Adapting In Response To COVID-19 Public Health Restrictions
Graduating to Resilience (the Activity) is a USAID Office of Food for Peace (FFP) funded Activity led by AVSI Foundation in partnership with IMPAQ International and Trickle Up, which seeks to test the Graduation Approach’s ability to graduate ultra-poor refugee and host community households (HHs) in Western Uganda from conditions of food insecurity and fragile livelihoods to self-reliance and resilience.
In early February 2020, during our second theory of change workshop, a team member asked if we needed to consider coronavirus in our assumptions. She was quickly dismissed as participants asked, “Is coronavirus in Uganda?” “Is it posing a threat to our communities?” One month later, on 17 March, Activity leadership provided guidance to field staff to be sure accurate and consistent messaging about COVID-19 was reaching all employees and subsequently, all participants. Messaging included COVID-19 prevention such as handwashing; not touching eyes, nose, and mouth; staff use of hand sanitizer; understanding symptoms of COVID-19; staying home if someone has flu-like symptoms; and reporting to a health center, if necessary.
The situation escalated quickly from there. On 18 March, President Museveni addressed the nation and announced 13 restrictions, including a ban on groups larger than 10 people for 30 days. To respond to these directives, the Activity temporary disbanded Village Savings and Loans Associations (VSLAs) and the group coaching component of the Activity. Monitoring and Evaluation (M&E) trainings that were scheduled to take place the following week were modified so that no more than 10 people would be at a training location at one time.
However, during these trainings on 25 March, United Nations High Commissioner for Refugees (UNHCR) informed AVSI personnel that they could not implement any components of the Activity as only health projects could continue during the COVID-19 restrictions. This severe interpretation of the national restrictions imposed by the Ministry of Health (MOH) came as a total surprise, but AVSI complied and stopped all field operations. On 31 March, President Museveni officially locked down the country.
DATA COLLECTION AND ASSESSMENTS
The initial response of Graduating to Resilience was to suspend all field activities. The safety of participants and field staff was of utmost importance. What can we do if people cannot meet in groups or visit the homes of participants?
The first step in the mindset change from “There is nothing we can do” to “We should try to do something” came from the Monitoring, Evaluation, Research and Learning (MERL) team, who came up with a plan for remote data collection. Quarterly and bi-annual data collection was supposed to occur in April, but due to these restrictions this effort was initially suspended. The MERL team developed a standard operating procedure (SOP) to guide remote data collection. This SOP included: increasing airtime to field-based staff who would collect the data, revise the data collection tools so they were shorter and easier to administer on the phone, and sample the participants rather than collect data from all primary participants.
But rolling out this remote data collection was not as easy as planned. The team first had to understand cell phone penetration among participants. The last data collected with this information was in early 2019 at the start of implementation during a gender assessment that revealed 64% of female and 78% of male respondents in the host community owned a mobile phone. Whereas in the refugee population, 50% of female respondents noted they owned a mobile phone as compared to 68% of refugee male respondents. If this was still the case, the team worried cell phone ownership was too low for remote data collection, however the team suspected cell phone ownership had increased since the start of the Activity. Learning this information prior to remote data collection was essential to know if it was feasible. Another SOP was developed for this context assessment on cell phone ownership as well as a data collection tool to measure:
- Do primary participants own phones?
- If yes, verify the phone number.
- If no, is there a phone in the HH?
- Whose phone is it?
- Can the participant access it?
- Does access require permission for use?
- Are phone charging options readily available?
In short, we learned that cell phone ownership among primary participants increased to about 80% and access to a cell phone increased to about 99%. The team then felt comfortable rolling out the quarterly and bi-annual data collection.
Along with routine data collection, the MERL team also developed tools to understand the current context since the public health restrictions in response to COVID-19 were put in place in the Rwamwanja Refugee Settlement and the surrounding sub-counties where the Activity is implementing.
The three context tools deployed measured:
- COVID Participant Awareness: to understand if participants were receiving information, how they were receiving information, and if they were able to comply with the recommendations, etc.
- COVID Participant Experience: How were the restrictions affecting business, how were HHs adapting, what coping strategies were they using, were they able to get ANC, did they know where to get support for gender-based violence (GBV), market prices for certain goods, etc.
- COVID Market Research 1 and 2: these were split into two surveys because they were quite long. The design was modified from the Rapid Assessments of Markets (RAM) and looked at operations, supply chain, prices, consumer behavior, etc.
Combined, these three assessments have helped Technical Advisors structure messages to be sent via SMS or Interactive Voice Response (IVR) as well as coaching messages to be sure participants are receiving all necessary information about COVID-19 restrictions and safety. This information is also being used to be sure participants are receiving relevant support to maintain their businesses in the new context.
While the team rolled out the data collection and began analyzing the data from the context assessments and routine monitoring, we learned that more could be done remotely than we initially thought possible. The team engaged in a scenario planning exercise. Using an Excel spreadsheet, the team first created three columns:
- Current state
- Scenario 1: lock down ends, but some restrictions remain
- Scenario 2: lock down continues for another 21 days
For each scenario, the team then discussed:
- Brief description of the scenario
- The impact of the scenario: what happens after that scenario occurs?
- How each component of the Activity will be implemented in that scenario (components included but are not limited to: data collection, group and individual coaching, VSLA, business coaching, referrals, nutrition screening, team meetings)
- Cross-cutting considerations such as increased airtime and data for field staff; Personal Protective Equipment for field staff; sensitizing local leaders, partners, and participants on our activities, etc.
Portion of Scenario Planning Tool
The Technical Advisors then created SOPs for their respective components so that when the President announced his decision on 5 May the team could inform field staff quickly of how to move forward. In this case, the President continued the lockdown for 14 more days, and so Scenario 2 was put into place.
ADAPTING FIELD ACTIVITIES
Activity leadership is finalizing an MOU with a technology company who can provide SMS and IVR messaging. But while waiting for this messaging, we learned there is so much that can be done using basic cell phone technology, such as phone calls and conference calling. Even while in full lockdown, we have been able to modify our programming successfully across different components, and the table below highlights some of these modifications:
Examples of How Particular Components Were Adapted
WHAT WE LEARNED
There are more solutions than you may think. We were able to switch our mindset from suspending all activities to finding solutions to implementing all activities remotely using low-level technology like basic cell phones. Our achievements can be attributed to:
- Not underestimating the ingenuity of our team
- Capitalizing on the willingness of our team to make things work
- Testing something, not being afraid to fail, refining approaches, and quickly scaling up successes
- Utilizing our local community of practice to learn from and share experiences