent of respondents had been within 6 feet of individuals outside their household that day. This share was only slightly higher in Kenya (46 percent), where no lockdown measure was in place. In Nigeria, 29 percent of participants in locked-down states were not practicing physical distancing, compared to 46 percent living in states not under lockdown.

A majority of respondents supported government lockdown policies, though support was lower in Kenya and Nigeria (50 percent and 53 percent support, respectively), than in Uganda, where three-quarters of respondents supported the lockdown.

People underestimate others’ support for lockdown

Health officials worldwide have stressed reducing the spread of covid-19 requires everyone to cooperate for the good of the community. However, encouraging compliance may be difficult if people don’t believe their fellow citizens support good health behaviors and policies. We find respondents underestimated other people’s support for a lockdown policy by an average of 6 percentage points in Kenya, by 8 percentage points in Nigeria, and by 21 percentage points in Uganda.

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Peer-to-peer messaging may improve compliance

Our study suggests individuals support lockdown policies and are more observant of health measures than they perceive others to be. That is, they underestimate public support for these important health policies. In classic collective action problems, like energy conservation — where the outcome of a group is better off if everyone works together, even if at a personal cost — you are less likely to contribute to the greater good if you believe others will not do so.

Reinforcing the collective narrative about everyone working together to stem the covid-19 pandemic might be one approach to broaden support for public health policies. In sub-Saharan Africa, health authorities have used peer-to-peer communication to promote health behaviors and prevent the spread of HIV/AIDS. Interpersonal appeals may help inform individuals, personalize risks, and increase compliance with health policies.

More than half of our survey participants were willing to write an anonymous public message to their compatriots encouraging physical distancing. Between 32 and 53 percent of these messages included an appeal for people to work together to end the spread of the virus.

Our research suggests public appeals from fellow citizens — for example in the form of WhatsApp messages, public posts or widespread peer-to-peer campaigns — might encourage more people to comply with pandemic mitigation strategies. Why? These messages show others there is broad public support for covid-19 health policies. They demonstrate friends, family, neighbors and fellow citizens are willing to do what it takes to stop the coronavirus, even if personally costly. These insights about human attitudes and behavior could travel well beyond the three countries in our study.

Clara Bicalho is a PhD student in political science at the University of California, Berkeley.

Melina R. Platas is an assistant professor at New York University Abu Dhabi.

Leah R. Rosenzweig is a postdoctoral fellow at Stanford University.

Read more:

The coronavirus is about to hit Africa. Here are the big challenges.

The World Bank’s 2017 pandemic response fund isn’t working

How can African governments persuade citizens to follow coronavirus guidelines?

Many Africans distrust their governments. How will that affect their coronavirus response?

Covid-19 is accelerating multilateralism in Africa

Here’s why Ebola has been so hard to contain in Eastern Congo