COMMENT: It’s difficult to enforce a lockdown in informal settlements, and social distancing may be impossible. New ideas are needed.
It’s difficult to enforce a lockdown in informal settlements, and social distancing may be impossible. New ideas are needed
, they have enforced countrywide lockdowns. Lower-income countries are beginning to copy this model. Rwanda, South Africa and India are on full lockdown, while Kenya and Sudan are on partial lockdown. Measures implemented by other low-income countries in Asia, Africa and Latin America grow stricter by the day.
A one-size-fits-all approach, however, risks overlooking the enormous differences between rich and poor countries with regard to living conditions, social mores and the availability of resources and services. In particular, the large number of low-income-country residents who live in informal settlements, or slums, will be ill-served by measures that rely on the stockpiling of food, the availability of savings, the ability to work from home and the need to keep your distance even from close relatives.
In these environments, staying at home can itself be a risk. Cramped, often poorly ventilated dwellings housing large numbers of people are potential petri dishes for Covid-19.Queuing to use shared toilets or draw water from wells or boreholes, using crowded public transport or simply walking past others in narrow lanes heightens the risk of exposure.
If informal settlements are locked down and their inhabitants lose access to work, food and other essentials, there will be a risk not only of the coronavirus ravaging communities that contain large numbers of individuals who are vulnerable to its most serious effects, but also of exacerbating malnutrition, increasing the risk of other diseases and plunging millions of people into — or further into — long-term poverty.
Policymakers need tailored rather than uniform approaches to tackling Covid-19 in informal settlements. Here are eight ideas for doing it differently.1. Adapt to the context Just as measures that work to combat Covid-19 in high-income countries will not necessarily be suitable for the developing world, so will blanket measures covering all informal settlements likely be ineffective. A Brazilian favela is very different to a slum in rural Tanzania. An informal settlement in Ouagadougou is different to a Turkish gecekondu or refugee camp.
In rural areas, for example, residents of informal settlements will be better able to implement social distancing measures to contain Covid-19 than their urban counterparts. They will be better able to grow their own food in the event of a prolonged lockdown. Residents of urban slums, on the other hand, may be protected from the virus to some extent by their relative youthfulness and their higher education levels, although vulnerable elderly residents of urban settlements may be more likely to live alone and have weaker support networks than their rural cousins.
There are many other differences between informal settlements that will affect the response to the virus. These relate to the physical environment, the climate, population size, cultural and linguistic factors, crime rates and the presence of gangs, the relationship with the state, intergenerational relationships and so forth. Policies including resource provision, educational messaging, and training and support for community leaders will be effective only if they are adapted to the characteristics of each settlement.
2. Test and tailor education messages Educating the residents of informal settlements about how to avoid infection, what to do if they are infected and how to care for the sick are critical tasks in environments in which state-provided healthcare is
largely or completely absent.Education messages must be appropriate to their audience. They need to speak their language (in urban slums in particular, residents often hail from a number of different ethnic groups or countries and speak many different languages), respond to their concerns, take account of available resources, be distributed through media that slum residents use and counter false information. To transmit messages effectively, moreover, trusted messengers must be deployed, and their buy-in secured.
Although some messages — such as the value of regular handwashing — are universally appropriate (at least where people can access soap) and can be delivered immediately, others will need testing and refining over time.For example, early messages about HIV/Aids in Africa so alarmed people that they created enormous stigma around those people suspected of having the virus. This made people more reluctant to present for testing and helped the disease to spread more quickly. During Sierra Leone’s Ebola
epidemic, researchers discovered that government health workers, who in the early days had been charged with delivering prevention education, were not trusted in many informal settlements. In Sudan, myths about the coronavirus include the protective effect of mangoes, ice cream and previous use of chloroquine for malaria treatment. In the United States, President Donald Trump’s claim that the virus was a hoax has persuaded many people that they have nothing to fear.
Only research can show educators the level of existing knowledge in different populations and help them to develop culturally appropriate messages that will help to combat rather than aggravate the virus. And only research can show them who is best placed to deliver resonant messages in each context — and to different population groups in each context.
3. Don’t expect to eliminate risk People living in informal settlements have much more contact with others than those who live in formal settlements — research inDelhifound they have 50% greater contact duration per day than non-slum residents. Policies that aim to eliminate Covid-19 transmission will, therefore, need to be so draconian that all other activities must cease. For households that bring in only enough income each day to buy a day’s supply of food, the risks of such confinement will be impossible to bear for long.
But although mass self-isolation may be undesirable, more limited containment measures can help reduce transmission. Banning large gatherings at weddings and funerals; persuading religious leaders to postpone services, or at least to hold them outdoors or stagger them to reduce attendance; closing video halls and bars (perhaps allowing the latter to sell take-outs only); and educating people to stand as far as possible apart while queuing are obvious first steps.
Temporary measures to isolate cohorts of people — whereby individuals group themselves into the smallest possible unit that can provide each member with essential provisions and services — can also slow transmission. In Europe the predominant cohort unit is the household, but in informal settlements it might encompass a house, a compound, a street, a block, or even a district or village.
Such cohort units could assign specific dwellings for those people athigh riskof Covid-19 infection (a measure known as targeted quarantining), people who are infected and in need of care, and people who have to leave the unit to work. They could also develop rota systems to reduce the number of members who go out to the market or to fetch water, dispose of sewage, collect mobile payments or use public transport.Read more: Mail & Guardian »
Yes! You'd expect the ANC as self acclaimed leader of society to have thought this through, factored it in their calculus b4 mounting a redemptive mission to reverse & stem the notorious CoronaVirusSA It's wierd how they prescribe remedies not implementable Paldron Maybe if the anc spent money on housing instead of stealing trillions, we would not have this problem
Greatest challenge! Paldron Some good ideas here. I think the whole situation is a work in progress and some things will, and must change. It’s not a failure for government to change its mind about some things as we go along. I realise that they are terrified of an Italian situation, though. Me too. You meant it’s IMPOSSIBLE to enforce a lockdown..
Testisting is the only solution in densely populated areas. Exactly so.
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