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%) 9
DEMOGRAPHIC 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 type
KNOWLEDGE 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 11
RISK 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 intensified
ADHERENCE 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 14
KEY 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 16
KEY 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% 18
ACCESS 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 19
KEY 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 21
KEY 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 23
KEY 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 25
KEY 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 takers
CLOSING 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 27
THANK 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 28
THANK 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 29
STAKEHOLDERS 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 30
HUMAN 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 31
UKZN 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 Tandile Nongqoqo Sihalaliso Motha Tiara Maharaj
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