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UKCDR safeguarding seminar

Understanding safeguarding in international development research: The process and intricacies involved

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By Lynda Keeru

On 1 July 2020, UKCDR hosted a webinar titled, “Preventing harm in research – safeguarding in international development research.” The webinar came a few months after UKCDR’s launch of the guidance on safeguarding in international development research in a bid to ensure the highest safeguarding standards in this context.

UK funders of international development research worked with UKCDR to develop a set of principles and best practice guidance on safeguarding to anticipate, mitigate and address potential and actual harms in the funding, design, delivery and dissemination of research.

This webinar, targeted at the international development research community, aimed to:

In the link provided, you see an agreed definition of ‘safeguarding’ as:

Any sexual exploitation, abuse and harassment of research participants, communities and research staff, plus any broader forms of violence, exploitation and abuse relevant to research such as bullying, psychological abuse and physical violence.

There was however a caveat on the fact that this definition was agreed on by UK funders and expert advisory groups and specific to the research context.

What does the guidance do?

The guidance supports all who are involved in the research processes to anticipate, mitigate and address potential and actual harms in the funding, design, delivery and dissemination of research. Safeguarding processes face various challenges in the international development research realm; some of which were outlined as safeguarding falling between the cracks and the idea that safeguarding was something for NGOs rather than academia.

At the breach of safeguarding guidelines, several things come to play that inhibit the reporting of these issues including:

  • Attitudes of colleagues and supervisors, concerns about being a ‘good’ fieldworker
  • Concerns about career prospects and fear of jeopardizing research
  • Rights of victims/survivors and whistle-blowers

Equity and fairness, transparency and accountability and  good governance were the key principles of safeguarding that were outlined in the webinar.

Among the key speakers were Sally Theobald and  Bintu Mansaray both of whom are part of the ARISE consortium which also contributed to the UKCDR guidelines. Sally highlighted that ARISE has written their experiences of preventing and addressing safeguarding concerns and practices, process and positionality in marginalized spaces as a practice paper in the BMJ Global Health. It is a jointly authored paper that draws on the experiences of everyone across ARISE. She ran the participants through what was in the paper and said that it featured safeguarding and global health and vulnerability as relational concepts. The paper delves into the realities of informal urban contexts, where we see the intersections of inequity play out and how they are shaped by gender, class, sexuality, disability as well as unequal power relations.

The paper also outlines the different steps undertaken in ARISE to develop a shared approach to safeguarding as well as the key learnings which includes how safeguarding, ethics and health and safety concerns overlap, the challenges of referral and support for safeguarding concerns within frequently underserved informal urban spaces and Importance of reflective practices and critical thinking about power, judgement and positionality and decolonization.

Bintu pointed out that ARISE started by asking all the countries in the consortium to outline the existing policies of safeguarding which fed into the safeguarding policy that was developed. They also set up a training to give researchers a feel of what safeguarding was, followed by country teams brainstorming on the meaning of safeguarding in their contexts and developing equivalents of the term in their local languages. This provided a unique opportunity to see the similarities and differences on safeguarding issues in the different contexts (between Kenya, Sierra Leone, India and Bangladesh). She concluded by saying:

The UKCDR guidelines act as a guide and then as ARISE, we contextualize them to fit our different contexts.

Sally wrapped up the session with saying that safeguarding just like ethics is not a tick box exercise. It is an ongoing, critical and reflective journey that includes partnerships, participatory processes and building of trust. The process needs to speak to the key values that come through in the guidance of equity transparency, accountability and having the different vulnerable groups at the heart of the process. It is vital for everyone to understand that everybody has a role to play when it comes to safeguarding.

Webinar contributors:

Safeguarding in International Development Research – Presentation by Sheila Mburu, Research & Policy Officer, UKCDR

Developing and applying the UKCDR safeguarding principles and guidance – Presentation by Linnea Renton, Research Fellow on Safeguarding, Antislavery Knowledge Network, University of Liverpool

Reflections on safeguarding – Presentation by Sally Theobald and Bintu Mansaray on behalf of ARISE hub

 

 

Haja in PPE for health workforce

Celebrated but not supported: The need for a gender equitable health workforce

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By Lynda Keeru

On May 24th 2020, CNN published an article titled “Coronavirus is killing more men. But the lockdown is disastrous for women and their rights.”

“The novel coronavirus seems to be more deadly for men. But in many other ways, women are bearing the brunt of this pandemic. From a spike in domestic violence and restricted access to family-planning services to disproportionate economic impact, the lockdown measures put in place to stop the outbreak are hurting women and their basic rights a lot more than men. Previous epidemics of Ebola and Zika have resulted in major setbacks for women and girls in the regions most affected by the outbreaks — and experts and activists are warning the same thing is happening globally right now,” CNN London.

The article’s theme is similar to a webinar hosted on 22 May 2020: Masked Heroines? Building Resilience Begins with a Gender-Equitable Health Workforce. In this webinar, we heard that 70% of the health workforce is still made up of women and only 25% of senior global positions are held by women.

COVID-19 response in Sierra Leone

Dr Haja Wurie, a health systems’ researcher who is part of the ARISE Consortium spoke about COVID-19 in Sierra Leone and highlighted the lessons learnt from the Ebola outbreak that also affected her country.

“Health Care Workers are tired of being celebrated and not supported. They are often likened to frontline soldiers which begs the question of why we send them to the frontlines without preparing them,” was her opening statement.

In Sierra Leone, many patients are asymptomatic and once identified, they are isolated and managed in community health care centres which is something that was started during the Ebola outbreak. The challenge with this is that some of these patients are in denial about testing positive because they have no symptoms, and this makes them largely uncooperative. Women health workers, who predominate in Sierra Leone, face the challenges of supporting different patients in this new pandemic.

Almost all the frontline workers interviewed, are facing psychological stress and an increased fear of contracting COVID-19 but essentially what is the scariest for them is passing the virus on to their loved ones. For this reason, psychosocial support should be offered to all health workers at all levels including community health workers. Primary health workers are so important because they bridge the gap between communities and health systems. We also have to ensure that we have supportive supervision in place that uses problem solving approaches to  respond to health care workers’ different gender needs. Supporting health workers helps in building trust.

Having been part of both the Ebola and COVID-19 pandemic, Haja was engaged on what she thought was the best way to prepare for future pandemics.

Community engagement is vital: The voices of the right people need to be heard and captured; including bringing the importance of  gender in the conversations. Right from the onset, the right stakeholders who bring the right perspective to the table should be engaged and should be in the conversation well into the policy formulation and implementation stages. Their voices should be heard and brought to the table (and not just paying lip service). It is vital to ensure that gender dynamics are considered in policy development, formulation and implementation process.

Noteworthy, she advised that what they do with the ARISE research consortium should be replicated in  as many countries as possible. ARISE works in partnership with vulnerable groups in informal settlements, together building platforms to speak on their priorities and what is required for them in terms their health and wellbeing. This should ensure that decisions made at the highest levels are informed by evidence and that marginalized voices are captured using a gender lens. Data should be disaggregated by gender.

COVID-19 response in India

Dr Sneha Krishnar from India highlighted that ASHAs (Accredited Social Health Activists) have been going house to house carrying out surveillance since the onset of the COVID-19 pandemic. The use of digital technologies to help the ASHAs do their work was being tested. Zoom is being used by public health officials to pass information on COVID-19 to the ASHAs and they are in turn expected to use WhatsApp and Facebook to disseminate information as well report their findings to their respective health centres. In addition, it has also become mandatory for them to download the contact tracing app by the government.

The challenge however is that most of them (less than 25% of those interviewed) own smartphones. This then makes them rely on their husbands and sons to download the apps so that they can attend these calls and provide their daily reports. This disempowers them and is a hurdle in their work. With the right enabling environment, digital tools can aid community health workers to deliver in their work and it is hence imperative to empower ASHAs with the means and technology to carry out their work themselves.

The realities for health care workers

Michelle McIsaac from the World Health Organization noted that there’s a lot of recognition of health workers at the moment but the truth for them is that it really is a lot of hard work. Women make up the majority of the health workforce, and are unfortunately the ones that are least paid and put to serve on the least secure roles in the health system. There’s a fear that the shortage in Personal Protective Equipment (PPE) will affect some groups of health workers more than others. We need to address the burden of care that women face not just in the work place but also domestically because we know that much of the domestic care falls on women as well. Women who are health care workers are dealing with increased responsibility both in their homes and at work. These are very challenging times for them as they attempt to find balance.

Gender data gap

Shirin Heidari, who was the last of the speakers, talked on a very vital topic: the gender data gap and how to close it. Due to the fundamental gender implications of this pandemic, it is critical that we  collect and ensure that we have accurate gender data to inform our policies and guide our actions. Unfortunately, when it comes to health care workers, we have very little data. For example, countries are not producing data on COVID-19 infection rates and mortality rates among health workers. In some settings we have up to 20% of health workers infected but this data is not released. Data from Italy and Spain for example, show that among infected health workers 60-70% of them are women and this excludes health care workers outside the formal heath care workers as well as workers within the health system that are not counted as health care workers. Moreover, we are limited on data that captures the experiences of health care workers like their experiences with violence, sexual harassment stigma and discrimination.

We are aware that that COVID-19 affects health workers in different ways. For instance, we all know that COVID-19 is a potent stressor yet we have very little data on how it impacts female frontline health workers who are exposed to a lot of stress over the long period of time. Female health workers are likely to feel it more due to their caregiving roles. A study from the early period of the epidemic in China shows that female nurses, frontline health workers working with COVID-19 patients have a higher risk of mental health concerns and report much more severe degrees of mental health symptoms such as severe depression, anxiety, insomnia and distress in comparison to other health workers. There is need for accurate data and not just quantitative, but also qualitative and experiential data if we are to really understand all the dynamics and nuances fully and formulate evidence based policies. She concluded by saying, “I think we need to apply feminist perspective in data collection.”

In the face of the COVID-19 crisis, existing gender inequalities may worsen, as was seen in previous large-scale health shocks such as the 2014-2016 Ebola epidemic. To avoid this, gender must be a key consideration when implementing the COVID-19 response.

Participation and power being explored through people drawing on flip charts

How do you navigate power dynamics Participatory Health Research? We need your expertise!

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We invite you to join in a conversation, via a participatory online workshop, to discuss and explore power, power sharing and empowerment in Participatory Health Research.

Whether you are involved in Community-Based Participatory Research (CBPR), Participatory Action Research (PAR) or any other approach that aligns with participatory principles, we are interested in your views and experiences. We would like to involve researchers from the community, from academic institutions, from health systems and other related organisations, and to gather global perspectives on power while focusing on under-represented voices from the Global South.

The online workshops will take place at the following times:

Workshop Date Time (GMT) Language Region
1 1 June 12:00 – 14:00 English Asia
2 2 June 14:00 – 16:00 English Africa
3 3 June 14:00 – 16:00 English US/Europe
4 9 June 15:00 – 17:00 Spanish Latin America

If you are interested in taking part or would like to find out more information, please contact Beatrice Egid at 194711@lstmed.ac.uk (@beatrice_egid) or Kim Ozano at kim.ozano@lstmed.ac.uk (@Kim_Ozano) indicating which workshop you would like to take part in. If you are unable to attend any of the workshops but would like to contribute, please get in touch – we are also encouraging written responses to key questions.

Through these workshops, we aim to understand how empowerment and power sharing are defined, addressed and monitored in Participatory Health Research. These insights will feed into a wider research agenda, in collaboration with the International Collaboration for Participatory Health Research, to develop a Monitoring and Evaluation framework to assess power dynamics in participatory processes. This framework will help donors, communities and researchers to track progress against participatory principles, and to demonstrate how power is shared and to what extent empowerment has been realised.

methods

Remote research methods to use during the COVID-19 pandemic

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Kate Hawkins, Jessica Amegee and Rosie Steege

The COVID-19 pandemic has unsettled the world as most countries were not prepared to face such a wide and disruptive event, with very little knowledge of how things would progress at the onset. As the pandemic continues to impact societies – organisations and communities are dealing with challenges on an unprecedented level. This exceptional situation shakes how organisations and communities are working together throughout the world.

Researchers and implementers, who are closely working with communities using participatory methods are facing a difficult time in maintaining their work and collaboration. The restrictive and protective measures put in place across most COVID-19 affected countries, from a partial to total lockdown, have an impact on their working methods. Because most of these methods require direct social interaction, physical distancing, quarantines, and the like raise questions about the continuity of operational or participatory research. Many have moved towards the use of online and other remote tools as a solution.

This pandemic can be seen as an opportunity to consider new ways to maintain links with communities, especially marginalised populations, who struggle to cope financially, mentally, or physically with this crisis and to comply with restrictive measures, even on a short term.

Online and remote research tools have been used for some time, but their importance is growing to mitigate challenges in operational and participatory research.

Many people wonder how to navigate their research in these troubled waters while guaranteeing digital safeguarding. Resources and ideas are spreading around several networks about how continue to undertake field work, collecting data in the best and most appropriate ways. From audio messaging, live stream apps to social media, some interesting resources are listed below to hopefully help you and others find some answers to many questions and instill creativity in research methods. We need to develop this type of research resilience as the COVID-19 pandemic is unlikely to be the last event to cause such large-scale disruptions.

General

Fieldwork in the Times of COVID-19: Doing Ethnography During a Pandemic

Raul Pacheco-Vega

http://www.raulpacheco.org/2020/03/fieldwork-in-the-times-of-covid-19-doing-ethnography-during-a-pandemic/

Disturbing the Aesthetics of Power: Why Covid-19 Is Not an “Event” for Fieldwork Social Scientists

Aymar Nyenyezi Bisoka

https://items.ssrc.org/covid-19-and-the-social-sciences/social-research-and-insecurity/disturbing-the-aesthetics-of-power-why-covid-19-is-not-an-event-for-fieldwork-based-social-scientists/

Field research in lockdown: revisiting slow science in the time of COVID-19

Zahra Hussain

https://blogs.lse.ac.uk/wps/2020/04/29/field-research-in-lockdown-revisiting-slow-science-in-the-time-of-covid-19/

Doing Fieldwork in a Pandemic

Crowdsourced document initiated by Deborah Lupton (@DALupton, d.lupton@unsw.edu.au) on 17 March 2020

https://docs.google.com/document/d/1clGjGABB2h2qbduTgfqribHmog9B6P0NvMgVuiHZCl8/edit#heading=h.9n5gzs5twud3

NB: Deborah also curates a community Facebook page ‘Innovative Social Research Methods’ which may be of interest for those wanting to think about new and creative ways of doing social research: Innovative Social Research Methods Public Group

Covid-19: Guide to community engagement at a distance

Short guide by BBC Media Action on behalf of Shongjog, the national platform for Communication with Communities in Bangladesh

https://www.dropbox.com/s/ao086yqa6un3mcq/Community%20engagement%20from%20a%20distance%20-%20EN.pdf?dl=0

Guidance for National Societies on safe and remote risk communication and community engagement during COVID-19

IFRC

https://communityengagementhub.org/wp-content/uploads/sites/2/2020/04/Safe-and-remote-social-mobilization-guide-COVID19_FINAL.pdf

Tips for Engaging Communities during COVID-19 in Low-Resource Settings, Remotely and In-Person

IFRC

https://communityengagementhub.org/wp-content/uploads/sites/2/2020/05/CE-low-resource-settings-distance-April-2020.pdf

Creative Research Methods, Dr Helen Kara

Part of the Qualitative Expertise at Southampton (QUEST) seminar series

https://www.youtube.com/watch?v=7PgWTVL92RM

COVID-19 & Virtual Fieldwork

Nvivo

https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/resources/on-demand-webinars/covid-19-and-virtual-fieldwork

Making design research work remotely

Futuregov

https://docs.google.com/presentation/d/1T0sjyDlvCRJG95q9LYmPiPaU8baLG7L2IQwRpNsfq2M/edit#slide=id.g4e808df0f1_2_208

Ethical concerns

Violence against women and girls data collection during COVID-19

UN Women

https://www.unwomen.org/en/digital-library/publications/2020/04/issue-brief-violence-against-women-and-girls-data-collection-during-covid-19

Phone surveys in developing countries need an abundance of caution

Subha Mani, Bidisha Barooah

https://www.3ieimpact.org/blogs/phone-surveys-developing-countries-need-abundance-caution

Considerations for Doing Intimate Partner Violence Research in the Time of Coronavirus

Innovations for Poverty Action

https://www.poverty-action.org/blog/considerations-doing-intimate-partner-violence-research-time-coronavirus

Remote data collection on violence against women during COVID-19: A conversation with experts on ethics, measurement and research priorities

UNICEF

https://www.unicef-irc.org/article/1997-remote-data-collection-on-violence-against-women-during-covid-19-a-conversation-with.html

Remote data collection on violence against children during COVID-19: A conversation with experts on research priorities, measurement and ethics (Part 2)

UNICEF

https://www.unicef-irc.org/article/2004-collecting-remote-data-on-violence-against-children-during-covid-19-a-conversation.html

Ethnography

Ethnographic methods for a time of lockdown and distancing

A Tweet thread by Julia Leser

https://twitter.com/_jleser/status/1240310808132886528

Digital and Online Ethnography – A Selection of Resources
Philipp Budka’s blog

http://www.philbu.net/blog/digital-and-online-ethnography-a-selection-of-resources/

Resources on online ethnography

A google doc curated by Philipp Budka, Heikki Wilenius, Rano Turaeva, Jordan Kraemer and Rachel Irwin

https://docs.google.com/document/d/1OrVaVQi_UPA54eUX8u-mVbUZpUHsNxG5VCfGDRF-Hu0/edit#heading=h.btb7ooxp8lx4

Sarah Pink: Digital Ethnographies

University of Copenhagen video

https://video.itu.dk/video/21489832/sarah-pink-digital-ethnography

Phone and Skype interviews

Best practices for conducting phone surveys

Poverty Action Lab

https://www.povertyactionlab.org/blog/3-20-20/best-practices-conducting-phone-surveys

12 Pro Tips for Digital Interviews and Interactions

Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University

http://regnet.anu.edu.au/news-events/news/7831/12-pro-tips-digital-interviews-and-interactions

Phone Interviewing as a Means of Data Collection: Lessons Learned and Practical Recommendations

Forum: Qualitative Social Research

http://www.qualitative-research.net/index.php/fqs/article/view/959/2094

Skype as a Tool for Qualitative Research Interviews

Sociological Research Online

https://warwick.ac.uk/fac/soc/al/people/mann/interviews/paul_symonds_-_skype-research-method.pdf

For PhD students

Virtual not Viral

Blog created to support PhD researchers in the light of the COVID-19 pandemic

https://www.virtualnotviral.com/

Acknowledgements

Some of these resources were highlighted by Twitter accounts such as @PascaleAllotey, @giannagayle, @a_peterman and @RosemaryJMorgan 

We are also grateful to the Gender and COVID-19 Working Group for their sharing of expertise on the ethics of remote inquiry into gender based violence during the pandemic.

 

JPG SPH flyer advertising vulnerability webinar

Prioritising the most vulnerable in the COVID-19 response in low- and middle-income countries

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By Lynda Keeru

COVID-19 has thrown the world into disarray and devastated people, families, communities and systems around the world. It has not spared anyone; it’s gone for migrants, refugees, health care workers – ordinary people trying to make a livelihood for themselves and their families. However, as much as COVID-19 poses a threat to everyone, some groups of people will bear the worst brunt yet; these being the poorer communities. This blog will focus on the urban poor.

The James P Grant School of Public Health, BRAC University hosted a webinar on 14 May 2020 – The Impact of COVID-19 on Urban Informal settlements. Something that stood out from a couple of the presentations was the fact that most of the measures to prevent the spread of the virus and the messages that are disseminated to the public are elitist. They assume people live in the best conditions and are underpinned by ‘one size fits all’ assumptions.

Measures put in place by governments to counter COVID-19

Some of the measures put in place by the governments from the three countries that were featured in the webinar (Kenya, India and Sierra Leone) were very similar. These include hand washing, encouraging people to keep their physical distance, cough etiquette and the wearing of masks. Physical distancing, for example, assumes that everyone has enough space while the reality is that the urban poor often live in overcrowded informal settlements that lack essential services. Hand washing for the recommended 20 seconds using running water is far fetched for this group of people because they live in places that have limited access to water and sanitation.

The urban poor are among those who will be disproportionately affected by the pandemic. During the webinar, a young man asked, “Is there any way that the masks can be distributed for free? Because at my area, they are being sold at a price of 50Ksh ($0.5)), which is seriously affecting the vulnerable.” Dr Lilian Otiso from Kenya explained that many people can genuinely not afford to buy masks because all that their money can do is place some food on the table and many are the times when even this becomes impossible.

Challenges facing the urban poor

Many of the challenges the urban poor face have been heightened. For instance, with a history of poor access to health systems, they now find themselves much further away from these services and with limited or no access to care. Gender based violence is on the increase and crime and violence from law enforcers exacerbated. The pandemic has also aggravated the already horrible state of unemployment with many of the urban poor losing their jobs. Many small and medium businesses have closed down and many livelihoods lost. For instance, due to the nature of the work they do, the waste picking communities from India had no time to prepare or save any money to manage their daily needs during the lockdown. This has left them worried about going hungry and taken a toll on their mental health and physical wellbeing.

Civil society and private sector involvement

As part of the response, many NGOs and CSOs are carrying out relief work and trying to mitigate the suffering of these communities. They also remain the main point of contact when it comes to sourcing information. LCVT Health in Kenya for example has been sending bulk SMS to clients to reinforce the COVID-19, HIV and gender-based violence messages, educating the communities through Community Health Workers, peer educators and mentors. They have also been hosting webinars with youth, informal settlement dwellers and collecting data and credible evidence on COVID-19.

Lessons learned

Some lessons drawn from previous pandemics like Ebola, and even from the early stages of COVID-19 are that in order to mitigate the horrendous effects the virus will have on vulnerable communities there is need to implement a socially equitable approach to the crisis. The response needs to be holistic and all-inclusive with solutions coming from governments, communities, civil society organizations, and the private sector.

Varun Sai and Smruti Jukur from India highlighted that collective bargaining, facilitated through local social networks have largely been the pillar of strength. Abu Conteh and Samuel Saidu from Sierra Leone also drew attention to the fact that community groups are providing leadership for providing social control during emergencies, coordinating distribution of water and food vouchers to vulnerable communities during lockdowns as well as monitoring movement of strangers to avoid spread of disease. These systems and organizations have been especially instrumental for high-risk and vulnerable populations.

Dr Hussein Zillur Rahman from Bangladesh put a lot of emphasis on the importance of accurate, simple communication to avoid misconceptions and myths. He reiterated that a lot of thought needed to be put in the messaging around the pandemic. He challenged the participants to translate and package all the information shared during the webinar into products that can be used to influence policy development. Communications efforts need to be paired with a simplified delivery process.

The speakers highlighted the many lessons drawn especially for use in the event that other pandemics struck in future. Emergency measures must be pro-poor like the provision of water and social protection measures. There is need to plan and develop informal settlements to address health and sanitation priorities and most importantly, utilize data generated from community groups to inform the interventions. Additionally, inclusiveness is paramount for better planning and prevention.

COVID-19 is a shared global challenge and we need a global effort to fight this pandemic and it is important to prioritize the most vulnerable people in the response if we are to change the trajectory of this crisis.

Villa Nueve in Guatemala

Recommendations from Guatemala to urban municipalities responding to COVID-19 in low- and middle-income countries

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By Guillermo Hegel with support from Yaimie Lopez and Kim Ozano

Local governments need to review their strategies so that they pay more attention to the wider impacts that COVID-19 will have. Municipalities will need to dig deeper and identify their weaknesses in order to address them and identify better ways to deal with the crisis and its outcomes at community level.

This blog aims to stimulate thought about what actions can be taken by urban municipalities to address the current COVID-19 pandemic. Addressing COVID-19 is a collective matter in which local governments are key. I am a former Municipal Director of Health (2014-2020) for Villa Nueva in Guatemala, and current researcher, who has experience of putting evidence and policy into practice. I have received several calls asking for advice on what actions need to be considered by Municipalities to implement decisions made by the Guatemalan government and the President.

Taking into consideration the measures suggested by PAHO/WHO, and the lessons learned from countries that have already gone through the early response to COVID-19 in order to ‘flatten the curve’, it is important to consider what the impact of implementing measures now will have for urban centres in the longer term.

What are the municipalities currently doing and what are their capacities to respond to the crisis?

A quick check of the social media coming from Guatemalan urban municipalities shows their main concern in responding to COVID-19 is complying with the guidelines of the Central Government and institutions like the Ministry of Health and Social Assistance. They seem less prepared for addressing a possible crisis or for monitoring the collateral effects of COVID-19 on the family economy, violence and mental health, for example. This is likely due to the lack of: well-defined internal structures for inter-institutional coordination; adherence and application of municipal planning instruments (policies, plans and regulations); and available up to date information on health equity key indicators, disaggregated at intra-municipal level.

One of the major challenges in less economically developed countries and for municipalities in Guatemala, is that governance and accountability structures are needed to drive the COVID-19 response, yet these are fragile and lack support in times of crisis. Accountability mechanisms that have worked well within the Guatemalan government, are face-to-face meetings within citizen participation structures, such as the Municipal Development Committees (MDC) and its working commissions. But these will remain inoperative during lockdown, potentially losing the voices of the most vulnerable. Furthermore, informal settlements with little or no input from governments, such as  “Barrio 18” in Guatemala have taken the rule of law into their own hands to ensure that quarantine is followed, highlighting the role of emerging informal governance structures which should also be considered.

The following recommendations are for municipal health leaders who are, and will continue, to have challenges in developing a comprehensive COVID-19 response. They are based upon my experience and the process to develop a municipal health policy using the Urban HEART tool from WHO.

Accessing and using data to identify vulnerable populations

It is important to identify key, relevant and up-to-date information about the different sectors of the municipality, from reliable sources, to provide a better understanding about the living and working conditions in which the population lives.  Shared learning on data collection has shown that valuable data only becomes available when comprehensive coordination work is carried out to collect information within and across operating units and other public institutions. However, a consistent obstacle for many municipalities is a lack of capacity to keep databases up-to-date in the absence of automated information systems. This means collecting and accessing information is time-consuming and often neglected, especially during a crisis. Disregarding information gaps will mean that vulnerable people remain invisible, this is unacceptable as no country is protected unless all citizens are protected.

In cases where data is available, it is useful to have it visualized in digital dashboard formats to facilitate communication and decision making across stakeholders at the urban level. If this is not possible, at least presented through maps or tables. Identifying vulnerability aggregated by region, community, neighbourhood or even household would provide information of which populations are at greater risk and provide an evidenced informed response. This data will form the basis of planning or responding to crises. In addition, municipalities should seek partnerships with researchers who can support data collection and analysis.

Consider challenges faced by people living and working informally within the municipality

Understanding the needs of people living and working in urban informal spaces during this time has been identified as one of the main challenges within urban spaces. Lack of access to basic services, pre-existing levels of violence in these areas, informal economies, restricted access to markets and food and poor housing conditions, will be aspects to consider if we expect citizens to stay home. Even if remaining at home is achieved through force such as the ‘State of Siege’, recently implemented by the Government of Guatemala, the risk of infection in overcrowded homes is considerable and the absence of basic services such as drinking water or electricity makes it difficult for residents of informal settlements to have food on hand in order to remain in quarantine. In addition, without access to informal earning opportunities, the already vulnerable within these settlements are at risk of starvation. All of these factors have the potential to increase violence (intra-family and crime). Municipalities must identify what are the needs and integrate them into COVID-19 response strategies and across sectors.

Improve and understand the capacity of municipalities to respond to COVID-19

Alioto in Guatemala

Ideally, if the municipal authorities already understand the current institutional capacity to respond to the emergency they would be expected to have plans and budgets approved address and prioritise needs. If not an evaluation of the municipal capacity to respond to the problems identified will be needed. In the case of Villa Nueva, the Health Policy provides preliminary guidelines that may be useful for the formulation of such plans and their implementation. Among the most important for the approach to COVID-19 are:

  • Establish a municipal information system that enables information gathering and sharing in real time, strengthen monitoring and creating a platform for accessing information from and to citizens. These aspects will facilitate the planning of actions and coordination between actors to improve the efficiency of the response and keep decision makers and the public informed.
  • Prepare a list of infrastructure, human resources, equipment and supplies within the health system in coordination with the Ministry of Health for the implementation of an Integrated Network of Health Services. This can serve as a basis to identify additional needs that must be fulfilled to address the emergency and improve coordination of actions.
  • Unify diagnostic and referral protocols and organise continuous training of institutional personnel. This will facilitate municipal officials, Ministry of Health, private providers of health services and other health actors to have clarity for better institutional support for case management, thus helping to maintain the functional health system for people with serious symptoms of COVID-19.

Create healthy living environments and spaces

Local governments will need to review their strategies to consider the wider impacts that COVID-19 will have. Coordination and multi-sectorial action is needed now more than ever, including more comprehensive support from the national and sub-national level. For example, attention should be paid to creating healthy environments and spaces. This includes a properly controlled food chain with strengthened hygiene protocols in markets. Promotion of healthy principles of housing (links health with people’s habitation and living conditions) has proven to be useful to improve hygiene measures and could be considered. Access to water and sanitation, the promotion of a healthy diet, and physical activity are all important. Actions in these fields can help people living in difficult conditions to stay at home. There is a need to promote coordination and participation of the public and private sector and civil society to implement prevention campaigns and structural actions that reduce the negative effects of COVID-19 through policy development across educational, economic and social sectors.

Community participation

Community participation and coordination with different actors is extremely important to ensure success in the short, medium and long term. The existence of recognised civil society groups with communication and social networks management skills, can be of great value to send messages to the largest number of families from reliable, trusted sources that can be useful to reduce the paranoia generated often through social media. Accountability structures that facilitate the participation of citizens and promote different levels of involvement, even while staying at home, are relevant. Civil society web-based platforms that can provide reliable information, and other ways of creative communication should be investigated and supported.

 

 

 

 

 

 

 

 

 

 

A rickshaw owner with an insecure livelihood sits cross legged facing the camera. He is older and he has a long white beard

A case for state-funded livelihood insurance for the informal economy in the era of COVID-19

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By Sumit Mazumdar

As the famous opening lines of Dickens’ A Tale of Two Cities go, most challenging times often mask opportunities for transformational changes moving hurdles in few weeks that might have taken generations otherwise. But only if nations are successful in leveraging from any unprecedented popular support for epochal public action.

As the global pandemic of COVID-19 spreads its uncertain tentacles across continents, an increasing number of countries — including India, most recently — is entering into various degrees of lockdown of all social and economic activities as the core strategy to contain the infection’s spread. But, the ripple-effects and aftershocks following the slack in economic activities is all set for a disproportionate impact across the workforce. This largely follows from the typical structural pattern of the forms and nature of employment which varies significantly across countries — more than 75% of the employed population in Europe works in the formal economy, but only about 30% in Asia-Pacific region are in jobs with long-term contracts and associated social security covers. In this lockdown-induced radical shift of work from establishments and offices to home-based work only a minority workforce worldwide can afford and adjust to alternative working arrangements being indoors without any significant dent to either their earning flows, surety of employment or other privileges, most livelihoods do not have such luxurious flexibilities. These include the motely mix of virtually every conceivable form of occupations with diverse range of skills — from daily-wage labour in the construction sector to the neighbourhood plumber — and the vast numbers in short-term, usually daily-rate contract informal jobs in the formal service sector such as hospitality, retail and transport, referred by some as the new gig-economy workers. As in most other developing countries, in India the share of these forms of ‘insecure’ livelihoods in the overall workforce for countries remains very high; as per the latest available statistics more than 80% of our workforce are engaged in different forms of informal livelihoods. As new reports indicate every day, it is for these vulnerable, economically insecure millions for whom the unforeseen restrictions imposed due to the epidemic’s spread is likely to be most hard-hitting and economically disastrous.

What could then be the content and the mechanics of suitable safety-nets that can cushion such drastic impacts on the livelihood of these vulnerable workforce? Several countries across the world have started experimenting with and implementing a slew of different measures aimed to cushion the likely catastrophic effects of the reduced economic activity cross-cutting diverse livelihoods. As we could see in recent decisions in countries such as Canada, the US or the United Kingdom — including some at an unprecedented scale like the decision to foot almost the entire national wage bill in the UK — these have mostly involved wage subsidies to firms and sectors to support individuals either on medical leave or forced to restrict outdoor activity, relaxing or simplifying tax contributions from businesses, or some sort of refinancing or smoothing outstanding loans to firms. Some of these are equally relevant in the Indian context too. For example, some form of these wage or income subsidy to payroll workers can be considered particularly for industries such as airlines or organised retail which are among the ‘new’ service sector with a sizeable employee base, but with them mostly on casual, piecemeal rate contracts with modest wages and little or no forms of social security. Looming risks of wage-cuts, cancelled contracts and lay-offs remain as the sector itself grapples with contractionary trends in business. Nevertheless, even if these forms of indirect social security or livelihood insurance — mediated via the employers — are implemented, these will still leave out large sections of self-employed workforce like auto-drivers or rickshaw-pullers and unorganised retail, who have even a greater risk of declining or zero incomes as a gradual shutdown of the economy looms.

Which is a powerful reason to consider a Targeted Emergency Livelihood Insurance (TELI) implemented as a direct benefit transfer (DBT) that could cushion the informal economy in the country against the massive economic shock due to COVID-19. As I clarify below, the nomenclature intended is rather generic — targeted doesn’t imply a cumbersome, means-testing type exercise for identifying beneficiaries, but instead excluding those who have easily identifiable alternative forms of social security; insurance doesn’t imply any prepayment-based, indexed coverage but rather in it’s use as shock-proofing at-risk families. As the bedrock need-of-the-hour social safety net system for this vulnerable workforce, TELI would be the instrumental shock-absorber for the dramatic risks of dropping earnings and uncertain living. Traditional and existing safety net programmes such as the MGNREGA and other public workfare programmes are out of question in the days of mandatory isolation and distancing; using PDS-type channels to ensure delivery of food and essentials involves enormous logistic arrangements across the food supply-chain, tremendously challenging even in usual times. So, a modest, monthly direct benefit transfer to the families nationwide relying on different forms of informal employment or informality in the nature of job contracts, to cover their necessary living expenses and other incidental needs has a natural appeal. There are also strong positive spillovers — an assured financial flow is undoubtedly the strongest deterrent to commutes and leaving home — and only increase wilful compliance to all calls of thinning out masses on streets. As a generic concept, this isn’t alien to the policy circles; discussions and debates on Universal Basic Income (UBI) in both academic and political circles have been vibrant in the recent years, including during the last Lok Sabha election campaign. Models and variants ranging from the past Chief Economic Advisor Arvind Subramanian-led Economic Survey 2016–17’s suggestion of Rs 7260 annually to 75% of the population, to Rahul Gandhi’s 2019 election manifesto declaration of Nyuntam Ayay Yojana (NYAY) for Rs 6000 per month to all families in the bottom 20% of households, and some more academic economists’ estimates e.g. Maitreesh Ghatak and Karthik Muralitharan’s suggestion of Inclusive Growth Dividend pegged at 1% of GDP per capita (working approx. Rs 110 per person per month) and a more recent upward revision of his own statements earlier by Subramanian and co-authors to a per-household annual transfer of Rs 18000. Except, a periodic quasi-income transfer in the form of the Pradhan Mantri Kisan Samman Nidhi and the Rythu Bandhu Agricultural Support Scheme in Telengana, nothing yet has taken off at scale.

The prime concerns countering the intuitive appeal of such a form of direct social support to tide over the uncertainties and vulnerabilities during the current epidemic crisis, are undoubtedly complex. It requires deciding on the most appropriate, efficient and fiscally accommodative forms of targeting the would-be beneficiaries and the size, frequency and longevity of these transfers. On targeting, the decision rule can simply follow the principle of automatic exclusions — anybody with a salaried job which besides guaranteeing an unaffected income stream will also come with some form of leave benefits and requirement to abide by government directives in the case of a lockdown or restricted activity, is left outside the coverage of the TELI transfer. In principle, this would also mean to keep out households with agriculture as sole or predominant means of livelihood, as strictly speaking these doesn’t rely on a steady, monthly income flow, but is unlikely to be socially or politically tenable. Considering these, one can start with this target as 75% of all households similar to the original Subramanian estimates. Somewhat more tenuous is the suitable scale of this payment — we do not have recent estimates of monthly average consumption expenditure from the 75th Round of National Sample Survey, but can use either the per-capita final consumption expenditure estimate from the National Accounts Statistics 2019 (at Rs 76619 per annum for 2017–18 current prices). Considering the target 75% (or about 195 million) households to have half the national average of expenditure levels, and with some conservative assumptions on number of family members and the economic dependency composition, anything less than Rs 6000 per month per family is unlikely to be adequate to meet most of the needs. Assuming this pay-out to continue for at least three months to start with, this amounts to Rs 3.5 lakh crores (Rs 3510 billion, or US$ 47 billion) amounting to about 1.7% of the GDP, and thereafter adding a bill of about 0.6% of the GDP every additional month. In the worst scenario, considering the crisis to last for a year, this is likely to cost the exchequer about Rs 14000 billion or nearly 7% of the GDP. These estimations can be calibrated both on coverage and its quantum and is within the range of the different cost ranges estimated for alternative UBI regimes. Thinking of the mode of the DBT, the dramatic expansion of savings bank accounts under the Jan Dhan Yojana — which at 225 million accounts provide a reasonable basis of assuming most of the target households to be having an account to receive the TELI transfers. Residual families without a functional account or other limitations could be enrolled through local government like the GP or municipal authorities. Finally, even for a measure at this scale, this has to move fast — itself a challenge with the already stretched administrative apparatus. But with strong, nonpartisan political support also visible these days, it is not impossible.

A direct cash transfer programme such as TELI, as outlined above, can thus have three major, economy-wide benefits. The most direct impact would be its insurance impact — ensuring households with threatened or vulnerable means of livelihoods doesn’t fall through the cracks and can maintain consumption above a minimum threshold; the deterrent impact works through using a steady, guaranteed income flow to discourage people from going outdoors in search of work so that mass contacts are avoided; the stimulant impact as noted by few observers recently — cash at the hands of a majority of households ensure that aggregate demand continues to be at a level — both during and post-shutdown phases — to avoid that a negative supply-shock doesn’t send the economy into a whirlwind spiral down into recessionary trends. I hope to talk more about this in a later post.

Definitely, this is a high watermark in publicly-funded social safety net programming in India — the three-month estimate is higher than the entire annual public spending on health in India — but the pandemic crisis is also an unprecedented event the world is passing through. In times of such a global challenge, no welfare state can abandon the fundamental responsibility of ensuring that vulnerable population doesn’t fall through the cracks. Of course, it requires economic will, but more of social solidarity which should be espoused, even at a higher pitch than social distancing.

Credit

This blog was first published on the Medium site and is reproduced with permission.

A man in a red t-shirt bends over to wash his hands to prevent the spread of COVID19 at a stand in Kibera Nairobi

The hard nut of cracking who is vulnerable in our communities in the context of COVID-19

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By Joseph Kimani

My visit to Korogocho was special in a number of ways. On arrival at Korogocho I had a moment to chat and interact informally with Korogocho Community ‘Covid response team’; Komb Green team (Wys, Okinda, Roba and team), Korogocho resident committee ( Kinyanjui, Gathu and Mzee Njoroge), Uncle, Balozi, Jemo and Emmy (Miss Korogocho). Having interacted with them at lengths and seeing their efforts in raising Coivid-19 awareness opened up to the possibilities of dealing with the pandemic through collective community efforts.

Residents in Korogocho are well aware of the pandemic and like most people everywhere are working hard to adhere to government directives regarding preventing the spread of the virus. However those I talked to were of the opinion that intense awareness is still needed.

Our conversations with the team were centered on looking at ways to protect the most vulnerable persons in the community. Korogocho according to APHRC’s, Nairobi Urban Health Demographic Surveillance, has a population of 31,000 people spread within 1-1.5Km square of land. Nairobi informal settlements densities are at 230 households per acre according to Muungano profiling data. Muungano wa Wanavijiji has counted over 300 slums in the Country and classified them as vulnerable settlements due to the fact that they lack secure tenure, basic amenities and infrastructure.

At a settlement based level vulnerability is defined differently by different interest groups. In Korogocho our conversation highlighted the following as those constituting the most vulnerable people in the context of Covid-19. These are; persons with disability, elderly persons who are living alone, elderly persons who are sick, elderly persons who are taking care of grand-children, single mothers, young mothers who work at night to earn a living, young men and women who work at night now affected by curfew, persons living with HIV, terminally ill persons with diabetes and cancer, tuberculosis patients and survivors, street children, persons earning their living through garbage collection among various other groups.

Through our discussions, it was evident that literally every single person spending and living inside an informal settlement is a vulnerable member of this society. Muungano and other community based organizations are working hard to identify and build realistic support approaches for those considered most vulnerable and hard to reach members of the community and in the long term build on the resilience capacities of the urban poor neighborhoods.

The Approaches

Youth from Huruma puts up a Covid-19 information banner around one of the settlements major roads by Know Your City Tv.

It is still unknown the extent to which Covid-19 will impact the country at large, but it is expected the virus may devastate the country’s most vulnerable people; many who dwell in the densely packed settlements in the capital. These settlements are characterized by inadequate water and limited access to quality and affordable health care, all key necessities especially at the wake of Covid-19 pandemic. Measures to prevent the spread of the virus have been introduced at various scales to provide a safety net for community residents and allow for a continuous undisrupted chain of activities within the communities. However the current state of affairs calls upon for much more interventions to ensure all are well cushioned from the social and economic impacts of the virus.

These communities are known for their strengths to mobilize and self-organize in a bid to secure opportunities for development. While capitalizing on this invaluable asset, Muungano working closely with its partners and local community, have made strides in rolling out local strategies that places some of the much needed essentials, within community reach. This has been executed through provision of Covid-19 information materials at key locations and provision of washing stations that have served hundreds of residents within settlements such as Korogocho, Mukuru, Kibera, Huruma, Mathare, Kisumu and Nakuru.

These approaches will be instrumental in stalling the spread of the virus through ensuring these much needed fundamental necessities are within community reach thereby contribute to flattening the curve.

“Everyone is making sure messages of Coronavirus are well spread in Korogocho. From the kids to the elderly. Everyone must take action” Fredrick Okinda Muungano, Korogocho resident.

Now is the time to act as high demand continues to be felt for more prevention interventions to protect vulnerable communities against the pandemic. With practical solutions, and collective efforts, a successful fight against the Covid-19 pandemic lies close.

Credits

This blog was previously published by SDI Kenya and is reproduced with permission. All images were taken by Know Your City TV and we extend our thanks to them for all of their great work documenting the COVID-19 response.

Informal settlement Egypt

The road ahead: What can we do to support disability inclusion in the COVID-19 response?

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This is the last blog in our series of learning from the Twitter Chat we hosted on 6 April. There is a lot already happening to promote the inclusion of people with disabilities within the COVID-19 response. However, more could still be done. Some evidence gaps also remain. In this blog we try to summarise some key actions that we can all take to promote inclusion. We also highlight where to go for further information.

What can we do to promote inclusive communication?

It is important that information regarding; infection mitigation, public restrictions, available services, myth busting, and information for carers is made available in accessible formats. Information for health workers when treating people with disabilities is also essential to ensure respectful care that is aligned with human rights norms.

We must learn to communicate in multiple ways through to reach all those in need. Within the Twitter Chat, participants highlighted many resources and approaches to accessible communication. This Repository of resources collated by core group and the International Disability and Development Consortium provides a comprehensive list of materials in plain language, easy read and various sign languages.

Additional, communication resources include: easy to read tools for people with intellectual disabilities produced by @InclusionIntl and its members; and messages and information briefings available in sign language for use in different contexts, specifically, Bangladesh, Kenya, India, USA, and Nigeria.

However, participants highlighted that more can still be done to ensure inclusive communication that should respond to the resource environments in which many people in the global south live.

Adaptive communication should focus across multiple areas including: high contrast visuals; text-based captioning on all TV broadcasts; and information in braille for the blind. It should also consider how messaging itself needs to be adapted based on the needs of people with disabilities and what is achievable based on individual needs.

How to support health workers and carers of people with disabilities?

Information, protective equipment, testing and guidance for carers is needed for disabled people who rely on personal care and support and as a result they cannot self-isolate.

Some masks that cover the faces of health workers can make it challenging for deaf people or those who rely on lipreading for communication. This innovation from a college student is supporting to overcome this challenge.

There were also calls to support and improve tele-rehabilitation, to continue providing an essential service to those who need it, in a time of restrictions and over-stressed health systems.

What can individuals and organisations do to support global advocacy on disability and COVID-19?

Twitter participants described the use of stories as a key advocacy tool in promoting inclusion and in promoting the needs and experiences of people with disabilities. These should be accompanied by the collection of disaggregated data on sex, age and disability to support the development of accounts of the impact of the COVID 19 pandemic on people with disabilities. The Chronic Illness and Disability Inclusion Project are rapidly gathering evidence for a UK parliamentary inquiry into the unequal impact of COVID19, you could reach out to them if you have a story to share.

We also learned of many examples where people have written to local media and also used social media as an advocacy platform.

Taking a twin-track approach to responding to the needs of people with disability was identified in twitter responses. This means mainstreaming adaptations for people with disability within all COVID responses, but that this should be coupled with disability specific responses to ensure protection and support. This was highlighted as particularly important by twitter participants in enabling the attainment of essential supplies. For example, specific opening hours in supermarkets are one example of a key mechanism to ensure inclusion and adaptation.

Organisations who can provide social protection and financial support to people with disabilities who will be hit harder by the pandemic was described as essential. We do not understand well enough how this can be done in low- and middle-income countries.

Developing clear action plans for the inclusion of people with disability during the crisis period was also thought of as essential. These should be developed in collaboration with people with disabilities. Global and country specific plans are both equally as essential.

Additional information about disability inclusive responses in the COVID-19 response?

Throughout the twitter chat we were inundated with responses that highlight particularly useful information sources in supporting disability inclusive responses. We have summarised these information sources in a table to enable us to continue to learn together.Summary table of information sources on disability and COVID19

Download the table

From the recommendations of our tweeters, it was clear that in looking for further information, always look first for information shared by people with disabilities, representative organisations (such as national federations of disabled people) and their caregivers.

If you are a frequent twitter user, why not also follow all of our Expert Tweeters who are constantly sharing useful resources.

Tweet that says, The world is coming to ensure a human rights based approach to responding to COVID19. Think accessibility, make hand washing points either designated or accessible

Structural violence, ableism and COVID-19

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COVID-19 presents additional barriers for people with disability that are linked to structural violence and ableism.  Unequal global and local political-economies and social organisation inflict embodied harm on people, in this case disabled people. This is structural violence. Ableism is a form of prejudice that characterises people with disability as inferior to the non-disabled. Discrimination is often experienced based on disability and under the assumption of limited capabilities and skills.

This is the fourth blog in our series on disability and COVID-19. In this blog we summarise learning from a Twitter Chat that was held earlier in the month.

Yesterday, we explored how the response to COVID-19 has been hampered because of the failure to include people with disabilities (and their representative organisations) in planning and decision making. Without this expert insight many of the public health messages and policy prescriptions continue to reflect ableist assumptions.

This is not a small oversight; it leads directly to disproportionate harm to people with disabilities. As @dr_ateeb put it, “People with disabilities are vulnerable to neglect, this may be exaggerated in outbreak contexts.” Neglect is not always passive. Sometimes it is an active choice. It is an active choice to continue to organise our societies in ways that discriminate against people with disabilities. Pushing back against this inequity needs to be part of our ways of working as we respond to COVID-19.

Access to personal care

During the Twitter Chat we heard that much of the advice to remain at home with your household and not to mix with people from outside is not possible if you require carers to assist you. COVID-19 planning and messaging has not adequately considered how the pandemic is affecting what care is available as helpers stay home or become ill. Tweeters were fearful of harm being caused to those who need carers to support them with daily tasks such as bathing and washing – this is particularly the case for those with complex disabilities.

Tweeters suggested that policies are adapted to take the needs of people with disabilities into account.

Access to assistive equipment

Equipment like wheelchairs and hearing aids and other assistive technologies need to be maintained during the pandemic. As @ShikukuObosi pointed out, this could be particularly acute for older people who may have been institutionalised in homes and asylums for many years where they are isolated and ignored.

Community initiatives

Participants explored how people with disabilities may not be prioritised in community-level responses to the pandemic. Health care providers and first responders may not be familiar with the rights of disabled people and exacerbate this problem.

Decisions about rationing care

Finally, various country protocols created in response to COVID-19 openly discriminate against older people and people with certain disabilities. Some care rationing policies discriminate against people with disabilities who experience serious symptoms of COVID-19 in ways that challenge article 10 and 15 of the UNCRPD.

Pandemic responses and recommendations have to take into consideration the rights of people with disabilities. This is particularly important during periods of crisis or shock to the health system and it is imperative that the needs and values of people with disability are considered now more than ever. We must do all that we can to ensure that people with disabilities have equal opportunity to attain their highest possible right to health during this period and beyond.

<<Find out more about this series of blogs on disability and COVID-19

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