HSRC Responds to the COVID - 19 Outbreak
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HSRC Responds to the COVID - 19 Outbreak
“Communities are at the heart of any disease
outbreak and health emergency response”
The HSRC launched the project “Street talk-Asikulume” at the end of March 2020 to gather crucial behavioural
data to provide insights into the social dynamics of the South African population’s response to the COVID-19 outbreak.
The HSRC’s rapid assessment of social and behavioural factors is crucial to assist government mitigate the effects of the spreading epidemic.
Engaging communities regarding their knowledge, beliefs, practices and
attitudes in response to the COVID-19 outbreak in South Africa
INTRODUCTION We acknowledge and appreciate the excellent work that has been done with respect to the epidemiology and health care aspects of this disease We also appreciate the extensive work undertaken on the economic impact of the pandemic This survey provides a starting point to balance the country’s response at this tipping point in the fight against the pandemic: the socio-behavioural insights from South Africans
HEALTH PROMOTION AND WELL-BEING FRAMEWORK FOR OUTBREAK RESPONSE ACTION GUIDELINES Health behaviour, health information and health literacy
STUDY METHODS
Study design and population
The HSRC’s research response to the COVID-19 outbreak employed a mixed methods approach with a
Quantitative studies – panel surveys conducted online and telephonically
General population survey 1: Socio-behavioural survey
General population survey 2: Lockdown survey Key
Informant
Healthcare workers survey – www.hsrc.ac.za/heroes Interviews
Youth survey
Data from surveys is benchmarked using the general population Community
Informant
Interviews
demographics based on Stats SA’s mid-year estimates allowing for
generalisability of findings Cape Flats Case
Study
Photovoice
Qualitative studies
Key informant interviews
Photovoice case studies
Social media studies
Study sample
Sample of all South Africans aged 18 years and older communities, including healthcare
workers
Qualitative studies included interviews with informants including teachers, shebeen owners
and sex workers
• Partnerships with UKZN, SAPRIN (Agincourt), Walter Sisulu University, NIHSS and Acumen Media were
crucial for expansion into these communities
ANALYSING THE DATA
The data was benchmarked (weighted) to the distribution of South Africa’s adult population.
The mid-year adult population estimates from Statistics South Africa by age, sex, race, and province is used
in this process. This allows the data to be generalizable to the country.
Source: https://www.healthcatalyst.com/in-pursuit-of-the-patient-
stratification-gold-standard
5
PRELIMINARY RESULTS OF LOCKDOWN SURVEY:
8 – 24 APRIL 2020
MOVING FROM LOCKDOWN TO COMMUNITY
PARTICIPATION, MOTIVATION
AND ENABLEMENT
DEMOGRAPHIC PROFILE BY RACE, SEX AND AGE
Out of a total of 19330 participants, the
majority (70%) were 25-59 years of age
48%
Female
6% 52%
8% 16% Male
Slightly more than half of the
participants were females
Age groups (years)
18 - 24 Population group %
25 - 59 African 78.4%
70%
60 - 69
White 9.6%
Coloured 9.0%
70+
Indian/Other 3.0%
7
DEMOGRAPHIC PROFILE BY TYPE OF EMPLOYMENT
Student
8%
Self employed
Employed informal/part time 9%
Unemployed 37%
Employed full time
10%
• 36% of participants are
unemployed
• 10% had informal/part time
work
• 9% were self employed 36%
8
DEMOGRAPHIC PROFILE BY PROVINCE
Majority of participants were from Gauteng
(28%) & KwaZulu-Natal (18.3%)
9DEMOGRAPHIC PROFILE BY COMMUNITY TYPE
Approximately one third of
participants stated their
community type was a
township (35.1%) and 1 in 5
indicated they were from a
rural community typeKNOWLEDGE ABOUT COVID-19 PREVENTION
Staying 2 meters away from another person 95.5 3.1 1.5
Wearing a mask 85.6 11.3 3.1
Staying away from people who are infected 96.8 1.5 1.8
Not touching my nose, eyes and face 92.7 5.3 2
Washing my hands frequently for 20 seconds 97.4 1.8 0.8
75 80 85 90 95 100 105
Percentages (%)
Yes No Dont know
11RISK PERCEPTION Most participants perceived themselves to be at moderate or low risk
KEY MESSAGE 1
What the findings tell us Logic for change Health promotion strategy:
from data to action health behavior change, health
literacy, information, policy
• Being in the situation of lockdown • If the burden of disease is high • As we lift the lockdown, preventive
could have given 1 in 2 people a and generalised, and mortality is behaviour change has to be
sense of security and so they high, most people will perceive intensified
perceived themselves to be at low themselves at high risk.
• All people of South Africa need to
risk
• When the curve is flattened and take responsibility for their own
• Only 1 in 5 people believe that the burden of disease appears behavior
they are at high risk of infection to be relatively low and • Targeted messages have to promote
mortality low, then most people voluntary behavior actions (hand
will perceive themselves to be at washing, social distancing and
low risk (complacency due to
masks)
lockdown success)
• The tipping point is between the
• We may becomes victims of the epidemiologic, the economic, and
successes gained during the the social/individual behaviors
lockdown if preventive
behaviours are not intensifiedADHERENCE TO LOCKDOWN REGULATIONS:
STAYING AT HOME BY AGE AND COMMUNITY TYPE
I have been at home since the start of lockdown, and have not left 100 Community type
I have had to leave to get food and medicine
I had to leave to collect a social grant 80 73
65 67
I spend a lot of my time visiting my friends and neighbours and 60
Percentage (%)
socialising 60 57
100 49
40 38
80 32 29 27
62 64 65 25 26
60 51 54 20 13 11
0 10
Percentage (%)
39 30 53
40 34 3 2 2 2
30 28
23 0
City Suburb Township Informal Rural Farm
20 12 12
7 63 6 settlement (Traditional
1 1 0 0 tribal area)
0
All ages 18 - 24 25 - 59 60 - 69 70+ 30% had not left home since the start of lock
down and 62% had left to get food/medicine
14KEY MESSAGE 2
What the findings tell us Logic for change Health promotion strategy:
from data to action health behavior change, health
literacy, information
The majority of people adhered This is important to build upon. The message is South Africa you
to the regulations: The country needs to move can do it to save lives. Take control
The results show that 99% from a situation of being in lock of your lives to prevent you, your
either left their homes for food, down to appealing for family and your neighbours from
medicine and social grants or community participation and contracting the Corona virus.
stayed home. invoking the spirit of Ubuntu.ADHERENCE TO LOCKDOWN REGULATIONS:
CONTACT WITH PEOPLE DURING LOCKDOWN
(While you were away from home, how many people did you come into close contact with? (within 2 metres)
Only 20% indicated that
they had not left home,
20%
8% had met with more
than 50 people
29%
8%
9%
12%
23%
1 to 3 people 4 to 10 11 to 20 21 to 50 More than 50 people Have not left home
16KEY MESSAGE 3
What the findings tell us Logic of change Health promotion strategy:
from data to action health behavior change, health
literacy, information, policy and
economic interventions
29% of people reported that It is important to use the psychosocial The message is that South Africans have to
they came into close contact and behavioural determinants to build disrupt their social relations and activities
with 10 or more people during a targeted culturally appropriate in order to save lives, by adopting social
the past 7 days when out of behaviour change approach regarding distancing. Anyone can be infectious with
their homes. social distancing and its meaning in or without symptoms, so everyone needs
the local context. To deconstruct our to have a duty to protect others by
normal lives so as to break the chain wearing a mask whenever out of one’s
15% had to use public of transmission. home. The message is for public transport
transport to get to the shops. to disinfect the taxis and ensure the use of
masks and social distancing inside the taxis
and at taxi ranks. (Enabling messages
about what you can do rather than what
you cannot do).ACCESS TO ESSENTIALS DURING LOCKDOWN:
FOOD Just under a quarter
(24%) of residents had
no money to buy food
We can buy from a shop
within walking distance from 24% 25% More than half (55%) of
my house informal settlement
We can buy from a shop, residents had no money
which I reach using a taxi/bus for food
(public transport)
We can buy from a shop,
About two-thirds of
which I reach using my car
15% residents from townships
We do not have enough also had no money for
money to buy food during the food
lockdown
36%
18ACCESS TO ESSENTIALS DURING LOCKDOWN:
CHRONIC MEDICATION
• Approximately 13.2% of the population indicated that their chronic medication was inaccessible during the
lockdown.
• Approximately 13%-25% of those living in informal settlements, rural (traditional tribal areas) and farms
indicated their chronic medications were not easily accessible.
60 53.1 53.8 51.5
49.9 50.3
50 44.5 45.5
Percentage (%)
40
30.7 30.3
30 25.6 25.3 23.2
18.7 20.3 19.8
20 14.8 14.4 16.3
11.2 12.2 11.8 12.4 11.6 12.7 13.3 13.2
10 7.2 6.5
0
City Suburb Township Informal settlement Rural (Traditional Farm Overall
tribal area)
Community type
Very accessible in the house or village Accessible at a nearby clinic /pharmacy
Accessible at a shop/pharmacy in town Not easily accessible
19KEY MESSAGE 4
What the findings tell us Logic of change Health promotion strategy:
from data to action health behavior change, health
literacy, policy
13% of people reported that Impoverished and remote We need to build a social
their chronic medication was communities continue to face compact to create a new model
inaccessible during lock down, barriers to health care access. between health care system
with over 20% of people from Those people who are struggling to and the local community at
informal settlements and rural/ access chronic medication will also municipal level. The message is
traditional areas reporting that struggle to access services related to take the medicines to the
their chronic medication was to COVID-19. It is important to home. Learn from the Cuban
inaccessible during lock down. relook at primary health care at a experience.
municipal ward level and to re-
examine the role of community
health workers, family caregivers
and youth.DETERMINANTS OF BEHAVIOUR: FINANCIAL CAPABILITY
I feel that the Coronavirus lockdown will make
62.7 14.3 22.9
it difficult to pay my bills/debts
I feel that the Coronavirus lockdown is making
60.3 16 23.7
it difficult to earn my income
I feel that the Coronavirus lockdown will make
57.5 16.7 25.7
it difficult to feed my family
I feel that the Coronavirus lockdown is making
45.1 23.2 31.7
it difficult to keep my job
0 20 40 60 80 100 120
Percentages (%)
Agree Neutral Disgree
21KEY MESSAGE 5
What the findings tell us Logic of change Health promotion strategy:
from data to action health behavior change, health
literacy, information, economic
and policy
Between 45% and 63% of people Structure the package and expand the The message is that the government
reported that the lock down would reach of the government’s economic and society as a whole acknowledges
make it difficult to pay bills, debts, and social relief programmes, in a way that some communities are struggling
earn income, feed their families and that every person feels that they are and people may have no money to
keep their jobs. Additionally, 26% of being taken care of, and in a way that buy food
people reported that they had no is accountable at all levels with
Create a social compact with
money for food. immediate consequences for communities and the public and
violations. private sector, to ensure sustainable
financial and social relief. This should
include promoting intergenerational
cohesion, sustainable food banks at
the level of the district.ADHERENCE TO LOCKDOWN REGULATIONS:
ACCESS TO ALCOHOL AND CIGARETTES
Cigarettes were more accessible than
alcohol during lockdown. A quarter of
people from informal settlements were
able to buy cigarettes during lockdown.
25 24
20
16
Percentage (%)
15
12
10 10 10
10 8
7 7 7 7 7 7
6
4 4
5 3
3 2 2
1
0
Overall City Suburb Township Informal Rural (Traditional Farm
settlement tribal area)
Able to buy alcohol Able to buy cigarettes Able to drink alcohol with your friends
23KEY MESSAGE 6
What the findings tell us Logic of change Health promotion strategy:
from data to action health behavior change, health
literacy, information, policy
Cigarettes (12%) were more One in five people in South This highlights the need for
accessible than alcohol (3%) Africa currently smoke, and tobacco control interventions
during lockdown. A quarter of approximately one in ten to prevent illicit trade and
people from informal smokers were able to access smuggling. The results also
settlements were able to buy cigarettes during lock down. call for better regulation of
cigarettes during lockdown. The continued access to tobacco sales in informal
cigarettes in informal markets.
settlements could imply
informal trade.EXPERIENCE WITH LAW ENFORCEMENT
I have not been involved with them at all 74.8
I have been treated badly and in a very
14.7
rough/rude manner
I have been treated fairly well 7.0
I have been treated very well and in a
3.5
respectful manner
0 10 20 30 40 50 60 70 80
Percentages (%)
The overwhelming majority of residents (75%) had
no interaction with law enforcement, 14.7% of the
residents indicated that they were treated badly
25KEY MESSAGE 7
What the findings tell us Logic of change Health promotion strategy:
from data to action health behavior change, health
literacy, information, policy
The majority of people were not The speedy introduction of Provide clear guidance and
involved with law enforcement at regulations without guidance support to people so that they
all and support sets people up for are able to adhere to regulations
15% of people were treated failure Acknowledge that it is difficult
badly/roughly Need to be sensitive to the for people to make these major
major disruption to people’s lives changes willingly in order to
In order to ensure that the law is protect their families and
enforced, they play multiple communities
roles (education and Law enforcement should be
information, enforcement laws, provided with clear guidelines
social support) and support to enable them to
deal with intentional violators
and risk takersCLOSING REMARKS
We are in a moment of psychological crisis, the situation is immediate.
We have empirical data that shows goodwill, solidarity and Ubuntu
South Africans are saying “we have your back” however
Medium term there will be challenges and we will be more open to scrutiny and
debate
The difficulties in accessing essentials such as food and medicines will erode goodwill
• The survey has shown that we have a window of immediate opportunity
- Prof Crain Soudien
27THANK YOU
Thank you to South Africans for sharing their views, perceptions
and thoughts with us by participating in the survey and for
sharing the survey link with their networks
28THANK YOU
Undertaking a project rapidly in the face of a public health emergency requires a strong
collaborative team working under pressure to provide the country with important
socio-behavioural and social data.
Thanks are due not only to HSRC staff across the organisation, but also to key partners
in implementing the survey
Thank you to influencers and media personalities for encouraging participation of the
survey and recording public health messaging
Thank you to the Department of Science and Innovation for your ongoing support and
strategic direction, particularly DG Phil Mjwara and DDG Imraan Patel and their staff
29STAKEHOLDERS AND PARTNERS
University of KwaZulu-Natal
Walter Sisulu University
KwaZulu-Natal Department of Health
South African Population Research Infrastructure (SAPRIN)
South African Population Research Infrastructure (SAPRIN) Agincourt
Harambee Youth Employment Accelerator
Banking Council
First National Bank
Acumen Media
Research and Academia for supporting the survey through extensive networks
BINU/Moya Messaging platform
National Institute for the Humanities and Social Sciences (NIHSS)
Government Communication and Information System (GCIS) and their networks and partners
Higher Health
Communication Cluster Advisory Group
Anti-COVID-19 group facilitated by University of KwaZulu-Natal
HIV and TB Healthworkers Hotline
30HUMAN SCIENCES RESEARCH COUNCIL
Prof Priscilla Reddy Dr Natisha Dukhi Ms Lehlogonolo Makola Ms Thembokuhle Mkhwanazi
Prof Crain Soudien Mr Mmakotsedi Magampa Ms Thelma Oppelt Ms Jill Ramlochan
Prof Leickness Simbayi Dr Shandir Ramlagan Dr Razia Gaida Mr Simphiwe Zondi
Prof Khangelani Zuma Ms Konosoang Sobane Mr Mohudi Mpayana Ms Sue Samuels
Dr Glenda Kruss Ms Ronel Sewpaul Dr Thabang Manyaapelo Ms Khanya Vilakazi
Dr Sizulu Moyo Ms Estelle Krishnan Ms Khanyisa Mkhabele Ms Sinazo Ndiki
Ms Yolande Shean Ms Monalisa Jantjies Ms Noloyiso Vondo Ms Nokuzo Lawana
Dr Gerard Ralphs Ms Vuyiseka Mpikwa Mr Lebohang Makobane Ms Sharon Felix
Dr Donald Skinner Mr Derrick Sekgala Ms Tenielle Schmidt Ms Tshegofatso Ramaphakela
Mr Michael Gastrow Mr Sintu Mavi Ms Phila Dyanti Mr Samela Mtyingizane
Prof Sibusiso Sifunda Ms Lelethu Busakwe Ms Philisiwe Ndlovu Mr Benelton Jumath
Dr Allanise Cloete Ms Anele Slater Mr Seipati Mokhema Ms Thobeka Zondi
Ms Manusha Pillai Mr Adlai Davids Ms Nokubonga Zondi Ms Ndiphiwe Mkuzo
Ms Alicia North Mr Viwe Sigenu Mr Puleng Hlanyane Mr Ngqapheli Mchunu
Ms Ilze Visagie Dr Jacqueline Mthembu Mr Nangipha Mnandi Ms Nandipha Mshumpela
Dr Inba Naidoo Ms Audrey Mahlaela Mr Managa Rodney Mr Adziliwi Nematandani
Ms Antoinette Oosthuizen Dr Whadi-ah Parker Dr Tholang Mokhele Ms Charlotte Nunes
Dr Finn Reygan Mr Luthando Zondi Dr Gina Weir-Smith Mr Snethemba Mkhize
Ms Andrea Teagle Dr Musawenkosi Mabaso Mr Frederick Tshitangano Ms Zodwa Radasi
Ms Kim Trollip Ms Juliet Mokoele Ms Feziwe Mseleni Ms Phumla Dladla
Ms Goitseone Maseko Mr Sean Jooste Ms Sinovuyo Takatshana Ms Yamkela Majikijela
Mr Antonio Erasmus Dr Jeremiah Chikovore Mr Xolisa Magawana Ms Bongiwe Nxele
Dr Saahier Parker Mr Noor Fakier Ms Octavia Rorke Mr Melton Kiewietz
Ms Erika Lewis and team Ms Marizane Rousseau Ms Claudia Nyawane Mr Diederick Terblanche and team
Ms Lindiwe Mashologu Ms Lee-Ann Fritz Ms Faith Ngoaile Prof Alastair van Heerden
Mr Phillip Joseph & team
31UKZN STAFF, VOLUNTEER MEDICAL STUDENTS AND AGINCOURT STAFF
Prof Mosa Moshabela Athisiviwe Macingwane Excellent Nkune Siphamandla Nkosi Prof. Stephen Tollman
Dr Nisha Nadesan-Reddy Athisiviwe Macingwane Nosihle Hlophe Mohamed Suleman Prof. Kathleen Kahn
Weziwe Ngophe Camille Simone Matthews Mxoli Xulu Prof. Francesc Xavier Gomez-Olive
Sihle Dayimani
Zinzi Melody Nkwanyana Celeka Ndamase Luyanda Dube Daniel Ohene-Kwofie
Celinhlanhla Mngomezulu
Zinhle Mzobe
Xolani Ntembe Philani Mbhele Zamanthusi Miya Pedzisai Ndagurwa
Charles Arineitwe Sihle Dayimani
Gugulethu Shange Mphilisi Siyaya Ngonidzashe Ngwarai
Cheshni Jeena
Kiara Ramauthar Sphiwo N Tom Sibabalwe Dobe Mercyful Mdluli
Gcinile Masondo
Kwanele Mcunu Ncebakazi Mbiko Zanele Cossa
Hawa Chandlay Christen-Joy Winnaar
Loueen Thiessen Sandiswa Mdlalana Nkateko Nyathi
Khumbulani Mlambo Ayanda Ndlovu
Lungelo Ntuli Lindokuhle Mbambo Lizo Mdolo Wisani Maphanga
Hluvuko Ndindani
Lungelo Mambane Mbalenhle Mzimela Mgayi Cwangco Corlia Khoza
Justine Govender
Naeema Suleman
Lusanda Magwenyane Mkentane Zizipho Annelie Lubisi
Rishay Dayalal Anelisa Kani Sinentlahla Qadi
Mthobeli Mntuyedwa Thandiwe Hlatswayo
Amina Ahmed Azizipho Nobanda Bongani Mafuleka
Musawenkosi Mthembu Polite Thibela
Gugulethu Shange Naomi Beth Conolly Caitlin Govender Philile Madela
Monareng Nester
Kwanele Mcunu Nduduzo Eric Nxumalo Khadija Gannie Atiyyah Ameen
Theodorah Mnisi
Lindelani Sithole Philasande Dube Mliya Ali Nozuko Lawana Sagwati Malumane
Loueen Thiessen Phindokuhle Mathenjwa Navitha Singh Samela Mtyingizane Solly Ndlovu
Lungelo Ntuli Priyanka Sria Chetty Zinhle Mzobe Mohundi Mpyana Simon Ndzimande
Lusanda Zwane Reena Panicker Zahrah Timol Mkhize Minenhle Prosperous Mlangeni
Minenhle Gumbi Robyn Milton Zamambotho Mabozo Teddy Monde Ngobese Agnes Themba
Minenhle N. Mthembu Sibiya Sinethemba Toni Renton Yolanda Wyatt Safira Sibuyi
Noluthando NM Phehle Sifiso Siboniso Zondi Xolani Ntembe Siyabonga Mtshali Thuli Wavele
Nonhlanzeko Ndlovu Sinenhlanhla Mthembu Sne Thobeka Mkhwanazi Snakhokonke Makhanya Iyander Ngobeni
Rishay Dayalal Siphelele Zondi Thamsanqa Zakwe
Sphamandla Nkosi Thandeka Magubane
Sabelo Moyana
Sunhera Sukdeo
sibongokuhle sithole Thandeka Nkambule
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