Strengthening Public Health Preparedness and Response Activities In

CoVID-19 Response Community Feedback Mechanism (Pilot)

July 2020 PURPOSE: To implement a community feedback program to guide evidence- driven risk communication and community engagement activities to build, restore, maintain community trust and confidence in response activities during public health emergencies. OBJECTIVES:

• To establish a responsive and near real-time reporting mechanism (every two weeks) across the country • Pilot to inform scaling up across other states • To understand underlying social norms and local dynamics; • To identify, analyze, characterize and respond rapidly to specific factors influencing perceptions, actions and trust levels in communities regarding epidemics GEOGRAPHIC* REACH – 11 COUNTIES:

1. DATA TEAM PER COUNTY - South Sudan May 2020

2. Yei SOUTH SUDAN Ezo - Social Mobilizers 16 Nzara - Note Takers 2 - Social Mobilizers 16 - Note Takers 2 Ibba Juba 3. Lainya - Social Mobilizers - Social Mobilizers 16 16 - Note Takers 2 - Note Takers 2 - Data Entry Officers 1 Yei Torit - Coders 2 - Social Mobilizers 16 - Note Takers 2 - National Data Managers 1 - Note Takers 2 - Data Entry Officers 1 - International Managers 2 - Data Entry Officers 4 4. Morobo Nagero - Coders 3

Tambura 5. Kajo-Keji Mvolo Nzara

Mundri East Kapoeta North Western Mundri West Lafon Ezo Yambio Kapoeta East 6. Magwi Ibba Maridi Juba Eastern Equatoria

Central Equatoria Ilemi Triangle Juba 7. Yambio Kapoeta South Torit Budi Yei Lainya Yambio - Social Mobilizers 16 Ikotos - Note Takers 2 Kajo-keji Magwi - Data Entry Officers 3 Magwi 8. Nzara - Coders 3 Maridi Morobo - Social Mobilizers 16 - Social Mobilizers 16 - Note Takers 2 - Note Takers 2 - Data Entry Officers 2

DEMOCRATIC REPUBLIC OF CONGO 9. Ezo Lainya Morobo Kajo-Keji - Social Mobilizers 16 - Social Mobilizers 16UGANDA - Social Mobilizers 16 - Note Takers 2 - Note Takers 2 - Note Takers 2 10. Maridi

Kilometers 11. Ibba 0 50 100 200 *Pilot to inform scale up across the country METHODOLOGY:

Data collection and Data management sample size Data transcription, and analysis Quality control translation and 22 note takers coding Participatory group 176 social mobilisers in C4D team will coding process conduct quality all 11 counties. 11 data entry officers Each note taker visits 3 control visits once transcribe/translate Innovative randomly selected every two months in 8 data coder codebook on households per day. all the counties, to UNICEF Juba COVID-19 verify correct receives about 660 implementation of Sample Size Target: typed, translated and 990 to 1320 data protocols coded documents per households per month month. PILOT PHASE – JU NE-JU LY 2 02 0:

Training data team Testing tools Challenges Timeframe 69 Soc. mobilisers: • Household guide • Insecurity (Lainya) 6 weeks • 8 note takers • Offline/Online data • Digital divide collection/entry • 5 data entry (Morobo) officers • Use of Tablets Geographic scope • Illness • 5 coders • ONA platform Juba, Kajo-KejI, • Unavailability of • 3 supervisors social mobilisers • Codebook Yei, Morobo • 48 Soc. mobilisers FROM TRAINING TO FIELDWORK: KEY ACTIVITIES AND ACHIEVEMENTS:

• Systematically collected data (perceptions, concerns, comments, questions, ideas) from community members on COVID-19 and general health issues • Shared findings with • Local communities – through Local NGOs (TRISS, ECSS) – validation sessions; participatory analysis; – influences their awareness raising activities • Health authorities, response leaders – through meetings, • Other Implementing partners/clusters – RCCE; IEC; Rumor SC • Informed programming for relevant follow-up action BELIEF AND BEHAVIOURS

• Demonstrated belief COVID-19 is real “I have seen these days people at least • People seen respecting control wash their hands frequently compared to measures Ebola preparedness phase last year” • Mention of social distancing, frequent (Luparate village 3, Yei) hand-washing, alcohol-based hand sanitizers, avoiding congested places, “I believe it is a sickness and can kill that proper nose hygiene is why people are dying worldwide” (Ref • Perception that COVID-19 measures 2) being more vigilantly followed compared to EVD times • Not perceive selves to be at risk of COVID-19, mostly young people “People in South Sudan are not dying from COVID-19” • Believe South Sudanese not dying “I heard that the Corona virus only affects the elderly above the age of 65 from COVID-19 (23yr old male) • Not convinced about true causes “I heard that corona is a mere cough. So anyone confirmed of the virus • Low risk perceptions above equal will not die because it infects and goes away” (Yei county) low uptake/practice of preventive measures “I heard that the virus will be dead after 15 minutes when it lands on a surface like the chairs, tablets” (Jogomoni village-Yei). PERCEPTIONS ABOUT TRANSMISSION:

• Some understand about transmission of “COVID-19 is transmitted through air” COVID-19 “COVID-19 spreads through shaking hands and • Majority clearly articulate ways in which coughing” COVID-19 is potentially transmitted “COVID-19 is easily transmitted in crowded places” • But some participants attributed “Transmitted by humans and not animals” transmission to other causes - largely “I believe the virus is real and is transmitted by societal myths and misconceptions human beings” MISCONCEPTIONS ABOUT COVID-19:

“I believe that COVID-19 is a manufactured virus that is why it is still new and spreading through body contact” (Ref 5) • Varied sources and origins “I heard that COVID-19 was man-made (genetically modified) in other to reduce • Etiology – unknown, the large population in china” unclear • Signs and symptoms – not I believed COVID-19 is not there because I have not seen a person suffering from seen it” (Erap village, Yei). • Transmission mechanisms “We have not seen or witnessed anyone having COVID-19” (Kondeko village) • Vaccine availability “Most of the people still want to see real evidence by seeing a real confirmed • No evidence of mortality person for them to believe that the disease real exists”(Luparate village) “Coronavirus is now causing a lot of division among family members especially between husband and wife since they are not allowed to sleep in the same bed” CONSPIRACIES:

• Beliefs that COVID-19 is man-made, related to NGOs, originates abroad “I heard that corona virus was manufactured to destroy the poor countries of Africa. Then thereafter the rich white will come to Africa and exchange the • Yet, measures largely advocated by African resources with vaccine” (Kanjoro village, Yei) NGOs and international humanitarian “I heard that the vaccine for COVID-19 is out but needed to be tested first on agencies the Africans by the ‘whites’ because they are black people with strong immunity” (Dimiliko, Yei) • Thus people likely perceive pandemic to “I heard that COVID-19 was manufactured with an aim of creating benefit these entities business to the NGOs” (Luparate village 3, Yei) • Some feel COVID-19 is supernatural, “I heard that the virus is only for the whites and brown people in Africa” only curable by prayer (Luparate village)

• Such beliefs may explain laxity, low “I know COVID-19 can only be cured when you pray hard day and night” (Luparate 1, Yei county) uptake of certain preventive measures “I belief that when your get an infected person and mention the name of • How to ensure communities follow Jesus you will be safe from the Coronavirus” (Mission Area) measures by these entities given apparent low trust in them or their measures! MISTRUST IN NATIONAL RESPONSE - GOVT/HUMANITARIAN SECTOR

“I heard over radio Miraya that world health organization donated 10 million US dollars for managing the spread of • Apparent mistrust in government, health COVID-19 to south Sudan and later we heard that the 5 workers, NGOs and other responders million dollars disappeared in the state house” (Kanjoro considered to be ‘using COVID-19’ as an village, Yei) opportunity for personal gain through graft. “I heard that COVID-19 is in Juba and it was spread by some • This lack of trust extends to general response UN staff who were sent by America with a goal of infecting measures including perceived lack of available the South Sudanese” (Kanjoro village, Yei) drugs and medicines to reduce symptoms being attributed to corruption. “The government has failed to control the border entry points and people are entering from DRC especially from Lasu Payam” (Jigomoni village- Yei) • Disapproval of COVID-19 “The networkers are not doing the right thing in the community because they are response always segregating us while distributing items” (Ref 1) • Perceived poor “The networkers in my area when given the opportunity to distribute soap, buckets implementation of guidelines they segregate and mostly distribute these items to their relatives” (Ref 2) (repeated use of same pair of gloves by bankers, “We are told to stay home when one develops the symptoms of corona, so how will community mobilisers such a person access the services from the health facility” (Ref 18) without masks) “Why are you always teaching us about hand washing and yet you are not providing • Different standards for us us with washing facilities e.g. buckets and soap” (Ref 23) locals (discrimination in food distribution, guidelines) “I heard that it was the President of South Sudan who permitted the son of the late Justice Minister to enter into the country and infect the fellow South Sudanese despite rejection from the authorities from the airport” (Jigomoni village- Yei)

“All the people working with the NGOs are not keeping social distancing e.g. travelling in big numbers in a vehicle” (Jigomoni village-Yei county). COM M ON QU ESTIONS ABOU T COVID-19: • “Why did government of South Sudan allow people who had travelled out of the country back during this COVID-19 pandemic?” (Ref 2)

• “Is there really going to be support for free medication during this crisis?”

• “Who are responsible for helping the people – is it the NGOs or the Government?”

• “How can South Sudan manage COVID-19 with embezzlement of funds?”

• “What are other countries using for treatment?”

• “Where are the confirmed cases hospitalized?”

• “How will we survive with no food distributed?”

• “What are the plans of NGOs as Government plans a lockdown?” COM M ON COM PLAINTS ABOU T COVID-19: “We don’t have money for buying hand washing facilities • State of health facilities as well as government e.g. buckets and soap” interventions to address issues arising out of the COVID-19 pandemic were a source of frustration “Why are other diseases given less concern, no • Dissatisfaction with distribution of supplies like messages on how the community can prevent these soap and water for hand washing for which other diseases e.g. typhoid, malaria etc.” (Ref 9) community members felt they needed particular support. “Why is it that surveillance teams are not responding to • Perceived neglect of other important illnesses the sickness reported in the community” (Ref 12) which community members rated more seriously than COVID-19 IN SUM, PILOT PHASE DEMONSTRATED:

• Ability and value of generating and responding to community concerns in near-real time; will be shared with UNICEF sections, sectors and external stakeholders • Some community members aware COVID-19 is real and exists in South Sudan. Many believe COVID-19 is a serious condition with potential for mortality

• Some participants able to identify and articulate signs and symptoms of COVID-19

• Young people appear more likely to adamantly defy preventive social distancing measures while also continue their livelihoods unabated (attending bars, markets and other crowded places) • Inadequate knowledge and awareness of COVID-19 preventive measures in the communities implies not been fully educated about them, hence negative perceptions

• Top-down approaches in handling the crisis may have negatively impacted uptake of mitigation measures ACKNOWLEDGEMENT: • UNICEF-C4D, CDC, Partners

• Data collection teams led by TRISS

• Most especially community members for their time

!!Shukraan رﻛﺷ ا ﻛ