London School of Hygiene & Tropical Medicine

“Since the lockdown in Zimbabwe was mandated beginning on March 30th, I take my daily walks to get out of the confines of my house. As the weeks progress, these walks have become…busier. Cars everywhere, people everywhere. My local potato and tomato vendors started reappearing at street corners, attempting to sell their produce. At one point I asked one of the vendors if the lockdown had ended, and I had somehow missed that announcement. No, the lockdown hadn't ended but the need to feed their families and earn some income had intensified. As one vendor gently mentioned ‘kusiri kufa ndekupi’ which loosely translates to ‘we are all going to die anyways’." – Constancia Mavodza

The COVID-19 global pandemic is made up of many local epidemics. The preventative measures, such as lockdowns for physical distancing and handwashing, mean different things for different countries, communities and individuals. How do you successfully implement a lockdown in a country whose economy is largely informal, where lockdown means loss of income, and there is no government safety net? How can regular handwashing be practised with limited access to clean water? How do we identify the context-specific circumstances that facilitate or prevent successful interventions?

As we adapt to existing alongside the threat of COVID-19, these are some of the big questions policy makers have to address. Southern Africa's early HIV era taught us that even when the science is clear, listening to community perspectives is critical to understand local realities and to develop locally effective interventions. COVID-19 poses a grave threat, but so do the implications of prolonged lockdown. The effectiveness of prevention measures such as social distancing and hand hygiene depends on whether  people can afford to practise them.

Given the resource constraints Zimbabweans face daily, the ability for most individuals to follow prevention measures is outweighed by a more tangible need to survive day to day. COVID-19 is a reality, with social, economic and health consequences that have the potential to be wide-reaching and devastating.

According to one community-based organisation we spoke to in our study, “social distancing and hygiene are preached, but there is no way they can be practised” for many in Zimbabwe and other low- and middle-income countries. Social distancing is perceived as a ‘privilege’ that only the rich could afford.

This was the catalyst for our recent work into community perspectives on COVID-19, and the government response, in the first two weeks of lockdown in Zimbabwe, published in published in the Bulletin of the World Health Organization.

We aimed to understand community and health worker perspectives on COVID-19 and Zimbabwe’s policy responses through interviews with community-based organisations and healthcare workers, as well as collating information from social media and news outlets related to COVID-19.

Our study showed that at the beginning of the lockdown in Zimbabwe there was widespread fear and unanswered questions amongst communities, stemming from an overload of information but lack of trusted sources.

Additionally, there was a shocking disconnect between the policies around social distancing and the ability of the community to follow such measures given the limited resources: daily income reliant on physically going to work, access to water at home, and long-term food supplies.

We also found that shortages of PPE left healthcare workers feeling vulnerable, undervalued, which exacerbated existing strikes due to low wages.

COVID-19 is stacking on top of an under-resourced Zimbabwean health system that is sagging under the weight of existing health and economic issues. If the already limited healthcare resources and personnel are redirected solely to aid the fight against COVID-19, the health implications beyond the virus could be wide-reaching and severe. Already we know that access to family planning and antiretroviral therapy is compromised, which are likely to have wide-reaching health and demographic consequences.

So, what can policymakers learn from this work? These findings allow us to provide concrete recommendations, which have been presented to the Zimbabwean Ministry of Health COVID-19 Social Science Taskforce:

1. Provide package of support for households to enable families to stay at home during lockdown, including reviving household water supply, distribution of food packages, and cash transfers
2. Support further research around, and development of, locally appropriate COVID-19 prevention measures, such as improvements in water and hygiene provision and shielding of vulnerable individuals
3. Provide personal protective equipment to healthcare workers
4. Support continuation of provision of key healthcare services, essential medicines and preventative methods
5. Provide coherent, accurate, trusted and targeted information to the public

As the epidemic evolves in different localities, listening to community perspectives and accounting for context-specific realities is critical to design locally appropriate and effective responses to COVID-19.

Publication

C.R.S. Mackworth-Young, R. Chingono, C. Mavodza, G. McHugh, M. Tembo, C. Dziva Chikwari, H.A. Weiss, S. Rusakaniko, S. Ruzario, S. Bernays & R.A. Ferrand. ‘Here, we cannot practice what is preached’: early qualitative learning from community perspectives on Zimbabwe’s response to COVID-19. Bulletin of the World Health Organization. DOI: 10.2471/BLT.20.260224