Early April amid the panicky crescendo of drumbeats for strong-arm solutions for managing COVID-19, my friends and I held series of online touch-base sessions. The friends were in four different continents- Africa (Kilifi, Kenya), America (Boston, USA), Europe (Leeds, England) and Asia (Kathmandu, Nepal). From the onset, we were struck by the commonality of the responses being adopted across the world – rapid militarization and medicalization of the pandemic all peppered in a variety of politicization. The way governments were relegating citizen capacity to decide and make informed choices while elevating the experts’ directives to extremes measures despite the absence of relevant infrastructure and resources to follow them through was also fascinating, especially for countries whose majority live in perpetual precarity, a state in which they must sweat to eat daily.
As the COVID-19 cases head towards the plateau, many of the measures that were rammed down communities by the governments are beginning to haunt everyone. Economies are in tatters as are the core tenets of liberal democracy as we knew it. In many ways, in many countries, people are living in quasi-states of emergencies with restricted movements and freedoms. Any deviation has seen rapid eruption of confrontations between the public and the police with some increase of COVID-19 incidence and escalation of infection threat levels. At philosophical level concerns over the potential misuse of the pandemic to limit the freedoms of people and the functioning of the market has been validated while the intrusive tendencies of the State into private lives and spaces has become norm. From a public health perspective these measures have been necessary and costs inevitable, but economically and socially not so much.
The sociology of interventions against social problems including complex public health crises like the COVID-19 pandemic suggests that working solutions must take a beneficiary-centered systems approach. Think of this: social problems are neither events nor incidents but a combination of situations that erupt because of inadequate anticipation, recognition or confrontation of the existing vulnerabilities, exposures and risks that rely on social networks and their attendant power relations within time and space. How we are prepared determines our exposure; how we respond will either escalate or deescalate the development of the situation; and how we integrate it into our daily routines, determines the eventual normalization (through cure or living with it). The complexity and dynamism of our response in relation to the complexity of problem will determine the extent of its impact and the efficacy of our interventions.
Like most countries, our response to the pandemic has been mostly incident and event focused- short-term and rapid action mode. Whereas the event and incidence-driven rapid containment measures may appear (and be) effective in the short-term, their efficacy and sustainability is not tenable in the long-run. Furthermore, whereas the State is responsible for guaranteeing safety and security for its citizens (by preventing external attacks including importation of infections), the question will still arise: to what extent am I responsible for my health- individually, household or community?
Absolute State responsibility for public health may be possible in extremely closed systems such as North Korea where the state controls the narrative, the instruments, information infrastructure and even the results of any intervention. It is also possible in countries where levels of literacy, poverty and socio-cultural norms are what Emile Durkheim describes as being based on ‘mechanical solidarity’ where given wisdom and authority are obeyed without question. But in democratic, literate and open societies such as Kenya, South Africa, USA and others, it is difficult, neigh impossible for the State to assume absolute responsibility of my health and health seeking behaviours. Thus, as we move to the next phase of the COVID-19 pandemic, Kenyans’ may be served well by reflecting on how best this social problem can be addressed.
I view COVID-19 as sociological problem rather deliberately. The state of the pandemic is such that it is not just a medical problem anymore, it is a pandemic of communication, behavior and investment (resources). There are historical precedents for this- HIV and AIDS, SARS, Ebola, among others. For instance, HIV and AIDS early on became driven by moral panics and significations. Poor communication through traditional channels and frames generated instinctive negativity and shame over the disease. People were afraid to test, ashamed to be positive and embarrassed to seek treatment. Now with COVID-19, we could be headed down the same path: there is growing fear of ‘being caught’; stigma is on the rise as incidents and rumours of State misuse of power and resources are becoming persistent. These could very well explain the reluctance to seek testing witnessed in Mombasa old Town, Eastleigh and Kawangware and the nationwide casual compliance with containment regimes. In particular, the low turn-out being witnessed in mass testing drives in Kawangware should serve as warning here.
To be clear, the trajectory of public health interventions is dictated by individual behaviour, social capital (including social networks, norms and culture) and structural instruments and institutions. Successful interventions then must adopt a dynamic socio-ecological framework which attends to individual needs and deficiencies, understands the social contexts and invests in responsive policy and political actors/actions. In simple terms, for interventions to be efficacious, they need to know me, understand my social set-up and institute objective measures that are inclusive. For COVID-19 this means that for me to adhere to the measures, my community’s ways of life and practices must be factored and the laws, policies and the market be activated responsively and sensitively.
The Ministry of Health learnt this long ago. HIV/AIDS and family planning programmes adopted this approach through the robust use of the community health strategy. Under the strategy, a community-based cadre of health workers came into focus and became the frontline cavalry for health promotion. Their effectiveness lies in the ability to understand and address local health concerns in a locally understandable and understanding manner in ways that demonstrate community respect, concern and mutual trust. At the moment, this is lacking in the national approach to the COVID-19 pandemic. There is need for a robust community-based approach which appreciates the complexity of the COVID-19 phenomenon as a complex social problem.
Dr. Justus Aungo teaches Social Planning in the Faculty of Arts, UoN, Mombasa Campus.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the policy or position of the University of Nairobi.
COVID-19 is a Complex Social Problem, Change the Approach
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