This blog was written by Irene R. Moshi, Kimberly Mihayo, Ibrahim Msuya and Francis Levira from Ifakara Health Institute.
The COVID-19 pandemic has affected a large urban and peri-urban population in Tanzania, 509 were confirmed cases countrywide with Dar es Salaam experiencing the highest burden of infections with more than 228 cases. Over the last 3 months, we have all felt the effects of the pandemic in different areas from the economy to education, health and our social lives. Globally, infection patterns show that older people with pre-existing health conditions are at greater risk of infection and developing to severe conditions. Healthcare workers are also at high risk, particularly due to insufficient Personal Protective Equipment (PPE) in many affected countries including Tanzania. However, we can’t forget, that, another group which is most at risk are those in the informal sector, who depend on a daily income to survive. Due to high rates of poverty, this group cannot afford to isolate themselves by staying at home without chasing daily income or purchase protective gear, as we have observed. Isolation was observed to be only possible in the presence of donor funding to support the low-income group.
In Tanzania’s COVID-19 response, decisions regarding mitigation, as well as measures to prevent the spread and alleviate the effects of COVID-19, have been largely centralised and led by the Ministry of Health, with local governments working to implement outlined actions in communities. This includes government’s mandates to coordinate and manage all information-sharing and health education centrally. Government authorities provided regular addresses and updates on the situation, and promoted several interventions including social distancing, reducing travel and handwashing and sanitization at household level, gatherings and workplaces to reduce the spread of infection. Authorities also issued mandates to close down schools, ban large public gathering and sports games, and suspended international flights.
When COVID-19 began to spread in Tanzania, people were worried about their health and lives, and many sought information about how they could prevent contracting it. When the community was told to use face masks in public, in our experience, many were observed heeding this advice. However, there has not been any public campaigns about the proper use of masks, hence many were still at risk due to improper use like re-using of surgical masks, as we have observed. Our observations also showed that during the early weeks of Tanzania’s response, many health organisations offered to collaborate with the government to in providing community health education. However, given government restrictions, implementing organisations and even civil society have played a more ancillary role in supporting Tanzania’s response.
"Together with education on proper use of public interventions, updated and reliable data is of the essence, but minimal access to such information has resulted in negligence within the community over personal protection against COVID-19 while the risk of infections still exists."
Focusing on community education to help halt the spread of COVID-19
Community education can help ensure public health interventions are properly and widely used, but as a local commentator on a radio programme discussed, no education has been widely shared on the proper use of washable face masks to ensure its’ preventive effect. As a result, what we personally observe here is that sharing of unwashed masks is currently the norm within neighborhoods and wider communities. Together with education on proper use of public interventions, updated and reliable data is of the essence, but minimal access to such information has resulted in negligence within the community over personal protection against COVID-19 while the risk of infections still exists.
As Tanzania began easing previous mitigation measures, we have also observed that fewer people have been observed wearing face masks and public places have stopped requiring facemasks or even hand washing. Recently, government-led community education and campaigns have become infrequent, forcing the public to depend highly on online platforms such as WhatsApp, especially for urban dwellers, where we have witnessed misleading information (such as use of garlic and hot water as medication for COVID-19). Currently, the disease is “said to have been wiped out” and only 66 active cases have been reported by the Prime minister but we still have reports of new infections.
Now the question is, if the disease bounces back, where are we going to start and who are we going to blame for the lives lost because of it? Investing on community education by involving different stakeholders and players is of the essence.
"As our conversations with community members show, most government schools do not have the resources to facilitate home studies, leaving children with no access to daily reading assessment as compared to private schools which have access to such services."
Impact of COVID 19 on education and household finances
Abrupt school closures during the pandemic have also carried great costs particularly for the most vulnerable groups of children in Tanzania. Students from poor households have been most affected because, as in other countries, their studies have been completely interrupted. As our conversations with community members show, most government schools do not have the resources to facilitate home studies, leaving children with no access to daily reading assessment as compared to private schools which have access to such services. While the use of e-learning has increasingly become an option to increase access to education for children in middle-income households, only few private schools have shown to have resources to afford the technology to facilitate online learning. In addition to lost learning, there is evidence that children spending increased time at home during COVID-19 have been at high risk of sexual abuse, violence and neglect.
Although the government did not implement lockdowns or stringent restrictions to social-economic activities, we already can observe a heavy financial impact on households, which have experienced a slump in their income-generating activities. The gap between ‘the have and have not’ also has an impact on access to education services among families during the pandemic. As in other contexts, parents with low-levels of education also find it difficult to supervise and teach their children at home, leaving children without adequate supervision or learning. This idleness has a negative impact on young children and can lead them to engage in risky behaviors in communities where drugs and crime are prevalent. What we have unfortunately witnessed is that many children have also found themselves being pulled into child labor, including small businesses which can hamper their learning, cause them to fall behind or even drop out of their studies.
Community level protection
Social distancing, hand washing and wearing of face masks was practiced at early months of COVID-19 cases, but recently we can see that there has been a gradual decrease in the use of protective gear and other proposed measures including handwashing. Because a considerable number of people depend on informal economies to get by and meet their daily and family needs, they had to continue working despite the risks of infection where others ended up being infected and some managed to contain the situation at home.
We have observed a social bond within some communities that have helped them come together and teach each other on the ways to protect themselves and treat the disease if infected. Traditional and home remedies such as concoctions of ginger, honey, garlic, lemon, turmeric and steam inhalation have been touted by them as community-level protection for managing the disease.
Initially, we witnessed how COVID-19 created widespread fear, which caused people to take precautions. Now that restrictions are easing and people are beginning to increase their social interactions, and many seem to believe that things are going back to normal – even though Tanzania has not provided information on cases in nearly a month. However, recently, the Prime Minister Hon. Majaliwa announced that positive cases have fallen from 509 cases to only 66 active cases. However, a question still remains, what if the pandemic wave strikes again in the near future? Are our health systems, government and community ready to face and fight it? My take is that collaborations between different players including government through the Ministry of Health and health system officials, researchers, funders, economists, education experts and community representatives should be at the forefront to plan precautions and practical ways that could be easily implemented to prevent and fight any future pandemic. Despite the uncertainty on pandemics, “Readiness is KEY” if we intend to save lives.